Guest shutterbug Posted March 9, 2003 Report Share Posted March 9, 2003 Should we have (i.e. pay for) safe drug injection zones in [your city here] ?. Follow up questions: YES: OK, what about prosititution; should we have safe prostitution zones? What's the difference here. NO: OK, 10 people OD'd in Vancouver [or your city] last month and the HIV infection rates are skyrocketing; what would you do to stem this tide. Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted March 9, 2003 Report Share Posted March 9, 2003 Hi shutterbug, First, if it's a matter of cash outlay, then there will be the consideration of what other civic needs are vying for these funds and where they sit in the priority chain relative to this issue. Next, it would be positive to consider the cost/benefit of implementing this plan, e.g., would it reduce the burden of disease (both economic and other...). To help review the previous and to help determine if it may be a good fit for this city it would be positive to first ask to consider other cities where these types of models have been implemented so that their experiences can be considered before implementing such policies here. Once all these contextual factors are considered then I'd be more comfortable getting into the nitty gritty. Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 9, 2003 Report Share Posted March 9, 2003 NO WAY! On a personal taxpaying level, I'm not paying for someone's addiction (maybe for its treatment but not for its continuance). Moreover, I do NOT believe in the philosophy "well they're going to do it anyway so why not give them what they want." I believe in a free will; that is, as Mayflower posted recently, we guide our lives by the choices we make! Would you give an alcoholic free booze? Moreover, would you pay for the booze via taxation? Doubt it! Do drug users need help? Yes, absolutely! But I'm not personally (or professionally as a physician) going to reward someone for addictive behaviour. As I've posted before, how can you say to one patient, I would like to help you quit smoking only to turn around to another individual and say, how can I get you clean needles? What paradoxical and hypocritical reasoning! Finally, an addict needs to admit they need to help themselves STOP (not continue to inject). A clean needle does nothing to address the real problem and as a physician we need to learn to get to the root of the problem! In a similar vein, giving out condoms doesn't stem promiscuity among youth-it's a behavioural choice, and eventually a pregancy or STD WILL necessarily result! I think we should be ready, willing and able to TREAT and PREVENT but not to continue to reward risky behaviour... I suggest frontline workers going out and providing lists of support services available in the community or providing on-site counselling etc. oh yeah, EXCELLENT ethical question BTW, shutterbug! Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 9, 2003 Report Share Posted March 9, 2003 Kirsteen, I'd like to say I really like your answer...although I'm not sure if "cash" is really the most important aspect....and, actually, I don't think you actually meant that either. I think that one would have to definitely see where this fits within the context of other needs as you said (sure, it will eventually come down to how much money one has and where to spend it) and where to allocate already scarce resources (i.e., more than money...also people...buildings...etc.). I also think that if it is deemed a "worthy" or "important" issue relative to other Civic issues, a look at effectiveness in other cities...outcomes...benefits...drawbacks...would be necessary to see what impact this would have/not have. macdaddyeh, While I would also have a problem supporting this type of program for many of the reasons you have cited...and, primarily because I believe there are other way more pressing needs in healthcare...I think that giving clean needles and providing a safe environment would have a positive impact on the healthcare system, even if small, by way of reducing disease, etc. Anyway, interesting mock. Peter Link to comment Share on other sites More sharing options...
Guest BCgirl Posted March 9, 2003 Report Share Posted March 9, 2003 I disagree with you on this topic, macdaddyeh. I don't think that safe injection zones would include providing the drugs to people, so you can't really compare it to giving an alcoholic free booze. I also don't think that providing clean needles is hypocritical... if the person isn't ready/willing to quit doing drugs then I think that providing clean needles is a very good way to try to prevent them from catching diseases (HIV, Hep C, etc). I don't consider that "rewarding" a person -- it's trying to make the most out of a bad situation (decrease the spread of HIV, which would decrease the cost on the healthcare system for treating the disease, etc.). Counselling would hopefully be involved in such a program to promote treatment of the addiction. I don't think that giving out condoms is to "stem promiscuity among youth" -- it's done to try to decrease the risk of pregnancy or STD infection. Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 9, 2003 Report Share Posted March 9, 2003 Both of you above: Excellent and succinct responses to my view! Good job! Link to comment Share on other sites More sharing options...
