Harm Reduction Paper – Currently, in Canada and across the globe, there are two dominant policy approaches towards illegal drug use. The first approach involves strict prohibition and stresses the need to maintain order using law enforcement as a means to enforce the policy objectives. It includes the use of criminalizing illegal drug use with penalties of incarceration.
The second approach involves classifying drug use as a social problem and takes a public health approach that promotes the safer use of illegal substances in order to reduce the damage not only to the individual but to society as a whole. This approach is termed harm reduction and involves using methods such as safe injection sites in order to fulfill the policy objective while also involving a dynamic of decriminalization.
Recently several provinces have shown interest in harm reduction such as British Columbia and Ontario however, the federal government has kept its strict stance with their federal policy towards drug use; removing harm reduction from the governments four pillar strategy in 2007.
This paper argues that harm reduction should be the policy approach to the use of heroin and other illegal substances within Canada.
The Complex Problem of Illegal Substance Abuse
Drug abuse is a complex problem. The illicit use and production of drugs comes with many burdens to society in the form of social, health, economic and environmental costs. The effects of the drugs themselves, mental health issues, high rates of childhood abuse, homelessness, social marginalization, and poverty, all hinder drug users’ abilities to reduce the behaviors that put them at risk of disease and death. (Wood et al. 2003)
This problem is further entrenched through government policies which treat users as criminals rather than victims in the process. This can and does put users into a perpetual cycle between the streets and judicial system because of the stigma that perpetuates from both.
The current government approach that treats drug use as a moral issue and approaching it through enforcement fails not only to address the evidence supporting harm reduction, it also neglects the problem for what it really is; a public health issue and not a social order problem.
The cost of illegal substance abuse to individuals and to society as a whole is substantial and any path to reducing the burden to society should be embraced by governments in Canada.
Drug users create many burdens to society such as higher rates of incarceration and use of healthcare services. For both of these taxpayers are left to foot the bill for the consequences of unsafe illicit drug use. For instance, it is estimated that the lifetime medical costs (i.e., direct taxpayer-funded dollars) of each case of HIV infection among injection drug users is approximately $150 000. (Wood et al. 2003)
The current approach is to throw this person in jail where they are more prone to contract pathogens and impose administrative costs to society, when a needle-exchange program along with a safe injection site is a viable alternative to reducing the individual and social costs as a whole.
This method in Vancouver and many European countries (explicitly Portugal) has helped their governments fight back against HIV through taking an intermediary support role with the individual as opposed to a direct conflictual. The Canadian federal government, however, has not adopted such an approach, leading many scholars to call for a scientific approach to Canada’s drug policy. (DeBeck et al. 2010)
The Current Federal Government Strategy
The Harper government has taken a strict stance against the use of illegal drugs; removing harm reduction from the government four pillar strategy in 2007. The government’s approach overlooks the fact that drug use is a complex social problem which requires more than enforcement.
Despite Harper’s early emphasis on balance, the planning and priorities report tabled with the federal Treasury Board for the next five years reveals deep cuts in Health Canada`s budget for drug treatment–but hefty increases in budgets for drug enforcement by police and prosecutors.(Geddes 2012)
Health Canada`s Drug Treatment Funding Program was reduced from $122 million to $80 million, while the RCMP will see its five-year funding boosted from $85 million to $113 million, and the federal office of the Director of Public Prosecutions will rise from $43 million to $61 million. (Geddes 2012)
This signals a sharp policy change from harm reduction to enforcement within the government. Despite this, Harper was quoted as saying, “I think what everyone believes and agrees with, and to be frank myself, is that the current approach is not working, but it is not clear what we should do.” (Valleriani et al. 2015)
Although for Harper the answer might not be clear, for many others this is not the case and the answer is simple; harm reduction, not enforcement.
Enforcement: A Failed Policy Approach
Since 1908 the Canadian approach to illegal drug use has been to use enforcement and penalties of incarceration.
The thought has been that fear of criminal sanctions will effectively act as a deterrent towards the use and sale of illicit drugs. However, data from Canada and elsewhere show that this approach fails to meaningfully reduce supply of–or demand for–drugs and results in many unintended negative consequences. (Butler-McPhee et al. 2012).
The adverse effects like human rights abuses (such as harassment, coercion, compulsory screening, and denial of life-preserving care) are often committed in the course of enforcing the ‘war on drugs’ and even in the name of drug ‘treatment.’ (Butler-McPhee et al. 2012) There are also the negative externalities caused by enforcement through perpetual cycling of offenders through the judicial system, re-exposing them to many risks that impose costs on society.
The primary objective of enforcement is to curb the supply side of illegal drugs through direct intervention. However, many reports have been published which show that enforcement has failed to control the supply of illegal drugs, if anything, throughout the years they have become more available.
