The past few years have seen a resurgence of interest in the use of psychedelic substances. The word “psychedelic” is an umbrella term for natural or synthetic substances that alter the senses, change thinking and impact mood. Also known as hallucinogens, they belong to various classes of drugs, and include peyote, MDMA, LSD, ayahuasca, ketamine, psilocybin, ibogaine and others. Though it is not fully understood how the different classes of psychedelics might have a therapeutic effect, neuroplasticity—the ability of the brain to “rewire” associations, impulses, emotions and memories—is thought to play an important role.

Psychedelics have been used by humans for various reasons, including traditional healing, spiritual practices and recreation, for millennia. They have received special legal and moral scrutiny in North America since their use became associated with the so-called “counterculture” of the 1960s. During that time in the US, the criminalization of psychedelics granted authorities a reason to target Vietnam war protesters. Since then, psychedelics have been subject to the “war on drugs.” In Canada psychedelics are considered a controlled substance with criminal repercussions whether one has them for personal use or with the intention to share with or sell to others.

This is why it was such a surprise to hear Mike Ellis, associate minister of mental health and addiction at the time, announce on October 5, 2022, that for patients with substance use disorders and trauma, psychedelics would now be available as treatments. Did I hear that correctly Alberta’s UCP has consistently opposed decriminalization and regulation of illegal drugs. In the words of its previous leader, Jason Kenney, “flooding the market with government-provided illegal drugs is not something Alberta will be doing.” Yet, with this new policy, the UCP would allow criminalized drugs to be used in as-yet unproven therapies for substance use disorders.

It was such a surprise to hear that psychedelics would now be available in Alberta as treatments.

As an addictions physician, I pay close attention to changes in drug policy. As a street doctor with family-physician values, I’m constantly on the lookout for new resources for my patients. I wanted to believe there was something in Alberta’s new regulations that would help my patients.

I had grounds for skepticism. At the same October 2022 press conference, in just as radical a departure, Ellis announced new restrictions to supports for patients with opioid use disorder. Those patients’ physicians would be prohibited from offering certain treatments, and would even be required to send patients to a difficult-to-access clinic called the Narcotic Transition Service to be taken off their medication. Tapering stable patients off their opioid medications can sharply increase the risk of death from drug toxicity and should only be done cautiously in the context of a strong therapeutic alliance, such as with one’s primary care provider. It was devastating news for patients who were stable on these medications. For some the change proved fatal.

At the time, the juxtaposition of these two changes puzzled me. Why were evidence-based harm-reduction interventions being quashed while unproven therapies using illegal psychedelic drugs—that the UCP until recently found abhorrent—were receiving enthusiastic endorsement?

On Tuesdays I wear work boots and cargo pants. The extra pockets are needed for latex gloves, a mask and hand sanitizer. I stuff donated socks, first-aid supplies and throat lozenges into a backpack. In winter I layer on thick long johns and a toque. A portable oxygen monitor and naloxone kit are clipped to a D-ring on my waistband, and my boot treads have spikes. I want to be prepared for anything. Not only are Tuesday patients often quite ill, but many have had terrible experiences in the healthcare system: stinging moments, while sick and asking for help, of dehumanization or outright racism.

Having internalized the stigma of violence over many years, homeless people often tolerate subpar conditions of outreach care. They don’t expect anything more than what US medical anthropologist and physician Paul Farmer calls “shitty care for the poor.” They will express gratitude for a bit of antiseptic spray and a band-aid to cover chronic ulcers and emotional wounds. Just doing my job, I say, struggling to tuck in ragged edges of tattered gauze. I try to hide my fury and sadness from patients who need their doctor to have a strong back.

The chronic rubbing of the bandage’s ragged edges, combined with the recent government announcements and my stubborn yearning for less-shitty care for the poor, may be why, one day last winter, I noticed a chic new storefront clinic near downtown. The interior gleams with glass and white marble. Plants thrive on windowsills streaming with natural light. I imagine the air is filtered just so, warm and humid with a hint of eucalyptus. I gaze up from my slushy streetcorner at shiny chrome letters: The Newly Institute.

I pull out my smartphone: “More like a spa than a clinic,” reads an online review. The Newly Institute website confirms it is a facility for psychedelic treatments enabled by new UCP legislation—ibogaine, psilocybin and ketamine, though Newly’s director is also “looking forward to pushing the boundaries of psychedelic therapy by employing substances like LSD and ayahuasca.” Photos portray clinicians in immaculate scrubs while executives in smart suits exude corporate confidence. A beautiful place, filled with beautiful people, for helping folks struggling with their mental health. I feel dowdy and damp in my muddy boots and sweaty layers.

Nevertheless I try to imagine practising within the Newly Institute’s pristine walls. In my mind I steam up a fresh espresso between appointments as patients relax amongst the plants and pleasantries. I stride across gleaming maple hardwood in spotless sneakers, dripping with efficacy. If this place, I reason, provides the newest treatments for the most intractable cases, then my current patients would be good candidates for its services. I think especially of one soul who lives with complex post-traumatic stress and substance-use disorder. He has been to residential treatment programs many times and to residential school before that. So many of my patients carry the most severe forms of the illnesses the innovative Newly Institute treats. I want to get them inside. So I make a call.

“I have a few patients I would like to refer to your clinic,” I say. A staffer in the spa clinic reassures me that they can help.

I had noted that the website mentions drumming, so the first thing I ask is whether there is an Indigenous adviser or elder on staff. The staffer apologizes. No, there is not.

Most of my patients live in homelessness or poverty, I explain, still a little hopeful. Is there a cost for treatment Well, yes. Consultations and treatment are “fully private,” I’m told, and paid for by the “client, an employer or by an insurance company.” Later I discover that the cost of psychedelic treatment courses varies widely but can range into the thousands of dollars. The standard one-month “intensive outpatient” program for mental health at Newly, for example, costs $12,950. Bloom Clinic in Calgary advertises a 10-week ketamine-assisted program for $5,965.

I try again. If someone has Alberta disability or income supports, will they be covered No. What about Indigenous patients with status under the Indian Act No.

The friendly person educates me cheerily: most of their clients—I feel chastised for saying “patients”—with substance-use disorders use only alcohol, or maybe cannabis, but not opioids. Those clients, I am advised, should first go to medical detox if they have opioid-use disorder.

Thanking the person on the phone, I feel a familiar disappointment, but also bafflement. If only their suggestion were that easy. So-called “detox,” or safe withdrawal, is a notorious bottleneck in Alberta’s system of care. Getting a spot when it’s needed is nearly impossible. Instead, in a wealthy province that now sees a drug poisoning death every five hours, our government is ushering in an intervention that helps only those who can afford it and are using the “right” substances.

I asked Dr. Leah Mayo, Parker Research Chair in Psychedelics at the University of Calgary, about the access disparity in the world she studies. She agreed that “major limitations to these interventions [are] becoming mainstream, and a lot of thought will need to go into how to make access equitable.”

And equity is about much more than simply access or cost. As a young anthropologist, I worked in rural Mexico with a group of curanderos, or traditional healers. During long drives between Indigenous villages, where they worked with young mothers learning to grow and use medicinal herbs, I listened to the healers as they grappled with the problem of commercialization of their plant medicines. In a recent forum on psychedelics, the Canadian Public Health Association voiced a similar concern: “…We must question how traditional Indigenous knowledge, cultural rights and opportunities for economic participation will be adequately protected as psychedelics gain prominence in Canada.”

Though services might struggle to be inclusive of Indigenous practices and perspectives, they must. We have the guidance: biomedical colonialism is addressed in Canada’s Truth and Reconciliation Commission Calls to Action and in the UN Declaration on the Rights of Indigenous Peoples and should always be explicitly included in any new health-related regulations, programs or services.

Drug policy in Alberta is determined not by science, safety, access or equity but by commercial potential.

Maybe, after witnessing the toxic-drug crisis rampage for the better part of the past decade, I’m becoming impatient. Novel approaches take time; we have to gather data and properly implement sensitive aspects such as inclusion and reconciliation.

It has been well over a year, however, since Alberta’s new regulations were implemented, and though scientific evidence might someday prove the therapeutic value of psychedelics, it hasn’t happened yet. In a search of clinical trials registered by Health Canada for two of the psychedelic drugs approved under the UCP’s new regulations, one of the drugs—psilocybin—had only two clinical trials, both now closed. The other—a traditional central African root medicine called ibogaine—has no clinical trials registered. Dr. Mayo acknowledged that only one psychedelics clinic in Calgary, SABI Mind, is currently involved in a regulated clinical trial of its therapies. (The Newly Institute website has since removed references to treatments using ibogaine and psilocybin. Other clinics, including ATMA CENA in Edmonton and Calgary, are offering MDMA and psilocybin as well as ketamine.)

Meanwhile, evidence in favour of the interventions blocked by the UCP’s new legislation, including studies of prescribed safer supply of opioids, continues to accumulate.

Despite Mike Ellis’s stated rationale, his ministry’s mash-up of regulatory changes improves neither access nor safety for my patients. So, what’s really behind the changes The answer is disconcerting. Many psychedelic facilities and, it should be noted, residential treatment facilities receiving massive taxpayer-funded “investments,” are run by privately held, for-profit companies. The reality is that the public system of care holds no market prospects, while, as noted on Nasdaq.com, “psychedelic stocks have a bright future.”

The truth is that even during a crisis that annually kills thousands of Albertans, and despite sneaking in words such as “compassion” and “stewardship,” drug policy in this province is determined not by principles of science, safety, access, equity or human rights but by commercial potential. Alberta’s UCP government believes that health services should be driven not by a patient-centred mission but by marketing strategies like the Newly Institute’s: “We are firmly rooted in our collective commitment to excellence, whether it’s patient care, inter-office communication, or the impact of the colour we choose for our wallpaper in the office bathrooms. No detail is too small to be considered.”

As I lace up my spiked boots for yet another Tuesday of street medicine, I’m conflicted. While I’m glad for the existence of clean and beautiful places for patients, and for new approaches to treating severe mental health disorders, I recognize the pipe dream. My espresso fantasy melts away like dirty snow as I realize that neither my patients nor I would be any more welcome in a fancy private clinic than we are in general society. This is because, wherever we go, we expose the marble-clad foundation of discrimination upon which both for-profit clinics and society itself are built.

While the UCP cheers on the psychedelics industry to monetize its visions, I am deeply sad for the ongoing loss of lives and dreams in my community. Regardless of whether we use the word “patients” or “clients,” people are still people, not commodities, with challenges that are still illnesses, not market prospects. It turns out that what we sacrifice in a private system is accountability. Even more chilling is what we sacrifice in a for-profit health system: care.

If current conservative governments continue their path of destruction all in the name of profit, too many people will have to continue to hold their breath while waiting for care out in the cold, some until they simply stop breathing.

Bonnie Larson is a physician and community organizer who for 15 years has worked with people experiencing homelessness.

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Tonight we’ve gathered in an underground LRT station passageway. Beside us, a long stretch of yellow fencing separates us from a lone electrical outlet, a rare treasure in public spaces. The outlet was recently deemed too popular among the city’s unhoused citizens—hence the fence.

Through slurred speech, Brandon Shaw fawns over my toque, which reads “Hoot ’n’ Blow” beside an owl logo. I offer it as a trade for his, but he declines. Someone later explains Shaw was afraid he’d picked up lice in the shelters. He was protecting me.

Brandon is the namesake of the organization (“For B”), which was launched by his mother, Angie Staines. He’s 28 years old and still alive after 12 years unhoused—but only just. In the summer of 2022, Staines and her team found Brandon blue-lipped, deep in a fentanyl poisoning. They revived him with naloxone and oxygen. But in the ensuing months he was set on fire during a drug deal gone wrong, then suffered a kidney infection, then withered through the dysentery that hospitalized over 100 of his unhoused neighbours.

Half of Alberta’s treatment beds are in explicitly faith-based facilities, with an overwhelming focus on total abstinence.