Guest thelaze Posted March 9, 2003 Report Share Posted March 9, 2003 I think it's important to remember not only that it's clean needles, not free drugs, being provided by safe injection areas, but also that most proposals for these services include having drug counsellors on hand to talk quitting with the people showing up to inject. Think of it this way: are drug addicts better off on the street using dirty needles and mired in a situation and environment that reinforces their addiction, or woulld they be better helped coming to safe, clean areas, staffed by people who can counsel them on quitting. IMO the key factor in the debate on safe injection zones is not providing free drug paraphenalia, it's being able to reach people who might otherwise be unreachable if they stayed in the streets. Link to comment Share on other sites More sharing options...
Guest shelleyrn Posted March 9, 2003 Report Share Posted March 9, 2003 Hi, Macdaddyeh...I appreciate your honesty...but I respectfully disagree with your point of view...my reasons being: 1. People will always have sex. No matter how much we tell people that safer sex is the best way (next to abstinence) to prevent STD's, chlamydia, gonorrhea, syphilis, HIV, etc will continue to effect populations. Behaviours are very difficult to change (heck, people may not want to change)...so, should we not continue to educate ie. primary prevention? Should we quit making condoms and BCP? Or should we just say, "Hey bud, you made your(proverbial) bed, now lay in it?" The moral/values judgments we make in our practice become a slippery slope. 2. Addictions are a reality of society. An unfortunate reality. There was a study of injection drug users in Winnipeg circa 1997-ish called the WIDE study. From that, and other studies, it was shown that if >10% a population of IDU (injection drug users) have HIV/HCV, you will start seeing a spill over effect into other populations ie. "joe suburbia". 10% is the magic number. The face of HIV is changing. Again, you see the increases within the gay community, BUT, it is becoming more a "hetero" male/female, as well, numbers are rapidly increasing within First Nations communities. Why do you think that is? 3. Recidivism is approx. 85-90% for alchohol and drug treatment programs---it may be even higher (translated: falling off the wagon). Obviously, something is not working. Yes, I agree that there is a personal responsibility of the individual who may have a drug or alcohol problem, BUT, how can we as practitioners assist them in their recovery? Not by making value judgments, but in advocating for better treatment, care, etc...oh, and macdaddyeh...the harm reduction model is not about "supplying" persons living with addictions alcohol/drugs...it's about educating peopleabout safe injection, using clean needles, drinking less ("you drink 24 beers in a night?..why not try just 18 tomorrow"). If you are open to a person, when they are ready to quit, they may be more likely to approach you and seek help....isn't that what this is about? 4. Taxpayers' money. Hmm....if you prevent that 10% from spilling into the masses, would this money for safe injection sites etc. not be money well-spent? HIV/HCV care is very costly. 20-25 K/year for HCV treatment x a fast growing number,and you've got yourself a big old bill $$$. HIV care is also somewhere up there as well....never mind the medications...what about hospitalizations? Also,we must remember, the human cost is exponential....and very real.... My humble opinion....Shelley Link to comment Share on other sites More sharing options...
Guest bcdentalgirl Posted March 10, 2003 Report Share Posted March 10, 2003 Shellyrn, I'm guessing the rn stands for nurse. If so, your above comments are further evidence to me of what a valuable resource we have in our nurses. I agree with you on many points. As a citizen of Vancouver and former resident of Strathcona (an area basically surrounded by the so-called downtown east side), I have seen the human trageties that play out down there daily. It is quite simply, horrific. I feel that we need to come up with some revolutions in thinking if we are going to start to solve this problem. Many of the addicts are mentally ill as well and/or have come from backgrounds of abuse that would make our hair stand on end. Models of recovery that work in the "regular" population do not work down there. We need to start approaching drug addiction as a symptom of the larger problems: poverty, inequality and abuse. I believe "safe injection sites" would send a much needed message to addicts: "you are valued members of our society and we care about you. We don't want you to die of AIDS or OD alone in a back alley". The proposed sites would put addicts in daily contact with counselors and health care professionals where their afflictions and secondary health problems can be regularly monitored and addressed. This can only be a good thing. One problem I do have: they have been talking about modelling the sites after dutch injection sites where treatment facilities would exist in the same building. Addicts who are trying to recover in one area might find it difficult to be in such close proximity to addicts who are still using. Anyhoo, that's my 2 cents! If you haven't already, you must see the film "Fix: portrait of an addicted city". Link to comment Share on other sites More sharing options...
