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The harm reduction model of drug addiction treatment

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    I remember the first time that
    I saw people injecting drugs.
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    I had just arrived in Vancouver
    to lead a research project
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    in HIV prevention in the
    infamous Downtown East Side.
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    It was in the lobby of the Portland Hotel,
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    a supportive housing
    project that gave rooms
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    to the most marginalized
    people in the city,
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    the so-called "difficult to house."
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    I'll never forget the young woman
    standing on the stairs
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    repeatedly jabbing herself with a needle
    and screaming,
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    "I can't find a vein,"
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    as blood splattered on the wall.
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    In response to the desperate
    state of affairs, the drug use,
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    the poverty, the violence,
    the soaring rates of HIV,
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    Vancouver declared a public
    health emergency in 1997.
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    This opened the door to
    expanding harm reduction services,
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    distributing more needles,
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    increasing access to methadone,
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    and, finally, opening
    a supervised injection site.
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    Things that make injecting
    drugs less hazardous.
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    But today, 20 years later,
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    harm reduction is still viewed
    as some sort of radical concept.
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    In some places, it's still illegal
    to carry a clean needle.
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    Drug users are far more likely
    to be arrested
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    than to be offered methadone therapy.
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    Recent proposals for
    supervised injection sites
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    in cities like Seattle,
    Baltimore and New York
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    have been met with stiff opposition:
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    opposition that goes against
    everything we know about addiction.
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    Why is that?
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    Why are we still stuck on the idea
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    that the only option is to stop using --
    that any drug use will not be tolerated?
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    Why do we ignore
    countless personal stories
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    and overwhelming scientific evidence
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    that harm reduction works?
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    Critics say that harm
    reduction doesn't stop people
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    from using illegal drugs.
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    Well, actually, that is the whole point.
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    After every criminal and societal sanction
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    that we can come up with,
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    people still use drugs,
    and far too many die.
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    Critics also say that
    we are giving up on people
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    by not focusing our attention
    on treatment and recovery.
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    In fact, it is just the opposite.
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    We are not giving up on people.
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    We know that if recovery
    is ever going to happen
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    we must keep people alive.
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    Offering someone a clean needle
    or a safe place to inject
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    is the first step to
    treatment and recovery.
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    Critics also claim that harm reduction
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    gives the wrong message to
    our children about drug users.
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    The last time I looked,
    these drug users are our children.
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    The message of harm reduction
    is that, well, drugs can hurt you.
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    We still must reach out to
    people who are addicted.
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    A needle exchange is not an
    advertisement for drug use.
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    Neither is a methadone clinic
    or a supervised injection site.
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    What you see there are
    people sick and hurting,
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    hardly an endorsement for drug use.
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    Let's take supervised
    injection sites, for example.
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    Probably the most misunderstood
    health intervention ever.
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    All we are saying is that allowing people
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    to inject in a clean, dry space
    with fresh needles,
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    surrounded by people who care
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    is a lot better than
    injecting in a dingy alley,
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    sharing contaminated needles
    and hiding out from police.
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    It's better for everybody.
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    The first supervised injection site
    in Vancouver was at 327 Carol Street,
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    a narrow room with a concrete floor,
    a few chairs and a box of clean needles.
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    The police would often lock it down,
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    but somehow it always
    mysteriously reopened,
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    often with the aid of a crowbar.
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    I would go down there some evenings
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    to provide medical care
    for people who were injecting drugs.
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    I was always struck with the
    commitment and compassion
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    of the people who operated
    and used the site.
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    No judgment, no hassles, no fear,
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    lots of profound conversation.
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    I learned that despite
    unimaginable trauma,
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    physical pain and mental illness,
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    that everyone there thought
    that things would get better.
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    Most were convinced that, someday,
    they'd stop using drugs altogether.
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    That room was the forerunner
    to North America's
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    first government-sanctioned
    supervised injection site, called INSITE.
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    It opened in September of 2003
    as a three-year research project.
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    The conservative government was intent on
    closing it down at the end of the study.
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    After eight years,
    the battle to close INSITE
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    went all the way up to
    Canada's Supreme Court.
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    It pitted the government of Canada
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    against two people with a
    long history of drug use
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    who knew the benefits of INSITE firsthand:
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    Dean Wilson and Shelley Tomic.
