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We still await the scientific proof of harm reduction's success

MARGARET WENTE

From Tuesday's Globe and Mail

Latest comment posted at 6:06 AM EST 18/07/08

Ten months before Vancouver's supervised-injection site opened in 2003, two young researchers argued such a facility was vital in order to reduce public-health problems ...Read the full article

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  1. Luke R from Canada writes: sharing of raw data and exact methods for the collection of you data with other researchers so that they may authenticate your findings is a corner stone of peer-reviewed research. since the insite cheerleading squad does not seem to want to do this their research a cannot be considered valid. they only real research into the effectiveness of insite is to have a prospectively follow parallel cohorts of insite drug users and non insite drug users for a period of time and assess health outcomes. no so research exists.

    if we have to do a clincial study to prove that aspirin (a drug used for decades with next to no serious health issues) reduces the risk of heart attacks (the FDA got Bayer in trouble for making that claim without data to substantiate it) then perhaps at least the same standard should apply before we let people inject heroin, a lethal and addictive drug, at tax payers' expense

    it really bothers me how biased an narrow minded the insite crew are but hearing them talk you hear this primal hate towards anyone that dares question them. grant it some of their critics are cookie but they are just as fanatical but on the other end of the spectrum.
  2. Ariel Laver from Vancouver, Canada writes: Thank you Margaret for bringing this issue to light. While I believe that Insite does theoretically yield many benefits for the health and safety of the Downtown Eastside community, it would be nice to see a study on this produced by someone without vested interests.

    One thing that seems clear to me is that Insite is not a solution to the extremely poor living conditions experienced by those in the Downtown Eastside. At times I wonder if the money spent on Insite could be better allocated towards other forms of drug-use reduction.
  3. S M from Canada writes: I often disagree with Margaret Wente, but she is right about this one. Insite may be a good idea, but in order to know we need truly objective research by investigators who are committed to learning whether it works (not proving that it works). That these "investigators" were strong advocates of the creation of Insite (making it at least partly "their baby") and that they refuse to share their raw data with other academics are certainly grounds to wonder whether they seek truth or just vindication.
  4. A B from Saskatoon, Canada writes: Interesting writing style, first set as stage as categorizing them as newbies, then discard the research. Even though it seems like it is supposed to point out toward objective independent review - based on the set tone of the article I read writer being biased. What happened to real objective journalism?
  5. Joshua Gardiner from creston, New Zealand writes: my only problem with what has been said so far is that i don't actually see researchers behaving as advocates as fundamentally a problem. as part of the health care profession, i have been trained from day one to advocate for my patients, and i guess i see what these people do in their advocacy as nothing more than an extension of what i do, albeit at a higher level. so in that sense, i don't think it should be surprising or considered invalid that advocacy is happening here; in fact it's an important part of the health care profession. with this as a given, and in the absence of any compelling evidence that InSite is not working, i would suggest that wente is a little off base in her direction and perhaps even typical in her response. it's just another rehash of "i don't think my hard-earned taxpayer's dollars should be spent on junkies" and its tiresome and wrong-headed. just because some people need a little more help from society than you do doesn't mean that they should be treated with disdain. and it certainly doesn't mean you get to advocate, without any research to back you up, to take away the one advantage that they may have.
  6. e g from Canada writes: No doubt objective research is required for a final determination on Insite's effectiveness.

    But when Wente says "Neither Mr. Wood nor his colleague, Thomas Kerr, had a background in addictions medicine or public policy. Mr. Kerr was a PhD candidate in educational psychology, and Mr. Wood was a PhD candidate in health and epidemiology," I can't help but note she goes on to quote an AIDS policy expert, an addictions doctor, a criminology research methodologist, and a health economist. Obviously the reality is that all of the above researchers have something to share based on their discipline's perspective on the topic.

    Wente makes a good point in this article, but her biased writing overshadows the point. Instead of questioning what researchers from different specialties have to offer, she should be questioning what a non-objective journalist has to offer.
  7. Compos Mentis from Toronto, Canada writes: It's always amusing the way reasonable people will so readily accept as fact, what agenda driven researchers proport to be science, when the actual evidence to the contrary is staring them right in the face. Any sensible person, walking around that part of Vancouver, would quite rightly conclude there are some very serious problems with drug addicts. By reaching a conclusion and then conducting research to support it, these researchers have succeeded in ensuring the dogma that "harm reduction" saves lives. What is really needed is research that measures any increase or reduction in the numbers of drug addicts and the use of non-prescribed drugs by injection and the impact that it has on those who use Insite, especially as it relates to HIV/Aids and Hepatitis.
  8. J.C. Davies from Canada writes:
    "the B.C. Centre for Excellence in HIV/AIDS"

    Sounds like a joke, akin to the "Annual Montgomery Burns Award for Outstanding Achievement in the Field of Excellence".
  9. Chris H from Vancouver, Canada writes: The problem I have with Insite is the fact that it's portrayed as some sort of holy grail of drug policy, and dominates any conversation about the downtown eastside.

    Vancouver has lousy social housing policies, and shoehorns all it's poor and undesirable citizens into a ghetto. BC has lax drug enforcement, even for trafficking in hard drugs, and it cheaps out on traditional rehab programs.

    But they spend a few million bucks on an injection site, and pat themselves on the back like they're solving the problem. And the problem remains unsolved.
  10. Bobby Dy from Canada writes: I find it difficult to believe that graduate students were awarded funding to complete any study. I also find that the critics lack the necessary credentials to be legitimately recognized as critics. If we take the example of Dr. Conway, for example, it is interesting to note that he receives lots of funding from the pharmaceutical industry but lists no funding from the Canadian Institutes of Health Research. The difference is the absence of peer review. I also note that the same criticism that he applies to these former graduate students could apply equally to him (prolific but the quality is not obvious based on where he is publishing). He is certainly, though, the most qualified of the critics.

