Redução de Danos- em inglês
Toronto Harm Reduction Task Force
100 Lombard Street, Suite 205
Toronto, M5C 1M3 647-222-4420
supplementary issue: December 2004
& Best wishes for all good things in 2005!
From the Board and Staff of The Toronto Harm Reduction Task Force
…from the Annual General Meeting, December 3rd, 2004
Some time ago, when I was an employee rather than a free-lancer, I would have periodical “performance appraisals”, in which what I accomplished (or didn’t) at work was compared with what was in my job description. I have decided to frame this year’s annual report in a similar manner, and look at how our accomplishments over the year stack up against our objectives, as stated in our Bylaw.
Objectives, of course, can be somewhat grandiose and not immediately attainable in the short term ... such as our first objective:
1. To reduce individual and community harms associated with the misuse of alcohol and other drugs.
It is difficult – if not impossible – to measure the degree to which the Task Force has done this. Actually, we have planted a lot of seeds over the past year, and I believe are truly making a headway toward this goal. This year, we held educational sessions for the general public as well as for peers and agency staff – at the rate of more than one per month. Not only have the topics covered in these sessions been varied and pertinent, but the people attending have come from well beyond the usual harm reduction agencies – in fact, many came from out of town. People are interested in harm reduction ... and we are responding to that interest by providing leadership in education.
Also, we participated in the planning and execution of a continuing education course in Harm Reduction at York University. The course has been given twice and was so well received that two additional four-day sessions are scheduled for the spring. We are engaged in the development of plans for expanding further in the immediate future.
We continue to take part – as we have for over ten years – in the planning and evaluation of the core course in the Determinants of Community Health, which must be taken by all 1st-year medical students at the University of Toronto, and to participate on the Faculty of Medicine’s Community Programs Advisory Council, of which I am now a vice chair. Because of our presence and our influence, new medical graduates are increasingly aware of and receptive to harm reduction.
2. To provide a Toronto-wide network of individuals, organisations and groups to share information, strategies and expertise to reduce individual and community harms associated with the misuse of alcohol and other drugs.
When we bring people together for our informational and educational events, we provide them not only with excellent speakers, but also with the incentive to mingle and network over light refreshments. Common interests are uncovered and connections are made, which further the application of harm reduction in Toronto. My regret is that – though we have been able to pull in people beyond our typical constituencies, some important players are missing. I am very pleased to see today marijuana activists and politicians in the room – but this has become a rare occurrence. There was a time, up to about five years ago, when some police personnel regularly attended our presentations and participated in our discussions. Perhaps they will return, when conditions are different. We must develop stronger, broader alliances with these and other spheres without diluting our vision.
3. To provide public information and education to individuals and community organisations on reducing harms associated with the misuse of alcohol and other drugs.
Complementing our public education activities, our staff, Holly Kramer, and our core of drug user experts, on their own as well as in collaboration with others, work “behind the scenes” in panels and on committees and provide staff development and education on harm reduction. The drug user experts from the Task Force who participated as presenters in the York University courses were far better, in fact, than any I have heard in educational presentations. They did not tell horror stories, or speak of their experience in the bad old days. They were not set up as freaks or poster bunnies. They provided, instead, useful information with clarity and eloquence. Simply put, they were good and highly informed educators. What a relief and what a blessing! Our peer work is paying off.
4. To develop and implement Harm Reduction strategies in Toronto.
We are really on track with this: as members of three of the community committees participating in the planning process, we are actively engaged in developing Toronto’s drug strategy. We are bringing to those committees articulate, passionate, reasonable and well-informed voices on behalf of harm reduction, developing very effective alliances and learning a great deal. We are also playing a very active role on the Community Advisory Board of NAOMI - the North American Opiate Maintenance Initiative in Toronto – which is preparing to deliver and evaluate the effectiveness of prescribed heroin to longtime users who have been repeatedly failed by methadone prescribers.
5. To initiate, conduct, and collaborate in public research into the efficacy of Harm Reduction.
We are not on the mark with this. We do not have the means or the expertise or the money or the staff to do this ourselves, and this year, other than NAOMI, we haven’t participated in or nurtured any research projects. We maintain excellent relationships with a number of researchers, and will undoubtedly do more in this area ... but it has not been a high priority this year.
