Why I Help Addicts Shoot Up: A Christian Defense of Harm Reduction

About a decade ago, a brilliant young nurse who was studying with us at Regent College engaged me on the question of harm reduction to addicts. In particular, she talked to me about where she worked: InSite, Vancouver’s innovative safe-injection house in the city’s notorious downtown east side.

My initial reaction was dumb shock: How could such a serious Christian person, and a health care professional, possibly conspire in helping addicts shoot up? But as we talked, and as Meera cleverly used some of my own ethics against me (from what I was teaching, which would become Making the Best of It), I was persuaded.

I was all the more persuaded when I found out that other staff members were connected with Regent or with other Christian schools in Canada.

Once persuaded, I wanted to spread the word, and so did Meera. So we wrote an article for ChristianWeek, at the time a significant national newspaper for Christians. The article got noticed, and received a national award.

Alas, it has vanished from the online archive of ChristianWeekSo Meera kindly supplied me with an electronic version of it and I’m putting it up here for consultation by others who are wrestling with these issues…especially as they are being considered across Canada and elsewhere.

And for citations of the scholarship justifying InSite, please consult Meera’s weblog here.

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Why I Help Addicts Shoot Up: A Christian Defense of Harm Reduction

by Meera Bai with John Stackhouse

[Originally published in ChristianWeek, October 15, 2010]

It’s evening, and I’m walking where a middle-class, university-educated woman normally wouldn’t walk alone, if ever. I’m in Vancouver’s Downtown East Side (DTES), home to the poorest postal code in Canada. And I’m going to work.

I approach the electronically secured doors at my job, and a staff member buzzes me in past what to most readers of this magazine would appear to be a mess of ragged people, dirty bicycles, and bottle-filled shopping carts. I work at InSite, Vancouver’s supervised injection site for IV drug users. It’s where I choose to work as a nurse—and as a Christian. Trying to follow the command of God to seek out and care for those in need of mercy has led me to find grace and pass it on among these people in the streets of the Downtown Eastside, the very definition of a marginalized population.

Walking through the waiting area and entering the injection room, I chat briefly with the day staff, asking them how their shift has gone. “There’s some bad dope going around,” one of them says. Some dealer has laced the heroin. Drug dealers often take advantage of people living with addictions, knowing that they will buy and use drugs even though they know there is a chance they may overdose or be hurt by contamination. Instead of allowing such people to die on the street, however, InSite staff have intervened in hundreds of overdoses, bad trips, and poisonings, preventing every single potential death on InSite ground.

A participant walks up to me and gives me a hug. She comes in to use drugs multiple times in a day to feed the habit gnawing away at her. The previous week, she had overdosed and stopped breathing, her whole body shaking with a seizure. Now, she has returned to thank us. “You guys saved my life!” Then she adds, more quietly, “Sometimes I think that’s not worth anything – what’s the point? I’m just gonna use again anyways.” A moment passes, and her face brightens a little. “Well, at least I got hope, I got another day, another start, another chance.” This is a woman who understands grace.

Something about seeing people at their lowest and most desperate, half-clothed from turning tricks for drugs while hating themselves for it, opens into a profound level of intimacy. I am blessed to enter the darkest place of people whose sins are far more public than those of the rest of us. Constant humiliation makes the people I work with especially vulnerable, and vulnerable in almost every way: to violence, to exploitation, to false hope, and finally to despair. When allowed into these dark places of other human beings, it is my privilege, and that of all InSite staff, to communicate worth and love instead of judgment and scorn.

The day nurse asks me to keep an eye out for a specific participant – a regular who comes in several times a day. She hadn’t been seen yet. Later that night, the woman finally comes in, and she’s beaming. “I went to see my daughter today! And I didn’t use all day! F—, soon I’m gonna get off this s—!” We break out in applause and cheers, celebrating her triumphs with her—as she mixes her drugs to take in a few minutes in our facility. Other participants in the room are excited as well; two of them come over to hug her.

