Drug policy and maintenance programs

Vancouver is suffering from a plague of poverty, homelessness, drug addiction, mental health issues and crime. The good news is that all of these are inter-related, and that senior governments have the funds to make a difference. So with the Olympics coming is just three years, the political culture of neglect is showing signs of activism. Vancouver’s Mayor Sam Sullivan deserves credit for putting out some good ideas (that do not necessarily win him any points with his more right-wing, pro-business base) on how to deal with drug addiction.

Building on the harm reduction credentials of his predecessors, Larry Campbell and Phillip Owen, Sullivan is championing the next stage of harm reduction, providing drugs to addicts, so that they can stabilize their lives, and hopefully get clean, but in the interim get them out of the cycle of desperate need that fuels too much property crime in the city. This may all come to naught, as the Mayor faces serious ideological opposition in the form of the Harper government, who morally objects to harm reduction, and financial opposition from the provincial Liberal government, who have not been willing to spend money on the marginalized, despite having overflowing coffers.

This strategy should also be connected to a major initiative to create new supportive housing for addicts and those with mental health problems (and more affordable housing in general). If housing, drug maintenance (and treatment), and mental health issues could be packaged into a coherent plan, it would go a long way towards reducing the symptoms – namely crime, panhandling and homelessness – that everyone wants to see improved. We just need to get over the knee-jerk moralizing that prevents us from doing the right thing. If we do, we still have time to prevent Vancouver from being a global laughing stock come the 2010 Winter Games.

Below is today’s lead editorial from the Vancouver Sun, followed by a story in the Sun a few days ago.

Alternative treatments give addicts a chance

Vancouver Mayor Sam Sullivan’s plan to set up an alternative drug-treatment plan for 700 cocaine and crystal methamphetamine addicts might never come to fruition, but it’s something that should be seriously considered.

… Trials have already been conducted in a number of jurisdictions, including Great Britain, which has been providing stimulants to addicts since 1988, Australia, South America, and surprisingly, the United States, and even more surprisingly, Texas. This means that, unlike the supervised injection facility, a maintenance program in Vancouver would not be the first of its kind in North America.In fact, University of Texas psychiatry professor John Grabowski, who has conducted maintenance trials involving the provision of methamphetamine and dextroamphetamine, has said that interest in such programs has been growing across the United States on the strength of the results he has seen.

Grabowski has found that heavy stimulant users reduce their consumption while on maintenance, and also report fewer signs of depression and behavioural disturbances. This improved biological and behavioural stability has allowed addicts to get on with their lives and focus on such things as behaviour-control counselling: A 2001 trial in Sydney, Australia, found that dextroamphetamine therapy increased the likelihood of addicts remaining in counselling.

Further, since many stimulant addicts currently inject their drugs — and do so many times a day, unlike heroin users who inject once or twice daily — they are at greatly heightened risk of contracting blood-borne diseases such as HIV and hepatitis C, and of suffering from skin problems.

But as Simon Fraser University’s Bruce Alexander and Jonathan Tsou noted in a 2001 paper in Addiction Research and Theory, maintenance programs could help addicts replace injections with oral medication and avoid all the risks associated with injection drug use.

Stimulant maintenance, therefore, shows considerable promise and it’s worth conducting a trial in Vancouver to see if the results from other studies are replicated.

The one thing standing in the way, it seems, is an ideology that says we must never provide drugs like heroin or methamphetamines to people.

And the story from a couple days ago by Frances Bula:

Mayor proposes ‘revolutionary’ plan for addicts

Sullivan wants city exempted from federal narcotics laws

Monday, January 22, 2007

Vancouver Mayor Sam Sullivan is lobbying the federal government for an exemption from Canada’s narcotics laws that would allow what he calls a “revolutionary” alternative drug-treatment plan to give substitute drugs to at least 700 cocaine and crystal-meth addicts.

If he is successful, Vancouver would be a global pioneer in running such a large-scale program of drug maintenance for stimulant-drug users.

Sullivan said the drug plan, along with three other key elements that have to come from Ottawa or Victoria, will eliminate most of Vancouver’s problems with homelessness, panhandling and drug-dealing. Those are the three social problems he promised to reduce by half in time for 2010 in the Project Civil City initiative that he launched in November.

Although the project document listed 54 suggested strategies aimed at everything from mental illness and homelessness to litter and motorcycle noise, Sullivan said the city won’t have that much work to do if the provincial and federal governments tackle the big, underlying issues.

The other three elements he says are key:

– The province needs to provide the money to build social housing on 12 empty sites the city has available for it;

– The province needs to come up with a more aggressive plan for taking care of the mentally ill, which might mean moving some back to Riverview Hospital in Coquitlam;

– The federal government needs to ensure that community courts are used to channel drug users into the alternative drug program he envisions.

But he sees the drug plan, which would provide legal drugs as substitutes for the stimulant-type illegal drugs like cocaine and crystal meth, as pivotal, and he says that’s the focus of most of his energy.