A City Free From Addiction: A Fairy Tale
In mid-February, 2024, “Red Deer city council has made history as the first in Canada voting to close an overdose prevention site. Ignoring decades of research, Mayor Ken Johnston asserted this will set the groundwork for the city to become "free from addiction." People across the country should pay attention.”
This was the main point of a news release on February 16. Covering other sources I highlighted some of the comments made by Red Deer City Council. Their lack of knowledge about substance use disorders, treatment, and harm reduction is deafening. City councilor, Vesna Higham made the motion on December 18. Her rationale was that “[Users] could get all of the same first-step connection services and assistance that the OPS currently provides without the illicit drug use," she said.
So let’s return to the not so before times when if you wanted to get help, you had to stop using first. I say not so before times because while I was still working as a mental health and substance use clinician, community programs began changing their policies to exclude abstinence from admission criteria to various housing and treatment programs.
Unfortunately the requirement of abstinence before service is still a very prominent approach in an aging and stagnant treatment industry. From my experience abstinence first didn’t work when I started in this field in the 1980’s and it blatantly does not work now. It is based on the outdated, ineffective and dangerous beliefs in rock bottom and punishment as viable strategies to substance use related challenges such as relapse. This thinking is based on the old, tired and dangerous propaganda that drug use is immoral and socially unacceptable. So people simply did not and still don’t access services because they are still active in their use.
“While it [Overdose Prevention Site] does save lives in the short term, admittedly no question, from a broader community perspective it appears in fact to be increasing the harm that over time actually perpetuates exponentially more deaths for the simple fact that more people become sucked into the vortex of addiction,” [Higham] said.
She bases this statement on the fact that the number of people using the facility has increased since the UCP blindsided the organization that originally ran the facility and turned it into a much smaller place. And the only conclusion she can reach from an increase in people using the facility is that people are now choosing to use drugs because there is a safe place to use. I will tell you most factually that no one aspires to get wired on opiates, to become addicted and then have to attend a most stigmatized and unwanted place. However overdose prevention sites (OPS)’s are a place where people who already use drugs can go for nonjudgmental and compassionate services while using safely.
Not to mention that more than half the deaths that happened occurred in private residences. So far only one death ever, anywhere in the world, has been linked to have occurred in an overdose prevention site.
This myth must die! Safe consumption sites do not attract first time or recreational users. If they did, the number of dead would be much smaller.
Safe consumption sites save lives. Especially as we as a people are so loathe to consider the one thing that could virtually end deaths by overdose to toxic illegal drugs; a safer supply. What does not work is closing them down thereby restricting access. Thus more deaths will increase in private residences and on the street. Because the supply is unpredictably toxic!
“The majority of people who spoke to council were in favour of keeping the OPS”. (CBC). So despite the majority favouring the site, city council and business vetoed that sentiment. More blood will be on their hands.
“Since the UCP formed government in 2019, there has been a move away from harm reduction measures toward an emphasis on getting people into recovery” (CBC)
Since its election in 2019, the UCP government has closed supervised consumption sites, significantly reduced funding for other sources of harm reduction all under the guise of balancing the needs of those who are struggling with the safety of communities.
In 2019, Alberta’s government committed $140 million over four years to increase access to addiction and mental health services and supports and strengthen Alberta’s recovery-oriented systems of care.
This commitment included adding 4,000 publicly funded addiction treatment spaces to the continuum of care by funding new beds, funding existing beds, and upgrading existing detox spaces to medically supported detox spaces. Prior to this commitment, there were approximately 19,000 publicly funded addiction treatment spaces in Alberta.
Alberta’s government is now funding more than 29,400 addiction treatment spaces annually. This is a 55 per cent increase in funded capacity. The government claimed over 30% decrease in overdose deaths in 2022. But the numbers were not close at all. The government had claimed major reductions in overdose and overdose deaths. That has now been challenged.
From January 2023: “Today, Alberta researcher and advocate Dr. Euan Thomson, Public Interest Alberta and Friends of Medicare presented data and called on the UCP government to retract its claims that drug poisoning or overdose deaths are significantly decreasing as a result of their policies. The analysis shows that overdose announcements being made while medical examiner backlogs continue have artificially dampened mortality numbers, calling into question the provincial government’s entire shift in strategy toward an abstinence-only focus”.
And According to Alberta RCMP:
[1] 1026 suspected drug overdoses (all drugs combined) from January 2023 to November 2023, compared to 511 in 2022. Of these suspected overdoses, 347 (33.8%) resulted in death.
Furthermore, from January to August 2023, there were 1262 opioid related deaths in Alberta, which is up by 255 compared to the same time period in 2022.[3]
So it’s coming out in the numbers. Recovery oriented strategies, while definitely needed to help those who struggle with substance use disorders, are not affecting decreased deaths due to overdose
Response to treatment is not a matter of all or nothing, complete success versus total failure, but of degrees of improvement.
What this points to is that the so called “Alberta Model” addressing the overdose crisis has eliminated precious lifesaving programs and strategies in favour of programs and strategies that only address addiction. This under the false assumption that addiction is at the root of the overdose crisis.
