Monday, July 21, 2008

Margaret Wente on drugs

Over the last few days, I have watched with a kind of horrified fascination as Margaret Wente cherry-picked her way through an orchard of data to "prove" that harm reduction (safe-injection sites) are useless in dealing with drug addiction.

Much of the nonsense has already been cleared up by Globe and Mail correspondents. The key point, of course, is that harm reduction is only one of the so-called "Four Pillars" strategy to combat "drug abuse." (I detest that latter term: it makes me think of sadists torturing the inanimate. It's meaningless, and loaded. Addiction is an illness, not a crime.)

Wente carried disingenuousness to new extremes by ignoring the strategy and pretending that the harm reduction folks don't have one. The four pillars, in fact, are prevention, treatment, harm reduction and enforcement. Law-and-order types are heavy on the last. If I had the time and inclination, I could probably write at least five columns on how enforcement by itself is a dismal failure anywhere it has ever been tried. But that doesn't stop the punishers. In Canada, we spend four times more on drug-law enforcement than we do on prevention. (Single E, Robson L, Xie X, Rehm J. 1996. The costs of substance abuse in Canada. Ottawa: Canadian Centre on Substance Abuse.)

Prevention and treatment, Wente says, "have been neglected," and she's right, but the neglect isn't on the part of the harm reduction people, as she rather dishonestly suggests.
We do-gooder, touchy-feely types have cried aloud for prevention and treatment for years, but the de-tox centres aren't going up, and the root causes of addiction aren't being addressed. For conservative governments, these things are a very low priority indeed. So the money, expertise and treatment options just aren't there.

Wente gets a little hazy and confused about the legalization option, too. She does the requisite pearl-clutching about the tactics of the legalization folks, but for once spares us the selected studies indicating that this would be a Bad Thing. I'm speaking hypothetically: such studies might not even exist. In the UK, as a correspondent in today's Globe and Mail reminds us, there was once a cheap program that involved registering heroin addicts and providing their drug legally. There were fewer addicts in all of Britain at that time than there are today in Vancouver. Then Thatcher came to power, and took her usual conservative mailed fist approach.The rest is history: A clampdown began in the late 1960s: since restrictions took hold, the UK has experienced soaring addiction rates and a multi-million-dollar windfall for organized crime.*

Certainly a skirmish of statistics is currently going on. I've read a few papers, some indicating that needle-exchange programs are effective, and some presenting arguments that they aren't, or even that they actually cause more transmitted infection than before. There is on-going debate about selection bias and confounding variables--diffusion effects through secondary exchanges of clean needles amongst the intravenous drug-user population, for example, or the concentration of high-risk users among IDUs who use the exchange sites, or the possible formation of new networks at such sites, exposing isolated IDUs to more risk.

But all of this, valuable discussion though it be, obscures the main issue. The long-term war against addiction and its virological, social and personal consequences will not be won by statistics, nor by vigorous law enforcement, nor by Wente's "tough love." It will be won, or greatly mitigated, by a mixed strategy like the Four Pillars, a strategy that is
carefully balanced and properly resourced in all respects--and one that is enhanced by a 21st century approach to outmoded and harmful anti-drug legislation.

*UPDATE: Dan Gardner, author of the recent book Risk: The Science and Politics of Fear, notes that the restriction of access to heroin in Britain didn't begin with Margaret Thatcher. His own article on drugs and the history of their legal/illegal use may be found here.


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