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Supervised injection and alcohol intake sites

Supervised injection and alcohol intake sites

When my brother was on the street as a psychiatric person, it was the network of people, shelters, soup kitchens, and social services that allowed him to eventually seek the help he needed. He is now taking medication faithfully and receives a disability pension. He is able to hold a part time job and is living in a communal home with other psychiatrics. Without this social network I am convinced he would still be on the streets or worse, wrongly in jail.

Supervised injection sites are needed in order to compassionately assist people in dealing with and eventually ending drug addiction. Forcing addicts into a back alley or derelict buildings increases the sense of hopelessness and despair. Addiction to alcohol and drugs is a condition that needs to be treated in the same manner, not traumatized further. These sites cut down on HIV infections, overdoses, and a host of other related problems. Supervised injection sites treat addicts. They are not hang outs for casual users. The same idea is being used for hard core alcoholics. This has led to fewer hospital visits and treatment by emergency services. They should be continued, made legal, and expand to include other chronic, dangerous addictions. People become well when they have support systems available to them and addiction is no exception. We cannot be a socially progressive party or society and not advocate for this. To his temporary credit Health Minister Tony Clement did not go through with the reprehensible election promise to shut down these programs. However he hasn’t endorsed them either and is merely extended the program another year for further consideration.

During the 2006 election I remember seeing Stephen Harper standing in front of a supervised injection site, vowing to shut them down and end the program. The problem with the ‘Regressive’ Conservative Party of Stephen Harper is that they can’t help but impose judgment followed by punishment on the poor and disadvantaged. Their societal goals are based on maintaining and enforcing a winner vs loser mentality. Drug addicts and alcoholics are losers, deserving every nasty thing that happens to them. They should be tossed aside until ‘divine intervention’ gives them the sign. The same applies to poverty with the poor as losers while the materially wealthy are winners. No matter how hard they try they just keep spinning their wheels, eventually moving backwards. This is why, even with the numbers crunched showing that these programs reduce the cost of police and emergency services, they can’t help themselves. The need to invoke moral judgment and punishment is too great.

InSite (Vancouver) http://www.vch.ca/sis/docs/insite_brochure.pdf
http://www.vch.ca/sis/

"Improving Access to Care
Drug users who live on the margins may have difficulty accessing health care. And without this care, the chances of improving health outcomes are slim. By visiting insite and being exposed to health care professionals in a non-threatening environment, many
clients willingly ask for referrals to other health and social services. Over a one-year period, insite made more than 2,000 referrals to other services, with about 40 percent of the referrals to addiction counseling. People using insite are more likely to enter withdrawal management (detox) programs, and people using insite who also talk with addiction counselors are even more likely to enter detox. In fact, one in five regular visitors to insite began a detox program, showing that insite is a proven entry-point for the Downtown Eastside’s highestrisk injection drug users. Detox programs are an important marker of addiction treatment system use, as most addiction treatment programs first require people to complete a detox program. Researchers also compared the rate of detox program use among people using insite – before and after insite opened – with the rate of detox use going up substantially after people had been using the facility. Research results show that insite is playing an important role in managing overdoses that occur at the site – overdoses that would, in all likelihood, be occurring on the streets if the facility didn’t exist, and could result in death. Overdoses have been common at insite, with almost 500 occurring over a two-year period, but none
resulted in a fatality. In fact, insite staff managed the majority of overdoses on their own, with only four in 10 needing ambulance support, and fewer than one in 10 resulting in a transfer to hospital."

Link to report on controlled alcohol distribution for chronic alcoholics. http://www.cmaj.ca/cgi/content/abstract/174/1/45

"The client care workers interviewed all noted improved hygiene and nutrition for all participants during the program. Compliance with medication, defined as taking it as prescribed at least 80% of the time, was noted for 88% of subjects. The majority were reported to attend scheduled medical appointments. A cost analysis was performed (results not shown). Mean monthly direct cost of the program was $771 per client, with estimated per-client reductions in the costs of ED services of $96; hospital care, $150; and police services, $201.
Interpretation
This article describes the effect of providing supportive shelter for a subset of chronically homeless people with alcoholism and providing them with institutionally administered alcohol as a harm-reduction measure. The 17 participants enrolled in MAP drank heavily and had long drinking histories. They were regular users of nonbeverage alcohols such as mouthwash, had significant medical and psychiatric comorbidities, and were frequent users of emergency, hospital and police services. Within MAP they received housing, health care and treatment of their alcoholism with doses of alcohol that were modest in comparison with their previous levels of consumption. Police encounters decreased by 51% and ED visits by 36%, which, given the associated “unit encounter” costs ($93 and $270, respectively), offset a portion of the costs of MAP.
Finally, the option to detoxify from alcohol is always presented; once stabilized in the program, a few participants have successfully been medically detoxified and received housing, a formidable accomplishment considering the severity of an on-average 35-year addiction in which subjects drank daily to unconsciousness. This appears attributable to tempering alcohol consumption in a safe environment, which makes alterations of behaviour, including detoxification, possible."

