June 26, 2025, is one of those blue-sky Alberta mornings that finally feels like summer. While other doctors make their way to a clinic or hospital, I head for a courtroom in the heart of the province. Tucked between transport trailers and farm trucks, I steer my minivan up the QEII from Calgary to Red Deer, where the provincial government has recently closed central Alberta’s sole supervised consumption site (SCS).
I’ve never been to Red Deer’s downtown, but as a prairie girl I feel immediately at home parking diagonally beside a diner fronted by a cheerful red-and-white awning and a sandwich board declaring today’s special: beef dip. I walk a block to the modern courthouse surrounded by a pretty garden. Inside I surrender my leather bag containing a notebook and three packs of nasal naloxone to bored-looking security guards. They ask if I’m a lawyer. I shake my head. Nobody gives me—a neatly dressed, middle-aged white woman—a second glance. I consider telling them I’m trying to understand the anatomy and physiology of fundamental rights.
The reason for my trip to Red Deer is to attend, in person, the hearing of a Charter challenge arguing that an SCS is an essential health service, one that’s potentially lifesaving.
Canadians believe that access to healthcare is a right of citizenship. Yet even people who are keenly aware of health inequities are often surprised to learn that the Canadian Charter of Rights and Freedoms, the Canada Health Act and the numbered Treaties all fail to guarantee us a right to healthcare. And although Canada is a signatory to the Universal Declaration of Human Rights, which directly addresses health and medical care, that document is legally non-binding. Such lack of statutory protection partly explains why we see so few cases of Charter breaches regarding access to healthcare in Canada. The need for such protection has also been obscured by an assumption that elected officials, guided by the principles of medicare, will act in the public’s best interest.
I am attending, in person, a Charter challenge arguing that supervised consumption sites are an essential health service.
As a physician, it was only after health services that my patients really needed came under threat that I began to question why the public interest seems to regularly exclude the population I serve: people experiencing homelessness who use drugs.
The closure of Red Deer’s SCS is only one example. An SCS is a health service where people can consume their own criminalized substances (which are increasingly contaminated with toxic additives) without being arrested for drug possession or accidentally dying. In this uniquely decriminalized space, service users and care providers alike are exempted from charges under the Controlled Drugs and Substances Act (CDSA). Health professionals and medical equipment provide a life-saving response in cases of overdose, which is one of the reasons an SCS is sometimes called an overdose prevention site, or OPS. But an SCS operates under federal exemption, while an OPS operates under provincial ministerial order for an urgent, temporary response to a crisis. An SCS is also a simple and cost-effective intervention that connects people with other health and social services as well as decreases transmission of infectious diseases.
Over nearly a decade, between January 2016 and September 2025, at least 10,936 Albertans—an average of three per day—have died from opioid poisoning. But across Canada, including in Alberta, supervised consumption sites have responded to tens of thousands of poisonings—and not seen a single death. Irreplaceable by other services, SCSs are as critical to my patient population as cardiac catheterization labs are to people with coronary artery disease.
In following various court challenges around my patients’ access to care, I reviewed what all Grade 9 social studies students in Alberta learn. Federalism—the division of powers and the checks and balances that enable our democracy to operate—assigns to the judiciary the interpretation of legislation designed by elected representatives accountable to the electorate. The judiciary presumes that policymakers intend to be and are, after careful community and expert consultation, equipped to determine and prioritize the public’s best interest. When called upon to review a dispute, judges must at times balance the rights of some against the well-being of many. For example, an Alberta law meant to protect against traumatic brain injuries requires that all minors must wear helmets when bicycling, even though some object to the infringement on their bodily autonomy. This balancing act is a weighty responsibility and relies heavily on the public-interest presumption.
Yet times are changing. What happens when the presumption does not hold? What happens when a government decides to ignore established frameworks for healthcare, when its community engagement is merely performative, when scientific expertise is mocked, when the public interest is defined so narrowly? I’m all too aware how hard it is to witness despair on the streets. But I can’t reconcile how one person’s feelings of fear or inconvenience legitimize the annihilation of what is—to someone else—a life-saving health service.
Court of King’s Bench Justice Debbie Yungwirth presides over the hearing in Red Deer as lawyer Avnish Nanda reads from the affidavit of plaintiff Aaron Brown. Nanda describes how, prior to the Red Deer SCS opening in 2018, Brown had experienced numerous drug poisonings. In the seven years the SCS was operating, he had none. Then, within only a few weeks of the SCS’s closure on March 31, 2025, Brown experienced another life-threatening drug poisoning. He is arguing that the closure of the SCS is a breach of his Charter rights.
When I was working in Calgary’s emergency shelters as the drug poisoning crisis accelerated in 2017, a patient told me that, knowing he might lose consciousness after using drugs, he’d try to “land” in a public space with the hope someone would find him. To this man—as to Aaron Brown—an SCS is a lifesaver, a place to receive dignified and competent care instead of facing the end of his days alone on the floor of a mall washroom.
