Canada's drug problem: time to get serious
CMAJ 1999;160:477
In response to: E.A. Voth
I agree with Eric Voth's sentiments about trying to prevent drug use. However, I fear that his opposition to harm-reduction efforts arises from a serious misunderstanding of the approach.
Voth calls for a "tough international policy that tries to prevent drug use in the first place." If by this he means efforts to reduce illicit drug supplies by targeting criminal syndicates that produce, traffic in and promote the use of drugs, his suggestion is compatible with a harm-reduction approach. However, if he means that individual drug users should be treated as criminals, then we disagree.
The addicted drug abuser no more makes a personal choice to be an addict than an obese inactive person chooses to have atherosclerosis or diabetes. Addicts deserve to be treated the same as people with any other disease and to be given the best available care. However, this does not mean that some form of coercion is never appropriate.
There is growing evidence that many drug users who are convicted of nonviolent drug-related crime and who are offered an alternative to jail — such as enrolment in a drug rehabilitation program — can be successfully and cost-effectively rehabilitated.1 This is analagous to the "coercion" now applied to doctors, airline pilots and others with substance abuse problems: "Get rehabilitated or lose your job."
A harm-reduction approach aims to achieve a drug-free lifestyle whenever possible through primary prevention and access to effective rehabilitation services. But it also recognizes that this goal will not always be realized. A supportive approach often reduces the occurrence of the negative aspects of addiction — criminal activity, social disorganization, needle sharing and sexual transmission of diseases.
It is time to implement this harm-reduction approach for the drug abuse problem and to develop policies on the basis of evidence, not the stale rhetoric and worn-out battle cries of the failed "war on drugs."
John S. Millar, MD
Vice President
Canadian Institute for Health Information
Ottawa, Ont.
JMillar@cihi.ca
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