    The point of "cheerleading", however, is an interesting one. Any researcher who makes claims about the importance of their work in a public setting should be viewed with suspicion. However, the universities tend to favor these individuals for press conferences. Good scientists recognize the limitations of their studies, etc...but this does not make for good press conferences. That fault lies with the university, politicians, and the public. There is pressure on researchers to make their work sound definitive and the impact of the work on human health immediate or short term. That pressure originates with politicians who perceive this as a requirement to persuade the public about the value of research. The universities are then complicit in what is poor practice. The fault does not entirely lie with the researchers when implicit pressure is put on them to do just what these individuals have supposedly done.

    Those facts aside, that has little to do with obtaining research funding and establishing a reputation in a field of research. Rather, overstating the significance of your work is a certain path to losing credibility within the research community. The public eye is a different matter entirely (unfortunately).
  11. Bobby Dy from Canada writes: Safe injection facilities are a cheap substitute for what has genuinely been shown to be effective. What has been shown to not be effective, however, is prohibition and the criminal justice system as a means to reduce drug use in society. Rehabilitation facilities have a very poor success rate. There are solutions but Wente has yet to present any of them.
  12. Kent Lewis from Toronto, Canada writes: J.C. Davies from Canada wrote: "the B.C. Centre for Excellence in HIV/AIDS" Sounds like a joke, akin to the "Annual Montgomery Burns Award for Outstanding Achievement in the Field of Excellence".

    Are you merely mean-spirited, or ignorant to boot? Clearly the term "research" is implied; the aptitude required to hit sand after plunging from a camel, during a hump, should be more than sufficient to infer this.

    That aside, Wente's article points to a truth that proponents of HR don't find savory - the addict [and alcoholic] is utterly POWERLESS over their use, and until they admit that they are screwed, and look to something bigger than themselves for a real solution, they're doomed to remain in a hellish existence. Better that some well-endowed philanthropist would bequeath buckets of cash to get these people into 12 Step Boot Camp, and teach them the truth about their disease, and how to conquer it. That would be so politically incorrect, and would require a brutal level of honesty that many find unpalatable - but when properly worked , the results are astounding.
  13. Tim Rutkevich from Canada writes: It is time to close the tap once and for all.
  14. John Smith from Canada writes: Nice to hear Margaret Wente is now promoting research and quality evidence rather than opinion and quack experts. Maybe she can start holding her own columns to the same standards.
  15. yrret 4bi from Lethbridge, Canada writes: Margaret Wente and her babbling reactionary pseudo-journalistic scribble, as indicated in her latest attempt at not-so-subtle persuasion, piles on more proof that she and many other Globe and Mail writers have become hand-maidens of the Harper Reform/Conservative propoganda machine.

    Shame on the erosion of journalistic integrity and journalistic professionalism at the Globe!
  16. vincent furnier from Montreal, Canada writes: The criticisms of Wood and Kerr that Wente presents may be legitimate, or they may not. It is impossible to tell from this article, however, because as usual Wente is more interested in pushing her agenda than in presenting a balanced view of the issues involved.

    I can accept that InSite is a failure--but why, specifically? Where is the evidence to support Wente's conclusion, apart from ad hominem attacks against the researchers who support it? If InSite does not work, then what are the alternatives or solutions to the problems?

    Wente's article is so full of holes and lack of objectivity that her argument comes across as vague and unsupported. If Wente wishes to discredit Wood and Kerr, fine--but she needs to do it on a more solid basis than that the researchers are too young, too solicitious, and too prolific for her liking.
  17. W ho from Canada writes: "...none of these studies addresses the central issue in the public mind: Does Insite reduce overall drug use?" Not necessarily "the central issue" nor "reduce...use", but it's a more humane direction than simply imprisoning the sick.
  18. Pamphleteer . from Canada writes: Yeah, you go girl, Ms. Wente. Everyone knows what a joke the New England Journal of Medicine is anyways, right? It published a peer reviewed article by medical professionals who trumpeted the success of insite. There's a NEW England, now? pfffff. Yeah, whatever. Seriously, what do those 'doctors' have on a Toronto columnist who has a BA in basket weaving?

    And don't even get me started on those other quackery publications that have shown what a success insite has been; the Canadian Medical Association Journal, The Lancet and the British Medical Journal. Thank God for Ms. Wente! She can set the record straight where those garbage learned journals have failed.
  19. Michael Sharp from Victoria, Canada writes:

    Insite's own paper to Tony Clement, in defense of Insite says and I quote:

    "We have saved, on average, one life per year."

    Look it up.
    Their own paper.

    I was viciously and personally attacked on previous Insite threads for being a heretic.

    Insite does NOT work.

    Insite's only purpose is to make the public feel better about itself.
  20. Anti Fascist from Canada writes:
    Maggie, Maggie, Maggie tsk tsk tsk. All the smart folk are wrong, huh?
  21. Michael Sharp from Victoria, Canada writes:

    Anti Fascist?

    One life per year.
    You could do as well if you knew CPR.

    Insite is a noble failure.
  22. Bobby Dy from Canada writes: Michael Sharp, we spend a lot more money than that on cancer chemotherapies that save no lives. Rather, they merely extend them by a few months. Would you advocate that we stop giving chemotherapies that don't save lives to cancer patients?