6. To develop and maintain a public resource centre of information about Harm Reduction.
This is a project dear to my heart – and a long held dream. We have some resources in our office – but the office is too small to be open to the public; the materials we have are not catalogued; and we do not have the staff to provide the kind of service I envision. I had long hoped that a Harm Reduction Resource Centre would be established at one of the downtown universities, but that does not appear to be likely, despite personal and professional relationships with both U of T and Ryerson. However, there is a glimmer interest at York, and we are in there lobbying for this. Keep posted.
7. To liaise with other organisations with related objectives, nationally and internationally.
Obviously, local liaisons are easier to form than are national or international ones, and we have done our work well here. Among others, we have had a close and productive working relationship with the Safer Crack Coalition of Toronto (SCUC) and with Public Health – though not especially the city’s needle exchange program, The Works, which frankly confounds me. We have spent a considerable amount of time building a relationship with TEDNA - The Toronto East Downtown Neighbourhood Alliance – but that has not yet produced substantive results. Liaisons with neighbourhood associations are difficult at best. Though the stated end goals of the Task Force and some neighbourhood associations may be similar in very broad terms, the means of achieving them are usually very far apart. Simply talking with each other cordially and respectfully is perhaps all that can be expected for now. With many neighbourhood associations, however, this is not merely difficult but impossible. TEDNA has been an exception.
We have had working relationships with various large organisations – St. Michael’s Hospital comes to mind first of all (they manage our money) and with key individuals from various organisations, such as the Ontario College of Physicians and Surgeons and the Centre for Addiction and Mental Health (CAMH). I do want to say that the Patrick Smith’s departure from CAMH, as VP Clinical, is a great loss to harm reduction in Toronto. Patrick “gets” harm reduction ... and has been quite forthright and fearless in promoting it. He was always supportive of our work.
Nationally our closest alliance is with the Canadian Harm Reduction Network, and that relationship will be further enhanced over the coming year as we work with them to develop and host the Task Force’s web presence. At the moment the Network has been doing our mailings. Through the Canadian Harm Reduction Network, the Task Force’s voice has been heard in on such issues as funding, crack, youth concerns and drug policy Ottawa, and at international conferences. Our Newsletter circulates to more than 12,000 people internationally. An article in our Summer issue, which addressed the future of Harm Reduction, received enthusiastic responses from people outside Canada, especially in the US and Australia and was an inspiration for a “Town Hall” session at the recent US harm reduction conference in New Orleans.
Overarching all our activities is our work with current and former users of illicit drugs – commonly referred to as peers, a term with which I have great discomfort. These people are and must be the cornerstone and core of harm reduction. Without their input and overview, harm reduction will reduce itself to just another politically palatable but ineffective health promotion intervention – or worse, become professionalised into just another experience of health fascism, as is already happening in some places.
The work of the Task Force with these experienced users of illicit drugs is geared toward empowering them. It is focussed on enhancing their capabilities in general, particularly those needed for the dissemination of knowledge and information.
I hope that we are also fostering their skills for community activism. People who use drugs need to reclaim harm reduction and take over the leadership of the harm reduction movement itself .... drawing their inspiration from not just the remarkable user group movements in Europe and Australia, but as well from the work of early AIDS activists – the gay men and women who confronted enmity, indifference and prejudice with commitment and passion, to see to it that what had to be done was done to stop the deaths of their brothers and sisters. These people by the way were called many things but were never called peers.
I will wrap up with a large thank you to our funders: SCPI (Supportive Community Partnerships Initiative) and DPG (Toronto Public Health’s Drug Abuse Prevention Program). They have enabled us to do our work.
Thanks too to our volunteer board – those currently serving (David Collins, Richard Coleman, Chris Gibson, Tammy McKenzie, and Gale Yardy), as well as to Claudia Mann, who left us earlier this year to relocate in Labrador.
Considering the fact that we are a very small organisation with one excellent and very dedicated full-time staff – Holly Kramer – I think that we do pretty well.