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    The court ruled in favor
    of keeping INSITE open by nine to zero.
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    The justices were scathing in
    their response to the government's case.
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    And I quote:
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    "The effect of denying the services
    of INSITE to the population that it serves
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    and the correlative increase
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    in the risk of death and disease
    to injection drug users
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    is grossly disproportionate to any benefit
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    that Canada might derive
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    from presenting a uniform stance
    on the possession of narcotics."
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    This was a hopeful moment
    for harm reduction.
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    Yet, despite this strong message
    from the Supreme Court,
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    it was, until very recently,
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    impossible to open up
    any new sites in Canada.
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    There was one interesting thing
    that happened in December of 2016,
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    when due to the overdose crisis,
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    the government of British Columbia allowed
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    the opening of overdose prevention sites.
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    Essentially ignoring the
    federal approval process,
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    community groups opened up
    about 22 of these de facto illegal
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    supervised injection sites
    across the province.
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    Virtually overnight,
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    thousands of people could
    use drugs under supervision.
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    Hundreds of overdoses were reversed
    by Naloxone, and nobody died.
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    In fact, this is what's happened
    at INSITE over the last 14 years:
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    75,000 different individuals
    have injected illegal drugs,
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    more than three and a half million times,
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    and not one person has died.
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    Nobody has ever died at INSITE.
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    So there you have it.
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    We have scientific evidence
    and successes from needle exchanges
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    methadone and supervised injection sites.
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    These are common-sense,
    compassionate approaches to drug use
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    that improve health, bring connection
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    and greatly reduce suffering and death.
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    So why haven't harm reduction
    programs taken off?
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    Why do we still think
    that drug use is law enforcement issue?
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    Our disdain for drugs and
    drug users goes very deep.
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    We are bombarded with
    images and media stories
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    about the horrible impacts of drugs.
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    We have stigmatized entire communities.
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    We applaud military-inspired operations
    that bring down drug dealers,
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    and we appear unfazed
    by building more jails
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    to incarcerate people whose
    only crime is using drugs.
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    Virtually millions of people are caught up
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    in a hopeless cycle
    of incarceration, violence and poverty
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    that has been created by our drug laws
    and not the drugs themselves.
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    How do I explain to people
    that drug users deserve care and support
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    and the freedom to live their lives
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    when all we see are images of guns
    and handcuffs and jail cells?
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    Let's be clear:
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    criminalization is just a way
    to institutionalize stigma.
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    Making drugs illegal does nothing
    to stop people from using them.
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    Our paralysis to see things differently
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    is also based on an entirely
    false narrative about drug use.
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    We have been led to believe
    that drug users
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    are irresponsible people who just
    want to get high,
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    and then through their
    own personal failings
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    spiral down into a life
    of crime and poverty,
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    losing their jobs, their families
    and, ultimately, their lives.
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    In reality, most drug users have a story,
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    whether it's childhood trauma,
    sexual abuse, mental illness
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    or a personal tragedy.
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    The drugs are used to numb the pain.
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    We must understand that
    as we approach people with so much trauma.
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    At its core, our drug policies
    are really a social justice issue.
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    While the media may focus on overdose
    deaths like Prince and Michael Jackson,
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    the majority of the suffering
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    happens to people who are
    living on the margins,
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    the poor and the dispossessed.
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    They don't vote; they are often alone.
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    They are society's disposable people.
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    Even within health care,
    drug use is highly stigmatized.
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    People using drugs avoid
    the health care system.
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    They know that once
    engaged in clinical care
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    or admitted to hospital,
    they will be treated poorly.
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    And their supply line, be it heroin,
    cocaine or crystal meth
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    will be interrupted.
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    On top of that, they will be asked
    a barrage of question
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    that only serve
    to expose their losses and shame.
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    "What drugs do you use?"
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    "How long have you been
    living on the street?"
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    "Where are your children?"
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    "When were you last in jail?"
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    Essentially: "Why the hell
    don't you stop using drugs?"
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    In fact, our entire medical
    approach to drug use is upside down.
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    For some reason,
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    we have decided that abstinence
    is the best way to treat this.
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    If you're lucky enough,
    you may get into a detox program.
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    If you live in a community
    with Suboxone or methadone,
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    you may get on a substitution program.
