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CMAJ
CMAJ - February 23, 1999JAMC - le 23 février 1999

Canada's drug problem: time to get serious

CMAJ 1999;160:477

See response from: J.S. Millar
It is time for Canadian physicians and policy-makers to get serious about the country's drug problem. Edward M. Adlaf and Frank J. Ivis1 [abstract / résumé] report that marijuana use increased by 112% between 1991 and 1997. It is no wonder that cocaine and heroin use is increasing as well, given the virtual anarchy surrounding drug use in places like Vancouver. A 1997 study2 reported that since the inception of Vancouver's needle hand-out program in 1988, HIV prevalence among addicts who use drugs intravenously has risen from 2% to the current level of 23%. Vancouver now has the largest needle exchange program in North America — it provides 2 million needles per year — but the rate of needle-sharing is still high. The study found that 40% of HIV-positive addicts had lent a used syringe in the previous 6 months and 39% of HIV-negative addicts had borrowed a used syringe during the same period.

Another study of misguided public policy3 demonstrated that the Montreal needle hand-out program was associated with HIV seroconversion rates of 7.9 per 100 person-years among those who participated in the program and 3.1 per 100 person-years among those who did not. Even the authors were surprised by the findings and tried to discount them.

In an editorial accompanying Adlaf and Ivis's report, John S. Millar4 [full text] calls for greater harm-reduction efforts by equating addiction with other diseases such as diabetes and hypertension and citing the poor compliance common in the management of chronic disease. What he fails to realize is that for any disease, an element of coercion is often necessary to effect changes that will improve health.

We at the International Drug Strategy Insitute believe that harm-reduction policies are doomed to failure and doomed to result in increased drug use. We instead call for harm prevention and harm elimination through a tough international policy that tries to prevent drug use in the first place and, just as important, places pressure on the user to eliminate drug use.

Eric A. Voth, MD
Chairman
International Drug Strategy Institute
Topeka, Kans.
EAVMDTOP@aol.com

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References
  1. Adlaf EM, Ivis FJ. Recent findings from the Ontario Student Drug Use Survey. CMAJ 1998;159(5):451-4.
  2. Strathdee SA, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, et al. Needle exchange is not enough: lessons from the Vancouver Injecting Drug Use Study. AIDS 1997;11(8):F59-F65.
  3. Bruneau J, Lamothe F, Franco E, Lachance N, Desy M, Soto J, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol 1997;146(12):994-1002.
  4. Millar JS. A time for everything: changing attitudes and approaches to reducing substance abuse. CMAJ 1998;159(5):485-7.