Thanks, Holly, for making so much happen with our limited resources. ~ Walter Cavalieri
With our thanks…
At our AGM on December 3rd, the THRTF recognized the ongoing support and commitment to our work of the following agencies, organizations and individuals:
All Saints Church Community Centre;Canadian Harm Reduction Network;Centre for Addiction & Mental Health;City of Toronto – Shelter Housing & Support Division;College of Physicians & Surgeons of Ontario;Frank Coburn;Fred Victor Centre;Gerry Leslie; Government of Canada – Supporting Community Partnerships Initiative;Pathways to Healthy Families Program – Jean Tweed Centre;Mic & Sue Finlay: Michael Nurse;Qeen West Community Health Centre;Safer Crack Use Coalition; St. Michael’s Hospital – Inner City Health; Toronto Public Health;Valerie Cartledge ork University – Continuing Education
York University – Department of Design
York University – Faculty of Education
Alan Young was our guest speaker at the 2004 AGM
Marijuana mountain built out of molehill
Having been deeply involved in the fight to change our marijuana laws, I feel some discomfort in again writing about the debate. But the government continues to weave a web of deception.
We find ourselves in a political twilight zone on the marijuana issue. I do not believe this government sincerely wishes to change the law but it is unsure how to placate millions of users and voters. The best way to forestall change in a democracy is to confuse the masses. So for the past two years this government has promoted the concept of decriminalization by repeatedly introducing legislation that pleases neither activist nor prohibitionist. To further confuse matters, there has been a corresponding increase in "reefer madness" misinformation, much of it coming from the very proponents of the decriminalization bill.
I have been on many TV programs debating members of parliament and police officers who spin the tired mythology of addiction, mental illness, failing health and the new and improved potent pot. These spinners may rely upon a touching anecdote knowing that it is bad television if I try to counter these misleading stories with a dull recitation of data and the nuances of statistical methodology. The government is able to maintain a low level of fear by relying upon a few true stories and the occasional fictional narrative. In the process, it obscures the fact that marijuana has been used by hundreds of millions of people over thousands of years with no discernable impact on morbidity, mortality or moral decay.
The debate over marijuana law reform exposes the treachery of state control of information. Within a democracy, one of the greatest threats to freedom is the control of information. Voting, making decisions, supporting initiatives only make sense if the choice is grounded in accurate and complete information. The invasion of Iraq seemed to have some modest justification when powerful people in control of information led us to believe Saddam had his finger on the chemical bomb button. Now we know Saddam's fingers posed no risk but it is hard for political leaders to admit defeat and disgrace. Governments can make bad decisions with the stroke of a pen but undoing the mistake is like moving a mountain.
When pot use was deemed criminal in 1923, there was no rationale for the prohibition other than official misinformation. Eighty-one years later, we now know that millions of Canadians smoke pot. We also know the moderate use of marijuana poses little risk to the user. Clearly, with millions of Canadians taking a puff here or there, some doing so for many decades, we would expect to find epidemiological evidence confirming the health risks detected in rats or some hard evidence that pot smokers are contributing significantly to carnage on the roads. Scientists keep looking but the evidence is not forthcoming. This is why most Canadians do not support the criminalization of pot use and why royal commission after royal commission has recommended reform of the law.
Yet I still see on the front page of some papers glossy photos of cops decked out in chemical warfare space-suits carrying bushy pot plants out of grow-ops. It turns out the weapons of mass destruction were not in Baghdad but were scattered all over the streets of Greater Toronto. This melodramatic photo-op thoroughly confuses the issue. People who have neither the time nor the inclination to research the true state of affairs would undoubtedly believe that marijuana must be highly toxic and dangerous if state officials have to don protective gear to uproot a plant.
The media can become a pawn in a government's campaign of misinformation. The grow-op hysteria has become good copy — almost biblical — with the plagues of fire, fungus and mould. Of course, every moral panic is built on one or two real tragedies. Homes have burnt down due to faulty wiring. Homes have been overrun by mould. The occasional tragedy does not constitute an epidemic, and one would expect an epidemic when the looming presence of criminal law forces growers into an unregulated black market where there is little incentive to comply with safety code standards.