Like everyone down here, Shaw’s life could have taken any number of trajectories. Twelve years earlier he had been a multitalented and athletic kid running full speed into behavioural challenges. “I left home for the first time out of fear and shame of the pain and harm I was causing my family,” he says. “I knew something was up with me; I just didn’t know what.” He quickly gave up on youth shelters. “I didn’t last long, because of my drug use and mental health,” he says (many shelters have strict abstinence policies). “And nobody asked me what I want or what I need.” So, managing bipolar disorder and ADHD with street drugs, the runaway teenager took up residence in a tent.

Years later Shaw would wait months on a medical detox list, only to be refused support for his potentially seizure-inducing benzodiazepine withdrawal. Given that his earlier attempts at detox from benzodiazepine-laced fentanyl “felt like having a stroke,” he was desperate for a better option.

Like so many other people 4B was out to support that night, Shaw is up against systems seemingly built to fail. Successive provincial governments have ignored survivors like him while holding fast to outdated conceptions of drug use and addiction.

In 2014 Dr. Esther Tailfeathers sounded the alarm about a sudden escalation of opioid poisonings in her native Kainai Nation (Blood Tribe or Blood Reserve), bordering Lethbridge, where she practises family medicine and advocates for harm reduction. “I had no idea we wouldn’t get on top of this, we wouldn’t have a good strategy—[that by 2024] we’d still be chasing the tail of the problem,” she says. At the time, she remembers, “We thought we were an anomaly, that it wasn’t happening anywhere else to this degree.”

Kainai was at the vanguard of the cataclysmic shift in Canada’s criminalized opioid supply, from use of regulated pharmaceuticals and “old-school heroin” to potent synthetics such as fentanyl that are made without opium poppy. Recognizing the trauma of people who use drugs, their families and frontline responders, Tailfeathers’s daughter Elle-Máijá documented the period. In 2021 she released the film Kímmapiiyipitssini: The Meaning of Empathy. 

Recently the doctor and her daughter “started counting the number of people in the film that have died. It was over half of them.”

Alberta has lately seen a seven-year drop in Indigenous life expectancy. In 2015 life expectancy for a First Nations man in Alberta was 67; today it’s 60. For First Nations women, it’s dropped from 73 to 66. This decline has been attributed in large part to our province’s narrow scope of drug policies, centred on abstinence. To Tailfeathers it seems like a conscious reframing of John A. Macdonald’s “clearing the plains” starvation politics. “Macdonald and all these other leaders thought they knew what was best for Indigenous people,” she says. “In 150 years there’s been no change… Making decisions about us, without us, is still colonial.”

During the NDP term in government (2015–2019), AHS incrementally piloted and adopted interventions falling under a “harm reduction” umbrella, such as naloxone distribution, supervised consumption sites and prescribed injectable hydromorphone. But these measures were too little, too late. While the tide of regulated opioids retreated—in an overcorrection to what some experts saw as loose prescribing practices—annual toxicity deaths in Alberta rose from around 100 in 2012 to 805 in 2018. In 2023 Alberta was on track to exceed 2,000 opioid-related deaths for the first time. (The data is not yet finalized.)

Elaine Hyshka, Canada Research Chair in Health Systems Innovation at the University of Alberta, still agonizes over the opportunities missed in the early days of the crisis. “The exponential increase in deaths was directly related to a change in the illegal drug supply. Before, people were primarily using prescription opioids. Those became less available, and the illegal market moved to fill that void.” With dangerous drugs flooding in, and deaths rising fast, drug policy experts called for immediate harm-reduction measures to save lives.

In the years since 2019, however, harm reduction has been turned into a political wedge, and “addiction,” an amorphous term increasingly avoided by drug-policy experts, has been reinforced as the nexus of public interventions. But we’re taking aim at the wrong target, says Hyshka. As Brandon Shaw’s story illustrates, this isn’t an addiction crisis, it’s a mass poisoning.

Successive provincial governments have ignored survivors like Brandon while holding fast to outdated conceptions of drug use and addiction.

When Jason Kenney’s United Conservative Party took power in 2019, it began cutting harm-reduction services. By 2023, grassroots overdose prevention sites had been criminalized, the number of supervised consumption booths in Alberta had been reduced by 35 per cent, and every patient in Alberta accessing a prescribed supply of hydromorphone (a synthetic opioid) was forced to accept a regimen of “witnessed oral dosing” in central facilities. To harm-reduction advocates, these restrictions became synonymous with the government’s recovery-oriented (or abstinence-oriented) focus.

Brandon Shaw experienced first-hand the staggering increase in poisonings during the transition to synthetic opioids. “I moved to BC [in 2013] when you could still buy actual heroin. …I had a somewhat normal life, working day labour, living in a ‘wet house’ [sober-living facility with loose rules]. Then fentanyl came along and everything changed.”

“At first, we just thought we were getting strong-ass dope… then we noticed all our friends were dying. My routine was on its head. Before, I would use four times a day. Then fentanyl came out and I was using sporadically, at weird times of day.” Shaw describes fentanyl’s lack of “legs,” its shortened effects compared to heroin or other opioids. After losing many friends to poisoning, he recognized the threat to his survival and returned to Edmonton in 2015.

As in BC, the ground in Alberta had fundamentally shifted. But a public health response equal to the crisis was nowhere in sight in this province. With few options to choose from, Shaw returned to residential treatment for his third time—for his first, as a teen, he had been involuntarily committed through the Protection of Children Abusing Drugs (PChAD) Act. He would eventually tally a total of seven attempts in the system.

Through these stays in “rehab,” Shaw learned some basic living skills. But these didn’t help him overcome his biggest barrier: securing stable housing. What he needed, according to Alberta’s drug-treatment system, was to be drug-free. “When you’re using drugs, that alone really screws you for a lot of options—there’s very little low-barrier housing. A lot of these places are 12-step-oriented.”

The 12-step method, developed in the 1930s for people dependent on alcohol, is rooted in Christian values to support people through abstinence. Countless people credit 12-step’s community support for their eventual success in maintaining abstinence. But the method has its limits and drawbacks. Critics refer to the community shaming that reveals itself, as one example, when people admit to resumption of drug use (or, to use the more stigma-laced term, when they “relapse”). Speaking of her own experience in a 12-step program, New York Times journalist Maia Szalavitz put it bluntly: “Such clearly religious practices would not be accepted as medical or psychological treatment for any other condition.”

An internal AHS document reveals that 12-step-based strategies are central in publicly funded facilities harbouring three-quarters of Alberta’s treatment beds. Around half of Alberta’s treatment beds are in explicitly faith-based facilities. Between religious undertones and an overwhelming focus on total abstinence from drugs, rehab can exclude people seeking other approaches to recovery, including ones that don’t aggravate their existing shame.

But one life-altering experience in treatment stands out for Shaw. “I’ve experienced all kinds of trauma through the last 12 years,” he says, summarizing lifetimes of harm in one breath. During an extended stint at Our House Addiction Recovery Centre in Edmonton, Shaw says, he underwent six months of trauma therapy with a professionally certified counsellor. That length of time “was the only way I was able to get vulnerable… I had to trust him more than anyone I’ve ever trusted.”

Trauma therapy, however, is expensive, intensive and outside the scope of most treatment facilities in Alberta. It takes weeks or months to conduct pre-screening and ensure that a participant is in position for routine follow-up and therapeutic work outside of regular sessions. In effect, trauma therapy requires someone to be sheltered, supported by a close network and ready to face their demons. Shaw wanted “treatment that would fit [him] individually, not just a one-shoe-fits-all, for every single person coming in.” Instead, the option offered by most rehab facilities he visited in Alberta seemed to create “a revolving door. It doesn’t work.”

After decades of advocacy by mental health professionals, Alberta not long ago was set to expand its therapeutic options. But in 2021, a day before the ribbon was to be cut on the College of Counselling Therapy of Alberta, the provincial government announced the college was “no longer a priority.” It cancelled the launch, preventing the professionalization of oversight and regulation of mental health and addiction therapy. Instead, the Kenney government doubled down on treatment facilities that are cheaper and unaccountable.

The lack of accountability at Alberta’s existing treatment services troubles Tailfeathers. “Without evaluation, we have no idea what works and what doesn’t,” she says. “[A program] might look good, but are we actually evaluating whether it’s successful or not Is there an overall decrease in mortality, an increase in people returning to the workforce, children staying in their households with their parents?” Our government is “shooting from the hip, putting all their eggs in one basket.”

Despite regularly publishing data on drug-related EMS-dispatch and drug-related mortality, the government of Alberta hasn’t shown how treatment impacts the odds of survival—if it even knows. Hyshka suggests the starting point to assess success would be to see if people who attended treatment “had any EMS activations or attended a hospital for substance use disorder for six months and one year following discharge.” In Alberta’s centralized medical system, this should be easy.

Alberta’s Ministry of Mental Health and Addiction did not reply to any of my questions. Reporting requirements to the government were, however, disclosed to me by a director and a manager at two private but publicly funded residential treatment facilities and a staff member at an AHS detox facility. (They requested anonymity to protect their provincial funding.)

The responses from the three facilities provide a rare insight into the government’s selective data management. By collecting client participation data such as number of people initiating and completing treatment, number on wait lists, and participant demographics, the government attends to the needs of the treatment industry.

Conversely, the government appears to actively ignore client outcomes, including how many people maintain abstinence or even survive in the months following their participation in a treatment program. And while the government tracks the number of people discharged early from treatment and the reasons for early discharge, this information is not publicly disclosed. As a result, the industry is protected from evaluation and scrutiny while clients continue to be ushered through the system. And the fact that one facility admitted to a “triage process” while another did not suggests the possibility of “pay-to-play”—priority access for people with the right network and a willingness to make donations.

The collecting of data on people using services and what helps them complete programs can create an impression that the programs are supporting recovery goals. But this hinges on how we define recovery and success. The lack of follow-up with patients, says Hyshka, “means the system isn’t accountable to [the public] or to patients. If you’re a politician and you’re not measuring success, you can’t be held accountable for your policy decisions.” And as Shaw points out, a “revolving door” system in which clients leave treatment only to re-enlist months later—at thousands of dollars per stay—represents a tremendous business opportunity.

It turns out that, in the distinct but overlapping worlds of addiction and drug poisoning, definitions of “recovery” and “success” are not universal.

The Alberta government claims that “acute interventions,” a veiled reference to harm-reduction services, have “come at the expense of supporting the long-term wellness and recovery of individuals, families and communities.” The implication is that helping people stay alive while using drugs comes at a cost to the individuals and their communities by delaying their transition to “recovery.” The government defines recovery as “a process of sustained action toward physical, social and spiritual healing and wellness while consistently pursuing a substance-free life.” This contrasts with harm-reduction-oriented definitions, many of which centre a person’s own goals related to drug use alongside informed consent on supports.

The goals, actions and performance metrics built into recovery-oriented (abstinence) systems of care are detailed in the 2023–26 business plan for Mental Health and Addiction. The ministry’s budget is $300-million for 2023–24, of which at least 80 per cent is allocated to addiction and mental health recovery programming and capital costs. In a rare instance, the plan specifies a secondary objective of reducing “opioid-related overdoses in the province, with a focus on Indigenous Albertans who are disproportionately affected.” The initiatives listed are limited to residential and day treatment, a helpline and an expansion of the Virtual Opioid Dependency Program (VODP)—hardly a complete recipe for managing a toxic drug supply.

The VODP was originally designed to provide access for people in rural settings to treatment and opioid agonist medications (such as methadone and Suboxone); it was recently adopted for use in prisons. However, a 2022 study funded by AHS and co-authored by Nathaniel Day, the medical director of VODP, showed considerable participant dropout. Those who could be studied, the authors admitted, “were individuals who remained in treatment and were agreeable to completing assessments, [so] they may have also had more positive outcomes.”

The best treatment for opioid use disorder is medication. “Rehab” for opioid use has little supporting evidence.

Alberta’s recovery-oriented system is operating as a flimsy raft in a storm of toxic drugs, unaffordable housing and structural neglect. Thousands of Albertans, unable to hang on, are annually lost at sea. Others, with resources, luck and a willingness to define recovery as abstinence, are eventually carried to dry land. How many Albertans are saved, and for how long, our government either doesn’t know or won’t say.