Another regular later chats with me in the treatment room as I dress his abscess, trying not to cringe away from the overwhelming odour he emanates. “It would have been my anniversary with my wife today, if she hadn’t gone missing. We’ve both been down and out, but she took care of me out here. Now, I got nobody to talk to. This is the first human touch I’ve had today.” I look up, startled. I am wearing gloves, holding my breath, cleaning his sores with a 10-inch sterile Q-tip. Even this, my deficient attempt to heal, is taken as love by a man desperate for human connection. I am ashamed.

I finish dressing the wound, clean up, remove my gloves, and give him a hug. I hop up on the treatment bench next to him and we sit together and talk for another fifteen minutes: about life, love, and faith. He says good-bye, and then asks for a referral to an exit program. I give it to him. He knows the referral is merely one point along our journey together, and that I will listen to his story whether he goes to the program or not. As a Christian, I know that his life is part of God’s real story of redemption. InSite is one of the few places where I get to hear it openly spoken, with trust, without judgment.

Having witnessed three generations of the same family shoot up in the same room, I have come to understand that injection drug use is far from being the result of one bad decision. It is the outcome of a complex of systemic, familial, and individual influences that must not be oversimplified to “It’s their fault. They should just quit and get a job.” I am still shocked by the stories of abuse that I hear at InSite. Some of the people I respect the most in my life are injection drug users. Having heard what they have survived, I realize that they have far more strength then they are usually given credit for. I can understand why they turn to drugs as a coping mechanism amid the devastation they have endured. Dulling the pain has become a way of survival for many who come to InSite. Appreciating this simple fact leads to love and compassion, which leads to grace, given as freely as it has been received.

Often, participants at InSite are forced to sleep outside at night. Not having a warm, safe bed takes its toll on bodies, and special care is needed for feet. An InSite staff member chats with me behind the desk as he fills up a basin of warm, soapy water. Kneeling on the floor, he gently strips damp socks off the swollen foot of a participant and lowers it into the soothing water. Washing feet here isn’t an oddity from a discomfiting Bible story, but a regular occurrence. Foot baths are healing – for body and soul. As I fill up another basin, I marvel at the timelessness of this act of community. The humility necessary for all involved in washing feet produces beautiful vulnerability and relationship, which, unsurprisingly, creates change.

So why am I here? Aren’t I enabling drug users to continue their awful habits? Aren’t I wasting charitable funds that could be directed to other projects (and, let’s acknowledge the implication, more “worthy” recipients)?

InSite has been shown to be a successful public health initiative in over 30 scientific research reports published in peer-reviewed medical journals. Such reports demonstrate that InSite users are more likely to seek long-term addiction treatment and to stay off the street, than users who choose to inject outside. The HIV rates in the DTES are on par with many African nations. Such blood-borne diseases are spread by sharing needles –something that is banned at InSite. And instead of using puddle water from urine-soaked alleys, participants are provided with sterile water, which reduces various kinds of horrific infection.

Clean supplies, safe rooms, friendly staff supervision during injection, and compassionate nursing care help injection drug users to learn how to value their bodies, and thus themselves, even as our society generally tells them they are worse than useless. The choice to stop using drugs is a decision that many addicts cannot even imagine making, but InSite provides reachable steps toward a healthier life, offering participants a chance at redemption of both body and soul.

Despite the overwhelming evidence in support of Insite, however, it is currently having to fight before the Supreme Court of Canada for the right to stay open. The Harper government—one supported by many otherwise compassionate Christians—has been seeking to shut down this initiative, pressing its case at tremendous expense despite losing in lower courts.

Why are they doing so? It is part of their policy to turn away from harm reduction and put more money instead into policing and prisons. Better, it seems, to spend much far more money locking up addicts or filling up waiting rooms in the ER, than making their difficult lives a little easier, a little safer, a little more graced by care.

The potential loss of this pioneering charitable work, the first supervised injection site in North America, should alarm Christians. Participating in God’s redemption of Canada requires a multi-pronged approach, one that must include the basic principle of harm reduction. Do we wish all addicts were off drugs and healthily contributing to society? Of course we do. But wishing don’t make it so. And in the real world—the only world there is and the world Christ calls us to love—sometimes the best we can do, at least immediately, is make things less bad—and in the case of InSite, much less bad.