    As I said above, this is the most socially acceptable approach to treating drug addiction. The most effective treatments would be a much tougher sell based on the criteria employed here. In contrast, we seem all to willing to spend billions on the least effective approach, prohibition and prosecution.
  23. Michael Sharp from Victoria, Canada writes:

    Here is a simple truth.

    If there were no drugs, there would be no addicts.

    That's what I call harm reduction.
  24. Paget Code from Saskatoon, Canada writes: Michael Sharp from Victoria, Canada writes:

    "Here is a simple truth.

    If there were no drugs, there would be no addicts.

    That's what I call harm reduction."

    Okay Michael, you get right on that. Why don't you start with alcohol and tobacco. I'm sure the Canadian people would be right behind you in empowering the state to tell them what they can and can't put in their own bodies. It sure worked well the last time.
  25. True Tory from Toronto, Canada writes: Another ace in the hole by Wente. It's simple - Harm Reduction never works. It's all an illusion. It hides the effects of poor decisions and a lack of discipline, which is what drug addiction is all about. The government should stop supporting any and all harm reduction measures, because they've simply never been proven to solve the problems they attack. Look at smoking - people still smoke, despite all the expensive care that lung cancer patients receive, and all the money we've spent on anti-smoking ads and second hand smoke laws. People still get medical if they're fat, lazy and stupid. Let them die, just like drug addicts and gay people who got AIDS from having unprotected sex. Taking junkies off the streets and letting them shoot up in peace and safety just makes their lifestyle attractive. I don't want my kids to live by their example, but there's not much we can do, living in a Nanny State that doesn't let people die for the choices they make. Wente is 100% right - it's all about PERSONAL RESPONSIBILITY. If you make yourself sick, society shouldn't have to clean it up under the guise of "harm reduction."
  26. Paget Code from Saskatoon, Canada writes: True Tory from Toronto, Canada writes: "Another ace in the hole by Wente... it's all about PERSONAL RESPONSIBILITY. If you make yourself sick, society shouldn't have to clean it up under the guise of "harm reduction." "

    Well true Tory I just have to say that I'm glad we aren't all as perfect as you and lead a 100% healthy lifestyle that doesn't require any help from the medical system ever for that odd donut or cigar. If you guys were really serious about personal responsibility you would let people make bad choices and suffer the health consequences rather than harrassing them and pursuing a U.S. style drug war which leads to more incarcerations of their citizenry than any other nation on this planet (which also costs a monumental amount of tax dollars that would be better spent targetting terrorism and violent crimes).
  27. June from Western Canada from Canada writes: Here we go again...if anyone writes the contrary to 'accepted' belief they are bashed. Personally, she is right. Anyone who has dealt with addictions in themselves or families knows there is no cure....the only way is to receive the treatment that puts the disease in remission. The remedy is No drugs, No drinks....Rehabs are necessary to help them through withdrawals and start to want to get well. It does work for those addicts who truly want to quit but treatment is a life long program...six weeks doesn't cut it without follow up in support groups. Self help programs work, saves way more than one life a year, and funds itself. Those who have contempt prior to investigation will stay addicted and the enablers will continue to assist them in that choice. If Incite and other Government funded agencies would work WITH these groups, more could be accomplished. Using people who have overcome their addictions is vital to reach the person who is still sick.
  28. Conservatives Lie from Canada writes: True Tory from Toronto, Canada writes: "It's funny - most of the attacks I see here on Wente remind me of the same exact attacks against Ann Coulter. Just because a blonde woman speaks the truth doesn't give you the right to automatically disagree with her"

    Ann Coulter called John Edwards a "f@ggot". That's hardly the truth and it's certainly not insightful. It's time folks on the right got off their duff and realized it's not enough to be angry, insulting and shrill. You actually have to say something of value, not just play to people's fear and bigotry. Wente doesn't like addicts. Tough. That doesn't make them go away. And the sooner we as a society stop entertaining this sort of garbage writing and start actually facing the problems, the sooner we will actually be rid of them.
  29. Josiah Smith from Japan writes: OK, so let's say for a moment that InSite and harm reduction doesn't work.
    Harshing sentencing and dedicated drug enforcement hasn't work.
    Trying to destroy all the drug production zones hasn't worked either.

    I realize that, as a critic, your job is to criticize, Ms. Wente. Could you please tell what you think are some possible solutions?
  30. Ricky for a Centrist Canada from Canada writes:
    Insite is a good concept and must be preserved.

    However, it is in everybody's best interest to modify, improve, and strengthen the facilities and process as much as possible.

    This cannot be accomplished by silencing critics.

    Truth be told, many critics are driven by ideologies that believe addicts are scum and should be eliminated or put away to rot.

    But others want to make the concept work better.

    I think there needs to be more done to treat addictions - do that, and rehabilitate these people back into productive lives, and a lot of society's ills will ease considerably.
  31. vincent furnier from Montreal, Canada writes: True Tory from Toronto, Canada writes: People still get medical if they're fat, lazy and stupid. Let them die, just like drug addicts and gay people who got AIDS from having unprotected sex.

    ------------------------------------------------

    If I were you, then, I would let you die on the basis of your incomparable stupidity. But then, I'm not you (thank god), so I hope you live a long and prosperous life in your angry little bubble.
  32. John B from Vancouver, Canada writes: As a Vancouverite living near Insite I am so thankful that someone in Canadian media is finally speaking the truth.

    Insite is a despicable failure. Close it now and save both the addicts and the public from this terrible and foolish waste of lives.