For every ‘big fish’ that is arrested, another steps up to fill his place, with petty street users caught in the conflict. This approach has an underlying moral imperative and uses normative judgments, disregarding facts and alternatives to solving the problem of drug use.
Enforcement is costly and not producing the ‘expected’ benefits. In a report entitled, “The Cost of Substance Abuse in Canada 2002”, the authors posit that Canada spends $2.3 billion on enforcement (police, courts, and corrections), and $1.1 billion in direct health care costs every year dealing with illegal drugs. (Rehm et al. 2006)
This number neglects indirect costs such as the loss of work productivity due to contracted diseases caused by illicit drug use. This is a substantial overall amount that could be placed into other programs and policies that need more attention; it is resource waste.
This is especially the case because observational data suggest that incarceration does not reduce drug use among injection drug users and it may even inhibit access to mechanisms that promote the cessation of injection drug use. (Li et al. 2009) Incarceration of illegal drug users only increases the social burden to society through placing them in an environment where they are more prone to pathogens, and less likely to stop the very thing that put them there; illicit drug use.
The problem with Canada’s current approach of enforcement is that it is discriminatory towards the disadvantaged populations within Canada and helps to perpetuate already existing inequalities. By neglecting the colonial and social context to which has contributed to high rate of illicit drug use among the aboriginals we only perpetuate the current inequalities that already exist.
These inequalities are connected to a high burden of drug-related harms and drug-related structural violence, including over-representation in the criminal justice system for drug offences; high rates of blood-borne infections related to injection drug use; high reported rates of illicit substance use and substance use disorders among Indigenous and multiple social damages to First Nations communities caused by the illegal drug trade. (Marshall 2015)
Nearly all the population growth in Canada’s prisons over the last decade has been drawn from aboriginal people, visible minorities, people struggling with addictions, and the mentally ill. (Bernstein et al. 2012) The current approach of criminalization of illicit drug use only perpetuates current inequalities in society at all levels through targeting those most prone to substance abuse and by failing to tackle the issue at the heart.
The failure of enforcement has been substantially documented.
For instance, Vancouver’s 2003 initiative named Citywide Enforcement Team (CET) did not produce the expected results. Instead, intensified police presence prompted ‘rushed’ injections, injecting in riskier environments, discouraged safer injection practices, and increased unsafe disposal of syringes. (Small et al. 2006)
This approach then enhances the damage to individuals, and to society who has to foot the bill and have to deal with decreased public safety because of the quick dumping of needles. Not only this but all the operation did was displace the injection drug users into a more widespread area, affecting their ability to reach health services.
The adverse impact of concentrated police activities upon urban drug problems and the implications for both public order and public health should be recognized. (Small et al. 2006) It is a problem enforcement has failed to be able to fix. The harsh reality is people are going to do drugs, whether they are legal or illegal enforcement will not correct the problem. These policies have had limited impact on eliminating or reducing illicit drug use and may have resulted in adverse consequences for social and community health. Instead, a new approach is needed which will tackle the heart of the problem, not just get it out of sight.
These policies have had limited impact on eliminating or reducing illicit drug use and may have resulted in adverse consequences for social and community health. Instead, a new approach is needed which will tackle the heart of the problem, not just get it out of sight.
Harm reduction: The Ideal Policy Approach
Harm reduction policies aim at classifying drug use as a social issue and takes a public health approach that promotes the safer use of illegal substances in order to reduce the damage not only to the individual but to society as a whole. The general aim is to reduce the social costs associated with illegal drug users.
This is done through programs such as supervised injection sites; prescription heroin; medical cannabis dispensaries; crack pipe distribution; drug testing kits; Naloxone for reversing an opioid overdose. (Valleriani et al. 2015) Harm reduction seeks to tackle the demand side of drug use, while enforcement aims towards reducing the supply.
Evidence shows that harm reduction is a more viable strategy than enforcement, which has even prompted many Canadian academics to call for a scientific approach to Canada’s drug policy.
The benefits of harm reduction to individuals and society as a whole have been substantially documented. The problem with prohibition is that it significantly hinders health efforts by creating a public barrier to reducing the proportion of risky behaviors prone to drug users that facilitate the spread pathogens such as HIV.
Needle distribution and recovery programs have been shown to be safe, efficient and cost-saving in reducing HIV risk behaviors while also increasing access to health and social services for people who use injection drugs. (Canadian Nurses Association March 2011) Needle exchange programs not only reduce the inter-person use of needles tackling the demand for needles but reduces the supply of needles on the streets, increasing public safety.