InSite offers more than that, however. InSite offers not only the great gift of harm reduction, but the greater gifts of recognition, compassion, stability, safety, and hope. In short, it offers love to people not well loved by Canadian society—or by most Canadian churches.

The Harper government must stop its wrongheaded hostility to InSite. Instead, it should look at why so many Christians, as well as other citizens, support it, and then work with municipalities to multiply it wherever necessary—along with, of course, proper funding for public safety, mental health, homes for the homeless, and a judicial and policing system that will come down harder on drug pushers and pimps. Will you tell your MP that the Harper government should drop its opposition and instead support InSite?

Near the end of my shift, I watch in horror as a regular participant stabs wildly into his neck with a needle. He has been trying desperately to inject into his neck in order to find his jugular vein. When I intervene, he consents to letting me try to find him one in his arm. Midway through, however, he changes his mind and grabs my arm. “Don’t!” he says. “I’m not worth it.”

I look him in the eye. “Yes, you are.”

He glares at me . . . and holds out his arm. I tie the tourniquet wordlessly and find him a much safer vein. He injects himself, and then gruffly thanks me, tears welling up in eyes that refuse to meet mine.

This is grace, manifest in care of desperate persons, flesh and spirit. This is harm reduction. And I do it because it is simply the Christian thing to do.

 

–Meera Bai is currently studying at the University of Calgary Medical School

22 Responses to “Why I Help Addicts Shoot Up: A Christian Defense of Harm Reduction”

  1. Paul

    Congratulations on your promotion of the enablement culture which has done a wonderful job of destroying the downtown east side and those who live there. As I have told you before your efforts are part and parcel of creating an ethos which has destroyed thousands including members of my family. The road to hell . . .

    • John

      Sorry, Paul, but I trust Meera and the other nurses I’ve known at InSite and I trust the judgment of the many peer-reviewed studies that back it up. I’m sorry for the pain in your life and in your family, and of course no one way to treat addiction is sufficient. But I’ve got to go with what makes sense to me, just as you have to say what you feel you need to say.

      • Paul

        John your trust is grossly misplaced, and this is one of the many examples of how peer-review has nothing to do with the protection of the integrity of research, but instead protects fashionable unquestionable orthodoxies. The irreproducibility of approximately 50% of “social science” “studies” demonstrates how intellectually bankrupt this propaganda is. The truth is there if you want to know it in the references I provided.

  2. Jim

    Hi Paul,

    Saving lives is not enabling but grace in action. John 8.7 comes to mind: But when they persisted in asking Him, He straightened up, and said to them, “He who is without sin among you, let him be the first to throw a stone at her.” 8And again He stooped down, and wrote on the ground.

  3. Jim

    Hi Paul, real propaganda from the BC Coroners Service. A little outdated but facts just the facts;

    BC Coroners Service overdose deaths:

    There were over 1,200 overdose deaths specified as due to illicit drugs and involving males, compared with 400 involving females in BC between 2004 and 2010.

    Overdoses at InSite supervised injection site:

    There were a total of 778 overdose events at InSite between 2004 and 2010. Of the total number, 589 or 76% involved injected heroin. Naloxone, the medical intervention used to treat serious overdoses, was administered for 256 individual visits and nearly 90% of the time it was used to treat heroin overdoses. There have been no fatal overdoses at InSite to date.

  4. Michael

    First off, many thanks for reposting. Yes, you’re reposting for archiving purposes, but it is also an issue we do need to continue to struggle with (Philippians 2:12). Certainly, it is for me.

    Having finished my first 30-year career I now find myself having recently completed my graduate work and looking forward to a residency and eventual licensure as a Professional Counselor. While my exposure to date with addicts has not been extensive I have had enough experience to be troubled by this post on two fronts: first, harm reduction with regard directly to addicts; second, “harm reduction” as it applies in other situations where it often becomes the first step off the ledge and on to the slippery slope.