    Treatment and counselling is the answer to addiction, not enabling it.
  33. Brad Reddekopp from Hazelton, British Columbia, Canada writes:
    "We still await the scientific proof of harm reduction's success"

    However, we DO have tragic and overwhelming evidence of prohibition's failure.
  34. Andre Carrel from Salmo, Canada writes: "The tab for the Insite studies is well over $2-million. Yet none of these studies addresses the central issue in the public mind: Does Insite reduce overall drug use?"

    Well Margaret, what is the tab for the "war on drugs" so far? How much has been spent on studies so far to address the central issue int he public mind: Does the War on Drugs reduce overall drug use?
  35. Josh Taylor from St. John's Dublin, writes: I agree the research should be open and non politicized. However, this just tells me that Insite is new and at the beginning of it's usefulness. It must remain open, more money must be invested and different stakeholders must be involved to gauge it's effectiveness.
  36. Brad Reddekopp from Hazelton, British Columbia, Canada writes:
    Keep in mind, though, that opposition to the obscene failure that is prohibition shouldn't necessarily imply support for government intervention of a different sort.
  37. R. Carriere from Maritimes, Canada writes:

    The attacks on the "writer" are both interesting and disgusting!

    Ms Wente, in the little space of a newspaper column, tries to present ANOTHER side of the argument, and gets lambasted for doing so.

    Also interesting is the usual and almost complete intolerance when the left gets questioned on any of their "Projects"-The debate is always OVER, if it does not fall into their wheelhouse of complete liberal thought.

    Where is the openness of spirit/debate that you ALWAYS demand, yet clearly do NOT adhere to that same notion when challenged?

    The attacks on Wente clearly indicate an agressiveness to attack the messenger, and not debate the information or dissenting positions. This is just a repeat of a proven method seen on other issues, camoflauged with words such as "progressive" or "sensitive" or ""tolerant" or "politically correct."

    Then again, the left has sold and pressured government with their positions on all issues, helped more often than not, by left trained journalists and columnists.

    While Insite may be good, it may also not be what's needed. Debate the facts, and stop with the "shooting of the messenger" when it doesn't suit your beliefs.
    .
  38. Mike Quinlan from Gatineau QC, Canada writes: Seems to me the Insite program was based on something similar in either Germany or Denmark. Surely a comparison can be made.
  39. roy stephenson from Waterloo, Canada writes: Wente doesn't say a word about how the Afghan opium trade has gone from zero in 2001 to a whopping $225 billion worth this year. She doesn't mention how most of this cultivation happens right under the eyes of NATO troops (see the UK Guardian). Nope. Wente's answer to the influx of heroin from Afghanistan? Make the victims of the heroin trade use filthy needles.
    She strikes me as someone that still wants proof about global warming. Why is the Globe and Mail wasting newsprint on this rubbish?
  40. Dan Shortt from Toronto, Canada writes: True Tory from Toronto, Canada writes: ".... Taking junkies off the streets and letting them shoot up in peace and safety just makes their lifestyle attractive .... it's all about PERSONAL RESPONSIBILITY. If you make yourself sick, society shouldn't have to clean it up under the guise of "harm reduction."

    Well True Tory, are you so sure that all addicts "make themselves sick," and that society in general doesn't have anything to do with it at all?

    One potential benefit to society that comes from providing substance abusers with their drugs is that the users are not out stealing purses, breaking & entering, and committing other petty crimes to finance their 'sickness'. Along with comes the added benefit that support for organized crime is reduced.

    Unless, that is, you think that these outcomes couldn't possibly be a benefit to the overall society.
  41. Mike Quinlan from Gatineau QC, Canada writes: Roy you make a good point and your analogy with global warming is useful. Its interesting how advocates for the "new science" want to stiffle critics while they play fast and loose with methodological and theoretical concerns.
  42. William Henry from Canada writes: Anyone interested in this topic should read "Romancing Opiates" by Theodore Dalrymple. Well written book by someone with front line experience treating addicts.
  43. David Griffith from NS, Canada writes: This is many mirrors what is happening in the global warming debate as well, where for the most part, only one side of the scientific debate is held as "valid", completely ignoring the dissenting side, and in some cases even attacking anyone who so much as dares to question them. It is when science almost becomes religion (there is only ONE God....OUR God) that we need to take a closer look at these issues. Oftentimes that is not easy when the "winning" side (in our world, that is the side receiving the most press coverage) is backed by certain business, government, or lobbying interests. When science starts to say, "there will be NO further debate on this -- we are right and all others are deniers", is it still science? Or has it become the new dogma?
  44. Michael B from Canada writes: R. Carriere from Maritimes, Canada writes: Also interesting is the usual and almost complete intolerance when the left gets questioned on any of their "Projects"-The debate is always OVER, if it does not fall into their wheelhouse of complete liberal thought. Where is the openness of spirit/debate that you ALWAYS demand, yet clearly do NOT adhere to that same notion when challenged?
    ************
    Your ignorant outrage is funny. The problem, Carriere, is that Wente is not allowing debate. She is twisting the information she uses and omitting much, and colouring it all with alot of insinuation, derision, and condescension. That is not the debate that "[we] ALWAYS demand". And you know what? Alot of people above, who are apparently nothing but intolerant, have actually provided quite a few debate points that are a whole lot less subversive than Ms. Wente's article.

    case in point: Joshua Gardiner from creston, New Zealand writes: my only problem with what has been said so far is that i don't actually see researchers behaving as advocates as fundamentally a problem.
  45. Hypo Critic from Canada writes: Bobby Dy from Canada writes: Safe injection facilities are a cheap substitute for what has genuinely been shown to be effective. What has been shown to not be effective, however, is prohibition and the criminal justice system as a means to reduce drug use in society. Rehabilitation facilities have a very poor success rate. There are solutions but Wente has yet to present any of them.