Guest bcdentalgirl Posted March 10, 2003 Report Share Posted March 10, 2003 ps... I know this forum is primarily for med interviews but I couldn't resist. Hope that's ok. Link to comment Share on other sites More sharing options...
Guest grandmellon Posted March 10, 2003 Report Share Posted March 10, 2003 I believe that no matter how much effort you put into trying to get rid of people doing drugs there will always be someone snorting or whatever else it is that people do these days. There are pros to doing this because number one you decrease the amount of IV transmitted diseases and number 2 you get people into a health care setting where they become comfortable talking to someone from the health care team.. this may lead to a wider acceptance of what they have to say… the cons are (and I believe they are false) that they could lead to an increase in the amount of users, and an acceptance of doing drugs. And macdaddyeh I don’t believe we are rewarding the people for their behaviour, we are simply giving them a safe place to do it, did you know the chances of getting Hep C are 60% (I think) from one needle sharing! I agree with dental girl… it is the safe supportive atmosphere we are providing… Great discussion! :rollin Link to comment Share on other sites More sharing options...
Guest shelleyrn Posted March 10, 2003 Report Share Posted March 10, 2003 Hey grandmellon...cha-ching...3 cents well spent...yes, HCV is incredibly easy to get (blood-blood)...I think the number is even higher than 60%! In fact it is even easier to contract than HIV (something about that fragile protein coat....thank god it hasn't figured out how to mutate protein into gore-tex!!). bcdentalgirl: I am not so familiar about the set up of the dutch centers, but I would venture to guess that they have worked out the logistics for triggering people that are not using...ie. separate entrances,etc...(hmmmm....I should look into this more....) Thanks for your comments. Yes, nurses do rock! lol...I am hoping to put some that knowledge into med school.... <crossing my fingers> (interview @ Mac) Link to comment Share on other sites More sharing options...
Guest grandmellon Posted March 10, 2003 Report Share Posted March 10, 2003 I'd have to agree with you Shelley.. NURSES rock... they are very well educated... so when we all become doctors we must always remember not to invalidate the knowledge of n urses because they do know a lot. And they are very helpful on the wards if you aren't sure about something. (just thought I'd put this in because I know a lot of Dr's who have a bad run in with a bad nurse then generalize that all nurses are bad... but they aren't!) Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 10, 2003 Report Share Posted March 10, 2003 Great points everybody, and yes, I concur that nurses are often overlooked, overworked, and undervalued:( . I still however don't agree with providing clean needles. I see the points of some people, but just can't agree; however, I must reiterate that I do NOT mean they are not entitled to some type of help. Someone did mention that injection sites often have counsellors or nurses to provided advice, therapy or other alternatives, etc.--this I can agree with. There are a whole tonne of other issues one would have to think about too if a "safe injection site" operated (Just like the myth of safe sex, I think you might want to call it safER). What about needle disposal? What about the health and safety of personnel? ie. desperate, drug-induced people doing crazy things. What about the operational hours? 24-7-365? Doubt it! From a purely economic perspective (and no I'm not an economist or even a fiscal conservative for that matter), as Kirsteen said there are competing interests for public dollars--and this is hardly a preventive service being offered, despite people saying it would "prevent" or at least reduce the incidence of hep c, hiv etc. So, would this be run from a non-profit service organization? A further insisputable point that people can NOT argue against is that providing needles does nothing to stop people from continuing to use drugs! Should they be offered a safe, friendly environment to get away from drugs and the street, etc? YES, absolutely! Should that place provide people with clean needles? NO! Just thought I would provoke some more thought on the logistical issues concerned. Great discussion thus far... Link to comment Share on other sites More sharing options...
