Hedging on harm reduction

Since Dr David Salisbury stepped down as Ottawa’s chief, medical officer of health at the beginning of May, fans of the city-wide crack-pipe distribution program have had a sinking feeling.

A strong believer in harm reduction as an important part of government drug policy, Salisbury has been replaced by an interim chief, Dr Isra Levy.

Salisbury was often pitted against the mayor and some members of city council who did not support the safer inhalation program. The program supplied drug kits to addicts to curb the spread of HIV and hepatitis C.

Levy, who was previously the associate medical officer of health, assumed the top position on May 5. A permanent medical officer of health has not been selected. Neither Levy nor city officials will say how the position will be filled or who gets the final say on hiring.

“When the deputy city manager talked to me about assuming this role for now, we really just talked about short-term work,” says Levy.

“I’m really just focussing on keeping the programs going, making sure we deliver the services we should be delivering, and looking at things the council has asked us to go over in the next couple of months.”

Levy says that he subscribes to the four-pillar approach on addictions — prevention, treatment, harm reduction, and enforcement. Harm reduction, he says, is an important part of that.

“We need to make sure that people [who are addicts] are reducing the spread of disease,” he says.

But when pressed, Levy hedges his bets. He won’t say whether or not he actually supports the crack-pipe distribution program, or if he agreed with the fact that the City cancelled it.

“I don’t think it really matters now,” he says. “It has been cancelled, and what is important now is to look forward and say, ‘where do we go from here?'”

The provincial Ministry of Health has picked up support for the crack-pipe progam, now run by the Somerset West Community Health Centre.

The gay community pioneered the harm reduction approach in the 1980s, in the midst of the AIDS epidemic, when others were preaching an abstinence- and monogamy-only solution.

Harm reduction remains an important plank for the gay movement, because it looks at people’s lives as they actually are and tries to help them — instead of telling them they must change in order to access health and other services. The harm reduction model was eventually morphed into the four pillars approach to drug policy.

And it’s drug policy that’s on council’s mind these days, Levy admits.

“I think changes to the way things are done here in Ottawa are certainly worth considering, and from my point of view, there’s pros and cons,” says Levy.

For now, the main focus is on establishing a proper drug rehabilitation centre for young addicts.

“What’s being talked about right now is a youth addictions treatment centre or rehab centre, but a lot of the addiction problems aren’t in youth. So the job isn’t going to be done when we see the treatment centre — we’re still going to be needing to do the other work as well.”

Ron Chaplin, chair of the Ottawa-Carleton council on AIDS says that the stem of the drug problem lies within the even bigger problem of homelessness.

“Sometimes the members of council have middle-class blinders on,” he says. “The crack-pipe program is targeted at homeless people. If you are middle class, you can buy as many crack pipes and supplies as you want.”

“This is not a part of a war on drugs — it is a war on homeless people.”

Chaplin points out that many of the people who live on the streets have a deep mistrust of institutions, and would probably never seek hospital care, anyway.

“[Harm reduction] is about establishing contact between homeless people and the public health system,” says Chaplin.

How much of the squeamishness about drug use would a rehabilitation centre actually fix, then? Chaplin suggests that perhaps the city should look first and foremost at solving the problem of homelessness, since one reason why homeless people turn to crack in the first place is that it is a way to cope with their other hardships.

So, while rehabilitation is certainly one element in helping to solve the drug problem, harm reduction also plays an important role in the process, Chaplin argues. But many city councillors don’t see it that way.

“There is a core group in city council that are looking for easy solutions for what is a very serious problem,” says Chaplin.

Rick Chiarelli was the councillor behind a motion last July that stripped the safer inhalation program of its municipal dollars.

“There is an enabling part to all harm reduction and I think it’s exponential on the crack pipe side,” says Chiarelli.

Those on the front lines disagree.

Administering crack kits “absolutely does not increase drug usage,” says Eugene Williams, Health Promotion Coordinator at Somerset West Community Health Centre.

The Somerset Centre is presently receiving funding directly from the province’s AIDS bureau to continue the crack-pipe distribution program.

“We know that people will use, regardless of if the program is in place or not, and it is better to be preventing the spread of disease and promoting health while that is happening,” Williams says.