Rev. Cpl. Andre Bigras,

Presentation at Ottawa’s City Hall
Ottawa’s Site Program Review Report
Harm Reduction (Needle Exchange Program)
March 6th, 2002.

My name is André Bigras. I am the past president of Ottawa Innercity Ministries and still remain active as a board member and volunteer when time permits. I’ve been involved with the homeless, poor and addicts of the Inner City for the last 11 years. Ottawa Innercity Ministries has 3 full time and 2 part time employees along with student interns and 70+ volunteers doing street outreach.

I’d like to preface this presentation with a few of the more popular definitions of Harm Reduction Philosophy on which the needle exchange programs are based.
This relatively new philosophy is severely affecting how care for the addicted is carried out in our city especially amongst the poor and homeless community.

There is no precise definition for Harm Reduction therefore I will quote four of the countless ones available to give you an idea of the range of choices:

1] “A Descriptive Study of the Health and Social Services use of the Low Income and Homeless” from the Department of Family and Community Medicine, St. Michael’s Hospital and Seaton House Annex Harm Reduction Program City of Toronto Hostel and Shelter services.

“Harm Reduction is an approach to substance use related morbidity that was developed as an alternative to the prohibitionist and medical models. The first views Drug abuse as criminal or immoral, while the latter views it as an illness or disease. Harm Reduction has a value neutral view of substance abuse: seeing it as a spectrum of behaviours that range from experimentation to problematic expressions. The focus of the Harm Reduction approach is on the problems or harm rising from the particular behaviour itself. Hence Abstinence is irrelevant: the approach accepts clients may continue to use substances while in the community and shelter programs”

2] Colin Mangham PHD Director Prevention source British Columbia
in his article “Harm Reduction and Illegal Drugs: The True Debate” defines Harm Reduction as:

“Harm Reduction is not new, we are familiar with it as a collection of strategies designed to reduce specific drug related harms without focussing primarily on consumption or necessarily advocating abstinence”

“Backers of Harm Reduction as the new drug philosophy tend to forward three overlapping arguments.

a] that a “Moral Panic” is the main reason drugs are illegal; that drug laws cause more problems than do the drugs themselves and that a “Values Neutral”…”Public Health” approach [i.e.: Harm Reduction] would rectify this.

b] that Harm Reduction focuses compassionately on reducing harm while other approaches label drug users as deficient and deviant.

c] that people always have and always will use drugs, so Harm Reduction is the only practical answer, using impure and unpredictable “street” drugs kill people, so clean drugs need to be made available: this will in turn reduce crime.”

3] Charles Perkins from the Lambdon Family Institute states in his article entitled Harm Reduction;

“The Canadian Government has taken a very poor and misguided approach to its drug problem and is basically doing nothing. The approach is-“we give up so learn to live with it”. Basically “Harm Reduction” was a term co-opted by a group of individuals and organizations that I refer to as “the advocates of drugs on demand”. These individuals and organizations advocate wide open drug use with no laws…Harm Reduction has become part of the problem as witnessed by increased drug use across Canada.

4] Following the World Drug Conference held in Visby, Sweden in 2001, the Institute on Global Drug Policy released the following statement:

“Softening of drug policy, which is termed “Harm Reduction” was identified as a major failure of International Drug Policy. Examples of failed policies [Harm Reduction] which were discussed include decriminalization of some drugs, needle exchanges or handouts of syringes, heroin maintenance, non abstinence based treatment, and prevention messages which accept drug use or encourage drug use in adolescence as inevitable. “Harm Reduction” policies are resulting in increasing drug use and crime throughout countries, which have implemented it. Specifically Canada, Holland, Switzerland, Australia and cities in the United States have seen their drug problems worsen under the softened “Harm Reduction” policies.

They also state, “It is increasingly clear that Harm Reduction policy should be regarded as Harm Production policy. Effective drug policy should instead embrace Harm Prevention and Harm Elimination.”

I would like to see a moratorium on any future Harm Reduction approaches until a proper scientific study can be made to determine its effectiveness and long term objective. From all the available documentation that we presently have the “Harm Reduction” movement seems to be a failure.

I pray that this preamble will give you a clearer picture as to why I have made this presentation.

First of all, I want to say up front, I am in favour of Harm Reduction but not in it’s present format. I believe that prevention and the elimination of harm has the best potential for effectively addressing drug problems. Harm Reduction is what happens when self-destructive choice becomes a thing of the past.

I would like to start my presentation by prefacing Lynne Leonard’s (CHRU) Community Health Research Unit report of 2001.

This research indicates that: (Quote)

“The evaluation of the Ottawa-Carleton HIV Prevention Programme for Injection Drug Users (the site) completed in 1992, revealed a seroprevalence rate among intravenous drug users (IDU’s) that was amongst the highest in Canada.

Remis and colleagues have conservatively estimated that there are 3,000 injection drug users in Ottawa-Carleton which is equivalent to approximately 4 IDU’s per 1,000 population.