    ***
    Good post Bobby!!! Wente is on a mission to discredit Insite.
  46. David Griffith from NS, Canada writes: Michael B from Canada writes: The problem, Carriere, is that Wente is not allowing debate. She is twisting the information she uses and omitting much, and colouring it all with alot of insinuation, derision, and condescension
    -------------------------------------------------------------------------------
    What you are describing above is the pro-Insite stance. Note for example how you attcked the poster and not the issue. Pure socialist strategy. Textbook. And IF all of these "studies" are so ironclad, why WON'T they share them and hold them to the test of the scientific method, hmm?
  47. David Griffith from NS, Canada writes: Hypo Critic from Canada writes: There are solutions but Wente has yet to present any of them.
    --------------------------------------------------------------------------------
    Nor has In Site.
  48. Kent Lewis from Toronto, Canada writes: I was flabbergasted to see something posted inside a clinic recently:

    "The Harm Reduction Team is saddened to announce an accidental death from overdose by injection with Fentanyl....." Went on to explain how Fentanyl is 80 times stronger than heroin, and should not be mixed with alcohol and downers.

    ???????????????? TOTAL ABSTINENCE and a program of recovery, based on a model which teaches the addict that his/her thinking and feeling is dysfunctional, ie., AA/NA, never killed anyone. If you have a friend/family member who is struggling with this, get to a solid counsellor who is pro-12 Step. That way, they just might live, and do it without running to someone for enabling of their habit.
  49. David Griffith from NS, Canada writes: Hypo Critic from Canada writes: Good post Bobby!!! Wente is on a mission to discredit Insite.
    --------------------------------------------------------------------------------
    Since when is questionning the validity of so-called scientific studies "discrediting"? Ms Wente brings up some very valid points, that, if nothing else, forces the "yes" side to account for their claims, be they right or wrong. Now, if you feel that is somehow wrong in a free and democratic society, perhaps I can interest you in a nice totalitarian regime where the only science is government science?
  50. Chris Edwards from Greater Sudbury, Canada writes: The mistake being made by Wente's supporters are twofold. First, Wente's tone hardly sounds like that of a person who has taken on a healthy scepticism around an issue. She has done everything she can, in as biased a manner as possible, to denounce Insite. In doing so, she is no less biased and one sided on the issue than Insites proponents. Those here who insist on railing against this "scientific dogma" are ignoring their own prohibitionist dogma. Unfortunately for them, the evidence that prohibition does not work is infinitely more demonstrable. ----- Second, Wente offers no alternatives. Her tone seems to mirror that of the more conservative commenters on this board. The only way to tackle the drug problem is to become MORE draconian. The argument loses all ration and reason, and we end up with the Michael Sharp's of the world spewing truisms such as "if there were no drugs there would be no addicts", or the Jan Bakkers insisting that all we need do is incarcerate every junkie until they are clean (what might THAT cost Jan?) ----- These arguments fail from the outset, as they are not rooted in any reality that exists now or ever has. Your doesn't work. It never has. It never will. Time to build a better mouse trap. ----- Insite may not be perfect, but it is a step in the right direction. It shouldn't be the only pillar, but it is a necessary one nonetheless. When they find themselves in a hole, only an insane person digs harder. Unfortunately, that seems to be what the prohibitionists have been doing for the decades their philosophy has held sway, and if they were to be honest with themselves, they would be forced to acknowledge that their philosophy STILL holds sway. ----- If we aren't getting anywhere with the drug problem, they need look no further than their own mirror to figure out why.
  51. F H from Canada writes: And what is Ms. Wente's background in addiction treatment? She seems to feel it's perfectly ok to advocate against InSite so one can only assume that she holds herself to the same high standards that she expects of others, so I'm wondering what her background in addiction medication and treatment is.

    Also, the goal of InSite was never to reduce drug use, but to reduce the harm that's involved in drug use, such as Hep C and HIV/AIDS, so that's nothing more than a red herring and a straw man argument.
  52. Unabashed Opinion from Toronto, Canada writes: Wente's strawperson argument about whether Insite reduces drug use is not the central issue around harm reduction. Harm reduction is precisely that: reducing harm. Reducing the number of unattended overdoses and deaths. Reducing the long-term health costs of needle-transmitted diseases. As a secondary effect, having a safe place, with relatively trusted (i.e., trusted by the drug users) street and outreach workers, increases the likelihood that when the user is ready to clean her/himself up, there will be the appropriate supports, contacts, referrals and welcoming hands.

    Wente, you have it all backwards. It may be that the central issue in YOUR mind is, "does Insite reduce overall drug use?" But it is not necessarily the central issue in the public's mind. The central issue for me is, do programs and facilities like Insite yield beneficial results for those who are marginalized by and afflicted with drug addictions, compared to what was the status quo (i.e., using the criminal justice system to deal with the complex epidemiology of illicit drug use in our society). Not so easy a question to answer, is it Ms. Wente?

    Being a researcher with a number of peer-reviewed publications to my credit, I can tell you - and your fan section - that not all worthwhile questions can be answered using the same empirical methods. Often, the really good questions become reframed into relatively useless ones in order to comply with the dominant positivist (i.e., you know what you're looking for before you start looking) paradigm.