    When I say “troubled” I mean it in a variety of ways: first, the science behind Meera’s plea is lacking (which is what I suspect prompted, at least to some extent, Paul’s responses). Second, is this a political argument or a Christian plea? Finally (and as I mentioned at the start of my comments), because I continue to struggle with this issue as both a counselor and a Christian.

    With regard to harm reduction as it applies directly to addicts, it would have been interesting to read a bit about whether InSite assesses/assessed its clientele’s “motivation to change” (perhaps this answer and others will be found once I explore the provided link, but let’s proceed if only for the sake of discussion). To my mind, “motivation to change” is the central element in the life of an addict and no model better addresses “the where” than Prochaska’s & DiClemente’s Trans-Theoretical Model (TTM). The TTM speakspeaks to five stages of change where the first, “precontemplation,” describes the state of many (some might argue, most) addicts. In this stage, for whatever reason, addicts have no interest in moving out of their current state. The TTM posits that it is only when an addict moves from “precontemplation” to “contemplation” (i.e., the addict gains some insight that there may be a benefit to change) that there is any chance of kicking the addictive behavior.

    So the goal of the counseling process for those in the “precontemplative stage” is to try to ignite a spark that encourages some sense of reflection or insight. But work when an addict is at this point in his/her life results far more in failure than success (because addicts who are “precontemplative” generally are in counseling only because they have been mandated to be there and are not concentrating on insight; rather, they are concentrating on how best to “check the box” and get back out on the street). It is the very small minority of addicts who move out of the “precontemplative” stage (why this is so is the subject for an entirely different, but equally as impassioned, discussion).

    If the addict is fortunate enough to move from “precontemplation” to “contemplation” the goal of the counseling process is to reinforce this new-found insight for change. In the end, an addict’s self-motivation is the key (see Miller and Rollnick, “Motivational Interviewing” (MI)) and as such, key to whether Meera makes her case.

    Does/did InSite assess their clientele to determine desire to change? Or were all treated “equally”? If InSite continued to provide needles (and drugs?) to those who were “precontemplative” I wonder what good was actually being done. In fact, since the “precontemplative” addict is certain that life is better as an addict than it could/would be not being an addict, InSite’s policy may have actually wound up being not harm reducing; rather, one could argue the policy is/was “harm maintaining” (even “harm increasing”) because InSite is reinforcing “precontemplative” behavior.

    With regard to “harm reduction” and the “slippery slope” I struggle with the question of why shouldn’t Meera’s impassioned plea to help the addict inject in a safe place be applied to other issues Christians face? Why shouldn’t, then, a Christian support abortion? After all, wouldn’t that be how we as Christians could best show our love: by ensuring that a woman has access to a safe facility to deal with her issue/emergency? Why shouldn’t Christians, in the name of “harm reduction,” support the providing of condoms (and other birth control measures, to include RU-486) to our children so that they can have sex in a safe way? Or for that matter, encourage our children to have sex in our homes/bedrooms so they can have sex in a safe place? Isn’t the argument “in support of” the same in each case? That “safe” trumps “responsibility” or “consequences”? I have answers, but none of them completely satisfactory….

    If Meera is angry at her government, then this isn’t a Christian (theology and ethics) issue, it’s a public health and public policy debate. If she’s angry at her fellow Christians for a general lack of compassion and/or lack of extending grace, then I think we need to have a larger discussion of what grace is and how it best plays out. But in the end, what Meera really seems to want us to understand and agree with is her belief that she is doing God’s work in helping addicts shoot up. At this point, I just don’t find her arguments “in favor of” compelling (yet). To my mind, the idea behind the TTM, MI, and other addictions research/theories/models for Christians to remeber is that how one extends grace (or whether grace is actually being extended) depends very much on where the addict is “at” (it is a major tenet of the counseling profession to “meet the client where they are (at)”). If Meera (and by extension, InSite) is/was taking that into consideration, then I’m on board because then the goal of InSite is/was to eventually move the addict out of “precontemplation” through “contemplation” and “preparation” to “action,” “maintenace,” and “termination” (the discontinuation of the addictive behavior). If not (and the meaning of “harm reduction” and “change” and “grace” and “worth and love instead of judgment and scorn” means that InSite continues only to provide addicts with a safe, clean place to continue being addicts), then I’m not on-board: Meera would then seem to be rallying the troops to support a cause that very well may be causing the very thing she claims to be fighting against.

