The Vancouver Island Health Authority has an uphill battle in getting to the point of distributing crack-pipe kits in Nanaimo. The health authority now has the blessings to start such a pilot program in Victoria, but in Nanaimo council and staff have not forgotten VIHA's first effort here.
About two years ago, health nurses just started distributing crack-pipe kits, without any consultation with the city or residents, and apparently without the knowledge of senior VIHA staff in Victoria.
The immediate result was an end to that project, but in the long run it created a distrust of VIHA. Since that time, the reputation of VIHA hasn't exactly improved in Nanaimo.
There has been the C. difficile outbreak at Nanaimo Regional General Hospital, in which several people died. The inability to get the outbreak under control has been traced to VIHA mismanagement.
To quote Health Minister Kevin Falcon: "(A) big part of the problem seems to be just how management responded to this incident."
And then there was the move of the VIHA funded health clinic from Robarts Street to Franklyn Street. Despite promises after the initial crack-pipe kit fiasco that the city would be consulted about any such VIHA programs, it never happened.
Whether it's a missed phone call or not, it remained VIHA's responsibility to inform the city in a timely way.
Nanaimo is not saying no to distributing crack-pipe kits, yet. But we want a chance to say yes or no.
VIHA makes a good case for the kits. They are a simple and effective way to prevent infections that are chronic in those who smoke the toxic concoction. The medical officer of health, Dr. Lorna Medd, says there is good scientific evidence that such kits reduce disease.
What VIHA has to keep in mind is one of the issues that emerged during the first failed Nanaimo experiment along these lines.
That effort was put forth as harm reduction. That makes sense in the context of reducing disease. But harm reduction is about much more than reducing disease.
Harm reduction includes reducing harm to the community as well as to drug users. Harm reduction must not be seen as tolerating drug abuse while minimizing the harm to drug users alone. In that context we will only end up with VIHA distributing an ever-increasing number of crack-pipe kits. This community will not tolerate VIHA building up an industry in which crack smokers are the consumers.
If that will be the end result, then perhaps it would be best if the city declines the program. There is a real risk that the program will only facilitate an expansion of crack smoking in the city without an effective backstop that offers treatment.
Real harm reduction must come with a commitment of funding that includes detoxification, treatment and follow up care.
Mayor John Ruttan has not shut the door on the program, and nor should he or any other city councillor. And nor should they heartily endorse it without first giving long thought to the exact type of service that VIHA is offering. We need to wait until the Victoria pilot project is completed and see how it has worked for the City of Victoria.
While VIHA must honour its commitment to talk with the city, they also have an obligation to speak with residents.
The proposal of any such program must be preceded by real engagement with residents in the area where the program would take place.
Residents understand and accept the idea of harm reduction. Given the decency of being consulted they may take a different view.
And we must remember that VIHA is now facing some very significant funding cuts. The priority for VIHA is acute care. Community programs like crack-pipe kits, and others, may fall victim to budget trimming.
VIHA's responsibility may be health, but they also have a moral responsibility to the people of Nanaimo.
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