Growing marijuana for personal use is safe if done correctly. Similarly, smoking marijuana is safe for the majority of people. Of course, some people have had bad experiences or suffered personal hardship from smoking pot. The plant is not everyone's cup of tea, but neither is the vine. The problem is that state officials will build a mountain out of a molehill to suit their devious purposes. Small problems become magnified into large-scale, social problems to convince an unknowing public that an expansion in state power is needed to fight the growing menace. Every expansion in state power results in a corresponding diminution of individual rights. That's the yin-yang of politics.
In a dictatorship, people are forced to give up rights at gunpoint. In a democracy, people are fooled into giving up rights by the creation of unfounded moral panics. Whether the panic is pit bulls, satanic cults or Quebec separatists, state officials are adept at manipulating and controlling information. Even if you believe smoking marijuana is a monumental waste of time, you should be alarmed whenever a government deliberately distorts the truth. What else might it be lying about?
Alan Young is a law professor, criminal lawyer and author of Justice Defiled: Perverts, Potheads, Serial Killers & Lawyers (Key Porter).
This year’s peer project, funded by Toronto Public Health, Drug Prevention Grants, is well underway. A core group of 6 community members have been meeting since October to develop a workshop for peer workers, based on the manual produced by and for peers in 2002-3. The workshop will cover issues such as boundaries, self-care and harm reduction strategies, and will be piloted early in the new year. If you are a peer worker, or if your agency employs peer workers who would be interested in attending the pilot workshop, please get in touch with us. For further information contact project facilitator: Andrew Nolan, firstname.lastname@example.org
How much do we have in common? Harm reduction seems to mean different things to different people. A variety of mechanisms employed to manage substance use have worked for individuals…but which methods can be qualified as “harm reduction”?
In early 2005, the THRTF will host the first of a series of roundtable discussions with people who have used different means to reduce the risks associated with their use, and front line workers who employ a continuum of strategies to support their clients.
The goal of these discussions is to better understand the diversity of what works, and what doesn’t, to minimize risks or harms for those involved with drug use, and to begin to recognize the extent of what can be considered “harm reduction”. Invitations to the initial meeting will be distributed in the next few weeks.
We are delighted to announce that “Pathways to Healthy Families”, a program of the Jean Tweed Centre serving pregnant and parenting women with substance use issues will present at the January 2005 session of the THRTF Speakers Series….venue, date and time TBA.
Front Line Harm Reduction Workers Meeting:
January: Housing is the ‘Fifth Pillar’:Toronto’s New Rent Bank Project
Venue, date and time TBA
Annual Harm Reduction Forum:
Plans for the 2005 annual harm reduction forum, to be held in late March, are in process, and we invite submissions from potential presenters. Presentations should be between 1.5 and 2 hours in length, and proposal letters should include a brief overview of the presentation’s relevance to the theme of this year’s forum: “Socio-economic Class and Effects on Substance use and Harm Reduction Practices/Strategies.”
The deadline for proposals is January 18th, 2005, and these may be submitted by email or regular mail: email@example.com or 100 Lombard St. #205, Toronto, M5C 1M3.
Please note: The THRTF has a very limited
travel/accommodation budget for presenters from outside the GTA.
The THRTF is pleased to announce that we have formed a partnership with the Canadian Harm Reduction Network. CHRN has an established, comprehensive website,
www.canadianharmreduction.com and has agreed to add specific THRTF pages to their site!
Centre for Addiction and Mental Heath, Toronto
Community Stakeholder Information Forum on Upcoming
Opioid User Studies at CAMH
We are inviting key local service provider reps and stakeholders serving the opioid user population of Toronto for an informal information session on the upcoming 1) Heroin – Hydromorphone (H-H) Cross-Over Study and 2) North America Opiate Medication Initiative (NAOMI) Clinical Trial Study
· To provide first-hand information, answer questions, on the status, nature and purpose of the H-H and NAOMI studies
· To actively address rumours and misunderstandings circulating about these studies, and clarify differences and linkages
· To request people’s assistance and encourage participation from community service providers in subject recruitment efforts
Researchers/clinicians involved with the H-H and the NAOMI studies will provide information and answer questions
· Centre for Addiction and Mental Health (ARF site)
33 Russell St., Rm 2029 (The Meeting Centre), Toronto Monday December 20th 2004, from 3:30 to 5:00pm
Please Note: This is NOT a subject recruitment event
Refreshments will be provided ... your attendance is very much appreciated For more information please contact Andrew Taylor at 416-535-8501 ext 6279 or just stop by on the 20th!