    My apologies for this long comment. I may not be correct to any degree with regard to any of my thoughts or views and I may well be all over the board with this post. But I do appreciate the chance to think about a very difficult topic, for the blessings that gave me time and equipment to try to put these thoughts into some reasonably-readable form, and for the opportunity to post some thoughts. In the end, “grace” is a very thin, very sharp knife edge we all dance upon. As such, I continue to try to be a better and more attentive dancer. For better or for worse, thank you for letting me be part of the discussion.

    • John

      Time does not permit me a full-length response to this comment.

      1. The science you seem to have overlooked is in the peer-reviewed literature Meera cites on the weblog page to which I direct readers before the beginning of the article. The fact that Paul prefers books published by houses not exactly foremost in scientific or social-scientific publishing is his choice, but hardly will sway the discerning reader. And while I share his skepticism about a lot of published research, I don’t see why these studies ought to be discounted, especially since his grounds for dismissing them is…his disagreement with them.

      2. If you can’t see the difference between helping an addict avoid a high risk of death by shooting up unsupervised and facilitating the abortion of an innocent child, then we can’t converse about these things. Offering sexually active people non-abortive contraceptives and prophylactics against disease does, it seems to me, offer a closer parallel to the basic principle of “harm reduction.” And, just like InSite, which is located within a series of other services, such an offering should be done within a context of other services as well (such as sex education, counselling, and so on). Each case, then, needs to be assessed on its own terms.

      3. Meera Bai and I are concerned to inform Christians about a public policy issue so that we can engage the issue as citizens and as neighbours. Thus theology, ethics, and politics intersect, and that’s why we wrote what we did to a Canadian Christian audience. I don’t understand your confusion about this point. For you to make this about her, as if she wrote this article for self-validation, seems to me both disrespectful and, frankly, dumb. Why would I write it with her? Why would she bother taking *this* route to self-validation? I suggest that you owe Meera an apology, and that you take the article for what it obviously is: the gift of a person with graduate-level theological education, substantial medical education, and pertinent experience teaming up with an ethicist to help fellow believers think better about a matter literally of life and death. You can disagree with it, but you shouldn’t assail the authors’ intentions without much, much better proof.

    • Jim

      Michael, how do you manage to dance around the body count?

    • Paul

      Hi Michael, well put. Welcome to the psychological community. If you are in the Vancouver area, it would be great to meet you some time. I began working with addicts in the early ’70’s in Kabul, Peshawar, New Delhi, and Kathmandu. I currently specialize in working with first responders. Thanks for your important contribution here.