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    Hardly ever would we offer people
    what they desperately need to survive:
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    a safe prescription for opioids.
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    Starting with abstinence is
    like asking a new diabetic to quit sugar
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    or a severe asthmatic
    to start running marathons
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    or a depressed person to just be happy.
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    For any other medical condition,
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    we would never start with
    the most extreme option.
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    What makes us think that strategy
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    would work for something
    as complex as addiction?
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    While unintentional overdoses are not new,
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    the scale of the current
    crisis is unprecedented.
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    The Center for Disease Control estimated
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    that 64,000 Americans died
    of a drug overdose in 2016,
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    far exceeding car crashes or homicides.
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    Drug-related mortality is now
    the leading cause of death
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    among men and women between
    20 and 50 years old in North America
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    Think about that.
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    How did we get to this point, and why now?
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    There is a kind of perfect
    storm around opioids.
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    Drugs like Oxycontin,
    Percocet and Dilaudid
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    have been liberally distributed
    for decades for all kinds of pain.
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    It is estimated that two million
    Americans are daily opioid users,
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    and over 60 million people
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    received at least one prescription
    for opioids last year.
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    This massive dump of
    prescription drugs into communities
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    has provided a steady source
    for people wanting to self-medicate.
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    In response to this prescription epidemic,
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    people have been cut off, and this
    has greatly reduced the street supply
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    The unintended but predictable consequence
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    is an overdose epidemic.
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    Many people who were reliant on
    a steady supply of prescription drugs
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    turned to heroin.
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    And now the illegal drug market
    has tragically switched
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    to synthetic drugs, mainly fentanyl.
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    These new drugs are cheap,
    potent and extremely hard to dose.
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    People are literally being poisoned.
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    Can you imagine if this was
    any other kind of poisoning epidemic?
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    What if thousands of people started dying
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    from poisoned meat
    or baby formula or coffee?
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    We would be treating
    this as a true emergency.
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    We would immediately be
    supplying safer alternatives.
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    There would be changes in legislation,
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    and we would be supporting
    the victims and their families.
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    But for the drug overdose epidemic,
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    we have done none of that.
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    We continue to demonize the drugs
    and the people who use them
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    and blindly pour even more resources
    into law enforcement.
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    So where should we go from here?
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    First, we should fully embrace,
    fund and scale up
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    harm reduction programs
    across North America.
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    I know that in places like Vancouver,
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    harm reduction has been a
    lifeline to care and treatment.
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    I know that the number of overdose deaths
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    would be far higher
    without harm reduction.
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    And I personally know hundreds
    of people who are alive today
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    because of harm reduction.
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    But harm reduction is just the start.
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    If we truly want to make
    an impact on this drug crisis,
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    we need to have a serious
    conversation about prohibition
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    and criminal punishment.
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    We need to recognize that drug us is
    first and foremost a public health issue
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    and turn to comprehensive social
    and health solutions.
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    We already have a model
    for how this can work.
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    In 2001, Portugal was
    having its own drug crisis.
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    Lots of people using
    drugs, high crime rates
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    and an overdose epidemic.
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    They defied global conventions
    and decriminalized all drug possession.
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    Money that was spent on drug enforcement
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    was redirected to health
    and rehabilitation programs.
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    The results are in.
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    Overall drug use is down dramatically.
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    Overdoses are uncommon.
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    Many more people are in treatment,
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    and people have been
    given their lives back.
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    We have come so far down the road
    of prohibition, punishment and prejudice
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    that we have become
    indifferent to the suffering
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    that we have inflicted on the
    most vulnerable people in our society.
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    This year even more
    people will get caught up
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    in the illegal drug trade.
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    Thousands of children will learn
    that their mother or father
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    has been sent to jail for using drugs.
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    And far too many parents will be notified
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    that their son or daughter
    has died of a drug overdose.
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    It doesn't have to be this way.
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    Thank you.
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    (Applause)
Title:
The harm reduction model of drug addiction treatment
Speaker:
Mark Tyndall
Description:

Why do we still think that drug use is a law-enforcement issue? Making drugs illegal does nothing to stop people from using them, says public health expert Mark Tyndall. So, what might work? Tyndall shares community-based research that shows how harm-reduction strategies, like safe-injection sites, are working to address the drug overdose crisis.

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Video Language:
English
Team:
closed TED
Project:
TEDTalks
Duration:
16:31

English subtitles

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