Addiction needs medical attention, not legal


Improved harm-- reduction services for drug addicts could significantly reduce the costs associated with the treatment of HIV/AIDs, say researchers at St. Paul's Hospital.

Lifetime medical costs for an HIV-infected injection drug user are estimated at about $150,000, they said. Health problems related to addiction account for approximately 15% of admissions to St. Paul's.

Treating addiction as a medical issue instead of a legal one will not only help control the costs associated with the disease, but can significantly improve the lives of those addicted, said Dr. Mark Tyndall, director of epidemiology at the B.C. Centre for Excellence in HIV/AIDS.

Dr. Tyndall said "the major epidemic of HIV in Vancouver" will continue. "Many people became infected in the 1990s, and are just now becoming sick with HIV-related complications. It's going to be a very costly problem for the province. We're looking at $150,000 for treatment of HIV, which includes all risk categories.

"But the new infections occurring today in British Columbia are among drug users, and drug users will be much more expensive to treat in the long run, due to problems keeping people on prophylactic medication and getting people to take their HIV treatment consistently."

Managing this group of patients is a challenge, and the team is spending much of its time coming up with programs to ensure adherence to therapy, he said.

"A lot of the emphasis remains on enforcement, and though there's been a four-pillar approach adopted by the city-- harm reduction, prevention, treatment and enforcement-the vast majority of resources end up going to policing. We've had decades of this experiment, and it hasn't worked very well."

Dr. Tyndall said people must start recognizing addiction as a medical issue, and addicts must be given every opportunity in the treatment of their disease.

"We keep thinking these people are irresponsible with their health, and the only response we've come up with is to punish them for their irresponsibility, basically. In a situation where HIV is prevalent, that is not a good approach."

B.C. has improved harm-reduction strategies through the needle-exchange program and plans to open a safe-injection site, currently under review by Health Canada. Community support groups are also active in Vancouver's Downtown East Side, where funding for policing increased to $11.2 million in 2001, from $6.7 million in 1995.

"There are positive things happening, but it (the Downtown East Side) is overwhelmed by the number of people," he said.

"Geographically . . . probably the actual number of drug users hasn't changed (an estimated 2,000) in recent years, but it hasn't gone down and there are new people coming in all the time."

Because of the focus on this area of the city, Dr. Tyndall said many of the addicts have been tested for HIV, though he said there are probably many who still have gone undiagnosed and continue to share needles.

"I think a lot of people do know their status, but because HIV is such an insidious, long-- term illness, it takes a while before people come to the point where they realize they need some care," he said.

There are no data showing cost differences between managing HIV infected drug users and non-- users, but for the patient adherent to the HIV treatment regimen, the cost of treatment for one year is about $10,000 to $15,000, he said.

Needles are cheap, but a safe injection site and the associated drugs and care would cost money, he said, but it's still more cost-effective than the current way of managing HIV infected drug users (including medical costs and policing, jail time and court costs).

"In Canada, when you arrive at a hospital, we don't differentiate how you got sick. You receive good, expensive care. But once you leave the hospital, we really don't offer you much. We wait until you come back to the emergency room and then we start all over again."

Spending money on early invention and steps that would prevent their return to ER would save millions in the long run, he said.

"The majority of people who end up down there (the Downtown East Side) have fairly substantial misadventures before they get there. Child care, child safety, schooling and Aboriginal issues are associated with addiction. Trying to prevent people from getting into this situation in the first place should certainly be one of our goals.

"We've basically left it up to the criminal justice system to deal with this, and it hasn't worked very well."

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