Focus on harm prevention and elimination | Behavioral Healthcare Executive Skip to content Skip to navigation

Focus on harm prevention and elimination

January 1, 2008
by Calvina L. Fay, MBA
| Reprints
A plan to introduce a “safe” injection site in San Francisco is tantamount to giving up on addicts

Giving up on addicts is the defeatist “harm reduction” approach that has been creeping into the United States for some time. Unfortunately, some advocates and public officials in San Francisco want to implement so-called “safe” injection sites, a harm reduction tactic that already is a proven failure.

The deceptive term harm reduction implies a positive—the reduction of harm. But that couldn't be further from the truth. Harm reduction not only embraces a despairing attitude toward drug addiction, it is a fatalistic policy—a policy that Canada has worked long and hard to terminate.

Advocates in San Francisco want to open the first U.S. shooting gallery where addicts can inject heroin, cocaine, and other drugs under the supervision of nurses. For addicts whose primary goal is total abstinence, this type of service would encourage and support their addiction. It not only prevents them from hitting their motivational bottom but, more importantly, does nothing to raise the “bottom” in order to leverage an earlier healing process. Consider the addict active in his addiction: Perhaps this would be a great opportunity for him to continue a career in addiction. Yet we must understand that an active addict's thinking is not clear, rational, or totally sane, given the destructive choices he continually makes.

Since “safe” injection sites only create safety from law enforcement and provide no legitimate benefit to society or the addict, why advocate for the execution of such programs? Follow the money. Eventually large amounts of tax dollars will be allocated to these types of government-sponsored programs that seek to maintain addicts on their drug(s) of choice.

This is where an individual's human rights come into play. Because addiction is a progressive disease, how can a responsible healthcare professional help to perpetuate the slavery of addiction? As an addict increases tolerance to her drug of choice, are these professionals going to watch as that addict puts massive doses of drugs in her body and revive her so that she can do it all over again? If addicts know they are being monitored, perhaps they will use more drugs to see how high they can go, and apparently it will all be legal.

In Canada, there has been an increase in drug overdoses (based on coroner reports) since “safe” injection sites have been open.1 A study presented at the 17th International Conference on the Reduction of Drug Related Harm in 2006 found that since these shooting galleries have opened, the number of addicts admitted to one particular inner-city hospital in Vancouver, British Columbia, for serious needle-related infections (e.g., of the heart valves or bone) has been steadily increasing.2 Addicts with these infections had to be treated intensively for six to eight weeks. The same study found that addicts now account for 18,000 to 20,000 days at this hospital per year. So much for these programs being “safe”!

Canada is on the verge of closing the dangerous Insite injection facility in Vancouver and reallocating funds to traditional inpatient treatment—real treatment that promotes eventual abstinence. The “three-pillar” approach (prevention, treatment, and law enforcement) that Canada is embracing is due to the dogged efforts of many law enforcement officers, drug policy experts, and physicians. Citizens and local business owners also have supported Canada's new position because they have been negatively impacted by increased crime rates, which have been reported near such sites in Australia3 and Canada. This approach eliminates the former fourth pillar (i.e., harm reduction) and, in my opinion, truly helps to eliminate harm, not just “reduce” it.

If San Francisco is given the green light to move forward with this perilous enterprise, the United States would literally be moving backward in its attempt to decrease drug addiction and drug-related deaths. For instance, let's look at infectious disease, the most commonly touted issue shooting galleries are supposedly rectifying. A recent article in the Journal of Global Drug Policy and Practice by Garth Davies, a professor at Simon Fraser University in Canada, spells out these misconceptions. Davies’ article states that two related factors render it very difficult to make the case for a connection between so-called safe injection sites and reductions in infectious disease rates:

First, many of the countries that have SIFs [supervised injection facilities] also have low population prevalence rates of HIV. These low prevalence rates make it difficult to detect changes in rates; for the most part, it is unlikely that changes in the number of cases would be sufficient to detect statistically significant trends….

Second, in the total population of individuals afflicted with HIV or AIDS, only a small proportion can trace their illness back solely to intravenous drug use. In the Netherlands and Germany, only 8% and 12% of AIDS cases are attributable to injection drug use. There is also a problem of attribution. In Australia, for example, 4% of HIV diagnoses since 2000 have been attributed to injecting drug use. But another 4% have been attributed to the joint category of “Male homosexual contact and injecting drug use.” That IDUs [injecting drug users] represent only a small slice of the epidemiological pie is an issue given the manner in which the proposition that SIFs limit the spread of disease is normally evaluated. Specifically, this assertion is commonly tested through recourse to aggregate data, a practice which obscures the specific role played by IDUs.4