'Our philosophy is: housing first. You can’t be healthy if you don’t have a roof over your head.'
In the managed alcohol program run by Ottawa's Inner City Health Project, they give alcohol to alcoholics. Participants get one drink of fortified sherry per hour as a safer alternative to the Lysol, Purell and Listerine they guzzle in desperation on the streets.
Toronto Public Health distributes safer crack kits to discourage the use of makeshift smoking implements fashioned from pop cans and broken bottles in the hope that users will be less likely to transmit disease through cuts.
Insite, the safe-injection site in Vancouver, provides clean needles, related paraphernalia, emergency medical help and addiction counsellors so that addicts don't share needles or overdose in alleys, and so that help is there when they are ready for it.
The Quebec government provides free nicotine patches to help smokers quit smoking.
These are just a few examples of harm-reduction programs that are in place in Canada for the treatment of those suffering from seemingly intractable addiction.
While harm reduction tends to touch a nerve, generally speaking, it works.
The philosophy is that, for some substance abusers, abstinence is unrealistic so it is best to try to reduce the harm caused by substance abuse rather than focus on stopping the substance abuse outright.
"Abstinence is the ultimate goal, but the view that we can get everyone abstinent instantly is out of touch with scientific research," says Evan Wood, a researcher at the B.C. Centre for Excellence in HIV/AIDS.
He says harm-reduction measures are pragmatic but result in healthier individuals and communities and, ultimately, offer the best chance of getting people with addiction problems treated.
That is particularly true, Dr. Wood says, of people with severe mental-health problems such as schizophrenia, which tend to be interwoven with addiction.
Jeff Turnbull, one of the founders of the Inner City Health Program, says it is important to understand that harm reduction is only one small component of a larger strategy to deal with addictions.
"It may seem counterintuitive to give alcohol to alcoholics, but we give them one-ninth of what they drink on the streets. And once the craziness of their alcohol-seeking subsides, we can work on their medical issues," he says.
Dr. Turnbull says that while the approach is "maybe not politically appetizing, … it allows you to provide better health care in a more cost-effective manner."
André Picard