    • Cindy Nelson

      Insite

      If you had worked in this field as long as I have, a commenter on anything having to do with the addicted population – whose first sentence is “While my exposure to date with addicts has not been extensive…” would cause you to pause, bow your head in humility – maybe not so much older but a whole lot wiser and remember when you thought it was that simple – that there was an answer, a formula a way.
      It wasn’t too long before I realized “Dorothy we’re not in Kansas anymore – I’m in the Matrix deciding whether to take the red or blue pill – and when asked about my success rate my answer would never be in percentage but in “what’s your definition of success”
      Also remember that Harm Reduction is not a “moral concept” It is something we do every day to reduce the risk of harm; seat belts, car seats, vaccinations, mammograms.
      In terms of research please read a little more – explore – look at how Portugal is dealing with their substance use problems – Read how death rates, communicable disease rates, crime rates, Overdose rates go down – and amazingly so does substance use. There’s something about spending time every day with someone that welcomes you with a warm smile, asks about your life and family WHILE injecting you with Heroin absent any judgment. When there’s no pressure to stop using then you can entertain what its like to not.
      And why does a political or Christian argument have to be mutually exclusive? Why can’t they both be Christlike?
      I have to giggle when you wonder if Insite assesses for Motivation to Change. If done properly that’s all this field ever does is assess – and it’s NEVER going to be a straight line and if by chance you find a hint of a straight line get ready – because it’s about to veer off.
      I have clients come into program in the Action Stage – successfully complete and come back court ordered 6 months later go through the same intake process and tell me “I have some reservations. I found out I really don’t want to stop using but I do want to stop getting into troubled’
      I have clients come to me in the Pre-Contemplation Stage – do the program to satisfy their legal issues never move into another Stage HOWEVER they have just put together a year of sobriety.
      I have clients on their sixth round of treatment have hit every Stage of Change at least twice in those six times leave the program for their sixth “successful” try and say – Hey – “One day at a time – I hope I don’t see you but if I do, I do.
      Am I cynical – not EVEN close. I’m realistic. My definition of success is broad and deep and I keep getting stretched broader and deeper every year I work in this field. I’ve always known it’s about the journey not the destination – but even that has drastically changed for me. When my clients say to me, “It must be very frustrating working with people like me.” I look them straight in the eye – “If I’m frustrated that’s my problems – it probably means I need to take a nap.”
      I guess my question to the assessor is when the client is in “any” stage of motivation are “you” okay with it. Read Motivational Interviewing enough and you realize this therapy modality has a lot more to do with the therapist than the client. Why? Ironically Because it’s about the client not the therapist. The therapist is the one that constantly needs to be in check – sit still – listen – pick up on the small things – NO ADVICE (and how absolutely excruciating is that) The hardest thing is most of the time we do know the right thing – but it doesn’t matter if the client isn’t there with us. If there’s a sniper on the street we all know the right thing to do is get out of harm’s way. How does a one year old who just learned how to walk do that without the help of a full grown adult that has the ability to run for his life?
      Be very careful when you say “So the goal of the counseling process for those in the “precontemplative stage” is to try to ignite a spark that encourages some sense of reflection or insight. THE THERAPIST DOES NOT IGNITE THE SPARK – WE FAN THE FLAME –
      But work when an addict is at this point in his/her life results far more in failure than success; AGAIN WHAT IS YOUR DEFINITION OF FAILURE OR SUCCESS (because addicts who are “precontemplative” generally are in counseling only because they have been mandated to be there and are not concentrating on insight; rather, they are concentrating on how best to “check the box” and get back out on the street). THE MAJORITY OF MY CLIENTS ARE MANDATED – COME IN THE BEGINNING AND CHECK THE BOXES AND GO ON TO DO WONDERFUL THINGS – PARTLY BECAUSE THEY ARE FINALLY IN REALTIONSHIP AND COMMUNITY – It is the very small minority of addicts who move out of the “precontemplative” stage (why this is so is the subject for an entirely different, but equally as impassioned, discussion). WHEN YOU WORK IN THIS FIELD YOU WILL FIND “A VERY SMALL MINORITY” WILL TAKE ON A WHOLE DIFFERENT DEFINTION FOR YOU
      Your question -If InSite continued to provide needles (and drugs?) to those who were “precontemplative” I wonder what good was actually being done Actual “good being done?” A clean environment vs a back alley – sterile needles and cotton as opposed re-used needles and cotton – a nurse finding a vein versus you or your friend – a human being that Jesus came to save with one more day to get just that – And wouldn’t Jesus do the same – but then we are AGAIN defining “what’s good.”
      I will save the comparison on safe injection sites to abortion for a later time
      Your statement “If Meera (and by extension, InSite) is/was taking that into consideration, then I’m on board because then the goal of InSite is/was to eventually move the addict out of “precontemplation” through “contemplation” and “preparation” to “action,” “maintenace,” and “termination” (the discontinuation of the addictive behavior). IT WOULD BE ALL OUR WISH WHO WORK IN THE ADDICTION FIELD TO GET TO TERMINATION – BUT WE WHO WORK IN THE FIELD KNOW WE WILL LOSE OUR MINDS IF WE WAIT FOR THAT MAGICAL MOMENT TO MAKE OUR WORK WORTH IT. It’s like saying as a Christian I’m waiting for my sanctification to be finished – not in this life
      I challenge everybody on either side of this debate to read Gabor Mate’s book “In The Realm of Hungry Ghosts” Whether you change your mind on safe injection site or not it can give you a good idea of what goes on in the background of the world of the addicted person

      • Michael

        Hi Cindy;

        I’ve heard it said that the first task is to be understood. Maybe true, but I learned from this experience (of posting) that the first task is to make sure readers understand that the writer is trying to accomplish this first task of understanding. It seems I failed miserably all the way around.