Furthermore, supervised injection services lessen the rate of overdose deaths and HIV risk behaviors, increases access to drug treatment and reduces public disorder. (Canadian Nurses Association March 2011) This approach not only reduces the amount in health costs accumulated by drug users, and ultimately society as a whole, but it also reduces the social and administrative expenses through the decreased need for enforcement.
This, however, is not the only program Canada could benefit from nationwide.
By implementing a Medical Heroin Prescription Program (MHPP) Canada could reduce many of the economic and health costs associated with illegal heroin use. In research conducted by Miller et. Al, they model the impact of implementing an MHHP. Over a five-year study of 356 eligible participants, the MHPP lead to a decrease in hospital days (4041 to 1477), emergency room visits (3088 to 1129), and criminal charges (1343 to 516), while employment moderately rose (4.8% to 7.1%). (Miller et al. 2004)
They estimated that the implementation of an MHPP could reduce costs associated with heroin users by 63%, or $9650 per treated subject. (Miller et al. 2004) Programs such as this are viable and don’t pose a threat to public order, they are relatively inexpensive when compared to enforcement and fulfill their policy object, that is; they reduce the ultimate burden to society as a whole by tackling the issue at the heart.
However, programs like this are not the only form of a program that is needed, many programs interacting together to reduce susceptibility to the danger of drug use are required in order to tackle the complex problem of illicit drug use. Canada is in need of a complete overhaul of its healthcare services in order to further reduce the social burden.
Canada needs to change its current drug policy in order to alter the fundamental structural-environmental context of healthcare services from a perceived hostile environment to a safe environment.
The approach of enforcement creates the most substantial barrier to offering treatment to the addict population because of the users’ fear of arrest. (Cato Institute 2009) By Offering mediated access to palliative and supportive care services which foster an atmosphere where drug use can be discussed without repercussions creates an open form of environment where issues can be addressed.
In a study focused on promoting a safer healthcare environment participants reported that the environmental supports provided by the DPC Residence decreased drug-related risks and improved health outcomes, including HAART adherence and survival. (McNeil et al. 2014)
A separate study on safer smoking rooms (SRR) also demonstrates significant potential in addressing health and social harms of crack smoking in which the unregulated consumption setting is characterized by violence (McNeil 2015) By only offering support and an environment when drug users can feel ‘safe’ can reduce the overall burden of drug use to not only individuals but to society as a whole.
Overlooking that simple programs such as these can make our society better not only burdens taxpayers, it creates a form of resource waste. Money spent on these programs means less on health care and incarceration, and more in other programs such as education. It is inefficient policymaking. This is also evident in the dollar return ration for a dollar spent on enforcement compared to a dollar spent on harm reduction.
Enforcement has shown to be a costly venture without producing the expected result or curbing the supply of drugs. A dollar spent on harm reduction is better than a dollar spent on enforcement.
In a study conducted in 1996 by Rydell et al., him and his colleagues draw conclusions regarding enforcement or treatment for drug policy that warrants extensive further research. The researcher’s most important conclusion was that $1 spent on treatment will achieve the same reduction of flow of cocaine as $7.3 spend on enforcement (Rydell et al. 1996)
This suggests that harm reduction policies could offer a positive externality in reducing not only the demand for illegal drugs but also the supply. Harm prevention in this perspectives tackles its own objectives and also those that enforcement seeks to achieve. This makes it the ideal policy choice because the return ratio on the flow of cocaine is curbed 7:1 through harm reduction, while enforcement has failed to show any quantifying numbers to the reduction in the supply of drugs.
This paper argues that harm reduction should be the policy approach to the use of heroin and other illegal substances within Canada.
There are currently two dominant approaches to the use of illegal drugs. Enforcement involves classifying drug use as a social order issue, criminalizing the use of drugs with the punishment of incarceration. The harm reduction approach classifies drug use as a social problem and seeks to reduce the cost of drug use not only to the individual but to society as a whole.
Currently, the Harper government has taken a strict stance against illegal drug use, boosting enforcement funding while reducing harm prevention funding. This has led many academics to call for a scientific approach to Canada’s drug policy, one of harm reduction and not enforcement. This is because enforcement has failed to produce the expected benefits, while there is substantial evidence to suggest that harm reduction can fulfill both policy objectives. Implementation of harm reduction programs can reduce the spread of many deadly pathogens that are costly to the taxpayers in Canada’s healthcare system.
Not only this, but by just altering the environment to which drug users interact with healthcare services to form a perceived safe as opposed to a hostile environment can increase individuals survival rate, and decrease there likeliness of contracting a deadly pathogen. These methods lead to decreased rates of incarceration, pathogen infection, healthcare use, drug use, and also drug supply.
Harm reduction is good for individuals and good for society, making harm reduction the ideal drug policy choice for Canada.
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