In their emphasis on mortality, advocates for harm-reduction options misinterpret the ideology underpinning Alberta government’s approach to the poisoning crisis. Long term, the government’s apparent hope is that its recovery-oriented system will give rise to drug-free communities. In the short term, however, the “pursuit of a substance-free life” is being prioritized over minimizing death and illness caused by an unregulated supply.

The way treatment programs are instructed to monitor participant mortality rates helps illustrate this ideology. An executive director at a facility (residential treatment facility #1 in the table) told me that they only learn about the deaths of recent participants through alumni, 12-step meetings, mentorship programs or when someone voluntarily reports a death to the facility. If a participant’s death is reported within two months of the person’s exit from a program, it is relayed to the Alberta government. That completes reporting.

In the run-up to the 2023 provincial election, UCP candidates frequently celebrated their system’s supposed ability to reduce deaths. But during the same period, drug toxicity deaths rose steeply, topping 195 in April 2023—Alberta’s worst month on record. The government has since pivoted to a “Recovery Capital Index” to measure the success of treatment. This approach defines recovery capital as “the combination of personal, social, community and other supports that a person can draw upon to begin and sustain their recovery from addiction,” including housing, employment and family connection among the eight factors in the framework.

An individual’s index is measured at several timepoints during treatment using the My Recovery Plan app. Created by BC-based Last Door Recovery Society, the app was licensed to the Alberta government through sole-source contracts totalling nearly $1.8-million.

David Hodgins, a professor of psychology at the University of Calgary, describes recovery capital as an “increasingly recognized construct describing dimensions of recovery beyond reduction of problematic substance use.” He points out that no research yet exists on whether the app improves outcomes, though this is typical for mental health apps. Hodgins is also careful to emphasize that recovery capital “has nothing to do with reducing drug poisoning deaths, beyond the idea that more people being successfully treated is a good thing. It may help people maintain abstinence by pointing out areas of strength and areas of need.”

The director at residential treatment facility #1, mentioned previously, was enthusiastic about Alberta’s new framework, saying, “I see the successes every day… Recovery capital is measured in simple points: when they come in, at the 30-day mark, when they exit… we see huge increases at those points and huge decreases in the barriers to recovery.”

Recovery Capital Index scores, if they improve—and assuming they can be trusted and are released transparently—may eventually help justify the Alberta government’s focus on rehab. But, says Hyshka, “if the number one goal is to reduce the death rate, funding treatment beds is not going to do that.”

She emphasizes that the gold-standard treatment for opioid use disorder is medication, while residential treatment has little supporting evidence thus far. In any case, she reminds us, “a large percentage of people who use opioids or other substances are not going to meet the criteria for substance use disorder [or for being admitted to treatment], but they’re still at risk of dying—especially if they’re accessing drugs from the illegal market.”

The Mental Health and Addiction ministry’s $300-million budget in 2023–24 is a roughly 40 per cent year-over-year increase. This is laudable spending against historical underfunding on mental health and substance use supports. But the same budget announcement designated just $14.5-million for supervised consumption sites, a 30 per cent drop that was obscured in subsequent budget releases. Underscoring this quiet manoeuvring, the UCP’s fall 2023 annual general meeting passed a resolution calling for the wholesale defunding of supervised consumption services. And the Alberta government continues to build out its plans for its notorious Compassionate Intervention Act. This legislation is expected to empower police, families and healthcare providers to obtain court orders that compel people deemed a danger to themselves or others to undergo addiction treatment.

“Tough love” might seem compassionate to some. But Hyshka says the evidence shows that people are at “much higher risk of death from poisoning” following a period of forced abstinence. She also worries that “we already have trouble encouraging people to talk openly about their [drug] use and speak out and reach for help when they need it.” Fearful of being subjected to involuntary treatment by those they trust, “people will stop reaching out for help.”

Despite plans to construct 11 “therapeutic communities,” at least four of them in First Nations communities, including Enoch Cree, Kainai, Siksika and Tsuut’ina first nations, the government is signalling further privatization in the ownership structures. Not only will the success rates of treatment remain unknown to the public and to patients, it’s unclear how public money is being spent. Tailfeathers is troubled by this lack of transparency: “It’s like building all the brick residential schools… we’ve got these things built, but nobody knows what happens inside.”

The government’s first such contracts, in Red Deer and Lethbridge, were awarded to Edgewood Health Network and Fresh Start Recovery. Edgewood is a private company backed by undisclosed investors, while Fresh Start is a non-profit. Both corporations are perennial Lead Sponsors of the Recovery Capital Conference, a public centrepiece of the UCP government’s recovery-oriented system of care.

The conference also happens to be organized by Last Door Recovery Society, the organization that licenses My Recovery Plan to the Alberta government. After a former staff member was charged with multiple sexual assaults in 2023, Last Door came under fire for alleged attempts by senior staff to prevent survivors and community members from coming forward. As individuals and treatment facilities load recovery capital scores into My Recovery Plan to shore up the government’s appearance of system monitoring, Last Door will grow its financial capital. Reducing deaths will remain a secondary concern.

To Tailfeathers, addressing deaths must be a top priority. The trauma of unending crisis and loss is “wearing down people at the frontlines,” while the government’s strategy is “way off the mark in terms of… healing people who are seeking the drugs.”

“If politicians are not measuring success, they can’t be held accountable for their policy decisions.”

It’s a sunny fall day seven months after my first meeting with Brandon Shaw, and my phone call with him is interrupted by someone dropping boxes of naloxone at his apartment. He’s been housed since spring, after detoxing at home with Staines’s support and getting access to a safe supply of hydromorphone. When he picks up the phone again he tells me, “Things are going amazing. I’m at a place in my life where I have more now than I ever have—emotional supports, people I work with in advocacy—all these people now that have come into my life…  Without my mom, I can’t guarantee you I’d be here today.”

When he was unhoused, he says, he was stripped of his voice and “tired of people crossing the street to get away.” With the support of 4B Harm Reduction, Shaw has launched a public education project—The Curbside Philosophy—to restore power to his community. As a society, he says, we spend so much time talking about unhoused people—Shaw wants us to speak with them. His project makes short videos situating real people inside the politics.

Not everyone from Shaw’s past has been able to transition to a life like his. “What keeps me up at night are the people I had to leave behind,” he says. His voice breaks as he describes the displacement of people who used to meet every day at the recently relocated Boyle Street Community Services, a ripple effect of the gentrification that is driving unhoused Edmontonians and their services out of the core.

Shaw knows his luck—in having Angie Staines as his mother, in surviving his interludes between the “revolving doors” of treatment, in finding a purpose with 4B Harm Reduction, in the grassroots community that supported him while he faced exclusion by the system. “I don’t want my whole recovery to be founded on… the fear of 12-step—having to tell everybody what a screwup you are. …When I screwed up, my community was behind me. People were just happy to see I wasn’t driven by fear and shame.”

Euan Thomson co-launched EACH+EVERY, which supports evidence-based, humane solutions to unregulated drug toxicity.

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The post What’s Wrong With Rehab? appeared first on Alberta Views.

According to Public Health Canada, 24,626 Canadians died of opioid poisoning between January 2016 and June 2021. Alberta has borne a disproportionately large share of the damage, with the second-highest death rate of the provinces. Fully 90 per cent of the deaths over the first three months of 2021 were in Ontario, BC or Alberta.

The main driver of deaths, according to the Canadian Drug Policy Coalition, is not that more people are getting addicted but that the drug supply has become increasingly toxic. “We need to get over the fact that people use substances,” the CDPC has stated, “and we need to put a very comprehensive consumer protection framework in place so that people won’t die from using these substances.” Thomson similarly advocates for a “massive expansion of harm-reduction services,” including more supervised consumption sites.

But Alberta’s government has taken a different approach.

“Helping addicts inject poison into their bodies” is Jason Kenney’s take on harm reduction.

In March 2018, when UCP leader Jason Kenney was campaigning in Lethbridge, he offered a preview of how he would approach the issue. “Helping addicts inject poison into their bodies is not a solution to the problem of addiction,” he told a Lethbridge Herald reporter. “Injecting poison” was Kenney’s take on harm reduction, a model that’s been proven to minimize the negative impacts of drug use and offers help to people, without judgment, coercion or preconditions such as sobriety. He argued instead for “interdiction and law enforcement” targeting people who sell illicit drugs.

Once he became premier, Kenney was true to his word. He immediately ordered an audit of Lethbridge’s ARCHES, a non-profit that operated North America’s most frequently used supervised consumption site (SCS). Since opening in 2018, ARCHES had a 100 per cent success rate at reversing overdoses, while also providing other emergency healthcare, education on drug harms and referrals to social services such as counselling. The audit’s finding in July 2020 that $1.6-million in funds weren’t accounted for gave Kenney a pretext to cut off funding for ARCHES.

Five months later, a criminal investigation by Lethbridge Police Service found that these funds were in fact accounted for, but the damage was done.

ARCHES wasn’t the only service to fall prey to Kenney’s disdain for harm reduction. The UCP government appointed an SCS review committee with a mandate to look solely at the socioeconomic impacts of sites on surrounding communities and not the merits of harm reduction services themselves. The committee’s March 2020 report unsurprisingly found the impacts of SCSs to be “predominantly negative,” citing complaints of needle debris, crime and “overall social disorder” around the sites. (Kenney himself has called SCSs “NDP drug sites”—despite their excellent track record at reducing mortality in Canada and across the world.)

The government announced in May 2021 that it would close Safeworks, Calgary’s lone supervised consumption site. Justin Marshall, a spokesperson for the associate ministry of mental health and addictions, called the site, at the Sheldon M. Chumir Health Centre, “highly disruptive to the neighbourhood.” He said the service would be moved to two other parts of the city and operated by “existing partner organizations,” but didn’t specify their locations or who would run them.

After the government closed ARCHES, it allowed AHS to open a mobile SCS in Lethbridge. Today this nondescript white trailer has three booths, compared to 13 at ARCHES; it operates 20 hours a day, compared to ARCHES’ 24 hours. A coalition of Lethbridge doctors called the mobile site “not adequate by any means,” noting that people who use drugs are being expected to wait five to six hours to use the trailer.

The government also shut down the Boyle Street SCS in Edmonton at the end of April 2021, redirecting those services to George Spady Centre across the street, which was supposed to operate in conjunction with the SCS, causing confusion. It pledged to open a new SCS in Edmonton’s Strathcona neighbourhood, but gave no timeline. “It’ll take a lot of time to set up services there,” a Moms Stop the Harm director told Global News. “[But] the need is right now.”

AHS runs a small mobile supervised consumption site in Lethbridge. Photograph courtesy of Alberta Health Services.

Lethbridge’s ARCHES ran North America’s busiest SCS. Staff reversed overdoses, educated on drug harms and gave referrals to counselling. The UCP government shut down ARCHES in 2020. Photograph by Jaime Vedres (2018).

The Kenney government’s disdain for supervised consumption stands in stark contrast to its eagerness to fund privately operated recovery clinics that promote an abstinence-only approach to addiction. Kenney and former associate minister of mental health and addictions Jason Luan like to call this “the Alberta Model”—a more compassionate face for the UCP’s approach to addictions than its campaign-trail tough-on-crime rhetoric.

A key architect of the UCP government’s shift toward abstinence and away from harm reduction is Marshall Smith, chief of staff to the associate minister of mental health and addictions. Smith described his approach in a 2015 interview with Talk Recovery Radio. “When we talk about reducing the shame and stigma, we’re talking about the shame and stigma of recovery,” he said, “I think a certain shroud of stigma needs to remain around addiction.”

His background story presents a compelling redemption narrative. A rising star in the Gordon Campbell-era BC Liberal party, Smith worked in that province’s Attorney General’s office and was a heavy drinker. He was eventually arrested twice for selling cocaine and meth in 2004, leading to an abrupt interruption of his political ambitions. For the next couple of years, Smith was homeless in Vancouver, selling drugs to pay for his habit while being chased by police.

