Power Politics and the Production of Harm Lynne Leonard Director HIV and HCV Prevention Research Team University of Ottawa OHTN SLI 2009 PPP CRACk

Research Evidence and Public Health Decision Making “The decision to kill the program was politically motivated, and it shows Council is not living up to its role as a Board of Health.” “Obviously we are not up to the task. When people are ignoring the clear advice of our chief medical officer of health, there’s a huge problem.” Councillor Peggy Feltmate, Ottawa Citizen, 14 July 2004 OHTN SLI 2009 PPP CRACk

Research Evidence and Public Health Decision Making “Politics Killed Crack-Pipe Program” Ottawa Citizen July 14, 2007 The City’s chief MOH…repeatedly told council that the program was working, saving lives, saved millions in future medical expenses and was good for public health in the city before it was cancelled. He added that scientific evidence backed up these claims and an internationally recognized study of the program concluded that it was working. His message fell on deaf ears as council struck down the program. OHTN SLI 2009 PPP CRACk

Peer-reviewed Evidence OHTN SLI 2009 PPP CRACk

Research Evidence and Public Health Decision Making “Politics Killed Crack-Pipe Program” Ottawa Citizen July 14, 2007 … there was clear evidence the program was working to help stem the spread of HIV and hepatitis C amongst the city's drug users, but that it was so unpopular with the general public, many city councilors and the Mayor voted to kill it instead of risking turning off voters. OHTN SLI 2009 PPP CRACk

Research Evidence and Public Health Decision Making “Council Kills Crack-Pipe Program” Ottawa Citizen July 12, 2007 “… We just voted to basically kill six to twelve people a year”, said Councillor Clive Doucet. OHTN SLI 2009 PPP CRACk

Research Evidence and Public Health Decision Making “Politics Killed Crack-Pipe Program ” Ottawa Citizen July 14, 2007 … it’s clear politics are getting in the way of rational decision making aimed at improving public health and Council can no longer be trusted to act in the City’s best interests. OHTN SLI 2009 PPP CRACk

Impact on Sharing Crack-Smoking Equipment Decline in sharing crack-smoking equipment 85 % 6 monthsPRE 85 % 1 month POST 80 %6 months POST 80 % 12 months POST Among “sharers”, significant decline in sharing every time 37 % 6 monthsPRE 31 % 1 month POST 12 %6 months POST 13 % 12 months POSTp=0.001 OHTN SLI 2009 PPP CRACk

Significant Decrease in Injecting Drugs Injected drugs in month prior to interview 96 % 6 monthsPRE 84 % 1 month POST 78 %6 months POST 78 % 12 months POSTp ≤ Frequency of injecting since availability of crack- smoking equipment 41 % “less” 6 months POST 40 % “less” 12 months POST OHTN SLI 2009 PPP CRACk

Transitioning  “Because I can get clean glass stems and am now trying to stay away from injecting.”  “I can now use clean stems so smoke more.”  “Now that stems are available, prefer to smoke crack.”  “Now stems are more accessible, I have stopped my injection use.” OHTN SLI 2009 PPP CRACk

Engagement 6 Months PRE 1 Month POST 6 Months POST Cumulative 12 Months IDU ONLY 2, ,8394,168 IDU and Smoke Crack N/A4311,9844,300 Smoke Crack ONLY N/A2641,9014,043 OHTN SLI 2009 PPP CRACk

Perspective from the Front Well I think that it’s actually been a facility and a service that has made a difference, so I would like to have it stay open. I know our minister of health will work with the federal minister of health and our federal MPs to secure its future for the long term. BC Premier Gordon Campbell CBC News, 2 October 2007 OHTN SLI 2009 PPP CRACk

How Much Data is Enough? We understand that the extension is being granted to allow Heath Canada to conduct, or gather, additional research on the impact of injection sites, on prevention, and treatment and crime. Viviana Zanocco, Vancouver Coastal Health Authority CBC News, 2 October 2007 OHTN SLI 2009 PPP CRACk

How Much Data is Enough? ……and now he (Stephen Harper) is out there trying to find a new study that will say the world is flat. Mark Townsend, Director of the Portland Hotel Society CTV News, 4 October 2007 OHTN SLI 2009 PPP CRACk

Ideology Trumps Science This case is an alarming example of a recent trend towards the increased politicization of science. Rather than embracing evidence-based policy- making, some politicians have sought to ignore or denigrate scientific findings because of a rigid ideologically-driven agenda. Science and Ideology: A Call for Action Stephen Hwang, Centre for Research on Inner City Health OHTN SLI 2009 PPP CRACk