        Having re-read what I wrote I get that people think I was being critical of the InSite project. Certainly would have been my right to be so, but the point of my post was something quite different: it was written to speak aloud all the things I am trying to sort through as a stream of consciousness type of post. In the end, my comments were intended to have been read as questions not as statements or accusations.

        In the end, poor choice on my part to write what I wrote in the unclear manner I wrote it in. Not sure what else I can say other than I regret the whole experience. If Dr. Stackhouse has a way of deleting my comment/thread I ask him to do so. It wasn’t worth it.

        • John

          I think lots of people have benefited from the back-and-forth in this exchange, so I’m grateful to everyone who has participated in it…and we can hope that everyone who reads will read with charity: We’re all just doing our best to deal with a vexed and vexing set of issues.

        • Michael

          Typo this time around with cut & paste (as I get used to a new phone). First line of my reply to Cindy should have read, “…first task is to understand” (not “to be understood”). Aargh & ugh; new technologies….

          • Jim

            Hi Michael,

            On humorous note, if I dare (this ones for you John) quote a Mel Gibson movie line; “In order to find his equal an Irish man is forced to talk with God”. I seem to be at an advantage….but we are all working out our sanctification (growing pains) so no need to be unduly hard on yourself brother as it is evident that your heart is in the right place.

            Warmest regards.

  5. Fions McGregor

    I’m interested and glad to read your reposting of this article John. I remember feeling excited about your comments when you raised them initially feeling glad that someone from our community was finally addressing the issue thoughtfully.

    Paul, I’m not sure how John is reinforcing the enablement culture? When Insite was first considered it was to fight the number of overdose deaths that Larry Campbell saw as coroner before he became mayor of Vancouver. He wanted a four pillars approach which has been seen as quite incomplete in its implementation. The four pillars consisted of prevention, treatment, (law) enforcement and harm reduction. It is quite widely accepted that these are not given the same effort in society.

    There is no doubt that there is quite insufficient treatment for the needs available. When I visited Insite I was told about the insufficient detox and treatment beds available for the number of individuals requesting help EVERY day. The use of stages of change is totally accepted as a tool for readiness throughout addiction training and assessment and would have been used to decide who gets those beds, Michael. However that is not appropriate for those who use the Insite facility, the focus there is on harm reduction. However the research does show – I’m happy to supply references – that more people request help and indeed achieve sobriety as a result of Insite. Why? Possibly because some of the frequent users make relationships with the staff and want something better once they allow themselves to make relationships.

    Finally to respond to the negative criticism. Has anyone any idea how difficult it is to become clean? Most individuals know no other lifestyle. Generally individuals come from families with generations of addiction. Addiction is an incredibly heritable disorder – again references supplied on request – individuals have limited friends outside the social circle. Individuals have to try and forge a new life in an entirely foreign environment. Jackie Pullinger who worked with addicts in Hog Kong talked about the difficulty of engaging with these people with such broken lives and the tears involved.

    To the best of my knowledge, the prevention of addiction has not been seriously addressed. When I first started to seriously study addiction and learned that chimpanzees at the bottom of the social ladder were the ones who became addicted – not the ones at the top of the hierarchy when all were exposed to unlimited cocaine and I learned of the manyother studies demonstrating that those who have suffered traumatized and neglectful childhoods are the ones who become addicted – what have we as a society done to help those who grow up in such situations? I am not aware of any churches who take on enormous numbers of abused children and are there for them through thick and thin giving them the love they need despite their difficult behaviour. Similarly secular society does little.

    I am so puzzled by Michael’s assertion that there is no evidence for Meara’s assertions. Insite has been studied inside out. Please let me know if there are any further information that would be helpful.