He got sober in 2007 and became a guru for the private recovery industry. His first recovery gig was at Baldy Hughes Therapeutic Community and Farm. Smith’s political interests, however, appear to have never left him. In 2011, according to reporting from Glacier Media, Smith had Baldy Hughes patients phone-bank for Kevin Falcon, a candidate for BC Liberal leadership, pressuring them to call party members to solicit support for Falcon. Confidential sources told Glacier that patients had no choice, since many of them were court-ordered to attend Baldy Hughes, and that Smith goaded reluctant patients into participating.

“It was a very political environment,” one source said. Smith, for his part, says any phone-banking his patients did was entirely voluntary and independent of his guidance.

In 2015 Baldy Hughes received $1-million from the BC government to open 20 new beds, 13 of which had been filled by the time of the announcement. Smith had already moved on by then to another private recovery centre in BC, Cedars at Cobble Hill, where he became director in 2013, a role he stayed in until he was made chief of staff to Alberta’s associate ministry in May 2019. Smith remained in the role in July 2021, when Luan was shuffled out of the mental health and addictions portfolio and UCP MLA and former Calgary police officer Mike Ellis became associate minister.

In November 2019 the UCP convened a 23-person mental health and addictions advisory panel, naming as its co-chairs Mustard Seed Ministry founder Pat Nixon—a reformed drug addict himself, and the father of UCP MLAs Jeremy and Jason—and Canadian Mental Health Association Calgary executive director Laureen MacNeil. Other members included Calgary Police Service inspector Rob Davidson, Edmonton Police Service chief Dale McFee, two bankers (ATB Financial CEO Curtis Strange and Edgemark Capital founder Bruce Edgelow) and acupuncturist Dr. Benny Xu.

Particularly noteworthy were the appointments of three people from the upper echelons of the private abstinence-only recovery industry: Fresh Start Recovery Centre executive director Stacey Petersen, Poundmaker’s Lodge Treatment Centres executive director Brad Cardinal and Simon House founding director Andy Crooks, who was previously director of the Canadian Taxpayers Federation while Kenney served as that organization’s CEO.

Two of these three recovery centres have since been the beneficiaries of government money. In December 2019 Kenney announced $1.4-million for Poundmaker’s Iskwew Healing Lodge, built just north of Edmonton on the site of a former residential school, to fund 28 new beds and seven existing beds. “This government needs to be acknowledged for its commitment to UNDRIP, TRC recommendations, MMIWG recommendations and its concerted effort to addressing the opioid crisis,” Cardinal said in a news release, which didn’t identify him as an advisory council member.

On February 1, 2020, the government announced that Fresh Start, which is only for men, would receive up to $1.56-million a year for three years to fund 294 more treatment spaces in Calgary. Petersen called the funding “unprecedented” and a “game changer,” in a press release that, again, didn’t identify him as a member of Kenney’s advisory committee.

At the same time, Calgary’s Sunrise Healing Lodge received up to $518,000 a year over three years to fund 156 treatment spaces, and Lloydminster’s Thorpe Recovery Centre got $2.21-million a year over three years for 1,722 treatment spaces.

In November 2020, associate minister Luan announced the elimination of fees for clients of Alberta’s 72 publicly funded treatment centres. Poundmaker’s, for example, had been charging $300 a day for “Indigenous-led treatment for drug and alcohol addiction.” Luan’s move is costing the public about $8.2-million a year, roughly $5-million of which was diverted from Community and Social Services.

Petersen, who is now the CEO of Cedars at Cobble Hill, has been one of the most enthusiastic evangelists for the UCP’s recovery-centric approach to addictions. “This is a strategy of which we are extremely proud,” Petersen wrote in an October 2020 Edmonton Journal op-ed, which identifies him only as a co-chair of Alberta Addiction Service Providers (AASP), a coalition of 32 private recovery clinics that includes Fresh Start, Thorpe, Sunrise, Poundmaker’s and Simon House. He dismissed critics of the recovery-centric strategy as divisive and lamented their spreading “hatred.”

In July 2021 the government announced the construction of a 50-bed recovery centre—one of the five new “therapeutic communities” promised a year earlier to the tune of $25-million—on public land adjacent to Fresh Start’s Lethbridge branch. It also provided $300,000 for 11 publicly funded beds at Southern Alcare Manor, another AASP affiliate in Lethbridge. The cost of the 50-bed centre is unknown, because the build is going through a “competitive tendering process,” said Mental Health and Addictions spokesperson Eric Engler. Nor is it known who’ll operate the facility, which Engler said will be determined through a “competitive process” closer to the facility’s opening in fall 2022.

The next of the five new recovery centres is a 75-bed facility being built on 10 acres in the industrial zone on the northern outskirts of Red Deer, announced in June 2021. Participants will be expressly prohibited from using drugs while in treatment, including at the local SCS. The ministry told the CBC that an accredited non-profit will be selected through a formal competitive process to operate the facility. “It is not about service utilization; it is about how people’s quality of lives get changed,” Luan said.

Documents obtained by Postmedia show the government plans to “re-evaluate (the) need” for a supervised consumption site in Red Deer once the recovery facility is built.

Supervised consumption has an excellent track record at reducing mortality in Canada and across the world.

Critics of the UCP approach say that the government fundamentally misunderstands the crisis. University of Calgary health sociologist Rebecca Haines-Saah, whose research focuses on addiction, says Kenney and his ministers have established a false binary between harm reduction and treatment that has dire consequences for people who use drugs. “They’ve pitted harm reduction against treatment, as if to say that funds for harm reduction somehow take away from treatment, that the two are in competition, or that people who support or advocate or benefit from harm reduction are opposed to treatment,” says Haines-Saah.

She identifies this line of thinking as the product of a “paternalistic” view that regards harm reduction services as “palliative care for people who use drugs.”

Elaine Hyshka, a professor of public health at the University of Alberta, says the UCP’s approach has been hyper-focused on mental health and addictions as the root cause of Alberta’s current crisis. She characterizes this as a catastrophic error that obscures the true crux of the issue. “It can be really tempting to focus on those areas, because there is a lack of investment in those types of services across the board in Canada,” she said. “[But] the reason we’re seeing so many people dying now is not because there’s been a huge, sudden spike in people who have opioid addiction or who are using drugs; it’s that the drugs have become toxic and poisonous.

“Putting in place services designed to support people who are struggling with addiction is a good thing—but it’s not addressing the fundamental challenge.”

Beyond supporting supervised drug consumption and other harm-reduction measures, such as opioid agonist therapy (in which people are prescribed methadone or buprenorphine), the most effective solution to the current crisis, Hyshka says, is to provide people with a safe supply of “pharmaceutical-grade” drugs—a policy that’s counterintuitive to laypeople but has been endorsed by Health Canada. The thinking: better to provide safe substances to people with a serious illness (and keep them alive until they’re ready to quit) than to wait for them to surely die from toxic street drugs. “The reality is that the vast majority of people who use substances, even if they have a substance use disorder or addiction, aren’t necessarily ready and willing at the moment to access care,” Hyshka said. “That’s not a reason to preclude them from accessing services that could save their lives.” BC, for example, began allowing nurses to prescribe specific drugs, including controlled substances, starting in September 2020, with a public health order from chief medical officer of health Bonnie Henry.

The UCP convened a committee in February 2022 to examine the merits of safe supply, but harm-reduction advocates whom the NDP opposition invited to present to the committee boycotted it, arguing that its conclusions were predetermined.

Hyshka also questions why this government stopped releasing geographic data on where overdoses are occurring in each city after it launched its online substance use surveillance database in December 2020, which would have informed where supervised consumption sites are needed.

Other experts note the absence of data on the recovery side of the equation. No independent analysis is available on the success rate of the various private recovery centres, meaning the government is essentially operating in the dark or trusting private operators’ attestations. In a December 2020 statement to the Progress Report, for example, Thorpe development coordinator Sara Fox said their 42-day recovery program has a 79 per cent completion rate, but said it’s nearly impossible to gauge its success in absolute terms. “For, what is success One day of abstinence One month One year It’s misleading to claim that someone will be ‘cured’ after programming,” Fox wrote. “Continued dedication to one’s wellness is necessary for a prolonged life in recovery.”

It’s also unknown how many publicly funded beds exist province-wide, how often they’re used and what wait-lists are like, as well as the number of deaths that have occurred in those facilities. “These basic metrics could be easily incorporated into the substance-use surveillance dashboard the province already publishes, but for some reason there’s just no appetite to share any information about these operators and the funding that goes to these services,” says Hyshka. “The province is investing hundreds of millions of dollars in these services, but there’s just no accountability in terms of their performance and whether they’re achieving their stated objectives.”

We’re spending hundreds of millions of dollars on private rehab, but there’s no accountability.

Meanwhile the UCP has expanded the use of drug treatment courts as an alternative to criminalizing people who use drugs, doubling capacity in Calgary and Edmonton as well as opening courts in Lethbridge, Medicine Hat, Red Deer and Grande Prairie. These are explicitly promoted as a means of funnelling people into recovery. In an interview with the Canada’s Premiers podcast about the UCP approach, Matthew Reid, who is in charge of the drug courts’ expansion, pitched them as a means to achieve the goal of strict abstinence. “Participants facing serious jail time for drug-driven offences are provided a chance to avoid a jail sentence by completing this program. They’re held accountable through judicial supervision,frequent and random drug testing, and the use of sanctions and rewards.” [Emphasis mine.]

U of C’s Rebecca Haines-Saah likewise criticizes this government’s fixation on beds and spaces. “This is just a political talking point—500 new beds, 1,000 new beds—and the situation never seems to change,” she said. Haines-Saah believes the UCP approach sends “mixed signals,” likening it to dismantling ICUs at the height of COVID and reopening them elsewhere. “It just doesn’t make any sense,” she said. “We need more [supervised consumption] sites now, in addition to what’s there.”

Beyond closing supervised consumption sites and spending big on abstinence-only recovery, the UCP government has allocated $325,000 on developing its Digital Overdose Response System app, which became available in Calgary in September and in Edmonton in October 2021. A drug user enters their location into the app and sets a two-minute timer. If they don’t respond to the timer, STARS air ambulance contacts them and dispatches help if necessary.

“I appreciate any attempts to trial novelty strategies here, and I think there’s a need to care for people and prevent overdose deaths among people who use at home alone, because that’s a huge risk factor for dying… but I don’t think an app alone is going to bring down the death rate significantly,” cautions Hyshka. (Meanwhile, Calgary’s EMS system reported 3,569 red alerts—periods when no ambulances were available—between June 2020 and May 2021; Edmonton reported 626 over the same period.)

New barriers are also being erected around the supervised consumption sites that remain. As of September 30, 2021, Alberta SCSs are required to sign a “good neighbour agreement” with the surrounding community, which includes a dispute resolution process. And as of April 2022, people who use drugs must provide their Alberta healthcare card to access the sites. In an Edmonton Journal op-ed, associate minister Mike Ellis said the restrictions are designed to redirect patients into recovery, arguing that requiring healthcare cards allows people to be more easily integrated into treatment. “Quality standards will ensure that supervised consumption sites are acting how they were intended, as an entry point into the healthcare system,” he wrote. “Clients will be able to expect consumption sites to partner with treatment and recovery programs, ensuring they get the care they need to improve their lives sooner rather than later.”

Edmonton lawyer Avnish Nanda is spearheading a legal challenge to the new SCS regulations, which he says greatly reduce people’s access to the sites. They will also prohibit more-informal interventions, such as Lethbridge’s pop-up overdose prevention tent in Galt Gardens, which is busy these days following the shutdown of ARCHES.

An emergency injunction application launched by Nanda to pause the implementation of ID requirements was rejected in January 2022. Court of Queen’s Bench Justice Paul Belzil agreed that the policy could cause “irreparable harm,” even death, to people who are deterred from using supervised consumption services, but said these harms don’t outweigh the government’s power to set drug policy independently.

Nanda predicts that the UCP’s approach to the addictions crisis will contribute to an even more “catastrophic public health emergency” than the COVID-19 pandemic, because when it comes to saving lives, the best evidence is being ignored—and because overdose deaths only keep rising, with no end in sight.

Jeremy Appel is a Calgary-based podcaster (The Forgotten Corner) and writer. See appelorchard.substack.com.

The post “Just Say No To Drugs” appeared first on Alberta Views.