Guest shutterbug Posted March 10, 2003 Report Share Posted March 10, 2003 Good points macdaddyeh. Yeah the logistics would be interesting. For example, how would you promote or advertise such a program to the target population? Are you going to wait for a OD to occur or are you going to monitor the 'dosage' so as to prevent an OD in the first place - who is going to assume the liability for this 'prescription'. The whole notion of 'harm reduction' is very polarising. You have an existing pool of individuals who are going to use drugs in a manner that may or may not be safe (relatively speaking; drugs aren't that safe to begin with). Preferably, you want them to quit or at least practice safe injection methods. But, in promoting safe injection methods are you also ecouraging/facilitating its continued use and uptake. One problematic thing about drug abuse is the physiological dependence it creates. It's not as simple as wanting to stop or telling someone that they should stop. Myself, I would definitely not be more likely to get into injection drugs even if there were a 'safe' place to do so. I think that if you at low risk for drug-use uptake to begin with you will not be at any higher risk to start because of these safe sites. The big unknown is whether current users will be more likely to continue. At least, in the safe sites they would have access to support systems that would make allow/encourage/help them to quit. Link to comment Share on other sites More sharing options...
Guest strider2004 Posted March 10, 2003 Report Share Posted March 10, 2003 I'm an advocate of safe injection zones. Macdaddyeh, you've put forth a personal opinion on drug abuse that obviously can't be ignored in this type of discussion. However, I look at the issue more in the prevention of further costs to our health care system. The goal of clean needle sites is to prevent the spread of blood-borne infections. Treating these people of their drub addiction is a distant second in terms of priority. We are NOT PROVIDING THEM WITH FREE DRUGS, only free needles. If they have the drug already, they're going to get it into their systems any way they can. We are simply trying to give them a cleaner way to do it. Are we endorsing their way of life? NO! We are saying that their way of life has many other adverse effects and we're trying to prevent those effects any way we can. The free booze to an alcoholic wouldn't be my analogy. It's more like a free ride-home program for bars. It is meant to reduce the number of drunks behind the wheel, improving safety for all. The provision of clean needles is to prevent any additional burden to our health care system. If they get HCV or HBV, how much would it cost our health care system? Could we have prevented it? We still treat drug addicts if they get hepatitis, so why wouldn't we try to prevent them from getting it? Safe injection zones are a way of the medical community infiltrating the drug community, lowering the future burden to our health care system. It even works for Hep positive addicts because we'd be stopping the spread of infection at the source. We're not trying to be ambivalent here. The motives are purely selfish. If we help them now for cheap, then they would drain our budget in the future. Link to comment Share on other sites More sharing options...
Guest bcdentalgirl Posted March 10, 2003 Report Share Posted March 10, 2003 Free, clean needle exchanges have been a reality in the downtaown east side for quite a long time now. Ask the street nurses if they are having a positive effect. The injection zones would take the actual injection of the drugs out of the alley ways, backyards and school yards, and bring it into a contained, safe environment. I agree, this is not ideal, but again, this is a crisis. Something drastic needs to happen to control the carnage right now. Can anyone think of a better solution? (I'm not being cute, I'd really like to hear your thoughts) Link to comment Share on other sites More sharing options...
Guest monksters Posted March 14, 2003 Report Share Posted March 14, 2003 I think this is a great discussion... Though I do feel quite strongly about this issue 1. Causes of addiction: The common thought around addiction is that it is the addicts fault. This is a gross misconception. As high as 30% of the addicts in the DTES are estimated to have some sort of mental health illness. Many others who like shelly mentioned have grown up from environments of abuse, poverty etc. We need to ask ourselves this question. What normal happy person with a good life would ruin their life willingly by following a life addiction? These people obviously have other issues that compell them to this self-destructive lifestyle. 2. The role of the health care system: because there is an action associated with addiction. However, should we then not care for people who have lung cancer from smoking? or liver cirrohosis from drinking....or diabetes from too much fast food? or atheroscerosis from inactivity and poor diet? No one can deny that the lifestyle is a huge component of health...but we can not discriminate our services based on someone's lifestyle. If it is at a cost to the society and to themselves we need to intervene to reduce the harm. I would argue that these individuals are the most in need in fact. 3. Economics: A IDU (intravenous drug user) in OD's and abscesses, HIV, etc etc.. could cost the health care system as much 98000 per year (from a recent figure I read). Under a controlled environment like safe injection sites, the OD's would be fewer, risk of HIV would be lower, and probability of accessing recovery services would be higher. In fact one of the major studies conducted through the Center for Excellence in HIV is evaluating the continuity of care for the DTES community right now which is virtually non-existent. So this population afflicted with multiple challenges is also not having equal access to health care services.. So how are to we speak of a universal health care system.... 