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In 2006, Governor-General Michaëlle Jean was hosting Queen Silvia of Sweden during the Swedish royal family's visit to Canada when the topic of illegal drug use came up. The GG told the Queen that Canada is taking an enlightened approach. Instead of punishing users, she said, society needs to be understanding of drug use and assist in reducing harm until the addict is ready to quit.

Alas, the Queen was not impressed. She briskly informed the GG that Sweden takes a hard-line approach, that users are given a choice between treatment and jail, and that Sweden's addiction rates are much lower than Canada's. After that, they changed the subject.

Advocates of harm-reduction measures, such as needle exchanges, methadone programs and Vancouver's supervised-injection site, often point to Europe's more enlightened approach to drugs as proof of how far behind we are in Canada. But parts of Europe are having second thoughts. Socially progressive Sweden had a brief but disastrous fling with prescription heroin back in the 1960s. After that, it embraced the hard-line approach. Today its policy is to make drugs very difficult to get, but treatment very easy - and sometimes compulsory. "The vision is that of a society free from narcotic drugs," says Maria Larsson, the Minister for Public Health.

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As a consequence of grassroots support for this policy, drug use in Sweden is a third of the European average. "The lessons of Sweden's drug control history should be learned by others," said Antonio Maria Costa, who heads the UN's Office on Drugs and Crime.

Scotland took a different tack. Drug use is widely tolerated, as you know if you saw Trainspotting. Rehabilitation programs are scarce, but the national methadone program has become a vast and ineffective money-pit. Scotland has more than 50,000 heroin addicts. Drug deaths have soared, drug-related crime is high, and tens of thousands of children are growing up with addicted parents. "Methadone has quite literally become the opiate of the masses," warned Neil McKeganey, one of Scotland's foremost drug policy experts.

Two months ago, the Scottish government announced a change in direction. From now on its primary focus will be on "recovery," not just harm reduction. "Harm reduction ideas have failed in Scotland," says Prof. McKeganey. "They have failed to protect injectors from hepatitis C, failed to reduce the scale of the drug problem, failed to reduce many of the harms inflicted on others."

The Netherlands is famous for its permissive drug culture, but even it is not as permissive as it used to be. Although you can still toke up in marijuana coffee shops, pot remains illegal. A parliamentary proposal to allow regulated, large-scale marijuana production was voted down, and the government moved vigorously against the psychedelic drug ecstasy. Switzerland (which runs supervised-injection sites but also has thousands of treatment beds) voted against decriminalizing marijuana. The UK made marijuana possession semi-legal a few years ago, but experienced an explosion of pot use among minors, as well as a sharp rise in harmful effects attributed to more potent strains of weed. It has now reversed course and reclassified marijuana as a harmful drug.

Like Canada, Australia is experimenting with a supervised-injection site, in Sydney. The passionate debate over whether it reduces harm is virtually identical to the one in Canada.

I asked Scotland's Neil McKeganey if he had witnessed the drug scene in Vancouver, a city that is famous for its harm-reduction approach. He had. "I was utterly shocked," he said. "I could hardly believe that in a culturally developed, sophisticated city there could be a drug problem of such magnitude." In his view, too much emphasis on harm reduction invariably undermines prevention efforts. "To provide a setting where someone can inject street drugs is doomed. The next step is saying, maybe we should be providing them with drugs as well."

The provision of "clean" drugs is, in fact, what many advocates of Insite want next. "Many individuals who promote harm reduction believe there's fundamentally nothing wrong with drug use, except the fact that it's illegal," says Prof. McKeganey.

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Every nation is different, and drug policies that work in one place may not work in another. But to him, Vancouver is a clear case study in what not to do. "It's a harbinger of what other cities could experience if they do not develop effective prevention methods."


LAST SATURDAY Three million needles a year

TUESDAY Insite: What the science really says

TODAY Sweden and

Scotland's U-turn on drugs

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Next stop: Legalization?

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