Assistant clinical professor of preventive medicine at the University of Alberta

Twelve-step addiction recovery programs teach that it is irrational to “do the same thing over and over again expecting different results.” This should be a lesson for legislators too. As the 4,000 Canadian families who lost a loved one to an opioid overdose last year know, our drug laws have been a spectacular failure. It’s long past time to change course and decriminalize drug use.

Let’s first dispense with the straw-man argument that drug decriminalization is about encouraging or condoning drug use. That’s simply untrue. Both sides of this debate argue that people are generally better off not using drugs. But whether or not you believe drugs are bad, everyone in a compassionate society must agree that drug-related problems are bad, and so are preventable deaths. Good drug policy would reduce those outcomes. Our current approach does the opposite.

The threat of jail or a criminal record causes people to hide their drug use. That’s why it’s so common for people to die while using drugs alone at home or in back alleys. “Tough on drugs” talk and policies fuel stigma, keeping people from seeking potentially life-saving medical help.

When people go to jail for possessing drugs, they frequently suffer horrific withdrawal and compulsions to use again at the first opportunity. In jail it’s far easier to get drugs than treatment, and drug use there is far riskier. Needle-sharing and disease transmission are common in jail. So is death. Alberta, BC and Ontario have all witnessed recent increases in fatal overdoses in jail, and the risk of drug-related death surges eightfold in the weeks following release.

For those who survive jail, life is permanently scarred by a criminal record, which worsens unemployment, social exclusion, trauma and family estrangement. These factors, by the way, all increase the risk of drug-related problems and overdose death. In other words, by punishing people who use drugs, the state harms public health.

Besides being ineffective and counterproductive, criminal drug laws are a disturbing departure from how governments should relate to citizens in free societies. If you’re like the vast majority of Canadians who recreationally use a drug (such as cannabis, alcohol, cocaine or heroin), the state should play a limited role in your drug use. That doesn’t mean families or faith communities, for example, can’t still encourage abstinence from drugs in accordance with shared values and beliefs. Health professionals can and should address substance use in their supportive environments. But governments mustn’t strip citizens of their freedom simply for making disagreeable personal choices affecting their own health and well-being.

Instead of spending tremendous resources on draconian measures that achieve the opposite of what they ostensibly intend, we should invest in evidence-based addiction treatment and prevention. Drug decriminalization may be unpopular in some circles, but countries that have taken this step, as Portugal did in 2001, have seen remarkable decreases in drug-related harms. Experts worldwide are clear on this: To reduce drug risks, governments must take some political ones.

Roger Chaffin says no

Chief of the Calgary Police Service and a board member of the Calgary Homeless Foundation

In Calgary in 2017, more people died as a result of an opioid overdose (415) than from traffic fatalities (11) and homicides (27) combined. While opioids continue to take a tragic toll at an alarming rate, corresponding drug trends show that methamphetamine use has also increased significantly, along with the acquisitive crime associated with drug use.

There is no doubt that this is a complex social issue requiring collaboration on many fronts. How do you tackle an issue of this magnitude, and where do you start What are the foundational pieces that are driving harm to the individual, their families and the community?

In the fall of 2017, Calgary welcomed its first supervised consumption service. The Calgary Police Service remains an integral partner in supporting this initiative and acknowledges that the complex social issues of substance abuse cannot be solved in isolation and is the responsibility of many stakeholders, not just police. Our role is not to criminalize addiction, but rather to ensure that vulnerable people are not being preyed upon by those seeking to fund criminal activities.

Research shows that factors such as mental health, trauma and toxic-stress effects on the brain are some of the main drivers for self-medication by way of substance abuse. These are vulnerable people who, first and foremost, need support to address the root causes of their addiction. The role of police is often to be that first point of contact when someone is in a cycle of self harm. Engaging with that person to provide support and services often begins with an interaction with an officer. Decriminalizing possession of drugs would eliminate the authority of the police to have meaningful, purposeful and effective interactions with people who are caught in a cycle of self harm, and who are likely causing subsequent harm to their family, friends and community. For those people, an arrest or charge might just be the key to accessing the resources and services they need. However, those resources need to be in place to effectively interrupt the cycle.

Simple possession charges, unrelated to other criminal offences, are not a focus for our officers. The vast majority of people charged with at least one drug-possession-related offence in the past seven years (86 per cent) have been identified as offenders in more than one criminal incident. Property crime, violent offences and Criminal Code traffic offences are the most frequently associated incidents. These involve victimization of others and impact the sense of safety and security in our communities. While we don’t criminalize addiction, police have a duty to ensure public safety for all.

To simply decriminalize possession of drugs without a robust community support strategy to address the underlying issues will not benefit the person in crisis or the community at large. Focusing on the foundational community responsibility to mental health would go a long way to address the root causes of drug abuse and the subsequent symptoms such as crime and social disorder.

Hakique Virani responds to Roger Chaffin.

Chief Chaffin is right. People with addiction must be supported by communities that prioritize mental health, treatment and social integration. We must protect public safety and social environments. And we must safeguard and enhance the well-being of vulnerable individuals amongst us. Unfortunately, criminalization of drug use doesn’t achieve these ends. It does the opposite.

Calgary opened its first supervised consumption service (SCS) last year, and my colleagues and I are grateful to Chief Chaffin and the Calgary Police for supporting this initiative. Worldwide, no one has ever died of overdose while attending an SCS—effectively a zone of decriminalization. Research shows that people who attend an SCS are more likely to then seek addiction treatment. In other words, providing environments that are medically and legally safer increases the chances that substance users will one day stop.

It’s counterintuitive to some that what appears to be acceptance of substance use actually reduces addiction. But the reason for this association is simple: Harm reduction saves lives, and dead people don’t recover from addiction. Environments that replace handcuffs with helping hands validate lives, reduce stigma and provide less objectionable avenues for people to seek help earlier.

Even if criminalization could somehow help people with drug-use disorders, our blunt legal instruments conflate possession with addiction. Addiction is chronic, relapsing, compulsive substance-use characterized by physical and social dysfunction. The vast majority of people who possess substances for personal use are not addicted to them. Most Canadians use psychoactive substances. There’s no better way for a Canadian politician to prove they are folksy and relatable than being photographed enjoying a cold beer.

Some might scoff at the comparison between a legal drug such as alcohol and illegal ones such as cocaine. And there are indeed differences. Injury, cancer, hospitalization and death are more common from alcohol exposure than from exposure to most illegal drugs. Alcohol is about as addictive as cocaine (and far more addictive than cannabis). And it’s the drug most often associated with violence. Anyone citing the harms of illicit drugs as justification for criminalization would have a hard time explaining why alcohol is legal. (Unless, of course, they’re willing to acknowledge that alcohol is a favourite substance among socially dominant groups.) But here’s one important way alcohol and illicit drugs are the same: Prohibition of alcohol in the 1920s gave rise to toxic moonshine, just as criminalization of drugs has brought about cheap, lethal chemicals such as fentanyl, which are so easy to synthesize and traffic that interdiction is effectively futile.

Using “authority” to impose care is rarely meaningful, purposeful or effective.

Criminalization of drugs doesn’t enable police to protect “vulnerable people” from predatory drug lords. As reports from the Global Commission on Drug Policy and the London School of Economics show, tough drug laws actually benefit organized crime. Low- and mid-level dealers are the ones caught and prosecuted, decreasing competition in the illicit market while demand for drugs remains high. Meanwhile, successful traffickers can charge exorbitant risk premiums despite the market evolving towards cheaper, more toxic drugs. Increased enforcement efforts are also associated with escalations in violence, not reductions. Let’s not forget: Al Capone made millions from bootlegging during alcohol prohibition while almost every US city saw increases in crime. And Capone was only ever indicted for tax evasion.

Since 86 per cent of people charged with drug possession are offenders in more than one criminal incident, it may seem that police are targeting troublemakers, not people with addiction. But criminalizing drugs drives up the cost, so that people with addiction—especially the socially disadvantaged—often resort to other crimes to afford them. Prosecution exacerbates trauma and reduces socioeconomic opportunity, resulting in progression of addiction and dysfunction. So of course there are subsequent crimes.

And what about the remaining 14 per cent whose only crime is drug possession No one benefits from their arrests, which widen inequity. Despite similarities in substance use across racial groups, Indigenous people in some regions are almost nine times more likely to be arrested for possession, and black Canadians more than five times as likely to be arrested. Our drug laws don’t protect vulnerable people; they harm them the most.

It’s true that decriminalization on its own would not optimize health and social outcomes related to substance use. But decriminalization saved Portugal tremendous resources previously spent on ineffective and counterproductive enforcement. Instead, that country reallocated funds to evidence-based prevention and treatment. Societies that invest in addressing inequity and social factors that influence health not only see reductions in substance-use harms, but improvements in outcomes for virtually every health issue.

People should never be so afraid of disclosing a personal health behaviour that it progresses to such dysfunction that a police officer is the “first point of contact.” Using “authority” to impose care rarely results in “meaningful, purposeful and effective” interactions for any health condition, let alone complex ones where trauma and psychosocial stressors play a role. In addressing Canada’s drug crisis, police leaders have commonly said, “We can’t arrest our way out of this problem.” But it’s time they and lawmakers recognize that we keep arresting our way further into it.

Roger Chaffin responds to Hakique Virani.

I happen to agree with Dr. Virani in many ways. Our current approach to the rapid increase in the number of addicted individuals in our communities is merely a band-aid solution to the complex social and health problems at the core of the problem. Jail is certainly not a place where individuals get the help they truly need to address core issues such as mental health and trauma.

That being said, the law enforcement community is not in the business of criminalizing addictions. The vast majority of individuals who are arrested and charged with offences serious enough to require jail time are not there because of simple possession of drugs. They are there because they have committed more serious crimes, often in the pursuit of fuelling their addiction, and have further victimized other members of our community.

We need solutions that will provide frontline responders—be they police, paramedics or social workers—with the tools to assist in the moment of interaction with that individual. Models such as Seattle’s Law Enforcement Assisted Diversion (LEAD) pilot program give officers the ability during their immediate interaction with low-level offenders engaged in drug-related or other illegal activity to redirect these people to community-based treatment and support services—including housing, healthcare, job training, treatment and mental health support—instead of processing them through traditional criminal justice system avenues.

The LEAD program is a coordinated approach with Seattle’s municipal government, prosecuting and defending attorneys, police, the Washington Department of Corrections and the American Civil Liberties Union. This client-centred, case-management approach has demonstrated much success. Clients were 60 per cent less likely than people in the control group to be arrested in the first six months after entry into the program, and had both 58 per cent lower odds of arrest and 39 per cent lower odds of being charged with a felony over the longer term. The program has also demonstrated statistically significant reductions in average yearly criminal justice and legal system utilization and associated costs.

LEAD is inspired by similar “arrest-referral” programs in the UK whose pilot projects proved so effective that they were eventually implemented in nearly every police department in the country. Programs such as LEAD provide relief for communities experiencing drug-related crime and social disorder, and offer opportunities for solutions and support for people with addictions. They allow police to use the power of the law to help guide a vulnerable population to an outcome that’s better for them and for the community. It’s about harm reduction working hand-in-hand with law enforcement.

Frontline responders, including police, can redirect people to community-based treatment.

Here in Alberta, the Calgary Police Service is a proud partner of the Calgary Drug Treatment Court. The CDTC, which has been in operation since 2007, provides a pre-sentence justice alternative for drug-addicted non-violent offenders through the integration of justice, health services and treatment options, including court interventions, addiction counselling, employment assistance and skills upgrading. Its philosophy: “…When drug-addicted offenders are provided with the right type and intensity of services, they can change their lives, and often in remarkable and transformative ways.” Indeed, 7 out of 10 CDTC graduates have no new charges or convictions, and overall the program demonstrates an 82 per cent reduction in recidivism.

The CDTC also takes other factors into consideration, such as research showing that over 90 per cent of women who experience serious addictions have known a history of abuse or trauma. The court offers programming led by women and uniquely tailored to women, and can provide referrals to women’s services in the community. A woman suffering severe addictions might not otherwise encounter these services were it not for justice system interventions such as those offered at Calgary’s Drug Treatment Court.