4. Innovative thinking: it is a misconception that providing a safe injection site will increase drug use. In fact a recent study between Switzerland and Germany and the Center for Excellence in HIV found that perscription heroin was an effective way for recovery in those that fail methadone treatment (it was a randomized control trial i believe). There was a very high (80% I believe) recovery rate after 8 months follow up. I have not read the trial myself but it is called the NIAOMI Trial for those interested). Anne Mclelland (Health Minister) has also approved for safe injection sites to be evaluated under RCT (although I'm not sure how this would work logistically)... But hopefully it will produce some answers as to whether the SIS will have a positive effect in the DTES community. Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 14, 2003 Report Share Posted March 14, 2003 Monksters: I think it is important for you and others to recognize another school of thought that exists concerning drug and alchol abuse. I am tired of people saying that they are not responsible for their own actions and behaviours. Sure, addictions *might* be influenced by environmental or genetic factors, but to limit addictions to such factors is an extremely reductionist argument. The bottomline is that people are born to make CHOICES: we are human beings with a free will, not brainless, helpless individuals at the mercy of genes and environment. Everything we do is a CHOICE; it is my choice to NOT drink just as it is for others to START drinking, or to CHOOSE to smoke (been there, done that--and CHOSE to QUIT). That addictive behaviour began as a result of my rebellious teenage spirit and I quit two years later by CHOICE. Do people seriously believe then that people who are drug addicts start and continue using drugs because they are predisposed to it somehow? Or because they were abused, homeless or neglected? I hope not! I have seen many desperate people before but if you talk to recovered people (and I've talked to many) they regularly recall in recounting their stories, the circumstances which led them to CHOOSE to continue their addictive behaviours. Case in point (beside my own smoking): A member of my family had an alcohol addiction, woke up one day and made the CONSCIOUS decision to say "enough is enough!" Having retrospective discussions with this individual, that person admitted that it was a CONSCIOUS decision to START to drink and to get to a point of desperation to make the CONSCIOUS decision to STOP. I was once in the frame of mind which you called a "misconception" in which I did NOT think it was the "fault" of the addict. When I worked at an unnamed health centre, I said to the staff, How do you account for those with addictive personalities? They all told me that research suggests there is no such thing as an "addictive personality"--in fact the staff said that admitting to such a ludicrous idea is absolutely denegrating to people who need help and maintaining such a philosophy would destroy the credibility of the work of many health promotion programs. If, as you suggest, this "self-destructive" lifestyle is not the addicts "fault" then do you imply they are hopelessly stuck to engage in or lapse into the same behaviour again? I also hope not. People often CHOOSE to start drinking or binging on food or using drugs (including nicotine) because they are desparate, lonely, shunned, angry, rebellious, etc--these reasons for starting drugs and alcholol are well understood. There's no guessing game as to why they continue..it boils down to choice, just like they have the choice to quit! I would agree that people do not start with the intention of becoming addicts,(accept for a few I've met who claim they wanted the attention) but the bottomline is that they CHOOSE to continue what you call a "self-destructive lifestyle." Removing the FACT of CHOICE from the equation is also implying that addicts have no responsibilites to themselves, to others or to society because it is not their "fault." To imply that drinking/drugs/smoking/gluttony etc. is a genetic or environmental issue is also culturally ethnocentric because it implies that people of certain backgrounds are more prone to it (ie. Oh look at poor Bob, you know he is from X culture, it is obvious that is why he is an alcoholic!) Such a notion is unacceptable. When I talk about CHOICE, FREE WILL and RESPONSIBILITY, I would obviously have to make the distinction that children and the seriously mentally ill might be exempt from the above views, simply because of their capacity or lack thereof for logical, coherent and accountable reasoning. Finally, I would like to further make the distinction that I DO believe that addicts need help and support and the above views do not imply that I would dare belittle an addict and say "It's your fault" if they sought my help. Rather I would commend them for making the CHOICE to quit or at least ask for help to make a decision to quit. PS. #2, 3, and 4 were brilliant in your discussion--very nicely stated... Link to comment Share on other sites More sharing options...
