the federal government is really waiting for all the science to be in before
making drug policy, it will be waiting a long time
May 23, 2008
minister Tony Clement insists the government's only concern is sound public
policy. Does Insite really work? That's all Mr. Clement cares about. If so, the
government will allow the Vancouver drug-injection facility to stay open. If
not, Insite will have to close when its federal exemption runs out on June
thing that will not be a factor in the decision, Mr. Clement says, is politics.
Not one bit. Science and evidence will settle it.
question Mr. Clement's sincerity.
all, 22 studies examining various facets of Insite's operations have passed the
rigorous peer-review process and been published in prestigious scientific
journals. Every one of those studies reported positive results. And recently, in
the International Journal of Drug Policy, researchers from the British
Columbia Centre for Excellence in HIV/AIDS argued that after the government
reluctantly granted a temporary extension of Insite's exemption, it had
strangled the production of research - by requiring researchers to agree not to
publish any results until after the exemption had expired. The UBC researcher
felt this was unethical and refused to co-operate.
the facts as presented," wrote Robert MacCoun and Peter Reuter, respected
American policy experts, in the same journal, "a well-executed piece of policy
research on a promising innovation was discontinued for unstated but blatant
who am I to doubt Tony Clement? He's one of the brighter lights in Stephen
Harper's cabinet, and, as Ontario's minister of health, he handled the SARS
crisis admirably. Besides, drug policy is a matter of life and death. To put
politics ahead of evidence in making a decision like this, a politician would
have to be callous and ruthless.
assume Mr. Clement is better than that. He wouldn't put politics ahead of lives.
The fact that he has balked at declaring Insite a success despite having those
22 peer-reviewed studies on his desk is easily explained: He simply has very
demanding evidentiary standards.
a good thing. All politicians should.
I've got terrible news for Mr. Clement, Mr. Harper, and all leaders who base
their decisions solely on high-quality scientific evidence: Almost every element
of Canada's approach to illicit drugs is unsupported by scientific
Insite and all the other harm reduction programs such as needle exchanges. They
may get all the attention, but they're actually very minor in the big scheme.
They cost peanuts. And they don't change the underlying approach to dealing with
drugs one iota.
underlying approach is where the real resources go.
there's prevention and treatment. A reasonable person could argue both are
underfunded. And yet both get far more money than harm reduction and both are
far more important to Canadian drug policy.
there's law enforcement. It's an elephant among poodles. A few years ago, the
auditor general guesstimated that 90 per cent of all the money spent on the
illicit drug problem by Canadian governments goes to law enforcement. That
figure is probably a little lower today but there's no question that the lion's
share of funding goes to cops, courts and jails.
reduction is fairly new - to Canada, at least - but not prevention, treatment,
and law enforcement. In one form or another, prevention and treatment have been
widely used for many decades. And law enforcement dates back to the
criminalization of alcohol and other drugs early in the last
how long these policies have been kicking around, one might think there's plenty
of research on all three. But one would be wrong.
a 2006 paper published in the journal Addiction, the aforementioned Peter
Reuter - a professor at the University of Maryland whose work is respected by
all sides in the drug debate - surveyed the scientific literature. His
studies have found treatment to have large effects on individuals' consumption
and harms," he wrote. "However, there is an absence of evidence that even
relatively well funded treatment systems have much reduced the number of people
in a nation who engage in problematic drug use."
dear. And prevention? "The scientific literature shows useful and modest effects
at the individual level but there is little support for substantial aggregate
unfortunate. But what about the policy that dominates Canada's approach to
drugs? "For enforcement, research has almost uniformly failed to show that
intensified policing or sanctions have reduced either drug prevalence or
drug-related harm. Nor - outside of the U.K. - is there more than a modest
effort to improve the evidence base for making decisions about the appropriate
level of enforcement of drug prohibitions."
is hardly alone in his assessment. In 2001, a committee of the U.S. National
Academy of Sciences - the world's premier scientific institution - issued a
report examining the state of the evidence on drug policy. In a phrase, the
committee said there's very little. Evidence, that is.
nation possesses little information about the effectiveness of current drug
policy, especially of drug law enforcement," the report concluded. "The central
problem is a woeful lack of investment in programs of data collection and
empirical research that would enable evaluation of the nation's investment in
drug law enforcement."
the state of research is actually worse in Canada than in the U.S. The federal
government doesn't even know how much money it spends on drug policy - which is
why the auditor general had to guesstimate.
might think that the police - who are in the evidence-gathering business, after
all - would be bothered by the paltry evidence in support of prevention,
treatment and law enforcement. But again, one would be
spokesperson for the Ontario Association of Chiefs of Police said his
organization is opposed to Insite. "We believe this isn't the way to go," said
Toronto Police Superintendent Ron Taverner. What the chiefs want, naturally, is
a stronger emphasis on prevention, treatment, and
the Harper government agrees. Its drug strategy rejects harm reduction and
instead calls for greater efforts in prevention, treatment, and
is why I am sure the news I have delivered today will devastate Tony Clement.
Not even Insite's 22 peer-reviewed scientific studies are enough to satisfy the
minister's demanding evidentiary standards. Imagine how he will feel when he
learns that Insite is supported by far stronger evidence than almost anything
his government is doing about drugs.
he will be shocked senseless. When his aides bring him round with smelling
salts, shock will turn to outrage.
spending all that money and having no idea if it's doing what it's supposed to!
Where's the research? Where's the cost-benefit analysis? This is
doubt Mr. Clement will leap up and rush over to the prime minister's office to
share the awful news.
wholesale review of drug policy will follow. And of course, there will be new
money for research -- so politicians will have something other than politics and
prejudice to guide their decisions about what does and does not
and in the meantime, Insite will be permitted to keep operating. After all, it
would be unconscionable to close a facility supported by evidence while
continuing to pour vast sums into policies not supported by
as we have agreed, Mr. Clement is better than that.
Gardner writes Wednesday, Friday and Saturday.
Ottawa Citizen 2008