“What’s Harper Smoking?” The harm reduction policies Mr Harper questions are supported by a great many peer-reviewed scientific studies, but perhaps Mr. Harper simply has very high evidentiary standards. But what I find harder to understand is that Mr Harper embraces law enforcement even though the evidence supporting the effectiveness of enforcement is generously described as slim to none. So is Mr Harper a skeptic? Or is he a close-minded ideologue? I think the evidence is clear. Dan Gardiner, Ottawa Citizen, 6 October OHTN SLI 2009 PPP CRACk

Collective Resistance Request to reconsider the potential impact of your decision and reinstate the program. AIDS Committee of Ottawa; Canadian AIDS Society; Centre for Addiction and Mental Health; Hepatitis C Society; Ontario Harm Reduction Distribution Program; Ontario AIDS Network; Ontario Advisory Committee on HIV/AIDS; Ontario Hepatitis C Task Force; Ontario HIV Treatment Network; Ontario Gay Men’s HIV Prevention Strategy; Canadian Treatment Action Council; Canadian Legal AIDS Network; Kyle Rae, Chair of Toronto Drug Strategy Implementation Panel; Perry Kendall, BC Provincial Health Officer; Thomas Kerr; and Senator Larry Campbell. OHTN SLI 2009 PPP CRACk

Ontario AIDS Network The increasing rates of Hep C and HIV co-infection are a growing problem in Ottawa and in Ontario that will not be solved by wishful thinking and personal beliefs. To continue to be effective will require tough decisions, true leadership and a practical approach that does not allow personal values to trump the hard scientific evidence that amply demonstrates your decision will result in increased infections. Who will be responsible then? Kim Dolan, Co-chair Board of Directors Rick Kennedy, Executive Director, OAN 1 August 2007 OHTN SLI 2009 PPP CRACk

OACHA and HCV Task Force  Memo to all Health Units that distribution of safer crack use materials consistent with Mandatory Health Programs and Services Guidelines  CBOs and health units can purchase safer crack use materials  Endeavour to ensure that decisions related to public health are made by public health officials independent of political interference.  Ensure sufficient long term funds for the distribution of safer crack use materials Don Kilby, John Plater 21 August 2007 OHTN SLI 2009 PPP CRACk

Collective Resistance Ten Ottawa community-based health and social services organizations cite health need as they fund safe inhalation program - $9:00 per organization per day The safer inhalation program is implemented by a collection of partners – one of our partners has decided to opt out – but the remaining partners are simply continuing the work we are already doing. News Release, Ottawa Coalition on HIV/AIDS 31 July, 2007 OHTN SLI 2009 PPP CRACk

Cost of Collective Resistance Threats to Agency Funding “As far as I’m concerned, any organization that will be using that as a tool to give out to our kids – I will vote against giving any funding to them.” “We made it very clear at council meeting that city council does not support handing out crack pipes.” Councillor Monette CBC News, 27 July, 2007 OHTN SLI 2009 PPP CRACk

Political Resistance Campaign for a Common Sense Drug Policy organized by Libby Davies, MP Vancouver East and NDP Spokesperson for Drug Policy to send petition to Stephen Harper “I support InSite and other important harm reduction programs. Drug use must be addressed as a public health issue.” “I urge you to extend the permit for Insite, and ensure harm reduction is an ongoing part of Canada’s National Drug Strategy.” Libby Davies Campaign for a Common Sense Drug Policy: Harm Reduction Alert OHTN SLI 2009 PPP CRACk

Individual Resistance High school teacher Rob MacLeod bought a domain name and set up a website seeking donations to keep the program running. “I am not going to let it fail. If I personally have to stand on the street corner in downtown Ottawa and hand out safer inhalation kits, I am going to do it.” Ottawa Citizen, 17 July 2007 CTV News, 20 July 2007 OHTN SLI 2009 PPP CRACk

Safer Crack-smoking Kit OHTN SLI 2009 PPP CRACk

Harms Associated with Smoking Crack OHTN SLI 2009 PPP CRACk

Harms Associated with Smoking Crack OHTN SLI 2009 PPP CRACk

Production of Harm  Crack is my drug of choice, I can’t quit and now I can’t get pipes, so I make them  I’ll make a pipe out of a pop can for example  I use dirty stems if I have to  It’s too hard to be running around to find pipes, so I find alternatives  I always borrow, if I don’t have crack smoking equipment  I’m now using a medicine bottle as a pipe  I’m handicapped and in a wheelchair and the van won’t deliver me pipes anymore  I’m at the point where I’ll use anything to smoke with  Convenience is key - when the Site (NEP) was close that’s great - but if not sharing takes place  It’s easier to get needles than stems  Back to syringes ‘cause there are no clean pipes OHTN SLI 2009 PPP CRACk