Both the LEAD program and the CDTC offer potential solutions to this complex social issue. Ultimately it comes down to resources. Our communities, municipalities and provinces must come together to make mental health and addictions a focus. We must all work together to acknowledge the harm caused not just to the individual and their families but to our communities by these chronic health issues.

In the meantime, police officers will continue to do what they can on the frontlines. We have a duty to care with compassion and fairness, ensuring impartial and just treatment to all. Our officers are currently undergoing training for trauma-informed approaches to working with our vulnerable populations. Toxic stress effects on the brain, trauma and mental-health conditions impact self-treatment decisions. Understanding this guides us in our daily interactions with individuals.

We will continue to work with our partners to address the complex social and health issues facing our city today and into the future.

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The post Should All Drugs Be Decriminalized? appeared first on Alberta Views.

When her name is called and the door to Lethbridge’s supervised drug consumption site buzzes open, Taylor moves quickly on her crutches. She settles into a chair at the second booth from the end and rests her pink sequined backpack on the stainless steel counter. The petite 21-year-old works swiftly, loading a speedball—a combination of meth and fentanyl—into a syringe.

This freshly wiped, well-lit booth belongs to her for the next 45 minutes. Taylor, who didn’t want to give her last name, doesn’t have to rush to avoid the notice of police or the public. No one here shouts racial slurs or points out that she’d be freed from her crutches if she’d stay clean long enough to undergo hip surgery. She needs the operation to fix injuries from a car accident last year, but the risk of infection is high given her IV drug use and lack of steady housing.

Two nurses watch from a desk a few feet away, overseeing the six injection booths. They monitor that Taylor follows injection practices that are as safe as possible. Everyone who works here points out that drugs are not safe—this is not a safe consumption site. People here still struggle from the effects of drugs; they still overdose. Taylor has, more than once. These nurses saved her life, along with nearly 140 others in the last three months.

Taylor is a near-daily visitor at Lethbridge’s supervised consumption site, run by the AIDS Outreach Community Harm Reduction Education & Support Society (ARCHES), a non-profit. In 2017, backed by a coalition that included Lethbridge police and EMS and Alberta Health Services, ARCHES applied to Health Canada to open a supervised consumption site to help the local population who use substances—many of whom were already ARCHES clients.

This site is one of seven in Alberta approved by Health Canada for drug consumption since the first was approved in late 2017. Two more mobile units are currently under review for Grande Prairie and Calgary.

These places are controversial, though not among people who study drug use and public health. The 1980s approach of “Just Say No” failed spectacularly—and with drugs far less potent than what’s available today. Instead, health officials, including the World Health Organization, say harm reduction strategies such as consumption sites and needle distribution programs are necessary to help people who use drugs and to protect the wider public.

Supervised consumption sites appeared in Europe starting in 1986 to mitigate the public health risks associated with heroin use. Consumption sites can reduce the number of deaths from overdoses, decrease the transmission of diseases and infections, and cut back on the social nuisance related to public drug use. Many clients of these sites distrust conventional health services but feel comfortable here. So these places can be an access point to counsellors, detox programs, healthcare providers, even housing.

Taylor isn’t thinking about straightening out today. Maybe one day, she says. Today is about feeling better under the watchful gaze of people who care. “We take care of each other here. We have people here we actually trust,” she says. “We don’t have that with a lot of people, considering how we’re treated out there.”

These places are controversial—though not among people who study drug use and public health. The 1980s approach of “Just Say No” failed spectacularly.

Across the province, cities and towns are feeling the effects of an opioid crisis spun out of control. In 2017, 579 people in Alberta died from fentanyl overdoses—up from 116 in 2014. The opioid epidemic has strained law enforcement and EMS, tied up emergency departments and hospital beds, contributed to needle debris and petty crime, and threatened to drive up rates of HIV and hepatitis C.

In Lethbridge, a mid-sized city known for its terrific winds and a main drag called Whoop-Up Drive, the crisis has struck with particular potency. The death rate here from fentanyl overdoses reached 19 per 100,000 people. Unlike Alberta’s largest cities, Lethbridge lacks a health and social infrastructure to help people who use drugs. There’s no medical detox, unlike in the smaller city of Medicine Hat, which has 24 beds for medical detox (eight are slated to open in Lethbridge this fall—one-third of what the City estimates it needs). Lethbridge has no intox centre, and its only treatment program requires drug abstinence. The city lacks a pain clinic and a specialist to treat HIV. It’s home to three shelters but no permanent supportive housing.

When fentanyl landed on the streets of Lethbridge, it hit full force. The shift happened almost overnight in 2015, says Stacey Bourque, an addiction specialist and executive director of ARCHES. One morning, ARCHES’s outreach team went around the city to empty boxes of discarded needles. “One box was so full, they had to jump back because needles were pouring out onto the street. They came back and reported something had obviously happened. This was nothing we’d seen before.”

For Lethbridge’s police department, 2015 brought major changes. Just a year earlier, they’d set out a four-year plan for budget priorities—without mention of fentanyl or opioids. Inspector Tom Ascroft says illegal drugs were so rare in this city that he remembers the first time a uniformed officer found cocaine. But in 2015, officers started noticing needles on the streets. They saw people dying from overdoses. Three people in the local jail died of overdoses in one year. For the first time, the department started giving commendations to officers for saving lives from drug overdoses. And petty crime rates rose as people started breaking into cars and homes. “This came on us so fast,” says Ascroft. “I don’t think people understand. It completely overwhelmed us.”

Ascroft estimates about 3,000 people use illegal drugs in Lethbridge. Of these, about 700 use on the streets. As the problem grew worse, the downtown library hired security to deal with the rash of on-site drug use. Visitors are warned to be careful walking alone through Galt Gardens, a well-treed park at the north end of downtown. Historically the city’s gathering place for community events, it’s now a hotspot for the street population. Mayor Chris Spearman remembers the embarrassment of leading a contingent of visiting officials from their sister city in Quebec through the park last summer and seeing people injecting. Just north of downtown, where the CP Rail tracks run under an overpass less than 50 metres from the local shelter, enough discarded needles piled up that Fire and Emergency Services regularly filled five-gallon buckets.

In 2016 one person died every day in Alberta from an overdose related to fentanyl. In 2017 overdose deaths were occurring at a rate of 1.6 per day across the province. The total 2018 figures are not yet available, but 355 Albertans died in the first half of the year, a rate of two per day. And here’s one telling stat from a single weekend in 2018 in Lethbridge: Just a few days before the consumption site opened on February 28, 42 people overdosed from fentanyl.

In Lethbridge the Indigenous population is the public face of the opioid crisis. This is common across the province: Indigenous Albertans died of opioid overdoses three times more often than non-First Nations people in a recent 15-month period. They’re also more likely to have been prescribed those drugs by a doctor. So goes Taylor’s story: She started taking Percocet at age 16 after tearing the ligaments in her knee during a barrel-racing accident. She doesn’t know why she got addicted to the sick sensation of Percocet but she has used the drug heavily since then.

She grew up in Stand Off on the Blood Reserve, which borders Lethbridge. Twice the Blood Reserve has declared a state of emergency due to opioids; dealers target the population, a case of history repeating itself—Stand Off got its name from a group of American whisky traders in the 1800s who were targeting the local population.

Taylor and her family were eventually evicted from the reserve for selling drugs. She moved to Lethbridge, where she started injecting fentanyl, meth and heroin. “It’s hard because it’s my whole family,” says Taylor, who often comes to the consumption site with her brother. “My little brother is just 19. I’m 21. I have a lot of life left. Last year around this time, I still had a home. Everything was really different.”

About 5,290 Indigenous people live in Lethbridge, somewhere around 5 per cent of the population. But they disproportionately account for the city’s poor and street-involved. In 2011, 24.5 per cent of the urban Aboriginal population in Lethbridge lived below the Low-Income Measure. The people most often seen using drugs in public spaces are Indigenous—they account for nearly three-quarters of clients at the supervised consumption site. They bear the brunt of anger from other residents about Lethbridge’s drug debris. “I’m not going to lie: Not a lot of people here in Lethbridge like natives. They don’t,” says Taylor. “We hear it all the time, every day.”

Marty Thomsen, the manager of the Community Social Development Team at the City of Lethbridge, says racism and discrimination against the local Indigenous community have existed for years but are exacerbated by the opioid crisis. “It’s made it 10 times worse because, unfortunately, that’s the demographic that is most afflicted by drug and alcohol use.”

He adds: “The opioid crisis has supersized all of our problems. In any municipality, you’re going to have poverty, homelessness, racism and discrimination, drug use and alcohol use. But all of a sudden, everything is blown up.”

As Taylor sets up in the injection booth, the high-pitched whine of a power drill drifts over the wall. On the other side, workers are busily building an extension to the building. Less than three months after its heavy metal door was first opened to clients, ARCHES decided it needed longer hours and more space. Gone will be the laundry and showers that organizers once offered users. New funding from the government will expand the site to 13 injection booths from six, and add two more inhalation rooms.

The consumption site is now open 24 hours a day, seven days a week. Even so, in the evenings, after dinner ends at the Streets Alive Mission seven blocks away and people wander over to ARCHES, wait times can be as long as 90 minutes. That’s a long time to wait when you need to get high. Thomsen explained it to me as it was explained to him: “Picture yourself a foot under water; you can see the top of the water but you can’t breathe. You will hold your breath as long as you can, but eventually you will do whatever you can to get that air. That is the need.”

This is the first and still the only facility in Canada to allow four types of drug consumption on site: injection, inhalation, intranasal and oral. Nowhere else offers specially ventilated booths for people who want to smoke drugs. In its first four months of operation, the site’s been visited an astonishing 25,000-plus times. Its client roster totals nearly 600 people. In terms of numbers, it’s far busier than the Safeworks consumption site in Calgary, a city with a population of nearly 1.5 million compared to Lethbridge’s 100,000.

Set in a brick building on the northeast side of downtown, Lethbridge’s supervised consumption site is easily missed from the outside. Inside, the reception looks no different than most medical clinics, with its large desk and four friendly staffers who greet clients by name. Most of the seven black leather chairs are occupied by clients sleeping, laughing, waiting. They’re all ages—the youngest clients permitted are 16; the eldest so far was 83. They wander in alone, in pairs, in trios, often carrying backpacks. The first time a client presents, they’re asked for a name—it doesn’t have to be their real name—and age. With that, staff starts a file to track basic information: history of overdoses, history of violence.

These nurses won’t inject drugs into a client. But they can show them how to cook their drugs, clean their skin and find a suitable vein. Teaching people how to reduce their risk of infectious disease, vein damage and abscesses is part of effective harm reduction. These potentially deadly problems can tie up healthcare dollars and hospital beds.

“It’s unique here,” says Sam Mackey (opposite), who works at the site as a “population expert.” “We let people use drugs here, but we also teach them. We’ve had people come in who don’t know how to cook their drugs properly or shoot themselves up properly—maybe because they had a friend or partner do it all the time for them. That’s very common out there.”

These sites can lead to fewer deaths, diseases and infections. They can be an entry point to counsellors, detox programs, healthcare, even housing.

When Mackey was growing up, her dad used heroin, crack and meth in the house. She learned to prep his heroin as a kid. She remembers trying coke for the first time around 10, snorting powder her dad left out; drinking in Grade 6; smoking weed soon after. By high school, she was hooked on over-the-counter and prescription medications. She was in and out of treatment centres, became homeless and was sexually assaulted at a shelter during one of her more prolonged periods of sobriety. She overdosed several times, once in a dealer’s house. “They didn’t call EMS. One guy said, ‘I was just scared I was going to have a dead chick in my apartment.’ ”

Last year, ARCHES asked Mackey to join a committee creating a plan for a consumption site. She remembers getting high before meetings but taking her role seriously. After the site opened, she came as a client but sobered up after a month. She now gets daily methadone as part of a recovery program.

“I can’t speak for anybody else, but I can speak for what this site meant to me when I was using here,” she says. “This is a place to come and not be judged. To be treated normal. It’s a chance to save lives and live a little bit longer. We have clients who OD here multiple times. I OD’d here multiple times. If I wasn’t here, what would have happened?”