    In the meantime common sense tells us that nobody who takes cocaine or heroin wishes to become an addict. There are too many tobacco addicts with the same tale. Neuroscience has demonstrated the changes to the brain as a result of repeated use and the vulnerability of brains that have gone through trauma and childhood neglect. This is not an issue of pulling oneself together and just getting over it. Addiction is the worst disease in the world and I am thankful I do not have that great vulnerability. My friend on her death bed told me that cancer was not as bad as depression – well addiction is one step worse from my observation of individuals’ sufferings.

    • John

      As I indicated above, Paul, I am sympathetic to skepticism regarding published research. I even cite some of the same sources in my book on epistemology, “Need to Know.” Still, unless we want to withdraw into our homes trusting nothing and no one, there are indeed ways–such as multifactorial, cross-sourced confirmation–to be more reasonably confident than less. When two students at Regent who have extensive experience at InSite testify to me of their experience, and that coincides with all of the scientific research available, and the logic of the situation makes sense to me (e.g., leaving someone to shoot up in an alley, and probably die, is worse than helping him not die), then I have grounds to be confident. The contrary grounds in my experience have been furnished by angry people who have some personal experiences in *other* aspects of addiction who show no signs of taking InSite seriously as a possible *part* of a much larger response to addiction. They might be right–How could I know? But the balance of likelihood seems, in my view, strongly the other way. So I write as I do…until convinced otherwise.

  6. Paul

    Sorry John, in order to know, you first have to want to know.

    When you misrepresent those who disagree with you, when you dismiss counter evidence, not based on its content, but simply on the basis of where it is published, when you disregard those who disagree simply because they are “angry” with no reference to why they are angry, you give the distinct impression that you really don’t want to know.

    Helping someone OD (in some cases repeatedly) with impunity is not saving their life, it is promoting and prolonging their death.

    Assisting someone to continue to engage in self destructive behaviours is not grace, it is to become a co-conspirator in their self destruction, and the destruction of those around them.

    The symbiotic relationship between addicts and those who enable them has been long known and well examined. It is known as codependence. Close examination reveals that it is not about what is best for the addict, but about how the enabler needs to feel about themselves as self appointed saviour. In my experience with co-dependents they confuse compassion with a self serving sentimentality. Sentimentality is not compassion, but sanctimonious self absorption most often for the sense of self righteousness on the part of the self appointed saviour, rather than what is truly beneficial for the one needing help.

    InSite is codependency writ large, institutionalized, if you will.

    It has been said:

    If an addict loves you
    you are probably enabling them. . .

    If they hate you,
    you are probably saving their life.

    The problems with the so-called “science” have been well documented, and while Insite proponents have ridiculed and denounced them using one form of the genetic fallacy or another, they have never refuted those objections. In fact if the criteria they use to dismiss the concerns about their methodology were valid, all of their “scientific” articles would be eliminated because they were all written by InSite advocates.

    To dismiss, as InSite proponents do, without examination contrary evidence simply on the basis of where it is published, it the epitome of intellectual dishonesty.

    As we learned from Viet Nam and other places, the “body count” does not tell the whole story.

    It is one thing to take a moral stance where you are the one having to deal with the consequences of that position, but to take a position which requires all the heavy lifting to be done by those who strongly disagree with your position is the epitome of hypocrisy.

    The irony is that those who have to do the heavy lifting to deal with the consequences of your moral posturing are those whose views your disregard. They know from having to deal with the realities the bankruptcy of the position you are so desperately trying to maintain.

    I do not expect to convince you. You seem to have done an excellent job of demonstrating that you are not, in any meaningful sense of the word, convincable. This information is provided for those who may wish to understand why they do not want to collaborate with the destruction you are promoting and perpetuating.

    • John

      Sorry you feel you haven’t been heard, Paul, unless you think that “hearing” you means “coming to agree with you”–while not minding the insulting way you keep putting things. But I’ll leave your comment here because I don’t want to silence you even in this situation, and I hope the truth about InSite will emerge for those who need to know it.

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