Finally some hope in AIDS wars
by Margret Kopala

Published in the Ottawa Citizen, August 12, 2006

Prime Minister Stephen Harper won’t be attending the AIDS conference and so far, too, he’s declined a visit to North America’s first safe injection site. Located in Vancouver’s downtown eastside, the scientific research pilot known as Insite will close on September 12th if its mandate isn’t extended.

More important than Mr. Harper’s absence will be the absence in either locale of discussion about human agency or personal responsibility. These, finally, may be humanity’s best hope in the wars against an AIDS virus and substance-abuse problem whose capacity to mutate, replicate and find new markets knows no bounds.

To be sure, the efforts of science and law enforcement in these wars are considerable and cannot be diminished. But a startling new book by a British writer and psychiatrist experienced in general hospital and prison work shows we’re seeking answers in the wrong places. While the central thesis of Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy by Theodore Dalrymple has implications for the AIDS war, its principal target is the thinking behind facilities like Vancouver’s Insite.

Insite is Canada’s poster organization for the provision of supervised facilities where addicts can inject their own drugs and access services. Its primary objective is so-called ‘harm reduction’, that is, the reduction of incidences of overdose, disease, crime, and shooting-up detritus. According to its advocates, Insite is a resounding success with peer reviewed, measurable data in all areas to support their case.

But behind this sanitized picture a disturbing reality nags. Harm reduction policy is inherently infantilizing, says Dalrymple, because it assumes the authorities ought to be responsible for the negative results of chosen behaviours. “If consequences are removed from enough actions, the very concept of human agency evaporates …”

If treating people as “inanimate objects rather than as agents of their own destiny” isn’t bad enough, Dalrymple presents yet more disturbing arguments, among them that opiates have been dishonestly romanticized by writers like Coleridge and De Quincy and that heroin use is a consequence, not a cause, of crime. His most eye-popping revelation? Heroin withdrawal is trivial compared with the real dangers of alcohol withdrawal. Most addicts and, he says, most doctors, know this.

Progress is difficult because of the self-serving nature of bureaucracies but the general public is complicit too. The blamelessness of victim groups confers on it high moral standing and absolution for its own weaknesses while at the heart of the issue is an existential angst that afflicts everyone. “The temptation to obscure life’s (difficulties) by means of chemically induced oblivion has always been, and will always be, great,” writes Dalrymple, “at least until the meaning of life has been found once and for all.”

Most vulnerable are those believing that immediate satisfaction of personal desires is the only good, but with no prospects for its realization. Disaffected, they lack either interests or the consolation of intellectual, cultural or religious pursuits.

“The addict has a problem,” says Dalrymple, “but it is not a medical one: he does not know how to live.” Instead, he pursues his daily fix, which at least keeps him busy.

Arguments to legalize drugs merely suggest the cause of crime is the existence of laws, he says, while comparisons with the prohibition era are simply invalid. Subject to abuse to be sure, alcohol use is supported by established custom in a way that other substances are not. Is the war on drugs winnable? No, but neither is the war on death and no one’s given up that fight. But we should definitely close the clinics which institutionalize bad romantic ideas, and end the pretense addicts are ill and need treatment.

Like the war on drugs, the war on AIDS must continue. Unlike addiction, AIDS is a real disease which humanitarian effort must address. Yet funding treatment that often results in the willful transmission of disease to multiple partners presents another challenge and here Dalrymple’s arguments warrant consideration. In Canada such behaviour is illegal but in Africa and India where AIDS runs rampant, we apparently believe inhabitants are incapable of making responsible decisions about their behaviour and that drugs and condoms will solve the problem. Like safe injection ‘harm reduction’ policies, this denies human agency, insults their dignity and smacks ominously of a soft totalitarian entry by the western world into a new era of third world colonialism.

MARGRET KOPALA’s column on western perspectives appears every other week.

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