VIHA MOVES CAUTIOUSLY TO STEP UP EFFORTS FOR HARM REDUCTION

South Nanaimo residents reacted angrily in 2007, when public health
nurses in vans started showing up in alleys, handing out crack-pipe
mouthpieces and other supplies to addicts.

It was part of a harm-reduction program geared to slow the spread of
diseases, such as hepatitis C, and to encourage addicts to seek
needed medical help.

The Vancouver Island Health Authority is now expanding its
harm-reduction program in the central Island, meaning Nanaimo addicts
will soon have more places to get condoms, syringes, crack-pipe
mouthpieces and other materials.

The goal is to reduce addicts' harm and to relieve life pressures
that tend to feed the vicious cycle of addiction, while at the same
time reducing the harm to society from increased crime, policing and
health-care costs.

Still, some people say the authorities are moving too slowly in
implementing harm reduction.

Critics say harm reduction enables drug addiction but practitioners
say passing judgment on addicts is a sure way to isolate them
further, making sobriety and normalization even less likely.

Experts who have witnessed harm reduction practised in European
cities say Canada is out of step with a movement that benefits
society overall, not just addicts' lives.

Simon Fraser University health sciences professor Benedict Fischer
published a recent study calling upon health authorities to go beyond
giving crack pipes and needles to addicts.

He looked at 148 crack cocaine users in Nanaimo, Campbell River and
Prince George and recommended creating inhalation sites as a calming,
safer alternative for crack addicts who sometimes experience
psychotic episodes smoking the drug on the street. Removing them from
public places reduces harm to the public, too, he said.

Walter Cavalieri, founder of the Toronto Harm Reduction Task Force,
calls upon health officials to be "respectfully fearless" of
opposition to advancing new, controversial harm-reduction strategies.

"Oftentimes we cower, we shut up," Cavalieri told the Daily News in
2010, when he gave the keynote address at a harm-reduction symposium
held in advance of Nanaimo moving forward on its biggest
harm-reduction project, low-barrier housing. That project has met
stiff opposition from neighbours.

Donald MacPherson, also of SFU, agrees with both Cavalieri and Fischer.

"Anyone who's seriously interested in a comprehensive, publichealth
approach to these things would validate what these people say," said
MacPherson, Canadian Drug Policy Coalition director.

"If you look at small cities in Europe - Bern, Switzerland and places
in Germany - where they've built out these approaches more
comprehensively, you'll see they've got good results."

There, authorities put the addicts' rights to health care on an equal
footing with the public's right to be free of social problems around
addiction. They use a range of means, including prescribing
medical-grade heroin to addicts to address both issues.

In Nanaimo, as in much of B.C., health officials balance the need for
harm reduction against a need to quell public opposition.

In Vancouver, it took the Supreme Court recognizing the Insite
supervised drug site as bona fide medical treatment to allow another
site to be considered.

"It's hard to predict in the longer term," said Dr. Paul Hasselback,
VIHA medical health officer, when asked if Nanaimo could have a
similar facility in five or 10 years. "Supervised drug sites really
do need to reflect what the needs of the community are, specifically."

Hasselback wasn't in his current post during the outcry over public
health nurses in Nanaimo handing out crack-smoking kits from a van
several years ago, but he understands the politics of harm-reduction
program implementation.

Crack-smoking paraphernalia is today's hot-button issue, but "20
years ago putting condom machines (in public places) was tough to
talk about," Hasselback said.

When VIHA is ready to move harm reduction forward, the city of
Nanaimo will be consulted.

"Our general attitude is we don't have any right to tell VIHA how to
conduct their affairs," said John Horn, city social planner.

"Far be it for us to say: 'You cannot address the health concerns of
citizens, just tell us what you're going to do,' if there's going to
be some community response. Of course, we don't have a veto on those
things. We have a right to express our thoughts," Horn said.

At Harris House Health Centre on Franklyn Street, NARSF Programs Ltd.
serves addicts and other high-risk clients by providing access to
such harm-reduction supplies as condoms, crackpipe mouthpieces and syringes.

More could be done, but it's about striking a balance, according to
Gord Cote, NARSF director.

"In the context of where we've come from in three years, we're
progressing," Cote said. "It's always a dilemma, how does what you
think can be there compare to other realities? It's a big system."

Moving forward on harm reduction, MacPherson agrees with Cavalier's
call for fearlessness.

"These sorts of (initiatives) don't happen without some leadership,
and leadership implies courage.

They're not issues that are easy to solve, but not to act is not
acting in the best interests of citizens," MacPherson said.

HARM REDUCTION TIMELINE

November 1999: John Howard Society releases controversial paper
advocating new approach to drug problem - education, harm reduction
and considering adult drug use a health matter, not a legal issue.

November 2000: New methadone clinic opens on Victoria Road, expanding
harm-reduction options for heroin addicts

November 2003: Issue of harm reduction raised again, as brazen public
drug consumption rises on downtown streets

May 2007: Mobile crack pipe distribution program becomes major issue
with south-Nanaimo residents. Many express outrage about addicts
congregating in public locations to get methadone and at needle exchanges.

December 2007: VIHA promises crack-smoking paraphernalia will not be
distributed without community input. City spends $60,000 on
harm-reduction study.

July 2008: City unveils ambitious $45-million supportive housing plan
targeting homelessness linked to drug addiction and mental illness

July 2009: VIHA gets go-ahead to distribute crack pipes but
initiative is shelved in Nanaimo due to resistance from city council

July 2010: SFU researcher calls for creation of supervised inhalation
facility in Nanaimo

June 2011: Bowen Road supportive housing project shelved amid public opposition

January 2012: VIHA decides to gradually add new distribution points
for harm reduction supplies ranging from condoms through syringes and
crack pipe mouthpieces