The Alberta model is built on a antiquated belief structure of treating addiction based on dated information from the early 20th century. Specifically the Minnesota Model of treatment initiated and adopting the 12 Step into a formal model approved by Insurance corporations in the USA. The primary purpose of 12 step at the time was addressing alcoholism.
Politicians and too many in the general public are relying on what they have been told, and what they believe, are good and common sense strategies to resolve the overdose massacre due to the toxic drug supply. With well-meaning intentions and even what appears to be compassion for people who are struggling with health issues due to substance use, people believe that addiction is the underlying and only cause of this catastrophe. Thus they are calling for more treatment to address the issue.
And that’s great, if the treatment is not the same old same old cold turkey for all approach. There are far more effective approaches that deal with opiate and stimulant use disorders than faith based recovery approaches (which are currently seen as the answer). And don’t get me wrong, the faith based 12 step approach has a role with many. I firmly accept a spiritual component in my own recovery. We don’t want to throw the baby out with the bath water. But there are so many more diverse people out there who need a different approach. These programs do work for some but not all. And that is part of the point here.
So my message to all those well meaning people out there who are calling for more treatment, good! Keep doing that but make sure it is accountable and regulated, up to date with the latest research and not the same old. Do not advocate for something you know nothing about just because someone says to. Explore and learn about all the different ways one can journey through substance use and all its challenges.
So many in the field with not only the education and training but also lived experience realize that addiction is not the underlying cause of the overdose death catastrophe. The increased toxification of the illegal supply is the cause of these deaths. Full stop!
Regulate the supply through sanctioned compassion clubs. And no, this doesn’t address addiction. It is the role of proper treatment to do that. This addresses the number of deaths occurring because of a tainted poisoned unregulated supply of street drugs.
And remember, less than half the people that attend residential and outpatient treatment programs are able to maintain stable abstinence, even, and usually after, multiple admissions and trying different approaches.
And read this next sentence carefully: studies have shown that stable abstinence rates after any program are low with more than half and up to 95% of participants relapsing after or during treatment periods.
So what do these folks relapse with…..an unstable, unpredictable, increasingly toxic illegal supply.
This should be the home run point exposing the lack of common sense in the call less harm reduction and no safe supply in favour of more treatment only.
Treatment addresses addiction, not the toxic drug supply. And it is not doing a great job if we’re expecting abstinence right off the bat. Recovery is a journey not a place. It takes considerable time and effort to heal and make profound life changes.
But, the justice and political system can address this massacre by creating an infrastructure that allows the distribution of safe supply.
Why would we do that? Because people die while they wait for a program. People die when they get kicked out of a program for “not being ready”. People die when they relapse after a program. And most importantly, people who are curious, thrill seeking, using for pleasure or stress management, and are not yet considered “appropriate” for treatment are using a toxic supply.
But no drug is safe so how can there be a safer supply?
The short answer is this, of course all substances can be dangerous, prescribed or from the street. But the illegal supply is being produced and distributed by big business known as the black market. There is no regulation nor even concern for the ingredients in a substance aside from what will make it easier to distribute, harder to detect, and more profitable.
But our kids are getting hooked through diversion
The short answer is no they’re not! Those youth who are getting diverted substances have always been getting diverted substances. Diversion has always existed for many reasons and should not be a deal breaker for a lifesaving strategy. And there has been no evidence since prescribed safer supply has been out there that any youth, or anyone for that matter has died from safer supply (see BC Coroners report for 2022 and 2023). So a diverted safer supply is safer than what they’re getting now. And they’re going to get something anyway. Let’s make it safer so people live to make changes when they are ready and not when we tell them to.
But there is violence outside the Supervised Consumption Sites! I’m afraid to walk by!
Oh okay. Show me a bar that has not hosted a number of violent events both inside and outside. And especially if you’re a woman, tell me you don’t fear inside or outside a bar. Yet no public backlash. Hmmm wonder why that is. Don’t touch my booze I guess.
As a treatment provider, I couldn’t treat any dead people. I lost far too many through overdose due to toxic poisoning. Far more than to any other substance. But I was able to treat live people with hope, dignity, compassion, motivation opportunity and effective strategies. I was able to provide harm reduction while I planted seeds. For those that know, that is the recovery process. It doesn’t start or end with more beds. It starts with breath, a heartbeat, hope, a reason. It starts with all of this.
So to end harm reduction in favour of an approach that is only one small partly effective step in a complicated and very long journey is akin to signing death warrants. And judging by the narrative out there that y’all care about people who struggle, I’m pretty sure you don’t want to cosign those death warrants.
We never will be a drug free addiction free mental illness free society just as we will never be a sex free or thrill seeking free society. The sooner we accept that and drop the hubris about what we think we know about substance use recovery and harm reduction, the sooner we understand and accept that recovery harm reduction and safer supply must co-exist, the sooner we can really save lives.
Again, that’s what we all want isn’t it…..isn’t it?
Sources:
(https://drugdatadecoded.ca/city-of-recovery/ )