Regular readers will know that I support harm-reduction strategies to address the horrifying death toll from opioid addictions — notably supervised injection sites and the provision of pharmaceutical-grade alternatives to the potentially fatal mystery-cocktails for sale on the street. Regular readers might also know I support those strategies not as an alternative to treatment or recovery, but as a complement to any other strategies we wish to pursue. For any strategy to come good, the patient has to be alive.
Because they read other things, regular readers will also know that Team Harm Reduction is losing this debate right now. The good news, from our perspective: A Nanos Research poll last year found resounding majorities in all parts of the country believe supervised-injection sites “save the lives of many drug addicts.” The bad news: Offered the choice between more supervised-injection sites and more treatment resources — a false choice, I would add — roughly half chose the latter. Conservative leader Pierre Poilievre has seized on that false choice and come down firmly on the false side of treatment and recovery.
Mixed feelings are understandable. People look at the disastrous scenes that manifest at the nexus of Canada’s homelessness, addiction and mental-health crises and they can’t fathom how providing “more drugs,” or facilitating their consumption, can make anything better. Their better-off neighbours remember what harm-reduction proponents promised them — fewer needles discarded in parks and on sidewalks; fewer people consuming drugs in public; less crime, less violence — and they perceive, nowadays usually accurately, that they’re living with more of all of those things.
If my side wants to stay in the debate, at the very least we need to concede the latter point: In many cases, the benefits harm-reduction programs were supposed to bring to entire communities simply have not arrived. It’s cringeworthy to hear experts citing 15-year-old research to the contrary, as if people can’t tell a discarded syringe from a cigarette butt; as if the view from their back deck isn’t an all-night opioid horror show; as if that isn’t actually human feces all over their parking spot. Indeed, the discrediting intransigence of some harm-reduction ideologues is helping Poilievre peddle the fiction that harm-reduction programs actually caused these urban humanitarian disasters.
To me that idea doesn’t even make superficial sense. Let’s imagine we closed the supervised injection sites on Vancouver’s Downtown East Side, or in Toronto’s Moss Park, and cancelled still-embryonic safe-supply programs. That would make the situation in those neighbourhoods better … how? And if Poilievre’s proposition were true, why are we seeing pretty-much identical scenes in Los Angeles, in San Francisco, in Portland, Ore., in Seattle?
Poilievre will tell you those cities pursued the same harm-reduction strategies as Vancouver. He’s either misinformed or he’s lying. As of last year there were only two supervised-injection sites operating legally in U.S., both of which were in New York City. As for providing addicts a safer supply of opioids — not opioid agonists designed to help kick the habit, but pharmaceutical-grade heroin (for example) designed to keep users alive — there’s nothing of the kind stateside. Blaming harm-reduction for the opioid crisis is like blaming vaccines for COVID-19. But Poilievre seems to have touched a nerve — again, understandably so.
Proof, perhaps, that there are no simple answers: Both British Columbia’s NDP government (led by former B.C. Civil Liberties Association president David Eby, no less) and Alberta’s United Conservative government are both now looking in earnest at the idea of involuntary commitment for drug treatment. Team Harm Reduction is mostly horrified by the notion, and the idea certainly makes me queasy as a civil libertarian. I’m sympathetic to the argument that certain people “deserve” intervention from a society as caring as Canada’s pretends to be — indeed, I have a couple in mind even as I write this.
But there’s disappointingly little evidence to suggest compulsory treatment is likely to stick — and considerable evidence that “graduates” of such programs are much more likely to overdose fatally upon release than those who attend treatment voluntarily. That’s intuitive, of course: By definition, people who seek treatment voluntarily feel themselves more ready to pursue long-term recovery. But that in turn raises the question of what exactly these mandatory interventions are supposed to accomplish. Surely no government wants weekly stories of patients leaving mandatory treatment and walking straight into a fatal overdose.
That said, I’m more worried about the practicality than the philosophy. Canada didn’t just deinstitutionalize mental health care in the 1960s on a lark, or because the idea had become academically fashionable. Especially in the later years, after the Second World War, the status quo became an obvious failure: Overcrowding, understaffing, dodgy treatments, isolating patients from their families, often providing little hope of release. “Contrary to the initial intent of moral treatment, institutional care became primitive and restrictive, relying on methods involving seclusion, as well as on chemical and physical restraints,” the Senate’s standing committee on social affairs, science and technology observed in a huge 2004 report.
Would we do better today? I can’t see any reason to expect we would, especially looking back at institutional failures during the pandemic. Consider the deadly squalor in which so many Canadian senior citizens found themselves living. These were among Canada’s most sympathetic people, defenceless, slavishly courted by politicians because they always vote, and they were left to die in their thousands. I shudder to think what might await Canada’s addicts once they’re off the streets and out of mind.
