Science and Harm Reduction

I'm stepping into it here, but the rush of these articles (here and here are two examples) proclaiming Insite's empirical goodness (my word, not theirs) is getting on my nerves. The implication is that any critic is motivated by moral panic or some evangelistic impulse. (Many critics fit these characterizations. I'm bothered by them too.)

The first clue that something isn't quite kosher is this line, "A scientific review at the XVI International AIDS Conference in Toronto on August 15 became the scene of an emotional outpouring of support for Insite, Vancouver's supervised-injection site."

Let me be clear. I think that there can be a place for a program like Insite, especially in a city with HIV rates like Vancouver, but context matters.

"Success" depends on how one defines "success", doesn't it? Science supports the use of opioids to reduce pain in cancer patients. Is that an adequate response to cancer? We can create situaltions where the surgery is a success but the patient dies.

Many harm reduction advocates accuse critics of having a value-laden perspective on drug problems. I agree. I'm suggesting that values drive harm reduction activities as well. Public health has its values too. For example, it tends to focus on disease transmission, it tends to focus on communities rather than individuals, and can, at times, reduce decisions to an accounting exercise. One extreme example is medicalization of female circumcision.

I'd encourage all providers working with addicts to identify the values that drive their practices. We've done it, here.

So, Insite is fine with me, as long as it is used as a place to engage addicts and move them incrementally toward recovery. To do so, you have to have a lot of other pieces in place. I may be wrong, I'm 3000 miles away, but I get the sense that there is a lot more enthusiasm for harm reduction than for recovery.

These agruments might get put to rest if they tried a both/and approach.