Professional Enrichment Program
The Division of Continuing Education, York University
Are you a practitioner, administrator or policy advisor/analyst interested in better understanding and implementing HARM REDUCTION policy and practice within your organization and community?
Harm Reduction @ York University
This 24-hour non-credit course is designed to introduce service providers, administrators and policy makers to the basic principles, philosophy and application of harm reduction.
Harm reduction is a term that refers to a specific set of approaches and corresponding policies that underlie those approaches to reduce risks for people who use drugs and/or engage in behaviours that put them “at risk”. This course will be of interest to a broad range of practitioners, administrators and policy advisors/analysts interested in better understanding and implementing harm reduction policy and practice within their organization and community.
Session #1: March 7-10, 2005 (Monday-Thursday) 9am-4pm
Session #2: April 11-15, 2005 (Monday-Thursday) 9am-4pm
Instructor: Diane Riley Ph.D.
Location: York University, Glendon Campus (Bayview and Lawrence)
Cost: $475 plus GST (this includes all program materials)
Should you have any questions, please feel free to contact us.
Marina DeBona-Ross, Program and Logistics Manager
Division of Continuing Education, Atkinson Faculty of Liberal and Professional Studies
(Room 107, Atkinson Building)
(Tel) 416-650-8049 (Fax) 416-650-8042
Web site: www.atkinson.yorku.ca/harmreduction
CHECK YOUR POLICY TODAY!
Recently, I received a special notice from my insurance carrier advising me that effective immediately, loss or damage “…directly or indirectly caused from marijuana grow operations” will not be covered by my household policy….
~ Holly Kramer, Project Coordinator
In the news…from the Toronto Star, 3/12/04
Jury lauds methadone program
STAN JOSEY;STAFF REPORTER
A coroner's jury investigating four drug-related deaths in Oshawa has recommended more education, regulation and assessment of doctors and pharmacists who regularly prescribe methadone for the treatment of drug addictions.
The jury concluded methadone use is a valuable program and urged those trying to kick prescription and other drug habits through controlled drug use to "applaud yourselves" for trying to improve their lives.
Coroner Dr. William Lucas said he hoped the carefully prepared verdict, with 46 recommendations, would go a long way towards preventing "such tragic and untimely deaths." Other recommendations:
More care should be taken in collecting evidence and sharing information when drug toxicity deaths take place.
A study to look at establishing a central prescription drug registry should be done so health professionals know what other drugs a person is taking.
The province should amend the Regulated Health Professions Act so that the College of Physicians and Surgeons of Ontario can co-operate with the coroner's office in the investigation of methadone deaths.
Better tracking of methadone-related deaths and better investigations are needed.
Toronto is tempting a pandemic
TB outbreak in shelter system is a warning to fix problem of the homeless,
By Kathy Hardill
The last century saw more medical advances than ever before in the history of humankind: CT scanning, magnetic resonance imaging, microvascular surgery — a dizzying list. Which makes it at all the more ironic that, even as we claim more superiority over the human body, it is the ancient plagues that now threaten to kill us off in droves.
The World Health Organization tells us to expect the currently mutating avian flu to deliver a long overdue pandemic predicted to threaten millions of us.
Drug-resistant bacteria thrive, as if to thumb their cellular noses at what begins to look like puny medical advances not providing much protection after all.
Predictably, it is our cities which act as gigantic petri dishes, incubating viruses and bacteria old and new.
These tiny organisms seek out ideal growing environments, which they find in poverty — among our shelters, rooming houses and squats. Like hungry wolves, they wait for the opportunity to attack first those animals at the edge of the herd weakened by illness, malnutrition, stress.
We have seen, recently, a virulent norovirus sweep through a Calgary homeless shelter, and sky-high rates of HIV infection among Vancouver's poorest citizens.
And now in Canada's largest city, more than three years after a tuberculosis outbreak began in its shelter system, we have a beleaguered public health department scrambling to locate the source person whose undetected TB has infected two shelter workers with active TB. So concerned are health officials that they have begun the laborious process of testing as many as 4,000 homeless individuals across the city.