Data show that more people die in public from drug poisonings after SCS closures. Despite warnings of foreseeable harms, SafeLink Alberta’s mobile SCS for Calgary and Medicine Hat had its grant agreement retracted in the summer of 2019, after the UCP government froze all funding pending a review of local supervised consumption services. The provincial government then closed Lethbridge’s ARCHES SCS in 2020, after which that city saw drug poisoning deaths rise from 56 in 2020 to 125 in 2023. In Edmonton the number of overdose-related EMS calls to the area surrounding the Boyle Street SCS—which was shut down in the spring of 2021 under cover of the pandemic—have increased dramatically. Operating licences, granted by the province, on all remaining SCSs (in Calgary, Lethbridge, Grande Prairie and Edmonton) are set to expire by March 2026. As the government shows no signs of renewing these, Alberta may soon have no SCSs at all. Contracts are instead being handed to private, for-profit companies operating abstinence-only programs.
My application to speak about the positive impacts of an SCS was denied. I attended wearing tape over my mouth that read “Silenced.”
The provincial government justified its closures using results from its SCS review, which was conducted by an internally appointed UCP committee and which considered only socio-economic factors. The committee noted the impacts of an SCS on businesses, who felt “left out” of consultations, and on condominium owners, who perceived disorder and needle debris. My own application to speak to the committee about the positive health impacts of an SCS was, however, denied. I attended the public forum wearing a piece of tape over my mouth that read “Silenced.” I intended for this to represent the committee’s disregard for frontline health workers like me and, more importantly, the voices of the forever silenced: those who had already died from lack of access to an SCS. The government report was later criticized by public health scholars as “fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors’ assessment of the scientific evidence.”
Albertans, now years into UCP governance, are no strangers to public consultation parading before a predeter-mined outcome. The SCS review was merely one of the first.
In the Red Deer courtroom, while I sit on an uncomfortable wooden bench suspiciously similar to the pews in my grandmother’s Protestant church, Nanda cites the case of Canada’s first SCS. Insite began operating in Vancouver in 2003. In 2008 prime minister Stephen Harper refused to renew the Criminal Code exemption that allowed Insite to operate. In 2011 the Supreme Court of Canada found this action unconstitutional. The court’s decision invoked section 7 of the Charter: Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.
While this decision preserved Insite’s service, Alberta’s SCS-related court decisions seem to take another tack. Even when a risk of irreparable harm is acknowledged by the courts, as it was in two other court cases I’ve tracked, policymakers are still given the benefit of the doubt to enact their laws. Judges here have overly relied on an interpretation of the public interest that is biased towards politically shaped perceptions of public safety, while their rulings undervalue the very lives of the dispossessed.
Aaron Brown’s is not the only case to challenge the provincial government’s cruel removal of lifesaving health services. “We don’t want to sue our government,” said Petra Schulz, co-founder of Moms Stop the Harm, “but we don’t have a choice.” Schulz lost her youngest child, Danny, to an accidental overdose in 2014, before the province had any SCSs. After the UCP took power in 2019, Schulz saw that government create barriers to access and then close the harm-reduction services she had worked so hard to help build in memory of Danny. She and others filed a Charter complaint in 2021; it was dismissed in 2022.
“As families who have lost loved ones to the toxic drug crisis,” Schulz says, “we do whatever it takes to ensure that people have access to essential lifesaving services. When all other avenues are exhausted, Charter challenges and the courts provide one more chance to reverse deadly government policies. As a private individual it’s scary to take your government to court. [But] it’s not as painful as losing your child.”
So many families and communities are still facing that pain. Meanwhile, Alberta’s government is determined to tackle an “addiction crisis” that seems illusory: while poisoning deaths are rising, the rate of substance use disorders in Canada has been holding steady.
In the court case I witnessed last summer, the provincial government claimed that the closure of Red Deer’s SCS was simply a matter of scarce resource allocation. Nevertheless, the UCP is pouring $1.55-billion into addictions recovery. If the decision to close an SCS were in fact based on a fiscally responsible government’s careful management of scarce resources, it would be difficult to reconcile how so many hundreds of millions can be invested in the ill-defined and far less acute problem of “addictions” while SCSs, meant to address toxic drug deaths, are shut down.
Having personally spent many hours supporting groups and agencies attempting to set up new SCSs in Alberta, I know that funding is far from the only barrier. It was difficult enough even before the UCP formed government to manage all of the protocols and processes for provincial approval and obtain the federal exemption required to run an SCS. After the UCP implemented new licensing standards in 2022, it became virtually impossible. Since then, no new SCS licences have been issued and no new permanent services have been opened.
Although Calgarians were told that dispersed services were being developed to reduce pressure on the single, centralized site run by Safeworks at the Sheldon Chumir Health Centre, and despite local shelter operators conducting meticulous community engagement and adhering to other licensing requirements, the public has subsequently been informed that new site proposals were unsuccessful. The Safeworks site itself has been threatened with closure ever since.
The Supreme Court of Canada has already ruled that access to an SCS is a Charter-protected necessary health service.