Guest monksters Posted March 14, 2003 Report Share Posted March 14, 2003 To return to the point of choice. I believe that people can make a choice to seek help. But it is more difficult (although not impossible) for some than others. 1. Smoking: you may have quit smoking and I commend you for that. I too was a smoker before. But I believe that the smoking cessation that I went through is much easier than those that I now help through a smoking cessation program that I run. 4 out of the 5 people... no joking are from background of bipolarity, depression and scizophrenia. 2. Addiction: The nature of addiction is a pharmacological effect. The chemical states in the body (dopamine receptors) sensitivity have been altered such that quiting causes withdrawal symptoms. So it is not a choice like getting up to brush your teeth in the morning, but it is an actual physiological dependency. 3. Environment and Addiction: You might be suprised to know that the highest profession for addictions is in medicine. One is access and two is the enormous stress and psychological strain that working crazy hours and facing life/death decisions, liability and responsibility causes. Of course we choose a career in medicine knowing full well that this will be the potential risk we are willing to take. However, take this example... this is a true story.. 4. Choice is a funny thing... We don't choose where we live. I could be living in South Africa where 1 in 5 people are infected with HIV. Or I could be in a war torn country like Isreal or Iraq. I could have grown up in Cambodia where 2 million people were slaughtered and inprisoned in my elementary school. I could have grown up with parents who were drug addicts and not have adequate housing or food. But instead I have grown up with the priviledge of being able to apply to a field like medicine where I can use my priveledge to do something for people who may not necessarily have the same. To deny that experience affects are choices would be silly. Then our experiences that supposedly help us in make the choice of medicine would be irrelevant to talk about. A native girl was thrown through 25 foster homes before landing at one that offered some stability. Her foster father paid her to have sex on a regular basis until she left home. She was so tramatized that eventually she dressed as a boy so that "no one could hurt her" anymore.. She now lives on the street of the DTES as a sex trade worker. There is a whole field of medicine now "Urban Health" emerging that focuses on finding the root causes of these circumstances. A recent conference issue was published by the New York Academy of Medicine. Things are not a simple as they seem. I don't pretend to understand the half of it... I just know that there is a whole lot that we don't know. And the DTES community deserves the same dignity and care that we afford to anyone else. Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 14, 2003 Report Share Posted March 14, 2003 Monksters: First, I thank you for your prompt and informative response. In fact, I did neglect to mention the physiogogical effects that an addiction has on an individual, so thank you for bringing that forward. I would not dare blame anyone for their "addiction" rather I was simply getting to the point that it IS one's choice to start. To continue the addiction does indeed become, at least partially, a physiological phenomenon. Perhaps it is because I am interested in, and have experience with, the social determinants of health that this issue really has me exasperated. I've met many desparate, poor, emotionally disturbed individuals, some of whom have shared with me their life story (and as per your examples, it is often tragic) and I am awe struck at hearing how, when, where and why the addiction(s) started. It is indeed an existential question why people are addicts. Genes and environment are not the full answer, but I will equally admit that neither is the notion of choice. Link to comment Share on other sites More sharing options...
Guest smg Posted March 15, 2003 Report Share Posted March 15, 2003 I've found this discussion quite fascinating. The whole choice debate tends to be one of the most divisive in issues surrounding drug abuse (and other social issues, for that matter). The reason why determining whether a condition is a choice or not is such a big deal is the law. The bottom line is that if something (i.e., age, race, disability, sexual orientation, etc.) is not considered a choice it is a protected as a right either by the Charter or other human rights legislation. I do recognize that people are not trying to have poverty and drug addiction protected on these grounds, but am simply trying to shed some light on why this issue tends to be so charged. There is a lot at stake. That being said, I think in recent years the political climate with such social issues has become very polarized, primarily due to the rise of neo-conservatism. The idea of social rights that was taking hold with the development of our institutional welfare state during the '60s, '70s and '80s has been all but been obliterated in the last decade. Therefore, I would argue that those on the front lines dealing with the poor, suffering and down-trodden, essentially those who have lost the most with this obliteration, have had to harden their positions in order to be heard. It's a fight and you need to ask for a mile to get an inch. I don't think many would argue that those suffering from drug addictions are asking to be absolved from their responsibility (unless some sort of incapacity or mental illness is involved), but that they are seeking compassion and consideration for the factors beyond their control that have lead them to make such choices. I think why this ends up being perverted into the whole 'it's not my fault thing' is because the general public, media and most governments have tended to take an approach that alienates and dismisses these members of society. I do think that we are creatures of free-will, but that we are also social creatures who are shaped by our experiences, background, upbringing, etc. The point is that most people suffering from addiction,while having technically made a choice to do so, have been heavily influenced by factors beyond their control. From my experience, it is THIS that addicts, front line workers and advocates are trying to have understood. I support SIS. I do not think they are perfect. More comprehensive approaches that would address the factors like poverty and abuse that put people at risk for addiction would be ideal. Unfortunately, as one poster mentioned, this is a crisis and something needs to be done. I am frankly not comfortable with simply writing these people off and dismissing them as part of our community. SIS are a way of reaching out to these members of our society. How can we expect a drug addict to CHOOSE to rehabilitate, when their own community seems to not even care whether they live or die? Moreover, I think harm reduction is simply a prudent and logical thing to do. Yes, we need to work on reducing drug use, unsafe sex, etc., but why would we not, in the meantime, want to limit the damage? Is it not in the best interest of our greater social (and health) good? Well, those are just my few cents. Goodnight folks! Simone Link to comment Share on other sites More sharing options...