    On the other hand, I don't disagree with the viewpoint that 22 papers by the same authors on the same topic may well be two actual pieces of research, each tweaked and republished eleven times.
  53. Egg Harr from Canada writes: Margaret, for shame. Your first article asserted harm reduction and insite did not work and were actually harmful ("Harm reduction – the philosophy that has come to dominate drug policy – doesn't work. Just the opposite.") Apprehended for a bit of lazy reporting, you shift the ground to say that we don't know whether it works -- quite a different message, but intended to somehow justify the sloppiness of the first one. You compound the sin by slandering the researchers who report findings contrary to your position, but don't really examine the evidence and arguments or report on what might be said about the critics and their work. This is ad hominem and obviously biased. This sort of behavior doesn't help and makes it seem that you're more interested in justifying your (shifting) position than in helping your readers figure out what the truth might be. BTW, it's just plain silly to imply that researchers in psychology and epidemiology and public health aren't qualified to study these issues but those in "addictions medicine or public policy" would be. Again, this sort of ploy just makes your motives clear -- justification of a poor job on the prior story (and not trying to sort out the truth). Better to promise readers to return to the drawing board, get hold of the real data (on both "sides"), and do a better story when you've done your homework properly.
  54. R. Carriere from Maritimes, Canada writes:

    Michael B from Canada

    Thank you for providing a perfect example and proof to this statement!

    " Also interesting is the usual and almost complete intolerance when the left gets questioned on any of their "Projects"-The debate is always OVER, if it does not fall into their wheelhouse of complete liberal thought."

    Then the aggressive, tiring, mostly laughable, and much expected witless attacks.....

    Answer this: " In any event, researchers who want to analyze the data for themselves are out of luck, because the researchers refuse to share it."

    I could only imagine the screams and hollering if some brought forth research that showed Insite didn't work........but also REFUSED to share the data with others!
    .
  55. David Griffith from NS, Canada writes: R. Carriere from Maritimes, Canada writes:

    Michael B from Canada

    Thank you for providing a perfect example and proof to this statement!...I could only imagine the screams and hollering if some brought forth research that showed Insite didn't work........but also REFUSED to share the data with others!
    --------------------------------------------------------------------------------
    Well of course. Then we'd need a full public inquiry, calls for resignations, etc...etc. Oh the righteous indignation there'd be!
    .
  56. David Griffith from NS, Canada writes: If these "researchers" are refusing to share their information, this flies in the face of one of the very foundations of good science, that of subjecting research findings to peer scrutiny. What are they hiding?
  57. k Sanders from PEI, Canada writes: Seems like we are caught in between PR campaigns.

    One one side the self championing Insite folks who have taken a questionable approach to research and scientific validation.

    On the other we have Tony Clement who is extremely pro-pharmaceutical (doesn't he own 25% of one?) and the tory war on drugs approach that is trying to mimic the completely broken and ineffective war on drugs policy in the US.

    Seems like you have to completely biased sides, who can we get to moderate the middle??
  58. Chris Chen from Ottawa, Canada writes: Thank you Margaret Wente! Finally someone in the media (other than the National Post) steps forward to bravely point out that the "facts" surrounding so called "harm reduction" facilities are dubious at best. Our money is much better spent trying to get people off drugs rather than enabling them to keep injecting themselves with poison.
  59. Luke R from Canada writes: Why are all the Insite supporters so opposed to doing real research into the success of this harm reduction program? Real research would be to actually follow a cohort of insite patients and regular junkies and measure health related outcomes. why so opposed? why so opposed to sharing the raw data on the project for other scientists to analyze. all of Wente's critics on this board have convienently failed to address those points as of yet.
  60. Tim Meehan from Ottawa, Canada writes: "That aside, Wente's article points to a truth that proponents of HR don't find savory - the addict [and alcoholic] is utterly POWERLESS over their use"

    Um, hate to break it to you, but AA and 12-step in general is just as much a cult as Scientology. Works for about 30% of the time I hear. Gee, has that been 'peer-reviewed?'

    Wente can keep spinning on this issue and injecting her bias until the cows come home, but it doesn't address the fact that we are a drug-driven society. Drugs aren't bad or good, they are used or misused. Some were deemed "illegal" for racist reasons, and are kept there due to the efforts of "cheerleaders" like the police unions, some uneducated social workers, and a lot of religious types. Why? Simple. Power. Why have the real thing when you can have the opiate of the masses, and at the same time make money off of it? But I digress.

    Anyway, we already have supervised drug use sites coasts to coast. They're called bars.
  61. Chris Edwards from Greater Sudbury, Canada writes: k sanders. You are correct that there seem to be two polarized sides to the debate. But the question of one side's approach to research and scientific validation is based on the statements of a few others. These are framed in a biased column that uses ad hominem to discredit the Insite researchers without any possibility of response. Within that context the statements of the detractors are given more weight.

    As noted above, several venerable and highly respected scientific and medical publications have published these findings. Their reputations hang upon ensuring that they do not publish questionable research or scientific validation. Perhaps this is why the authors of this research have so little patience for the opinions of biased right wing columnists and their supporters.

    Frankly, some of the statements by the experts quoted in this article smack of academic jealousy. Is it possible that the detractors Wente trots out have been cherry-picked because they share her bias?
  62. Tweev D from Halifax, Canada writes: Wow, I have never read a more professionally insulting article than this one.
  63. David Griffith from NS, Canada writes: Tim Meehan from Ottawa, Canada writes: "That aside, Wente's article points to a truth that proponents of HR don't find savory - the addict [and alcoholic] is utterly POWERLESS over their use"

    Um, hate to break it to you, but AA and 12-step in general is just as much a cult as Scientology. Works for about 30% of the time I hear. Gee, has that been 'peer-reviewed?'
    ------------------------------------------------------------------------------------
    Give us your facts Tim. Your sources. And what does "works 30% of the time" mean, Tim? And you "heard" that where? Again, facts please. And how does this number compare to Insite? And we are still waiting, Tim, for an answer to "why will they not subject their "findings" to peer review???