It seems obvious that neither cost savings nor discretionary, well-informed addictions policy are the real reason for SCS closures in Alberta. Policy proposal #22 at the 2023 UCP AGM reveals the party’s mission to deliberately close SCSs. It reads, in part: “Public consumption sites… are blights upon the neighbourhoods… and a hazard to the Albertans living in those neighbourhoods.” Although some perceive activity around an SCS as disruptive or even scary, there’s no evidence that an SCS creates additional crime. The absence of an SCS, however, does increase public drug use. Besides, any consideration of “neighbourhood residents” should include the people who use an SCS, as they often live nearby.
Done properly—that is, distributed sites with a variety of service models available—would enable harm reduction to be part of a comprehensive system of care that serves everyone. The UCP’s reasons for closing these sites are political.
Alberta deputy minister of mental health and addictions Evan Romanow outlined in an email the service alternatives to an SCS in Red Deer. These include a Rapid Access Addiction Medicine clinic, which provides walk-in treatment for substance use disorders, and “enhancements” to safe withdrawal (a.k.a. detox) capacity. While Alberta has long needed additional resources meant for treating substance use disorders or preventing severe complications of withdrawal, such as seizures, none of these alternatives provide a decriminalized space nor scientifically proven overdose prevention.
In Red Deer, Crown counsel Nate Gartke told the court that Narcotic Transition Service (NTS) would be one of the programs to replace the SCS. On a phone call shortly after my trip to her hometown, Dr. Thara Kumar, a Red Deer emergency physician who has worked at both the SCS and the NTS, explained why the latter cannot replace the former: “The NTS is small-scale, serving only those with opioid use disorder who were unsuccessful at all other treatments. The NTS is a different part of the continuum of care. The [SCS] serves everyone.” In the three months prior to its closure, the Red Deer SCS saw more than 5,000 visits from 173 unique service users. The NTS, according to a statement made in court by Gartke in April 2025, registered only six patients.
A few weeks after my visit to Red Deer, Justice Yungwirth dismissed Aaron Brown’s challenge. In so doing, she deferred to government: “Alberta did not create barriers to access available health services. Rather, Alberta made the decision to fund alternative services…. In the public interest, Alberta had a right to do so.” Nanda told me: “We are appealing. Mr. Brown believes that there is a moral, ethical and legal imperative to ensure that the errors identified in the decision are addressed.”
I too am troubled by Justice Yungwirth’s decision and its seeming disregard for the unique characteristics of SCS that protect the life and liberty of someone diagnosed with a substance use disorder, which is a mental disability. The potential for generalizing Yungwirth’s interpretation—which, it strikes me, is the whole point of case law—is also concerning from my point of view as a generalist physician in a province that is moving away from evidence-based health policy and toward supporting for-profit private interests. According to Yungwirth’s justification, “any specific health service” could thus be replaced: emergency departments by private hospitals, cardiac catheterization units by juice stands, primary care by quackery. Why? Alberta has a right to do so.
Jenn McCrindle is a long-term outreach worker in central Alberta and co-founder of Reclaim Collective. Many of the challenges confronting the Red Deer SCS arose, she points out, from the failure of promises to build out the tiny trailer’s services to include comprehensive, wraparound services in a permanent location. “The trailer was meant to be temporary,” she says. “It feels like [the government] just wanted it to fail.”
Angie Staines, founder of 4B Harm Reduction outreach group, notes that as contaminants in the drug supply have become more complex—and therefore so too have drug poisonings—permanent supervised consumption services are needed more than ever. Responding to complex overdoses in a controlled setting such as an SCS is by far preferable to trying to do so in an alley or park. The response on the streets falls to “a lot of broken people doing heavy work just trying to keep the community safe,” Staines says. They’re often short of sterile drug use equipment. They face tighter requirements for personal ID. Staines says such realities prevent services from adapting to patients’ needs. The inevitable inadequacies are then used as an excuse to eliminate a service rather than improve it.
Having responded to many overdoses on the streets myself, I empathize with Staines’s and McCrindle’s significant psychological, physical, emotional and moral distress. Though I’m fully trained to respond to medical emergencies, lately I’ve been experiencing shakes and nausea after responding to streetside overdoses. It’s a feeling beyond overwhelming. Dr. Kumar also points out that “the current government makes people working in harm reduction and addiction medicine waste so much time and energy simply fighting to keep services—that are evidence-based and widely accepted through the rest of the country—open and funded. That energy could be so much better spent actually doing the life-saving work and trying to create new solutions to these complex problems.”
In addition to these many risks and frustrations, people who respond to drug poisonings are vulnerable to drug possession charges under the CDSA. Removing the decriminalized space of an SCS could therefore, as the Insite decision acknowledged, engage their section 7 Charter rights.
With its ruling on Insite, the Supreme Court of Canada has already decided that access to an SCS is a Charter-protected necessary health service. Yet Alberta continues to deliberately exclude whole groups of people from accessing care and is making appropriate care provision impossible. Our justice system must rise to the challenge and fearlessly check the power of politicians who recklessly breach Charter rights. If it doesn’t, who will?
Bonnie Larson is a clinical assistant professor of family medicine at the University of Calgary’s Cumming School of Medicine.
____________________________________________