But many question the way harm reduction is carried out in Lethbridge.

On May 30, 2018, the 12-year-old son of Amie and Julio Ceron was walking through a gravel stretch on his way home from school. Along the way, he’d bend down to pick up rocks and toss them in the air. Reaching for another handful, he felt a prick in his finger. He looked down and saw a bent needle, the pointy end sticking out sideways through its orange cap. The boy went home and told his parents. That night, he underwent testing for HIV and hepatitis at the local emergency department. The family waited an anxious weekend for the results. The chance of a positive test was minute but a chance all the same. On Monday the results came back—negative, to the family’s enormous relief. But the fright of those few days spurred the Cerons to speak out against what they see as the unintended consequences of harm reduction.

“When it comes to the needle issue in Lethbridge, I’d known of it before but I wasn’t involved,” says Amie. “That’s a lesson for me. You don’t assume that something isn’t your problem until it affects you. This is a problem for everybody.”

She feels the city is too concerned with the health and welfare of people who use drugs, to the detriment of people who don’t. “Don’t get me wrong. They’re real people. But we’re so concerned for the addicts who’ve made these choices and we’re not concerned with the effect on my son. They’re taking more care to protect drug addicts than to protect our community.”

Some residents are speaking out, and angrily. More than once I was told that by reducing harm for one segment of the population, the city puts others in danger. A few days after the discarded needle stuck the Cerons’ son, another parent posted a video on Facebook tearfully describing how she found a capped needle in the backpack of her son, a kindergarten student. He’d found it at the playground, she said, and kept it because it was cool.

This spring, residents founded the Lethbridge Needle Crisis Support Group. They organize rallies, share photos of needles found around the city, and spearhead letter-writing campaigns. The majority of complaints aren’t directed specifically at the consumption site, though some certainly are. Some oppose it on principle; others say they’re concerned about increased crime in the surrounding neighbourhood. As in other cities, clients congregate near the facility. After complaints in the first weeks, ARCHES hired security to monitor the area around the site.

The police see more disruptive activity near the site, though not all of it is criminal. “It focuses people in an area that’s easier for us to control,” says Inspector Ascroft. “I don’t support drug use, but (the supervised consumption site) is a good strategy to manage it. I’m a cop. I’m a southern Alberta kid. I don’t like any of this either, but we need a pragmatic approach. We’re not going to lock everybody up. That’s not going to work.”

Some in the city are furious that people who use drugs have a place to do so without fear of arrest or pressure to enter recovery programs. After driving by the site, one man posted on Facebook: “It seemed like they were having a good time, laughing and talking. Doesn’t really look like they want help.” Lethbridge is a traditionally conservative town where people like to grouse about big government and wasting taxpayer dollars, common themes in public complaints about the site. Rumours abound: The site gives out drugs, it allows trafficking, it’s driving up drug use. None of this is true.

What upsets people most is the number of needles discarded around the city—in parks, in public bathrooms, on ledges outside buildings. Through its outreach team, ARCHES hands out clean needles for free—a long-standing practice in keeping with the WHO’s recommended strategies for harm reduction. There’s no needle exchange. Studies show that a restrictive policy requiring users to turn in a dirty needle to get a clean one leads to fewer sterile syringes being distributed—meaning more unsafe syringes on the streets, not fewer.

The outreach team leaves from their office each evening at 6:00 for a seven-kilometre walk around downtown. They clean up discarded needles, encourage people to go to the consumption site, hand out candy (it’s a good way to engage people), and distribute clean needles and pipes. They record all the needles distributed and collected.

On a warm Tuesday night in June when I joined the outreach team on their nightly walk, they spoke to a total of 76 individuals on the street over the course of three hours and distributed harm reduction supplies to 31. They handed out 12 long-tip needles, 50 short-tip needles, 10 “straights” (pipes for crack), 19 “bubbles” (pipes for meth), four containers for collecting personal sharps, and 16 “party packs.” Party packs contain one long-tip needle, a condom, lube, a small water packet, tourniquet, alcohol swab, cooker and a vitamin C packet, which is used to help dissolve substances into an injectable form. People with housing received more supplies than others.

In its first four months, the site was visited 25,000-plus times. It remains the only facility in Canada to offer specially ventilated booths to smoke drugs.

ARCHES collects 97 to 100 per cent of the needles it distributes, and says it has reduced distribution by 50 per cent since the site opened. (ARCHES is not the only local source of needles. Other agencies and pharmacies provide sterile needles; drug dealers sell preloaded syringes.)

Representatives of Lethbridge EMS and fire services say they’ve seen a major drop in the frequency of calls about needles, and they collect far fewer needles now. “We were going out five, six, seven, eight times a day just to pick up stuff in the community. Now we might go out five to eight times in a month,” says Lynn Villiger of Lethbridge Fire & Emergency Services. Villiger understands why people are upset about finding syringes in schoolyards—“I’d freak out too if I was the parent”—and says kids need to be educated about needle risk.

“People want to blame somebody,” he says. “That’s the wrong approach. We have to come up with a solution. We’re headed in the right direction, but people are impatient because the drug problem is going up so quickly. It’s hard for anybody to get on top of it.”

He equates the situation to a volcano. “You can get as angry as you want at the volcano, but that ain’t going to stop it from erupting. It’s erupting now and we’re learning more than we ever have about drug use and addiction.”

The anger directed at people who use drugs and those who care for them is taking its toll. In a city this size, many people know staff at the supervised consumption site. Employees are told that they enable drug use or keep people trapped in their addiction. Or worse: Let users infect each other, let them die. Stacey Bourque has been berated on social media, while shopping in the grocery store with her child, during a lunch out. “In big cities, nobody would know one person from the next, but here, every time you turn on the news, there I am, front and centre,” says Bourque.

There is no way to quickly reverse a widespread problem with opioids, she says. “People didn’t start using drugs because the facility was built. We’ve had 15,000-plus uses inside (the consumption site) that otherwise would have been outside in a public bathroom, in a park. That’s reality. This is happening whether we exist or not. It’s going to continue to happen. But if we can try to move people toward healthier practices, that will have a positive impact on the community.”

Last spring, UCP leader Jason Kenney stirred up controversy for saying he doesn’t believe supervised consumption sites work, adding governments are spending money to help “addicts consume poison.” The NDP say harm-reduction strategies, including supervised consumption sites, are part of a much-needed, multi-pronged strategy to care for people in the throes of addiction, even if the odds of recovery are slim.

In Lethbridge I asked everyone who works in harm reduction about the potential for political winds to change policies on harm reduction. Each one—EMS, law enforcement, addiction specialists—said the opioid crisis will not disappear. You cannot un-erupt a volcano.

Christina Frangou writes about medicine, health and fitness. Her most recent AV story (November 2017) was about assisted dying.

Photos by Jaime Vedres.

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The post Reducing the Harm appeared first on Alberta Views.

So there we were, a pot-decriminalized state, or almost—but the bill did not pass. It died on the order paper when Parliament prorogued, and word was it hadn’t been an accident. The US Drug Enforcement Agency had kneeled on Chrétien to stop the bill. The Martin government produced similar legislation with a similar fate in 2004. After that it was the Harper Conservatives, and though Steve liked to go on TV, play piano and sing that he got “high with a little help from his friends,” he was officially anti-legalization. Fast forward to today. Justin Trudeau campaigned on legalization and got a majority mandate to complete the move. He also had the courage to ignore foreign interference and “git ’er done,” as we like to say.

Soon after the Trudeau government officially announced legalization was going ahead, I happened to be spending a few days in downtown Vancouver. I was on foot, and I started noticing the smell of pot all around me. I commenced a little game with myself to see if I could walk a whole block without encountering pot smoke. Well, I never did, except once when crossing through an indoors mall.

So when people express fears about what will happen, what sorts of mayhem awaits Canada in the wake of marijuana’s legalization, I suggest they relax. I don’t mean that nothing bad will happen; I mean, rather, that whatever is about to happen has happened already. If we start noticing problems with cannabis consumers, it won’t be because the problems are new; it will be that we’ve only now decided to start noticing them or fixing blame for them on weed.

Pot comes with a long menu of negative side effects. Disappointment isn’t listed, but it should be. Wait a minute. I’m not elated. What the hell?

In the run-up to Canada’s Weed Freedom Day, media has been checking in on Colorado and Washington, which legalized in 2012. What dangers have these states experienced Judging by what I’ve read, a primary danger we should be aware of is that our right-wing pundits and politicians will probably start blaming legal pot for homelessness.

As for my personal suggestions of what to watch out for, I’ll parrot the old Woody Allen joke about cocaine: “I can’t do it because I become unbearably wonderful.” Cannabis can also have this effect (as can alcohol) of making you feel you’re just a tremendous social hit today. Try to bear in mind what others might be thinking, such as: “Will he ever shut up?”

Pot, of course, can also cause the opposite of self-aggrandization, which is to say: paranoia. I have noticed that few people talk about feeling paranoid when stoned—except when someone takes the plunge of bringing it up. Then, most everyone admits to having felt that way. It is never fun, when everyone else is laughing up a storm, to be locked in your own brain, thinking, “I’m a fool and everyone can see I’m a fool. See See that look on that guy’s face He knows!”

Is marijuana good for you It’s probably a godsend for certain medical and psychological conditions, but, otherwise, probably not. Just like alcohol, it comes with a long menu of negative side effects. Disappointment isn’t listed for either alcohol or marijuana, but should be. Wait a minute. I’m not elated. What the hell?

Am I happy or sad that marijuana is legal I’m not sure it’s either emotion. Back in 1975 I would have had a huge party. What I will be doing on the night of October 17 is sitting quietly at home. I probably won’t have a toke for old time’s sake, because the pot of the present day knocks me on my keester. However, I am relieved and satisfied to see pot legal, because it was silly and hypocritical to have a huge legal economy based on alcohol, while putting people in jail for possession and use of another recreational drug, one that wasn’t Canada’s traditional way of getting out of your head. You, sir, are drunk. Don’t drive, and have a happy evening. You, sir, are stoned. Get in the police car. It was insane, and now Canada’s laws are one statute less insane. For that, I send congratulations to the Trudeau government.

Oh hell, maybe I will go out. Maybe I’ll go to a bar—or maybe just to a parking lot. No sense buying what you can inhale for free.

Fred Stenson’s most recent novel is Who By Fire (Doubleday). Other books include The Trade, Lightning and The Great Karoo.

The post Legal Pot appeared first on Alberta Views.

This is the future of weed. And it’s a far cry from the head shops, fly-by-night dispensaries or friend-of-a-friend Ziploc baggie markets of yore.

“We went to the US to look at dispensaries, why some were doing really well and why others were not so great,” says Raj Jogia, one of four partners behind Kush Collective, which expects to open a retail marijuana outlet on 17th Avenue SW in Calgary now that the federal government’s legalization bill has finally passed and all provinces can bring their own policies and procedures into compliance.

On Jogia’s US fact-finding tour, “There were holes-in-the-wall and multi-million-dollar spaces that looked like Apple stores,” he says. “But the main reason some succeeded was customer experience. The store has to look nice and feel comfortable, but the most important thing for ensuring customer loyalty is experience and education.”

Jogia, sporting a crisp blue-and-white tailored shirt, is in the oil and gas industry. Co-owner Shaun Baid, in a black Kush-branded T-shirt and hat, was laid off from his job as an accountant shortly before the legalization process began; the other partners behind Kush Collective are a lawyer and a professional in the organic food business. All of them are Calgary-bred long-time friends who are passionate about pot—and keen to introduce themselves, their store and their product to the community.

The pair go on to point out literature on specific strain effects; chemicals called terpenes which shift pot’s flavour profile and are believed to account for minute aspects of a user’s experience. It’s a little like wine tasting, with a touch of the professional, pared-down Millennial aesthetic.

Jogia, Baid and their partners, along with dozens of other business owners big and small, have navigated a rushed and ad hoc process in which all levels of government frantically worked to implement a regime for the sale and consumption of legal marijuana—a process that has been untried since the repeal of Canada’s prohibition laws a century ago. It’s a process that left consumers and business owners alike on tenterhooks, unsure of the fine details of what will be legal, where and when. Given the timelines involved, concerns about the speed at which this social shift is taking place are not unfounded, and no one can rule out the possibility of unintended consequences.