    Answer the damned question.
  64. Chris Edwards from Greater Sudbury, Canada writes: Their findings HAVE been subjected to peer review David. You don't get published in the publications their research has been if you AREN'T peer reviewed.

    Wente casts aspersions on those who've done the reviewing without any mention of who they are or basis in fact. You've taken this shred of "information" and are now going to blow hot air at others insisting THEY answer YOUR damned question?! Give it a rest.

    How about YOU call the New England Journal of Medicine, the Lancet, CMA Journal, etc., and tell them all about your expertise on peer review?

    The fact that one "peer" in this article who thinks HE should be allowed to review it hasn't been given the opportunity to do so, isn't the damning evidence you and Wente's supporters would like it to be.

    Consider this. If this person wants so badly to see the data so HE can confirm it to HIS liking or discredit it, perhaps he should seek out HIS OWN funding and spend $2M compiling it for himself.
  65. Bubbles McBubbles from Trawna, Canada writes: Recent scientific studies indicate that Margaret Wente is a Harper toady and DEA apologist.
  66. Chris Edwards from Greater Sudbury, Canada writes: "David Griffith from NS, Canada writes: Tim Meehan from Ottawa, Canada writes: "That aside, Wente's article points to a truth that proponents of HR don't find savory - the addict [and alcoholic] is utterly POWERLESS over their use" Um, hate to break it to you, but AA and 12-step in general is just as much a cult as Scientology. Works for about 30% of the time I hear. Gee, has that been 'peer-reviewed?' ------------------------------------------------------------------------------------ Give us your facts Tim. Your sources. And what does "works 30% of the time" mean, Tim? And you "heard" that where? Again, facts please. And how does this number compare to Insite?" ________________________________________________________ Comparing a twelve-step program that insists on abstinence to a harm-reduction program is comparing apples to oranges. I can't do it. ----- I cannot validate the number Tim has quoted either. However, a quick Google search of AA Effectiveness will turn up a great deal of information. There is little or no agreement on how effective it is, in fact. Some say not at all, some say somewhat, and some swear by it. Go see Wikipedia, as it will point you to the studies. ----- One statistic that there doesn't seem to be any debate about, because it is AA's own, is that only 5% of people who attend an AA meeting for the first time are still there after a year. The attrition rate is pretty astonishing actually. At the two year mark, only 2% remain. This is further reduced by a fraction. At the 5 year mark, only 1 in 100 people will still be part of the AA fellowship. It is unknown how many of the people who have left stay sober. ----- AA may be great for those who stay on, but by their own admission, those people account for only 1% of those who start. Not exactly a shining success rate. ----- I have now answered both your questions.
  67. west slope from Canada writes: ---

    Gee, the integrity of the INSITE researchers/apologists reminds one of the low professional, scientific standards that activist fishery biologists bring to public fora here in British Columbia.

    Still, it was and is a valuable experiment though very much in keeping with the British Columbian colonial tradition of open access/easy access where all public services are provided free of charge, and if need be, public assets are trashed in the name of equality.

    Stop the bloody nonsense and fully legalize marijuana and heroin. Tax it heavily. Yes, I'm fully aware of the health dangers. So?

    Righteous, superstitious people should stop imposing their views on others and stop creating a haven for violent criminals/make-work projects for the police and the justice system.
  68. Ed Long from Canada writes: The issue is beyond Insite.

    We Canadians, especially West Coast, have surrendered our born ability to analyze and form opinions to 'experts" and "science" , and that goes against any academic method of criticism.

    I was taught and encouraged to always question and challenge, in my seven years of university back in the day. There was no black and white, only grey that kept changing.

    Today, we have a generation that demands certainty. Intolerance and shrill denunciations were not the response to criticism. In fact, it was a sign of academic achievement to receive and defend constant criticism.

    I cannot imagine anybody defending a theory or thesis with "it's peer reviewed and final ... Drs. so, so, so and so have read it."

    To explore and question, to seek out the unknown and challenge convention are the requirements for the advancement of humankind.

    However, in B.C. we now have government that passes six bills, including a gag law, in an hour without debate and using closure, then ends the Legislature likely until next year.

    It's a little Orwellian paradise by the sea.
  69. F H from Canada writes: I agree that treatment and councilling are the best answer but what are we to do with the thousands upon thousands of addicts who already exist while we wait for those treatment centres and coucillors to become available?

    What we do is support places like InSite that increase the chances that they'll all be able to live long enough for those treatment centres to be created. They also provide some councilling and help addicts get into the few existing treatment centres. Until then, this is the best we can do.
  70. Chris Edwards from Greater Sudbury, Canada writes: Ed Long: Of course we should question. There comes a point, however, when a question has been asked and answered, and debate boils down to arguing with obstinate people who just don't like the answer.

    I am not saying this argument applies to Insite. It needs more study, but it also needs more time before prohibitionists like Wente start declaring it useless or demanding proof in order to ensure its survival.

    If we applied the same test to prohibition, we would have considered the prohibition of alcohol in the 1920s a multi-year study in the failure of that philosophy and moved on to something else.

    If anything, I believe the question as to whether or not prohibition is a failure is one that has been given ample time to prove that it is beyond debate. It is. Period. Whether you like the answer or not.
  71. Michael Sharp from Victoria, Canada writes:

    west slope from Canada, "Righteous, superstitious people should stop imposing their views on others and stop creating a haven for violent criminals/make-work projects for the police and the justice system."

