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ANDERSON: What about the perverse incentives and unintended consequences of harm reduction?

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May 01, 2019 - 12:01 PM

 


OPINION


“However beautiful the strategy, you should occasionally look at the results.” — Winston Churchill

Housing First, whether in its true form or what amounts to the ersatz ‘Housing Only’ version in current practise in BC, is part of a larger government effort called harm reduction. Harm reduction essentially focuses on reducing the harm of the opioid crisis in BC, including housing, overdoses, and diseases common to drug use. It has had some notable successes in both, most notably overdose deaths through the use of naloxone and disease prevention through the use of clean needles. But its successes have created another set of problems entirely.

Once upon a time in French Indochina, French administrators in Saigon decided to do something about a rat problem that was developing in the city. Their solution was to put a bounty on rats, to be claimed by anyone who could produce a rat tail (since the shelf life of entire dead rats was presumably quite short). Strangely, a few months after the bounty was introduced, the number of rats in Saigon actually increased, although it was remarked that many of the rats were now without tails. Upon investigation it turned out that enterprising Vietnamese had heard about the bounty and turned their talents to creating rat farms on the outskirts of the city, where rats were bred, de-tailed, and set free. What had been conceived as a measure to reduce the number of rats actually had the opposite effect. So it is with harm reduction and half-measures at opioid treatment.

What we are doing is not working. The problem is not getting better. It’s getting worse.?? Why is it getting worse? Perhaps because by offering free everything without the necessary help and expectation to break free of addiction, we’re making it easier for the very people we are trying to help to carry on their destructive behaviour. Yes, it may be preventing some overdose deaths and stopping the spread of some diseases, but is it actually hurting addicts in the long term? And without adequate treatment for mental health, are we simply making the netherworld of mental illness and self-medication easier to stay in?

And then there is the impact of our efforts on civil society.

There are hundreds of examples of unintended consequences, including rabbits in Australia, vultures in India, and wolves in Yellowstone, but perhaps the most horrific example was Mao Zedong’s ‘Four Pests’ campaign in the 1960s. In an effort to boost agricultural yield, Mao demanded that everyone in China kill sparrows, since sparrows ate seeds and diminished the harvest. The campaign was a raging success and soon the Chinese sparrow population was significantly reduced. Unfortunately the locust population, previously kept under control by sparrows, soon ballooned and set off one of the worst famines in history, estimated to be directly responsible for over 20 million deaths.

We should be acknowledging by now that our efforts at harm reduction have entered the history books as yet another example of unintended consequences. Because of Interior Health’s single-minded focus on harm reduction, it spares no time for the impact of its policies on the population who live near its efforts, including its free needle clinics and overdose prevention sites. Similarly, BC Housing largely ignores or minimizes community pushback against its housing only projects as so much “NIMBYism”.

Both ministries and their associated service providers cling to the narrative that they are doing good work and/or saving lives, so any argument they hear is merely from people who are “uncomfortable” dealing with “homeless” people. But is that fair? Is it even accurate???

Calgary, to cite just one example, is living with the disaster of its Safeworks Harm Reduction Program, which has driven businesses away, chased residents indoors, and police claim it has attracted drug dealers and driven up crime statistics by 276 per cent (2018). Mitigation attempts have run into the hundreds of thousands of dollars and police costs are soaring. BC Housing, in an effort to clean up a “homeless camp” in Nanaimo, built an allegedly “temporary” facility on Terminal Avenue with predictable results…crime spiked, violence soared, and attempts at mitigation are causing costs to go through the roof. The free needle programs in all cities across BC has created a situation in which parents are afraid to take their kids to the beach or the park, and needles can be found in just about every urban “camp.”

Note here that I’m using scare quotes around “homeless” and “camp” because the provincial narrative simply doesn’t fit reality. This is not a homeless issue; it is a drug and/or mental health issue. Until we are willing to at least be honest about it, we stand no chance of curing it.

The stories repeat themselves across BC, involving missions, shelters, free housing establishments, overdose prevention sites, and free needle giveaways. The social impact of these efforts cannot be dismissed as NIMBY – they are legitimate concerns. For those who happen to live, run a business, or own property near one of them, they are existential concerns. Even IF – and there is frankly little hard evidence of it – even if they were actually achieving 100 per cent of what they are intended to achieve, at what point does the harm caused by the effort outweigh the good being done? At what point do the rights of taxpaying citizens who are trying to live their lives according to the norms of civil society begin to count in our attempts to help those who can’t or won’t?

A strategy that isn’t working, or is causing more harm than good, no matter how beautiful it is, should be rethought. There are no silver bullets to be sure, but there are better strategies out there. The short film “Seattle is Dying” advocates for one such strategy, for example, but nothing will work until we identify the problem and deal with it holistically. And by holistically I mean by including the impact on the community.

— Scott Anderson comments and analysis from a bluntly conservative point of view.


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