About “Forced Treatment” and Homelessness

I need to comment on the political pressure to force people experiencing addiction into treatment. Superficially, it seems to address a problem in society, but the reality is that this is a political approach to the wrong problem. 

Is addiction (and the deaths resulting from a toxic drug supply) a problem?  Absolutely.  Is this a solution to the social issues that are being assigned to addicts?  No.

Let me explain myself. 

Let’s assume for a moment that forced treatment will actually work, and produces a stream of people who are now former addicts.  Most of the people we are going to push into these programs are likely homeless, and therefore living fairly rough lives.  If they’re “lucky” they might be able to sleep in shelters, or have a room in a decrepit old hotel now being used as housing.  (Neither environment is exactly a good place to live - and a lot of the same factors that lead to drug use exist in both). 

At the end of the treatment program, we (theoretically) are going to release these newly sober people back into society.  Guess what?  You’ve just released a “newly sober” homeless person back into the same environment they were in before.  How long do you think it’s going to be before they relapse when suddenly all their old buddies are around, and urging them to participate in the same activities?  

Sure, creating these “shiny” facilities that we can sweep the homeless people into makes all the suburban types happy -  they don’t have to look at the people who have ended up at the bottom of the social and economic ladders any more. 

But, unless you are addressing all of the issues that lead to homelessness in a constructive manner, guess what?  You’re just creating the same “revolving door” problem that we complain about in the criminal justice systems.  Once that door starts spinning, not only do you have problems with relapse, but the risk of overdose goes up as well.  Oh, and let’s not ignore the effects of “institutionalization” that happen when someone spends extended periods in an environment where they have little or no control over their daily existence.

There are a myriad of issues that need to be addressed:  housing, income, mental health, addiction, socialization (including integration with society), and a dozen other factors.  Treatment for addiction is but one facet of a much more complex problem that we need to think about intelligently.  Reactionary politics aimed at people freaking out over seeing a discarded syringe somewhere is missing the point, entirely.  

These problems didn’t appear overnight, and they won’t “go away” overnight because suddenly we give police the ability to round people up and force them into treatment.  At best you’re sweeping things under the carpet and hoping they’ll go away on their own after that.  They won’t.  They don’t.  The solutions to these problems require all of us to take notice and realize that the systems we live in aren’t working the way they should and major change is needed. 

When a person working full time can’t afford a decent place to live, we have created a problem - and no, the “invisible hand” of the free market isn’t going to fix that.  There are fundamental problems in our society that are the precursors to homelessness and addiction.  

On Crime Waves and Policy

Much ink (most of it virtual) is being spilled these days about how “dangerous” our cities have become. Shootings, assaults and so on seem to take place on our transit systems on a nearly daily basis. I’m not here to say that there is no problem - there clearly is - but it is not what we are being told it is. 

Conservative politicians (especially) are spending an enormous amount of time pronouncing upon how they will fix these problems.  “More Enforcement!”, they cry out from their lecterns; “Ban opioids!” , “Sue the drug makers”, “Go after criminals who use guns!” and so on it goes. They complain loudly about how “woke” mayors have created this problem.

The conservative calculus seems to be (very roughly), that the current wave of crime stems from drug addicts and homeless people becoming violent in their efforts to survive.  Yet, they view both addiction and homelessness as moral failings, rather than the consequences of complex systemic problems in society. After all, someone who is homeless can solve that problem if they just get a job; the addict can solve their addiction if they just pursue treatment, right? 

So, their approach becomes one of punitive measures.  More policing, tougher laws, dismantling “harm reduction” programs because they think that those programs are “facilitating” the problem (likewise they argue the same about “safe supply” strategies).  

However, they never look at the role that their own policies have played in creating the current situation. For example, in 2019, the first UCP budget grabbed millions from policing budgets and diverted it into provincial coffers. In effect, this was a literal “defunding” of the police in both Edmonton and Calgary. However, unlike what “Defund Police” advocates want to do (redirect funding into a range of social programs), the UCP just took the money and rolled it into general revenues to balance the budget.

