Digitized by the Internet Archive in 2017 with funding from University of Toronto https://archive.org/details/5thinternational02inte ^^INTERNATIONAL CONFERENCE ON THE REDUCTION 5 OF DRUG RELATED HARM Toronto, Ontario, Canada March 6-10, 1994 CONVENING ORGANIZATIONS Addiction Research Foundation Canadian Centre on SubstanceAbuse Mersey Drug Training and Information Centre Province of British Columbia Province ofQuebec CONTRIBUTING SPONSORS Wegratefullyacknowledgethecontributionsofresourcesfromthefollowingorganizations: CityofToronto Health Canada Canadian Airlines Metropolitan Toronto Solicitor General-Canada American Airlines Partnersin ))111Canada'sdrugstrategy PROGRAM COMMITTEE Julie Bruneau, Province ofQuebec Patricia Erickson, Addiction Research Foundation (co-chair) Jackie Ferris, Addiction Research Foundation Wayne Mitic, Province of British Columbia Pat Q’Hare, Mersey Drug Training and Information Centre Diane Riley, Canadian Centre on SubstanceAbuse Robin Room, Addiction Research Foundation (co-chair) Eric Single, Canadian Centre on SubstanceAbuse ORGANIZING COMMITTEE Pamela Fralick, Canadian Centre on SubstanceAbuse (co-chair) Pat Q’Hare, Mersey Drug Training and Information Centre (co-chair) Diane Riley, Canadian Centre on SubstanceAbuse Robin Room, Addiction Research Foundation CONFERENCE SERVICES Assistance in organizing the conference has been provided by Ruth Abrahamson and hercolleagues at Base Services, Inc. AsAddiction Research Foundation staff, Mariella De Filippo and Sharon Airhart played substantial roles in the preparatory workforthe conference. CONFERENCE INFORMATION L HARM REDUCTION IN 1994 - 1 This International Conference on the Reduction of Drug Related Harm is the first to meet in the Americas. Previous meetings in the series have been held in Liverpool, England; Barcelona, Spain; Melbourne, Australia; and Rotterdam, the Netherlands. The concept of harm reduction became common currency in the context of criminalized drugs in the late 1980s in response to two particular pressures. The first was the problem of HIV infection among injecting drug users. The second was a growing suspicion that the strategies adopted in many societies to deal with drug use often exacerbated the problems, rather than ameliorating them. HARM REDUCTION AS A RESPONSETO URGENT NEEDS Preventing the spread of HIV among injectiondrug users andtheir partners, it was argued, justified bold measures, even ifthe measures acknowledged and might appearto condone injection drug use. One such measure was making sterile syringesavailableto intravenousdrug users, through needle exchangesand other means. Bythe mid-19S0s, such approaches had been adopted in Merseyside in England, in the Netherlands, and inAustralia. Bythe late 1980sthese approaches had also been adopted in some cities in Canadaand the United States. These harm reduction initiatives motivated bythe priority given to preventing AIDSfound commoncausewith someolderapproaches. Methadone maintenance, accepted sincethe 1970s inthe U.S. butonlyvery recently incountries like Germany, hasalsobeencommonlyjustifiedas reducing harm. Butwhat harm was being reduced has shifted and broadenedovertime. Whereas inthe U.S. inthe 1970sthe emphasiswason reducing hanm tothecommunityfrom drug-related crime, inan era ofAIDSepidemic a main reasonforproviding methadone isto prevent HIV infection. Manyofthe sessions and presentations atthis conference continue these traditionsofapproaching drug usersontheirown terms with practical approaches to avoiding potential harmsfrom drug use. Such an approach is very much in line with a much oldertradition of public healththinking. Public health agenciesfor instance, have long soughtto limitthe harm from sexuality, even where the particular sexual relationswere illegal ordisapproved and the public health measuresappeared to condonethem. This public health stance has long been concrete andclear: it isappropriateto actvigorouslyto prevent immediate