[homeles_ot-l] LETTERS OF SUPPORT NEEDED FOR OTTAWA HEALTH PROGRAM

[Michelle Ball]

Greetings: 

On Wednesday, 11 July, Ottawa City Council scuttled a two-year-old
program in which groups hand out safe-crack-use equipment - crack pipes,
mouth pieces and screens - to users at a cost to the city of a mere
$7,500 per year. Because people who smoke crack can experience cuts and
burns to their lips, pipe-sharing among them can transmit blood-borne
infections such as HIV and hepatitis C. Crack Kit Distribution Programs
are operating in several Canadian cities, including Victoria, Edmonton,
Calgary, Winnipeg, Toronto, Guelph and Montreal, and in a number of
cities around the world. 

Ottawa's Crack Kit Distribution - or "Safer Inhalation" - Program was
shown to be successful in lowering the risk of contracting HIV and
Hepatitis C in people who were reached by it, as well as in increasing
their access to Ottawa's health and social service agents. These
research findings were reported to Ottawa's city council by University
of Ottawa epidemiologist Dr. Lynne Leonard, who studied the program for
a year. They were also peer-reviewed and published in a leading medical
journal. (See links below.) 

This solid research meant nothing to the mayor and his minions, but it
did to Ottawa's medical officer of health, Dr. David Salisbury.  He
supports this public health initiative, stating that its cancellation is
a case of politicians following their gut in the wrong direction. "These
programs are very hard for people to understand and very hard to
reconcile with people's gut feeling," he said. "That's why these
decisions are generally left to the professionals to make them." 

In light of the cancellation of this program, the Canadian Harm
Reduction Network is asking everyone - ordinary citizens as well as
people who work in the areas of health and harm reduction - to respond
in protest to Mayor O'Brien, with a cc to the Ottawa City Council
members. Their addresses are below. It is very simple - a single e-mail
can be addressed to reach all of them in one click. We cannot allow what
is being called politics to supplant the provision of a beneficial
public health service.

Ottawa's mayor Larry O'Brien is a vocal supporter of the suppression of
public health services to people who use drugs, even threatening the
well established and highly successful health promotion practice of
needle exchange. In defiance of both wisdom and logic, he is willing to
put at risk the health and well being off all citizens of his city, not
merely those who use drugs.

In truth, Mayor O'Brien is not without his partisans. A group of
community members from the Sandy Hill neighbourhood applauded the mayor
after the vote. "It's a great day for Ottawa," said one of them. "It's a
great day for tourism." 

The cancellation of the crack kit distribution program must also be seen
within the context of such equally reprehensible moves as that of the
federal Minister of Health Tony Clement's request for an additional
evaluation of the Safer Injection Site in Vancouver, despite numerous
rigorous, scientific, in-depth evaluations of that program which confirm
its success. These evaluations have been published in major
international peer-reviewed journals. Also one must regard with serious
concern the federal Minister of Public Safety Stockwell Day's
cancellation of the tattooing pilot project in the federal penitentiary
system, despite evidence that the program worked. Both programs focus on
keeping people healthy and on reducing the transmission of infectious
disease.

Once again, we urge you to write to Mayor Larry O'Brien, with a copy to
all city councillors, to let them know how you regard their decision to
curtail the "Safer Inhalation Program", and that you want them to
reinstate this important initiative. The health of the public should not
be dealt with capriciously. 

Your support is greatly appreciated.

Best wishes.

Walter Cavalieri
Director
The Canadian Harm Reduction Network

________________________________

 E-mail addresses for the Mayor and Councillors are as follows:

The Mayor:
Larry.OBrien at ottawa.ca <mailto:Larry.OBrien at ottawa.ca> 

<mailto:Larry.OBrien at ottawa.ca> 

The City Counsellors:
Bob.Monette at ottawa.ca <mailto:Bob.Monette at ottawa.ca> ;
Rainer.Bloess at ottawa.ca <mailto:Rainer.Bloess at ottawa.ca> ;
Jan.Harder at ottawa.ca <mailto:Jan.Harder at ottawa.ca> ;
Marianne.Wilkinson at ottawa.ca <mailto:Marianne.Wilkinson at ottawa.ca> ;
Eli.El-Chantiry at ottawa.ca <mailto:Eli.El-Chantiry at ottawa.ca> ;
Shad.Qadri at ottawa.ca <mailto:Shad.Qadri at ottawa.ca> ;
Alex.Cullen at ottawa.ca <mailto:Alex.Cullen at ottawa.ca> ;
Rick.Chiarelli at ottawa.ca <mailto:Rick.Chiarelli at ottawa.ca> ;
Gord.Hunter at ottawa.ca <mailto:Gord.Hunter at ottawa.ca> ;
Diane.Deans at ottawa.ca <mailto:Diane.Deans at ottawa.ca> ;
Michel.Bellemare at ottawa.ca <mailto:Michel.Bellemare at ottawa.ca> ;
Georges.Bedard at ottawa.ca <mailto:Georges.Bedard at ottawa.ca> ;
Jacques.Legendre at ottawa.ca <mailto:Jacques.Legendre at ottawa.ca> ;
Diane.Holmes at ottawa.ca <mailto:Diane.Holmes at ottawa.ca> ;
Christine.Leadman at ottawa.ca <mailto:Christine.Leadman at ottawa.ca> ;
Maria.Mcrae at ottawa.ca <mailto:Maria.Mcrae at ottawa.ca> ;
Clive.Doucet at ottawa.ca <mailto:Clive.Doucet at ottawa.ca> ;
Peter.Hume at ottawa.ca <mailto:Peter.Hume at ottawa.ca> ;
Rob.Jellett at ottawa.ca <mailto:Rob.Jellett at ottawa.ca> ;
Doug.Thompson at ottawa.ca <mailto:Doug.Thompson at ottawa.ca> ;
Glenn.Brooks at ottawa.ca <mailto:Glenn.Brooks at ottawa.ca> ;
Steve.Desroches at ottawa.ca <mailto:Steve.Desroches at ottawa.ca> ;
Peggy.Feltmate at ottawa.ca <mailto:Peggy.Feltmate at ottawa.ca> 