The net cost of this program is actually $324.00 per client not $771.00. You can further reduce this net cost evaluation by adding into the equation the future opportunity of successfully detoxified clients obtaining jobs and paying taxes. The reduced cost to victims of any criminal activity related to client behaviour such as damage to property, assault, plus the increased ability of emergency and police services to respond to other incidences. For example, during the years I lived on Queen Street West in Toronto I regularly found old men lying on the street as the result of being drunk and falling. Often they would have head wounds as a result. When I called to report these incidents the response almost always included the arrival of ambulance, fire department and police. So even if you are motivated more by social cost factors than pure compassion these programs still make superior sense and produce better results than the present approach.

Social conservatives though don’t see this and will go to unintelligent, sometimes absurd lengths to argue against these programs. I watched a televised session at Toronto City Hall discussing the possibility of exploring these types of programs in the city. The study was presented and defended by Mayor David Miller and Councilor Kyle Rae. This was just the discussion of exploration not implementation. To my dismay both Councilors Ford and Nunziata stood to counter the proposal with ridiculous arguments. Councilor Rob Ford argued and interrogated Councilor Rae about whether he supported prostitution in the city. A line of questioning that had nothing to do with the subject. Councilor Nunziata started out on subject but waved pamphlets supplied by CAMH on safe use of drugs, stating that they were teaching people how to do drugs and was this what we wanted to do in Toronto. Teach young people how to do drugs. She also linked the program with endorsing prostitution basing it on the fact that junkies often use prostitution to pay for drugs. They are too morally blind to the realities of these problems. The need to judge and punish again supercedes the need to deal with and solve the problems of chronic addictions.

Soumis par Stephen LaFrenie le 21 février 2007 - 1:22pm.

WHy should we continue prohibition?

Lambton Kent Middlesex EDA (SW Ontario)
A significant part of our problem with illegal drugs appears to be the artificially created high profit to pushers, high cost to users, high crime rate to support habits, high crime rate to protect high profit to pushers.

Prohibition then forces users to do business with the criminal element, even to protect them from law enforcement to maintain supply. Law enforcement is more a threat to the users than the pushers are.

If there is no profit for the pusher, there is no pusher. If there is no profit for pushers, the user's cost to support a habit drops to very little, and the need to engage in crime to support the habit is gone, no need to protect the pusher either, and no turf wars among pushers.

Safe injection sites, ok, but let's go further and cut out the profits going to the pushers by providing the products at cost to users, even products that do not require injection.

Dangerous drugs need to be prohibited

We need prohibition on dangerous 'recreational' substances in the same manner as prescription drugs. You can't just go to the pharmacist and buy serious medication over the counter. Legalizing cocaine, crack cocaine, heroin, etc. is a regressive policy idea. If I can buy that crap over the counter then why prohibit prescription medicine? A doctor cannot prescribe medicine for 'recreational' use and so the government should also be held to the same standards. So if you stop prohibiting these drugs then who's going to manufacture and sell them? Who is going to market them? In my view legalizing soft drugs such as marijuana will actually contribute to a decreased use of more dangerous substances. Marijuana, yes. Cocaine, No.

http://stephenlafrenie.blogspot.com
www.twawareness.org
www.mimeguy.com

Drug Adiction

Drug adiction is an illness and should be treated as such. Letting organized crime make a fortune from these unfortunate people is extremely stupid and counter productive. They need help not punishment.

The giant harmaceutical companies or in fact responsible for by far the greatest number of drug addicts. Oops, I'm not supposed to mention that!....PJ

Marijuana addiction

Gareth Davies
Nanaimo-Alberni EDA
Parksville, BC

There are some 1.5 million users of marijuana in Canada according to the medical profession.

Of these, at least 12% are addicted.