harm, even ifthe action might involve adiffuse risk offuture harm. HARM REDUCTION AS OPENING UPTHE POLICYAGENDA Thinking intermsofharm reductionalso impliesacritique ofconventional thinking about drug policy in terms ofadichotomyofsupply reduction and demand reduction. Instead offocusing onlyon trying to eliminate drug use, whetherthrough treatment, education andother “demand reduction” approachesorthrough law enforcement andother “supply reduction” approaches, aharm reduction perspective refocusesattention on reducing the harm from drug use. This makes availableabroader rangeof strategies, including strategies which may eliminatethe harm without eliminating the drug use. 2 Aharm reduction perspective on illicit drugsthusconvergeswith thinking about licitdrugs like alcohol andtobacco. Strategies like server intervention .and automobile airbagswhich insulatethe drinker (and others) from harm are a \)vell-accepted part ofa public health approach to alcohol policy. Nicotine chewing gum and nicotine skin patches have become important components ofa harm reduction approachtotobacco, providing asupplyofthe main psychoactive substance while eliminating damageto health-ofthe smokerand ofothers -from breathing cigarette smoke. Thisconferencecontinuesthe initiative ofthe Melbourneconference in broadening theframeforharm reductionto include substantial attentionto alcohol and tobacco. FACING THE ISSUES IN HARM REDUCTION Harm reduction perspectives have been steadilygaining ground internationally in thinking about criminalized drugs. Harm reductionformally becametheframework for Canada’s National Drug Strategy in 1987, and in its newly-published 28th report, the World Health Organization’s Expert Committee on Drug Dependence adopted aharm reduction perspective. As harm reduction moves intothe policymainstream, it poses many issues fordiscussionand action. What isto be considered and counted as harm, and how is it to bemeasured? isthere anysensible wayofdifferentiating drugs bytheir inherent harm potential?What isthe likelihood ofharm from particular patternsand circumstancesofdrug use? What can bedone about gaps between public perception and the realityof harm potential?What about harm reduction inthe context ofperformance-enhancing drugs? Each oftheseissues isaddressed in one or moresessionsattheconference. Also given substantial attention atthe conference arethe practicalitiesand the practice ofharm reduction approaches. Harm reduction practice startsfrom the gritty realities ofthe everyday lifeofclients, often clientswho have been pushed tothe margin ofsociety. Accepting theambiguities ofthe humancondition, harm reduction practitioners struggle againstthe riskofburnout orcynicism to remain both humane andeffective. The exchange of ideasabout effective approaches and applicationswith colleaguesfrom nearand faris an importantfeature ofthe conference. FOR MORE READING ABOUT HARM REDUCTION Seethe booksresulting from the 1st and 3rd International Conferences: P.A O’Hare, R. Newcombe, A. Matthews, E.C. Buning and E. Drucker, eds., The Reductionof Drug-Related Harm, London&NewYork: Routledge, 1992. Nick Heather, AlexWodak, Ethan Nadelmann and PatO’Hare, eds.. Psychoactive Drugsand Harm Reduction: From FaithtoScience, London: Whurr Publishers, 1993. CONFERENCE INFORMATION 3 ROLLESTON AWARDS The Rolleston Awards are given annuallytothetwo persons who have made outstanding contributionsto harm reduction, one internationallyand the other in the countrysponsoring the conference. Theawardsare named afterthe chair, Humphrey Rolleston, ofthe British committee which, in 1926, madethe landmark rulingthat itwas acceptable medical practiceto maintain addictson opiates. The Rolleston Committeethus established the guiding principleof harm minimization: reducethe harm to individual drug usersand help addictsto lead useful lives. Thisyear’s award winnersare: International Rolleston Award - Dr. AlexWodak, St Vincent’s Hospital, Australia