Guest shutterbug Posted March 15, 2003 Report Share Posted March 15, 2003 To add fuel to the excellent debate I found some interesting links with stats and such. For example: - Over 2000 OD deaths since 1992 in Vancouver's Downtown Eastside - 125,000 IV drug users in Canada - projected 2004 costs of HIV/AIDS related to IV drugs ~ $8,700,000,000 - Singapore's solution: drug trafickers get :eek DEATH :eek (also, litterbugs get caned) www.publicaffairs.ubc.ca/...ction.html www.drugpolicy.org/reducingharm/ - elexellent for proc/cons of harm reduction and policy www.drugpolicy.org/docUpl...ention.pdf - paper discussing other prevention methods www.aidslaw.ca/Media/clip...120402.htm - nurses in BC already helping addicts temagami.carleton.ca/jmc/...1/n2.shtml - very ANTI-SIS As for the issue of free will versus psychosocial influences as the cause of addiction: I think both are contributing. I personally know (probably some people on this board as well) several people from very nice backgrounds (i.e. $$$$ and 'sound homes') who are now hopelessly addicted. One thing I noticed is that they cannot accept responsibilty for their actions. There always seems to be some other reason. Sometimes, I just want to tell them that it is THEIR fault that they are where they are. whoops...I've been here to long...got exams to study for Link to comment Share on other sites More sharing options...
Guest macdaddyeh Posted March 16, 2003 Report Share Posted March 16, 2003 Thanks shutterbug: I was looking for a "safe injection" of evidence-based medicine:lol . But seriously, thanks for showing all the sides and passing along those articles Link to comment Share on other sites More sharing options...
Guest monksters Posted March 16, 2003 Report Share Posted March 16, 2003 Thanks for the references shutterbug. Though I must say that cases where people from good homes end up with addiction are the exception rather than the rule. "When will we stop terrorizing and start treating those who suffer from the medical condition of addiction? " Patricia Spittal PhD Anthropology and Martin T. Schechter PhD Mathematics, MD. Martin Schechter has been following HIV since the beginning of the 1980's and is the pioneer of most of the relevant research in BC. He is the Director of the Center for Excellence in HIV/AIDS. Here is another inteview from one of the paper's below According to Marie, this man became like a father figure for her and showed her love like she had never known. But then he began to beat her, and her predilection for injected powder cocaine intensified. "He said to me, this is what happens to you if you enjoy being with a trick.... He wanted to make sure that all that was in my head was to make money, to get the money and go back and give it to him." She sometimes tried to make her money and run; however, he would track her down, inject her and then batter her, sparing only her face. Controlled by both fear and drugs, Marie's vulnerability escalated. "I just started using a lot, and every time I got into a trick's car, I felt relieved. I could escape." By the time Marie was 17 years old, drugs and tricks had become the only reality she knew. Today, at age 28, although she has survived gang rape, incarceration, miscarriages and 2 suicide attempts (slashed wrists and a heroin overdose), she is infected with both HIV and hepatitis C. Here are some other articles that may interest people on this thread www.cmaj.ca/cgi/content/a...RSMrM2h5Ow www.cmaj.ca/cgi/content/f....Amn9ZdlBA ije.oupjournals.org/cgi/c...E.bINhuphg Hope this can shed some light. It pains me to see the stigmatism that the DTES community goes through. Link to comment Share on other sites More sharing options...
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