That makes about 125,000 persons addicted to marijuana.

To legalize such a dangerous drug and tax it, thereby taxing those 125,000 unfortunates, is immoral. Yes it is also immoral to tax alcohol and tobacco, but two wrongs never make a right.

The drug underworld that supplies marijuana, organized crime, will never give up their billion dollar empire that easy either. Nothing but trouble on the horizon.

125,000, that's a lot of people and marijuana is a dangerous drug.

I agree that addiction to any drug is an illness and should be treated as such and afforded the total medical resources available. Addicts should be treated with respect and compassion.

Unfortunately, addicts often become violent, committing such crimes as home invasions, mugging and break and enter, just to feed their addiction. Then the solution is not so clear and incarceration seems the only way as long as that person remains a danger to people.

Lisa Khoo, CBC News Online | May 2001 | Updated Nov. 25, 2004, reported:

    NDP House leader Libby Davies said her party thinks C-17 could lead to too much enforcement for simple possession. The NDP said it would also seek amnesty for the estimated 600,000 Canadian who have a criminal record for simple possession.

    The Canadian Medical Association estimates that 1.5 million Canadians smoke marijuana recreationally. In November 2004, the Canadian Addiction Survey reported that 14 per cent of Canadians said they had used cannabis in the past year, about double the number from 1994.

See: http://tinyurl.com/4y42b

http://www.cbc.ca/news/background/marijuana/marijuana_legalize.html

There is no question that marijuana should be decriminalized for simple possession and that the 600,000 Canadians referred to should have amnesty.

Furthermore, people with chronic pain should be allowed, under medical supervision, to use marijuana without charge where such usage is shown to have a therapeutic benefit.

But for those who manufacture, grow, transport or sell or push the drug. a minimum jail sentence of at least 10 years, with no time off for good behaviour.

FYI: The following facts are confirmed in the Report of the Senate Special Committee on Illegal Drugs, Summary Report, September 2002, pages 13-18.

    The production of cannabis is largely controlled by organized crime for starters and they have increased the concentration of the active ingredient of cannabis, THC, from 3% to as much as 30% and the finished product is often laced with other unknown street drugs. Smoking pot can be very dangerous.

    THC readily spreads in the innervated brain tissues with psychoactive effects lasting for up to 7 hours after use, with the immediate effects being characterized by feelings of euphoria, relaxation and sociability, accompanied by impairment of short-term memory, concentration and some psychomotor skills.

    10% of users will become addicted, more so with young teenagers maybe 12%.

    There can be negative psychological consequences for users, in particular impaired concentration and learning and, in rare cases and with people already predisposed, psychotic and schizophrenic episodes.

    A significant percentage of impaired drivers test positive for cannabis and alcohol together, the effects of cannabis when combined with alcohol being more significant than is the case for alcohol alone.

Marijuana addiction? No such thing

Gareth, marijuana is not addictive. People may become psychologically dependent on it, but it is not addictive like alcohol, tobacco and heroin which produce physical withdrawal symptoms in addicts trying to quit. But even if you refer to those who are psychologically dependent on the drug as 'addicts', they do not often become violent, committing such crimes as home invasions, mugging and break and enter, just to feed their addiction. They may become under-motivated, eat too much and spend too much time in front of their computer screens (wait a minute, that's me I'm describing!), but they are very, very unlikely to start fights in bars, drive too fast or beat their wives.

As for the Senate report, it's true that the production, distribution and sale of marijuana are largely controlled by organized crime, but to me, that's the best argument of all for its legalization - let's tax it like alcohol and put the biker gangs out of business. And as they point out, being produced and distributed by thugs, it's often laced with chemicals that are really dangerous - another good reason for government oversight.

As for the claim that the concentration of THC has increased from 3% to as much as 30%, those very unscientific guesses are exaggerated in both directions, and though it may be true that marijuana has become stronger over the years, that is largely a result of prohibition. Were it legalized, the strength of the product would become mostly irrelevant; you don't often hear vinophiles discussing the relative potency of Pinot Noir versus Cabernet Sauvignon.

I'd never heard of the idea described in Stephen's original post about controlled alcohol distribution for chronic alcoholics (I always thought they were called 'bars'); but the idea warrants serious consideration. Alcoholics cause an incredible amount of damage to themselves and those around them and this might be an effective way to reduce it.