RollestonAwardforCanada-Dr. CatherineHankins, MontrealGeneralHospital, Canada NEW SCHOLAR AWARDS These awards were presentedforthethree best abstracts submitted by scholars who have not presented a paperat a previous International Conferenceonthe Reduction of Drug Related Harm. The awards are intendedto advancethe study ofharm reduction and attract new participantstothe conference. Francisco Bastes, FIOCRUZ, Brazil- Dissemination of HIV among cocaine injecting users: the historical background and dilemmasoftoday (presented by Reginade Carvalho Bueno) Bryan G. Nadeau, Departmentof Psychology, Simon FraserUniversity, Canada-Anabolic steroids, livercancerandthe amelioration ofdrug-related harm. Alan Rosenbach, Substance Misuse Service, Crawley Hospital, UK- From non-opiateto opiate prescribing forheroin users: implicationsfor harm reduction. CONFERENCE-RELATED EVENTS FIRST NIGHT RECEPTION Sunday, March 6th, 6:30pm to 8:30pm, inthe Grand Ballroom onthe lower concourse level at the Sheraton Centre. An evening that will provide conference participantswith an excellent opportunityto meet otherdelegatestheywill be seeing throughouttheweek. Light refreshments will be available, and therewill bea cash bar. ST. LAWRENCE FORUM Tuesday, March 8th, 8:00pm to 10:00pm, atthe St. Lawrence Theatre (27 Front Street East, at YongeStreet). Sponsored bythe Canadian Foundationfor Drug Policy, this public forum on harm reduction will feature Pat O’Hare, Ernie Drucker, RicardoSoberbn Garrido, AlexWodak, and Diane Riley. The St. Lawrence Forum is aregularseriesofsuch publicforums on majorpublic issues. Donation at door. “WELCOMETO TORONTO” RECEPTION Wednesday, March9th, 6:30pm to 7:30pm, inthe Rotunda, at New City Hall (directlyacross QueenStreetfrom the Sheraton Centre-two curvedtowers surround asmallerround building-thefoyeror Rotundaofthe smaller round building isthe location ofthe reception). ChairmanAlan Tonksofthe Metropolitan Toronto Council and MayorJune Rowlands ofthe CityofTorontowill hostthis receptionto welcome conference delegatestothe city. Ontariowines will be featured, aswell as hors d’oeuvres. CONFERENCE BANQUET Wednesday, March9th, 8:00pm inthe Grand Ballroom, lowerconcourse level at the Sheraton Centre. Please notethatthe banquet will begin at 8:00pm - delegatesshould be seated by 7:45pm. Thewinnerofthe International Rolleston Award, Dr. AlexWodak, will be thefeatured dinnerspeaker. The menu forthis eventfeaturesCanadian salmon asthemain course. FIELD VISITS Two-hourvisitsto Toronto agenciesinthefield. Therewill beacharge of upto $10fortransportation on the Donwood andARFtours. VISITTOTHE DONWOOD INSTITUTE Thursday, March 10th, 4:00pm. Please sign up atthe Conference Office by Tuesday. 6:00pm ifyouare interested inattending thistour (we need to arrange transportation in advance). Established in 1967, the Donwood is Canada’sfirst public hospitalto specialize inthetreatment ofalcoholism. Its programs have evolved to covermanyaspects ofthe substance abusefield, spanning asses- sment, treatment, and aftercare, aswell as youth, women, andcocaine users. VISIT “THE WORKS” STREET OUTREACH VAN Thursday, March 10th, 4:00pm. Please meet outsidethe ConferenceOffice ifyou are interested in seeing thevehicle. TheWorks isan outreach andsyringe exchange program run bythe Department of Public Health, City ofToronto. VISIT TOTHEADDICTION RESEARCH FOUNDATION Thursday March 10th, 4:00pm. Pleasesign up atthe ConferenceOffice by Tuesday, 6:00pm ifyou are interested inattending thistour (we need to arrange transportation in advance). An agencyoftheprovince ofOntario, the ARF is dedicated to research into alcohol, tobacco and otherdrugsand to developing that knowledge intheform of products, programs and servicesthat can be used in the community. ARFclinicians, scientistsand researcherswork in a range ofdisciplines from health recovery and prevention and health promotionto socio-behavioural, medical, bio-behavioural and biochemical research.