I would like to just take some time to discuss some issues of relevance on the information provided by Dr. Montaner. As he has pointed out, and as I'm sure many of you know, a significant majority of new infections occurring in Canada are among individuals who use illicit drugs. Currently the fastest-growing epidemic of HIV infection in Canada is occurring among drugs users in Saskatchewan.
It is very clear now that if we are going to succeed in controlling the HIV epidemic in Canada, we must address illicit drug use. This requires adhering to principles of evidence-based medicine, supporting innovation, and improving efficiency.
The federal government has certainly dedicated some attention to drug use through its national strategy and bills specific to criminal justice measures. I do not want to discuss the relative merits of this approach, but I will say that one consequence of the approach being taken is that, as a country, we appear to be falling behind other countries when it comes to implementing and expanding innovative preventive and treatment measures focused on drug use and the prevention of HIV infection among drug users.
There is now a substantial body of scientific literature that indicates very clearly that substance use programming should be based on a continuum of services that includes not only abstinence-based programs, but programs that engage people who are active in their drug use with so-called “harm reduction” programs.
The scientific evidence in support of harm reduction is so strong that the United Nations and the World Health Organization have issued technical guidance documents that state that these programs are essential. We know that these programs facilitate prevention by providing materials that reduce the likelihood of disease transmission, but they also prevent HIV infection by engaging HIV-positive individuals in treatment for HIV disease.
Accordingly, in Vancouver we followed this approach, and while roughly 19% of all injection drug users were infected in the downtown east side in 1997, that rate has dropped to less than 1%.
We also know that harm reduction programs facilitate entry into abstinence-based programs, including detoxification.
But despite these well-established facts, we are not adhering to international standards or optimizing our HIV prevention and treatment efforts. If we share the goals of preventing HIV infection, promoting the use of addiction treatment and abstinence from drugs, then it's clear we should be supporting the scale-up of harm reduction programs in Canada.
It is also clear that we are falling behind in terms of innovation and addiction treatment in the use of electronic systems to prevent harms with drug use. Recently the federal health minister elected not to stand in the way of production of generic copies of Oxycontin. I won't discuss the merits of this decision, but rather I'd like to focus on a systems-level gap that, if addressed, could offset much of the risk posed by Oxycontin misuse.
The Province of British Columbia has implemented a province-wide PharmaNet system that allows pharmacists and doctors to see exactly what medications an individual has been prescribed, including opiates. This is very helpful when assessing the risks posed by prescription opiate use in double-doctoring. However, this type of system is not available in many provinces where opiate misuse remains a major problem.
Another area where we could do more to promote innovation is by supporting the implementation and testing of new medications for addiction. For example, Vivitrol is an FDA-approved opiate receptor antagonist that has been shown to be very effective in the treatment of opiate addiction and recent alcohol addiction. Yet Vivitrol remains unavailable in Canada and we have faced substantial difficulty in obtaining access to the drug in order to test it in a randomized controlled trial—