Friday, November 14, 2008

Why not just give confirmed addicts their drugs

The “tough-punishment” crowd came to mind when I heard the Victoria police had caught three people smoking crack cocaine this week. They were parked in the police department lot. The police station is a distinctive - and attractive - building. And the parking lot almost always has some marked police cars in it. So the trio - two men and a women - weren’t confused about where they were. They were bringing something to a friend in cells. But they decided to do drugs before venturing into the police station. An officer noticed a car full of smoke and knocked on the window. They rolled it down to talk to him, he smelled drugs and the men were charged with cocaine possession and driving while impaired.
First, the case shows how frustrating police work must be some days. Instead of fighting crime, officers are social workers and counsellors for the troubled, like people who smoke cocaine in the police station parking lot and are surprised to be arrested.
Second, it reveals the laughable flaw in the argument that tougher sentences will make any real difference.
People who smoke drugs outside a police station don’t think about whether they will get a conditional sentence or jail time. They don’t assess consequences. If they did, the probably wouldn’t be drug addicts. (So, teach your children about choices, consequences and reasonable risk.) They are likely the people smashing their way into your car in a parkade or stealing your bicycle. Tougher sentences are not going to make them change their ways.
That should be the objective. It would be great if, in a moment of clarity, they realized that stealing was wrong and decided never to do it again because it must hurt the victims.
But really, it’s OK if they just stop.
That’s not the approach we take, though. Prescribing an effective heroin substitute for a long-term addict who just can’t or won’t quit makes practical sense. He or she is healthier, safer, less likely to go to jail, more likely to be living an orderly life - and to enter treatment. And less likely to be committing property crimes every day to get drug money. The NAOMI project reported last month on a thee-year trial in Montreal and Vancouver that tested the effect of prescribing both heroin and a heroin substitute for confirmed addicts. (Participants had to have been through treatment unsuccessfully twice; the mean age was 40 and they were pretty much considered impossible to treat.)
By any rational measure, prescription heroin and heroin substitutes made sense. After a year in the program, almost 90 per cent of those prescribed heroin or Dilaudid - the chemical substitute - had entered treatment or weren’t using heroin illicitly. (Only 54 per cent of those on a methadone program succeeded in achieving the one-year clean period.)
Those who stayed on the program spent far less money on drugs of any kind. The median monthly spending fell from $1,500 - or $50 a day - to $400. The number of participants who said they had committed crimes was cut in half, from 70 per cent to 36 per cent.
And the study found no negative effects, for individuals or communities. Other studies have shown similar results for programs offering substitutes for crystal meth and cocaine.
No one is comfortable with the idea of people using drugs. But in health terms, heroin does far less damage than alcohol or tobacco. The problems are mostly related to the struggle to get and use drugs illicitly, not the substances themselves.
It would be wrong to make drug use too easy for people for whom treatment could likely be successful.
But that leaves several thousand addicts in B.C, who could be helped through prescription drugs - and several hundred thousand fewer crimes each year in B.C. and far fewer customers for drug-supplying gangs. How could this be a bad thing?
Footnote: The other remarkable failure is our efforts at prevention. Drug education programs have been out there for almost 40 years, but alcoholism and other substance issues have increased over most of that period. What we are doing doesn’t work, but we seem unwilling to change.


Anonymous said...

Paul, I'm so glad to read your article reporting out on a study that confirms what I and others have been preaching for many years. We as a society must get beyond ideology and reach out for real solutions to the multifaceted problem of drug addiction. We've all paid dearly for the proven failure of an approach close to the hearts of the "law and order" crowd, who if they've proved one thing it is that they've been on the wrong track for decades. Let's open our minds (and hearts) and take the approach that produces results and would save Canadians, collectively, hundreds of millions if not billions per year in costs associated with the criminilization of drug abuse.

Marilyn Erickson said...

Paul, I always enjoy your approach and open-minded enquiries into our social problems!

Having been an addicted substance user myself and now on the other side (8 years) trying to understand addiction further, facing challenges working within the system, i am always curious about most people's ignorance of mental health and addictions, on every level. Any rational being examining the facts that the Naomi trial and other scholarly studies present, understands that government, enforcement, and health care's outdated responses fall far short of the mark and ultimately perpetuate the problem.

Despite the work of many dedicated and well-meaning service providers, we have a woeful lack of adequate detox and treatment facilities on the Island and within BC, not to mention our affordable housing shortage. This is reflected across Canada in general.

So many parents, (who are able financially), are forced to send their teens to private long-term treatment recovery homes out of desperation and immediate concern, at a cost of approx $10,000 a month. And when I find a stimulant (cocaine, crack, crystal meth) user on the street who wishes to access residential treatment, it takes an average of 4-6 months for intake, if it happens at all, and that is only for a 3-4 week residential program somewhere in BC, not at all adequate for a chronic user of course.

Again, a 10-day detox in the 10 beds on the south island, through VIHA, is available only to adults with an addiction to alcohol or heroin at the present time. There is always a wait. Youth have about six detox beds available here.

Adult stimulant users and concurrent disorder clients must join a long wait-list for beds on the mainland, and that remains the biggest gap in the system, whether it be for a vulnerable teen involved in the sex-trade, a criminal choosing community court, or for someone's father or sister.

Until the public, and those administrators holding the power, recognize that we do not have a homelessness problem but an addiction/mental health crisis that can only be addressed through more and better resources, not solely enforcement; and until we have a genuine level of financial commitment from all stakeholders and levels of government, along with a passion to solve the problem, then we will continue to see the escalation of addiction and street crime in our communities.

I don't want 20 new beds, I want to see a complete turnaround by the health profession in addressing addiction, and instead of a ferry housing media for the Olympics, i want to see a government willing to find THREE ferries destined for scrap to turn into affordable housing and drug treatment centres!

Everyone has a right to to adequate health care. We must not expect to solve the same old problems with the same tired level of concern! I urge everyone to suspend their prejudices and accept that we are not doing everything that we can to treat homelessness. Most people know someone addicted to some thing. What have we done lately to help?

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