Brian Smallshaw
Saanich-Gulf Islands EDA

Marijuana usage

Gareth Davies
Nanaimo-Alberni EDA
Parksville, BC

Brian, I know we have had this discussion before. Please allow me say this: if grown persons wish to indulge themselves in whatever activity, including smoking pot, that is their business (as long, of course, as they are not hurting someone).

Furthermore, marijuana use should be made accessible, under medical prescription, without charge to persons suffering chronic pain.

Also, I believe that use of marijuana should not be an offence under the Criminal Code, nor should simple possession.

Finally, the NDP estimates some 600,000 persons have criminal records for simple possession. These persons should receive a complete amnesty.

Persons who grow, manufacture, transport and sell or push marijuana should get minimum jail terms of at least 10 years.

Now, I have got that out of the way.

Report of the Senate Special Committee on Illegal Drugs, Summary Report, September 2002, pages 13-18.

Findings of fact

    The production of cannabis is largely controlled by organized crime for starters and they have increased the concentration of the active ingredient of cannabis, THC, from 3% to as much as 30% and the finished product is often laced with other unknown street drugs. Smoking pot can be very dangerous.

    THC readily spreads in the innervated brain tissues with psychoactive effects lasting for up to 7 hours after use, with the immediate effects being characterized by feelings of euphoria, relaxation and sociability, accompanied by impairment of short-term memory, concentration and some psychomotor skills.

    10% of users will become addicted, more so with young teenagers maybe 12%.

    There can be negative psychological consequences for users, in particular impaired concentration and learning and, in rare cases and with people already predisposed, psychotic and schizophrenic episodes.

    A significant percentage of impaired drivers test positive for cannabis and alcohol together, the effects of cannabis when combined with alcohol being more significant than is the case for alcohol alone.

Furthermore, it is easily verifiable that there are some 1.5 million users of marijuana in Canada according to the medical profession. Of these, at least 12% are addicted. That makes about 125,000 persons addicted to marijuana.

Addiction has psychological causes as well as physiological. Consider these definitions by medical experts:

Addiction defined

    Addiction: A person who cannot resist a habit, especially the use of drugs or alcohol, for physiological or psychological reasons.
    (Sources given at foot of web page.)

http://tinyurl.com/2bo4wv

ojjdp.ncjrs.org/PUBS/drugid/glossary.html

American Heritage Dictionary - Cite This Source
ad·dic·tion       (ə-dĭk'shən)  Pronunciation Key 
n.  

    1. Compulsive physiological and psychological need for a habit-forming substance:

http://tinyurl.com/2k65hm

http://dictionary.reference.com/browse/addiction

Personal observations

As a family law and child protection lawyer I came into contact with hundreds of drug addicts, many of them hooked on serious narcotics. It was heartbreaking to see how this destroyed the family unit, leaving children quite alone and frightened.

Every now and then I would have a client who smoked marijuana. No surprise there, but some of them were quite definitely addicted, losing all access to their children rather than give up smoking pot.

Obviously, the facts are that not everyone who smokes pot gets hooked, but denying that marijuana is addictive to some degree is turning a blind eye to the problem.

Narconon

Narconon is a substance designed to help persons addicted to marijuana. This is what they say on their web page:

    Marijuana is both emotionally and mentally addictive. Once an individual becomes addicted to marijuana it develops into part of who they believe themselves to be. Avoiding their friends who do not use, the addict will gravitate to others that do.

    Marijuana is a topic that is always on their mind, whether it be thinking about the next time they will be able to get high or where [they're] going to get their next sack. When someone is addicted to marijuana eventually their friends and the people close to them only know how they act when [they're] stoned because they no longer do anything without first smoking.

    Their constant abuse is due to the misconception that marijuana is what they need to solve their problems. Sometimes addicts will take their stash with them wherever they go, just in case an opportunity arises and they are able to take a couple hits. They may even go through several dealers in order to make sure they always have a constant supply of marijuana.

http://tinyurl.com/2mefsn

http://www.marijuanaaddiction.info/

Marijuana Anonymous

Who can deny a statement from persons who declare themselves to be addicted to marijuana? Read on:

    Who is a Marijuana Addict?
    We who are marijuana addicts know the answer to this question. Marijuana controls our lives! We lose interest in all else; our dreams go up in smoke. Ours is a progressive illness often leading us to addictions to other drugs, including alcohol. Our lives, our thinking, and our desires center around marijuana---scoring it, dealing it, and finding ways to stay high.