“Whether or not you think this is the best idea, there was, ultimately, in a certain way, a referendum on this issue,” says Kathleen Ganley, Alberta’s Minister of Justice and Solicitor General. “That was the (2015) federal election, and that government was elected on a very clear promise to legalize cannabis.”

The legalization of cannabis was up to Ottawa—but the nuts and bolts were left to provinces and cities to figure out. Every level of government across the country scrambled experts and task forces to create new pot regulations, bylaws and sourcing and distribution methods. Myriad questions had to be answered, from the age of legal purchasing, to how the product should be sold, to where it could be consumed. Well before the federal government had a final draft of the legislation it intended to pass, the provincial government and municipalities in Alberta conducted surveys to get a sense of how Albertans wanted lawful weed to work.

One of the most pressing issues was the question of whether to adopt a private or public retail model. Minister Ganley says Albertans were clear in their feedback, which was conducted through two rounds of public opinion polling in 2016: they overwhelmingly wanted a private retail model similar to how alcohol is sold here—in stark contrast to Ontario (initially) and the maritime provinces, which decided to sell pot only through government-run stores.

“A public system gives the province much more control, but is costly to establish and leaves financial risk with Albertans,” Ganley says. By comparison, “a private system puts faith in private retailers to follow the rules established by the province, but poses less financial risk and is more efficient to set up.”

The benefits and drawbacks of public vs. private liquor retail are hotly debated in Canada. One of the touted advantages of Alberta’s private liquor system is that it provides more convenience. That, however, is also considered one of the model’s drawbacks, as it allows easier access by youth. It’s long been alleged, for example, that it’s easier for minors to buy booze from private stores. A 2011–2012 government sting operation in BC, the first province to enact a hybrid public–private liquor retail model, seemed to confirm this theory. But corroborating evidence is scant.

All levels of government frantically worked on a process untried since the repeal of prohibition.

It’s unclear how this dichotomy will play out with regard to cannabis. Months before legalization, the Alberta Gaming and Liquor Commission (AGLC) had received more than 530 retail cannabis licence applications province-wide. At the same point in the process, 40 stores had announced they would dispense marijuana in Ontario, with an expectation that the province would see 150 stores by 2020—though Ontario has 3.5 times Alberta’s population. (That province has since announced it will change to a private retail model, with an unknown effect on the overall number of stores that will be approved.)

There was significant debate on this issue, which is why the Alberta government went back to the public twice on the question. “Our survey results ultimately leaned towards private retail, with 58 per cent of Albertans supporting this system,” Ganley said.

As with alcohol, the AGLC will source and obtain product in bulk that private retail outlets will buy and resell. The AGLC will also oversee retail licensing.

But while the province has taken a liberal approach to physical retail shops, only the government will be legally allowed to sell marijuana online. Ganley says survey results highlighted the fact that Albertans were concerned about how consumers could prove age at point of purchase and at delivery; a public online portal, she suggests, gives the government more control. “Already, even before legalization, retailers are selling illicit cannabis in the online space,” she says. “A government-managed system sends a strong message to consumers that there will be one, legal online source for recreational cannabis.”

The other question the government struggled with was the matter of the age restriction. The best science about the effects of marijuana to date suggests it can harm young people, whose brains are still developing, especially under the age of 25. In the end, Alberta opted for a minimum age of 18 to consume cannabis—a year younger than every other province except Quebec (also 18) went with, but the same age at which Albertans can legally drink alcohol.

“If you make the legal age higher, that does a better job protecting public health,” Ganley says. “But it brings the illegal market into the legal market—which does a worse job of protecting youth, who are still going to the black market.”

Pot smoking will be banned in private cars as well as at Alberta’s hospitals, schools and daycares. Smoking will also be prohibited within close distance of playgrounds, zoos, outdoor theatres or any place where children are likely to be present. But cannabis can be consumed in the province’s parks.

Ganley explains: “Say you have a campground in a provincial park. Now you’re saying people need to drive outside that area to a highway and stand outside their car [to smoke a joint] and go back again.” A restrictive parks policy would have presented more problems, she adds, including fears of impaired driving. “All sorts of different issues could have arisen if we tried to prohibit [consumption] in anything that could possibly be described as a park,” she says.

Provincial legislation, however, leaves this matter open to municipal governments to regulate within their own boundaries. And as Alberta conducted public opinion polling on minute matters of marijuana regulation, so did municipal governments.

“We were a bit surprised the province was treating cannabis like tobacco, for the most part, from a public consumption standpoint,” says Matt Zabloski, lead for the City of Calgary’s cannabis legalization project. “I couldn’t find any major municipality that had allowed for public consumption. Even in the States, they were treating cannabis as restrictively as Alberta treats alcohol, if not more so.”

The City of Calgary decided to take a much more restrictive approach, virtually banning all public cannabis consumption, including in its parks. (Smoking in Fish Creek Park will also contravene Calgary’s municipal bylaws, even though the park is provincial.) This, combined with the AGLC’s having no plan at present to license smoking lounges, has raised the ire of some pot advocates who point out that for many citizens, including those who rent their homes, this legal product could be virtually impossible to legally consume.

Many of these issues may be addressed by edible marijuana, which can be consumed more discreetly. However, edibles aren’t metabolized by the human body in the same way as cannabis that’s smoked; it takes longer for the “high” to hit, and thus it’s easier for users to consume too much. Edibles also raise concerns about food safety, dosing and proper labelling and packaging to ensure candy-like weed products aren’t accidentally consumed by children.

The province’s cannabis secretariat said it does have a plan to develop a policy framework for edibles, but it is awaiting direction from the federal government, which is not expected to legalize that section of the marijuana market until sometime in 2019.

Cities and towns are also responsible for where consumers can buy legal weed. after commissioning polls and studies, zabloski’s team took a series of proposals to council that would govern how marijuana retail outlets apply for business licences. Stores in Calgary will be permitted in the same types of commercial zones where liquor stores can be built, provided they are at least 150 metres from schools. Zabloski says the city considered a more restrictive setback, but that would have significantly reduced the number of viable spaces. By late April, Calgary had received 226 cannabis store applications.

Edmonton senior planner Colton Kirsop says his city ran into similar questions and tradeoffs. “If we’re too restrictive about where cannabis stores can locate, one of the unintended outcomes could be that we drive them to poorly accessible areas of the city—and we’ve seen that in US cities,” he says. Seattle, for example, “banned cannabis stores from downtown and entertainment districts, which left owners little choice but to set up in out-of-the-way industrial areas. These are easier to take advantage of in terms of vandalism and theft. Nobody’s there on weekends or after hours. They’re really quiet.”

Edmonton therefore decided to welcome retail locations to bustling commercial streets such as Whyte Avenue.

The process for applying for business licences varies by city and town; once a location in an appropriate land-use area is chosen, the outlet can apply for a permit and a business licence. Or it can apply to have an area rezoned—which often requires a hearing in front of council. Only after a business has obtained a lease on a storefront can it then apply for an AGLC permit. Current head shops will have to go through the process too, just as if they were new retail businesses. “This is definitely not one of those slam dunk things,” Zabloski says. “This is no walk in the park by any stretch of the imagination, trying to score one of these businesses.”

A higher legal age might do a better job protecting public health, but more people would use the black market.

Michelle Hynes-Dawson, spokesperson for the AGLC, says businesses must pay a $3,000 fee upfront to apply for a licence. “During the application, we do our due diligence. We do a background check for links to organized crime. There’s a questionnaire. We have to ensure there is no history of trafficking,” she says. “Just because someone pays the fee doesn’t mean they are guaranteed the licence.”

Indeed, even the stores themselves will be required to have special features and equipment, including a secure, locked storage area to keep cannabis and accessories. Stores must be equipped with alarms and video surveillance, have a separate entrance and have no access to any other businesses. The AGLC seems particularly concerned that no pot store be too close to a liquor outlet, as the government wants to discourage consumers from too readily compounding their intoxication.

Similarly to cigarettes, marijuana products will have to be sold in plain packaging with no undue salesmanship about effects. Stores will not be able to use words or images that connote any kind of health benefit. And, according to AGLC guidelines, branding must not attempt to appeal to minors, show the use of pot, display intoxication or “advertise a price or price advantage.”

The agency will also restrict cannabis retail monopolies; no individual or entity will be allowed to own more than 15 per cent of the overall retail cannabis licences in Alberta. The province will also set the wholesale price. These restrictions must strike a fine balance—they cannot be so restrictive that the black market continues to flourish.

As the legalization date drew near, the AGLC put out requests for providers to supply stock. Most of the early interest came from federally licensed medical marijuana suppliers. Given there are only so many licensed medical marijuana suppliers in the country, one of the big fears of legalization advocates is that there simply won’t be enough product to meet early demand once pot is officially legal.

Hynes-Dawson says the AGLC has heard such concerns. “Every province is in the same boat,” she says. “There are only so many producers right now. But we were really pleased by the response we got. We got a mix from right across the country.”

While marijuana advocates have long touted the benefits of taxing and regulating the drug, Alberta is not expecting a legalization windfall. In the 2018–19 budget, the province announced that it expects to lose money on pot—largely thanks to the enormous amounts of time, effort and cash that have already been funnelled into creating a legal regime.

The province can earn revenues from wholesale weed distribution, from online sales and from direct taxation—although a quarter of the taxation proceeds must be sent to the federal government. And, again, the taxation room is fairly limited; if legal marijuana proves too expensive, the black market, which isn’t hemmed by restrictions on advertising, price discounts or edibles, will continue to flourish. In the 2018–19 budget, the province expected to rake in only $26-million in taxes on marijuana in the first year of legalization, only about a third of what it has spent to set up the policies, staff and procedures required to make the stuff legal. Alberta will also receive a share of the taxes collected by the federal government. Ottawa expects to take in about $100-million in the first year of legal cannabis.

Alberta’s budget, however, has so far not indicated any revenue-sharing for municipalities, which are expected to bear a major enforcement and regulatory burden. Police and enforcement agencies are also expected to bear significant costs in things such as behavioural training and cheek swab testing to examine for impairment while driving [see sidebar].

“For the first little while, we’re not going to be taking in a surplus of revenue,” Ganley says. “There will be more costs than revenue to go around.”

Given the partisan machinations in the Senate, it was uncertain well into spring 2018 when legal pot could actually be purchased. The Senate voted on the bill on June 7, proposing 46 amendments. The government accepted most of these, and the bill received Royal Assent shortly afterward. The provinces requested several months to finalize regulations, acquire product and stock shelves. On June 20 the government announced October 17 as the day that cannabis officially gets the green light.

All of this uncertainty hasn’t just affected lawmakers. The partners at Kush Collective had to find an amenable landlord and commit to leasing a storefront months before they knew the final municipal rules for retail stores. They had to lease a building to acquire a pot licence—and they lost money on rent every month the drug wasn’t legalized. A sudden change of heart on city council—a small increase in the setback requirements, say—could have quashed their hopes, and their investment.

Further, business and governments both struggled to come up with complementary processes and regulations before legalization—before any of them had a final sense of what various other levels of government were going to pass.

And a retail licence is no guarantee of easy money. Nobody knows just how large the legal market for recreational marijuana will be, and because Alberta’s market is private, retail competition will be fierce. That level of uncertainty privileges retail players with a greater appetite for risk—and more cash in hand to weather it. That likely means more large chains, particularly from the US. Already, major liquor distributors and wealthy investors have announced their intentions to get into marijuana in Alberta.

Meanwhile some new dispensaries, Baid claims, started selling marijuana ahead of legalization. “They make us all look bad,” he says.

Kush Collective says it wants to reduce stigma around pot; the owners envision open-door days for the community to come in and ask questions. But it’s the small operators who play by the rules who stand to lose the most by delay, inaction and uncertainty.

“We’re just four local Calgary guys with a passion for marijuana,” Baid says.

Calgary freelancer Jen Gerson contributes to Maclean’s, The Walrus and CBC, and co-hosts the podcast Oppo.

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