    You are aware of the irony inherent in your post, I hope?
  72. Ed Long from Canada writes: From the OED ... intolerant - not tolerant, esp. of views, beliefs, or behaviour differing from one's own.

    Chris Edwards writes, "If anything, I believe the question as to whether or not prohibition is a failure is one that has been given ample time to prove that it is beyond debate. It is. Period. Whether you like the answer or not."
  73. June from Western Canada from Canada writes: The four pillars was a good concept...just never completed. Addictive personalities is studied by the medical scientific community and has discovered that these people have a genetic predisposition (heredity, endorphine, lack of a DNA requisite) The Downtown East Side also has a majority of these people suffering from mental illness needing other medications to control...this is a double whammy. Drugs destroy brain cells (alcohol proven to be one) Drugs are induced to control abnormal behavior (bipolar, scheziphrenics) and the results of drugs themselves creates paranoia. Damaged brains do not recover...but long term treatment could help these people start to live within their limitations in a controlled environment. If you give them the drug of choice which they buy on the illegal market and not remove them from the unsupportive environment they live in, what is the purpose? The health issues are still there. The $100 per person for Carbon Tax to the homeless probably went to buy booze & drugs...The $400 million could have built treatment centers that would work. Incite is first step to make contact and offer help to these people. There is a very narrow window of opportunity when they may ask for help....it should be there immediately. Waiting lists do not work for the addicted.
  74. Chris Edwards from Greater Sudbury, Canada writes: Actually Michael, please explain what you see as ironic in that statement, because as it applies to prohibition, it is very accurate. Over decades we have proven that we cannot eliminate the supply or the demand without imposing methods that would make Stalin proud. What, beyond kill or jail every person who may sell or buy drugs, is your solution?
  75. Chris Edwards from Greater Sudbury, Canada writes: Is that the best you can do Ed? Call me intolerant? How about defend prohibition based on it's track record instead? Ad hominem only wins arguments in the mind of the person who uses it.

    Next you'll label me intolerant for refusing to debate whether cigarettes are bad for you.

    My point is that some questions are closed. Asked and answered. Any future debate becomes a mere rehash of old debates and ends with the same outcome. Call it intolerant if you want. I call it pragmatic. Sometimes when you are wrong, you are wrong. The hard part is usually being man enough to admit it.
  76. Titus Andronicus from Canada writes: Wicked Wente writes: Yet none of these studies addresses the central issue in the public mind: Does Insite reduce overall drug use?

    ===================================

    Nice red-herring there, Peggy.

    Of course the fact is that Insite was never about 'reducing overall drug use.'

  77. Dr Strangelove from Tango, Tonga writes: David Griffith from NS, Canada writes: If these "researchers" are refusing to share their information, this flies in the face of one of the very foundations of good science, that of subjecting research findings to peer scrutiny. What are they hiding?
    ---
    Why don't you ask them? I'm sure they will be happy to point you to a few references summarizing their point of view. Actually, Wente apparently didn't bother about that either. I don't think that is proper journalism.
  78. jason c from Toronto, Canada writes: As a scientist, I am ashamed when my peers apply their high-powered expensive minds to whatever falls under their fingers without first stepping back and deciding if their craft is relevant. inSite allows an addict - a human being trapped in a hole too deep to help themselves - to practice their addiction near non-addicts in an open, civil environment. The feeling of acceptance, in general, cannot be underestimated as beneficial to a human being in that state. The community should judge inSite's merit, not science.
  79. Ed Long from Canada writes: Chris ... the article is not about prohibition.

    It is about a safe injection site and the claimed benefits of that site. Those claims are the subject of Wente's article and I believe she is acting responsibly by questioning the source.

    The prohibition argument was introduced by you.

    Try to focus.
  80. Scrappy Doo from Canada writes: I think I will continue to get my info from credible sources. Have a look at the final author on nearly all Wood et al's papers. You will find it is JS Montaner.

    Turns our Dr Montaner is one of the worlds foremost experts on HIV/AIDS research as evidenced by his recent election to president of the internation AIDS society. He is also the director of the HIV centre for excellence at St Pauls and is widely published and prolific researcher in AIDS.

    Their work has been peer reviewed and published in the highest tier of medical journals on a consistant basis. Thus, the work has been reviewed by experts in the field all around the world.

    I think I will stick with the experts on this one, despite what Wente and her hack, pseudo-experts say.
  81. Phil King from Ottawa, Canada writes: As far as I'm concerned "prove us it works" applies equally to the notion that you can control substances, substance abuse and its deleterious effects by relegating people to back alleys where they must deal with and fund organized crime syndicates.

    In my opinion the government is abdicating its responsibility to provide the consistent and structured regulation of substances that would generate the revenue neccesary to deal with the problem, while freeing the average taxpayer from supporting an unwinable "war" that has cost billions.

    The single most powerful economic stimulus the government could employ today would be to shift the billions spent into billions earned, freeing us from a tyranny that never made sense in the first place.
  82. Chris Edwards from Greater Sudbury, Canada writes: And now Ed says I should "focus". Boy, it never stops with you does it? Nevermind that several posters here have raised the prohibition issue, and ignore that Wente presents absolutely nothing as an alternative. If Wente comes out and says she thinks legalization is a solution, I'll be wrong and I'll admit it.

    How about you follow your own advice, focus, and read my previous posts if you don't think I've been clear on what I think of Wente's writing and her arguments in this piece.

    Wente is not questioning in the true sense of the word Ed. That happens when you present two sets of facts and allow them to stand on their own merits. Instead, Wente uses ad hominem against the researchers, demands Insite do something it isn't meant to do and then rips them for not doing it, and then cherry picks facts and pundits that support her argument while ignoring