http://tinyurl.com/n3kvx

http://www.marijuana-anonymous.org/Pages/basic.html

University of Wisconsin

The University Health Services offers this advice to its student body:

    By the twenty-first century, the answers to these questions are clear. Tolerance does develop to THC (the active chemical in marijuana). Moreover, withdrawal definitely occurs in some users. The effects of this withdrawal are generally the opposite of the effects of intoxication: anxiety and insomnia instead of relaxation; loss of appetite rather than hunger; excessive salivation instead of dry mouth; and also decreased pulse, irritability, and sometimes tremor. People who have used marijuana as a way to control underlying anger may also experience irritability, increased mood swings, and even an increase in aggressive behavior, as symptoms of withdrawal.

    Final comment
    Although marijuana use has been common in many segments of the American population for two generations, and many adults and teenagers know marijuana users who have not developed addiction even to prolonged use, the potential for the development of addiction is almost certainly greater today than in the 1960s or ’70s. The marijuana of today is different. It’s not just much more expensive; it also contains significantly more THC. In fact, the THC content of today’s pot is several times higher than that of even strong “weed” from the ’60s. This makes it more potent, but also more likely to induce tolerance and true addiction.

    Written by Michael Miller, M.D., of Meriter Hospital, and Brian Glueck, editor, UHS.
    Michael M. Miller, M.D., is Medical Director of the NewStart Alcohol/Drug Treatment Program at Meriter Hospital in Madison, WI. For other NewStart articles about drug addiction, as well as many related links, visit the Meriter chemical dependency page.

http://tinyurl.com/377mr6

http://www.uhs.wisc.edu/display_story.jsp?id=736&cat_id=38

Drug and Alcohol Resource Center

This organization speaks from experience:

    Nationwide Alcohol and Drug Addiction Rehab Information

    Marijuana Addiction
Marijuana is the most commonly used illicit drug in the United States. Marijuana is addictive. While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent on the drug or addicted to it. In 2002, over 280,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they needed help to stop using. According to one study, marijuana use by teenagers who have prior serious antisocial problems can quickly lead to dependence on the drug. That study also found that, for troubled teenagers using tobacco, alcohol, and marijuana, progression from their first use of marijuana to regular use was about as rapid as their progression to regular tobacco use, and more rapid than the progression to regular use of alcohol.

http://tinyurl.com/ywpq2z

http://www.addict-help.com/marijuana-addiction.asp

Brown University

This esteemed University offers advice to its student body on the addictiveness of marijuana:

    Health Education

    Is marijuana addictive?
No one would argue that marijuana is as addictive as alcohol or cocaine. However, it's wrong to say that it is not at all addictive. More and more studies are finding that marijuana has addictive properties. Both animal and human studies show physical and psychological withdrawal symptoms from marijuana, including irritability, restlessness, insomnia, nausea and intense dreams. Tolerance to marijuana also builds up rapidly. Heavy users need 8 times higher doses to get the same effects as infrequent users.

    For a small percentage of people who use it, marijuana can be highly addictive. It is estimated that 10% to 14% of users will become heavily dependent. More than 120,000 people in the US seek treatment for marijuana addiction every year. Because the consequences of marijuana use can be subtle and insidious, it is more difficult to recognize signs of addiction. Cultural and societal beliefs that marijuana cannot be addictive make it less likely for people to seek help or to get support for quitting.

http://tinyurl.com/9wh9d

http://www.brown.edu/Student_Services/Health_Services/Health_Education/a...

Violence

Unfortunately, simple marijuana use is no longer the case. It is a fact that marijuana is considerably stronger than hitherto and may be laced with a narcotic. Users, some, certainly not all, but some, will "enjoy" their buzz with a drink (alcohol). For the few that so indulge it is a slippery slope to violence.

However, I concede your point Brian, that one could, for all intents and purposes, say that the marijuana user does not resort to violence when just using marijuana without resort to alcohol or other drugs.

Health policy

The Green Party of Canada stresses the need for healthy living. People need clean air to breath, clean water to drink and clean earth in which to grow organic foods. Sucking in smoke into one's lungs hardly qualifies for healthy living, whether the smoke be from tobacco, marijuana or someone else's second hand smoke. Putting the brain to sleep instead of putting it to work is also a non qualifier.

But there, it is a matter of personal choice whatever another may think about it. I am definitely not in favour of regulating other people's behaviour (unless that behaviour causes another harm).

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