You know what they say: Every time you repeat history, it gets more expensive. More than 100 years ago, New York City's commissioner of public health, Hermann Biggs, said: "Public health is purchasable. Within natural limits, any society can determine its own death rate."
Biggs would no doubt be dismayed to see how few lessons have been learned a century later.
Public health officials knew more than a decade ago that almost half of Toronto's homeless population was infected with latent TB.
City officials have known for at least as long the public health risks associated with their policy of cramming homeless people into an overcrowded shelter system and forcing them to constantly move from place to place.
Toronto officials gambled on that risk, and now the pound of cure is proving very expensive, indeed.
The 2001 shelter TB outbreak cost Toronto Public Health more than $500,000. It cost three homeless men their lives. Last week, another homeless man died of TB in Toronto. The current case-finding strategy has pulled public health staff from many other departments and the financial costs are as yet uncalculated.
And so now, if I am homeless in Canada's largest city, these are my choices: Try to sleep outside, where I face rain, snow, disrupted sleep, violence, frostbite, hypothermia and police harassment.
Or, try to get into a shelter where I face noise, crowding, disrupted sleep, violence, influenza, tuberculosis, and bedbugs.
Or, try to get a mat on the floor of a church basement where I face noise, poor air quality, even more crowding, disrupted sleep, influenza, tuberculosis, the burden of carrying all my possessions with me wherever I go, and the exhaustion that accompanies travelling from place to place every night. A Hobson's choice if ever there was one.
Perhaps I will be among the 40 per cent of unlucky homeless people who contract latent TB infection. If I am even unluckier and develop active TB, how long before I am diagnosed? How will my movements or my contacts be traced?
The lessons repeat, over and over, and always the price climbs. But never, apparently, is it ever cheap enough, cost-efficient enough, timely enough or anything enough, to just offer people housing they can afford and let them live there — sleeping in their own beds, within their own walls, breathing their own air, looking after their health.
Even with a record-setting financial surplus, the federal government balks at spending money on a national housing program. Even after signing an agreement to spend $366 million on affordable housing, and promising 35,000 new rent supplements, the Ontario government drags its feet.
What if SARS had entered Toronto's shelter system? Where would you quarantine homeless people? Has anyone got a plan for that?
During the 1918 flu pandemic, Toronto city officials shut down theatres and all congregate facilities, in order to try to stop the spread of the virus. Now, we have about 5,000 weakened, stressed-out men, women and children crowded into more than 60 shelters.
In an epidemic, where will these people go? In a pandemic, where will they go? Does anyone have a plan?
Sadly, little has changed since Hermann Biggs' time, except that now we have microbes that are drug-resistant, and a bigger population.
How ironic it will be if the refusal of governments to improve social conditions ends up fuelling a cataclysmic pandemic that will change society forever.
Kathy Hardill is a Toronto street nurse who has worked with the homeless for 16 years.
New Year’s Resolutions…
ü Renew membership in the Toronto Harm Reduction Task Force OR
ü JOIN the Toronto Harm Reduction Task Force
ü Update mailing lists (Holly!)
Renew your membership/join now…It’s FREE! Don’t miss out on any of the FREE, informative Harm Reduction events, workshops and networking opportunities offered by the THRTF, as well as quarterly e-newsletters. You can join or renew your individual or agency membership, which allows you to vote at Annual General Meetings; simply
”cut and paste” the following form, fill in the blanks and email to:
firstname.lastname@example.org stating “membership” in the subject line
(you may also print and even photocopy this and mail completed form(s) to:
THRTF, 100 Lombard St., Ste. 205, Toronto, M5C 1M3 or fax to 416-364-7815)
* = required
THRTF 2005-6 Membership Registration:
*Name (individual or agency):
*Is this a new membership registration?
*City, Province/State, Country:
Mailing address (don’t forget postal code!)
Are there any particular harm reduction related topics or issues you’d like the THRTF to address at upcoming workshops or seminars?
Do you want to receive regular (up to three times/month) e-mailings from the THRTF?
Thank you for your (continued) support…and for helping keep our membership and mailing lists current!