In Ottawa-Carleton only 2% of HIV diagnoses made between 1985 and 1988 were attributable to injection drug use of all positive tests up to the end of 1991.

As of July 1st, 1999, Injection Drug Use accounted for 17% of the total 1,839 HIV infections reported in Ottawa-Carleton since 1983, the exposure category of men having sex with men accounted for 51% and heterosexual contact with a person at risk accounted for 10% of new HIV infections.” (End of quote)

As far as I am concerned going from 2% to 17% is not a positive report nor is it supportive of the Needle Exchange Program.

The report goes on to say: (Quote)

“In 1998, the Site Programme distributed approximately 135,234 new needles. However, this number is not sufficient to meet injection drug user’s need for clean needles. Assuming that 3,500 intravenous drug users in Ottawa-Carleton and using a method developed by Remis and colleagues (1994), it has been estimated that more than 3 million needles would have to be distributed in Ottawa-Carleton each year to meet the requirements of one new needle for each injection. Therefore, only 4.5% of the required number of needles was distributed by the site in 1998 (Leonard et al. 1999).” (End of quote)

So we can see here that the Needle Exchange Program is reaching only a very small proportion of most Intravenous Drug User’s needs to begin with.

Here’s what the report states for the frequency of use of Site services: (Quote)

“Between June 1996 and March 1998, Intravenous Drug Users were asked to report how often they had used the services of the Site in the previous six months……… the majority of men (56%) and the greatest proportion of women (46%) Intravenous Drug Users reported occasional use of the Site with less than weekly visits. However, women Intravenous Drug Users (31%) were more likely than men Intravenous Drug Users (13%) to report that they used the services of the Site on a regular basis; once or twice a week.”(End of Quote)

If I understand right there is a small percentage of people who use the Needle Exchange Program on a regular basis.

The report goes on to state:(Quote)

“Even with the Needle Exchange Program, the majority of both men (56%) and women (58%) Intravenous Drug Users had used needles already used by someone else including their sexual partners at some point in their injection history. Of these Intravenous Drug Users, the majority of both men (57%) and women (64%) had continued this practice in the six months prior to their interview.

Cocaine is the main drug of injection in Ottawa, 83% for women and 76% for men which means a higher rate of injections especially if the person is binging. The problem (high rate of HIV in Intravenous Drug User’s is largely driven by cocaine. There are needles available and users say they know they are available but when they are high on cocaine, they just forget about (safe injection). (Magner 1997)

The proportion of Ottawa Injection Drug Users attending the Site Needle Exchange Program who have completed baseline or repeat interviews who are HIV positive has doubled in the past eight years, rising from 10.3% in 1992 to 23% in 2000.” (End of Quote)

Now here are my questions:

Given your statistics for the year 2000, only 18% of contacts made are referred and I will give you the breakdown.
2% to HIV/STD testing
2% to Detox / Drug treatment
.5% to Social Services
4% to Other medical services
9% to Other counselling
.5% to Emergency

1) How many of these folks have been followed up and have
actually gone?

2) Seeing the raison d’etre for the Needle Exchange Program
is the reduction of HIV then is a 2% HIV testing referral adequate?

3) How many people have been successfully re-integrated in the mainstream of society? (Behavior change)
We must also remember that Injection Drug Use is not first and foremost a health issue, it’s a behavior issue with health consequences.

4) Seeing this program only touches a very small percentage of Intravenous Drug Users in Ottawa, what is the true cost of this program:
– cost for staff
– cost for needles
– cost for accessories
– cost for equipment, van – site etc.
– cost for funded clean up program?

From all the information I have been able to glean, this program is not working successfully, therefore shouldn’t we be putting our time and energy into trying to examine if there is something more we can do which would produce better results.

I will close with three comments:

1) On page 24 regarding your statement that any coerced referrals into a recovery service will be unsuccessful, I believe whether forced or voluntary, the results will be the same. Success is based on completing the program and the success rate in both cases is approximately the same.

2) Again on page 24, the statement that “the Harm Reduction approach is the first step in building relationships of trust and caring between the drug user and the health care worker”. I believe showing any genuine care, whether its meeting the immediate needs of food or providing clothing, will also open the door. (Maslov’s theory) Ottawa Innercity Ministries is a prime example of this, although we do not participate in Harm Reduction programs as they stand, we receive an average of 100 to 130 people every Wednesday to our drop-in centre which is at a fixed location, and we see people attending our health clinics.

3) Diabetes affects 2,000,000 Canadians. It is a chronic disease that has no cure. It is the leading cause of death by disease in Canada, yet diabetics must pay for their needles.

Somehow it just doesn’t seem to add up.

If you have any questions or comments re: this presentation or if you would like further information please forward them to this website and I will be glad to respond to you.

Rev. Cpl. André Bigras… Ottawa Innercity Ministries.