“Just Say No To Drugs”

More than four Albertans die of a drug overdose every day. In 2020, 1,358 people in this province—most of whom had taken an opioid—died of a drug overdose. In 2021, 1,758 Albertans died the same way—a 30 per cent increase. “The numbers are staggering,” harm-reduction advocate Euan Thomson told CityNews Calgary in late 2021. “This crisis has spun completely out of control.”

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.”

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.