________________________________

________________________________

ADDITIONAL RESOURCES:

Dr. Lynne Leonard's report on the success of Ottawa's safer crack kit
distribution program
http://www.ohrdp.ca/Final%20Crack%20Report%20ES%20f.pdf

Comments from Ontario Harm Reduction Distribution Program:
http://www.ohrdp.ca/files/Ottawa%20Safer%20Inhalation%20Program.pdf

________________________________

Below is the text of a letter sent to Ottawa's mayor and city
councillors by the Canadian HIV/AIDS Legal Network, calling on them to
reinstate support for the Safer Crack Use Initiative. If you wish to
frame your own letter within a legal point of views, feel free to use
this letter as a model.

Dear Mayor O'Brien and councillors:

On behalf of the 200 organizational and individual members of the
Canadian HIV/AIDS Legal Network, I am writing to urge you to reconsider
the termination of the Safer Crack Use Initiative, as decided by City
Council on July 11, 2007.

Opposition to this program is based in part on the mistaken belief that
it contravenes the law. As Canada's leading organization working on the
legal and human rights issues raised by HIV/AIDS, we wish to explain how
the distribution of safer crack kits is not only sensible as a matter of
public health (as demonstrated by the available evidence, including
peer-reviewed evaluations by University of Ottawa epidemiologists), but
also permissible under Canadian law and consistent with Canada's
obligations to protect and promote health under international human
rights law.

Distributing safer crack use kits does not contravene the Criminal Code.
The distribution of safer crack use kits is not qualitatively different
from the distribution of sterile needles. In Canada, needle exchange
programs (NEPs) have been operating for almost two decades with official
government approval and financial support. Both NEPs and safer crack
kits are sensible, pragmatic and cost-effective public health measures
that reduce the risk of HIV and hepatitis C (HCV) transmission - and
both are legal under the Criminal Code.

Section 462.2 of the Criminal Code states: "Every one who knowingly . .
. promotes or sells instruments . . . for illicit drug use is guilty of
an offence". However, the Criminal Code (s. 462.1) also states that the
definition of an "instrument for illicit drug use" does not include a
"device" as defined in the Food and Drugs Act. The definition of
"device" under the Food and Drug Act (s. 2) includes any article or
instrument that is used in the "mitigation or prevention of a disease".

As with the distribution of sterile needles, distributing safer crack
use kits to prevent or reduce the spread of blood-borne pathogens such
as HIV or HCV means these kits fall within this definition of "device"
and are therefore excluded from the definition of "instrument for
illicit drug use." 

The bottom line: Distributing safer crack use kits does not contravene
the Criminal Code.

Distributing safer crack use kits meets human rights obligations to
protect and promote health.

Not only is there a good public health rationale for ensuring access to
safer crack use kits, but doing so is also sound from the perspective of
Canada's international human rights obligations and Ontario's public
health law.

Under the International Covenant on Economic, Social and Cultural
Rights, Canada is legally obliged to take the steps "necessary for . . .
the prevention, treatment and control of epidemic . . . and other
diseases." The Safer Crack Use Initiative helped fulfill this legal
obligation, recognizing that not all people who use drugs do so by
injection. Up until July 11, the distribution of safer crack use kits
provided people who smoke crack with the necessary equipment to reduce
their risk of HIV and HCV infection.

Similarly, the International Guidelines on HIV/AIDS and Human Rights
(from the Joint United Nations Programme on HIV/AIDS and the Office of
the United Nations High Commissioner for Human Rights) recommend that
governments ensure the availability and accessibility of services for
HIV prevention, particularly with attention to vulnerable groups such as
people who use drugs. The provision of safer crack use kits was such a
public health service.

Finally, we note that Ontario's Health Protection and Promotion Act
states as its purpose ". . . to provide for the organization and
delivery of public health programs and services, the prevention of the
spread of disease and the promotion and protection of the health of the
people of Ontario." Again, Ottawa's Safer Crack Use Initiative was an
example of such a program.

Cancelling the crack kit distribution program constitutes a huge step
backwards, and not just in terms of public health and human rights. As
you heard from Ottawa's chief medical officer of health, the program was
a sensible investment of taxpayers' dollars, considering the savings to
the public purse of preventing new cases of HIV or HCV infection. Your
constituents deserve a responsible, effective response to drug addiction
that is based on sound evidence and respect for human rights. You can
deliver such a response by reinstating the Safer Crack Use Initiative.
We urge you to do so.

Very truly yours,

Joanne Csete
Executive Director
Canadian HIV/AIDS Legal Network

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