I would like to point out that policing is fundamentally reactive.  Police respond to crimes after they have happened. This is at the crux of the “Defund Police” advocacy - the question being asked is “why pour more money into reactive approaches, when a proactive model might well reduce the conditions that lead to criminal activity?”.  It’s a valid question, and one that we should be asking ourselves. 

Then the UCP turned around and proceeded to dismantle harm reduction strategies like Safe Consumption Sites (SCSes). “Oh, you’re just facilitating addiction” is very much the argument they make. Except that isn’t the purpose of these facilities. The point of any harm reduction strategy is to make it more likely that an addict survives long enough to be ready for active treatment. The “war on drugs” model that started in the 1960s, and really took hold in the 1980s failed because it emphasized treatment at the expense of everything else. It relied on stigmatizing the use of drugs, and ignored the reality that once someone is addicted, stigma just drives them underground. 

SCSes serve multiple purposes, including being a gateway for referrals into treatment, and often they ended up facilitating access to other social supports that helped get people into more stable conditions than the street. So, while the UCP has created a whole bunch of active treatment spaces, the dismantling of SCSes has actually reduced the number of addicts seeking treatment compared to the situation when the NDP was in power. 

Now we hit the third part of the problem. Under the UCP, Alberta Works (aka Welfare) was modified so that you could only access benefits if you had a mailing address.  If you suddenly found yourself homeless for any reason, *poof* there go your income benefits. I wish I was kidding.  So not only does this create a precondition for access, it guarantees that anyone who becomes homeless will suddenly have what little income they were receiving (and other benefits) revoked. Talk about increasing the problems!

More locally, policies such as locking up shelters at transit stations, or installing benches that can’t be slept on, actually amplify these problems. As people get pushed away from needed supports, they seek out what safety and shelter they can find - and that often ends up being bus shelters, semi-derelict buildings, and so on. Of course, civic politicians get an earful about this because quite frankly, it’s really uncomfortable to see someone who is in dire straits on your morning commute to the office. They often react by taking “steps” that push those already down on their luck even further.

When it comes to drug supply, any rational person would be looking and saying “why would you sell a product that kills your customer?”.  That’s true, but let’s recognize that even on the hierarchy of life on the streets, that gets just a bit worse - the reality is that just as conservative politicians have made addicts into outcasts, the drug makers and dealers tend to view their customers as disposable as well. If you die from one of their concoctions, well - you were just another junkie to them anyhow. 

Here’s one area where I think the conservative “get tough” approach is appropriate. Those who make and sell these concoctions, who choose to conduct a business that kills its own customers deserve hard punishment. Likewise, those who smuggle, sell, or create illegal weapons deserve to face much harsher penalties than they do today. These are the people whose actions facilitate criminality.

All this is to say that while conservatives are long on “solutions” that involve punishing people harshly, they’re more than a little bit short on insight into the causes of these problems, and how their own policies create the preconditions for more crime. Any real solution to these problems is multifaceted. Yes, there needs to be appropriate levels of enforcement, but that needs to be directed at the people whose “business activities” are oriented to creating the conditions we see today. Then we need a broad set of policies and public services that are able to reach those that have been discarded by society. The problems are systemic, and they start with taking the attitude that people who are down on their luck or circumstances are somehow the problem themselves. 

On Drug Deaths, Harm Reduction and Addiction Treatment

Of late, CPC leader Pierre Poilievre has been making a lot of noise about drug addiction, deaths resulting from overdoses, and so on. 

So far, much of his rhetoric and "solutions" are basically boiling down to pushing people into treatment.  Which misses the point entirely. One of many problems with "street drugs" is that they are often of unknown composition - or perhaps I should say "unknown until it's too late" composition, with street dealers "cutting" a particular drug with other substances to increase their profits.

Conservatives have long opposed harm reduction strategies such as Safe Consumption Sites, or more recently so-called "Safe Supply" initiatives.  The general mentality seems to be that they see harm reduction as "facilitating" drug users, and therefore removing motivation for them to seek out treatment and recovery. If you look at addiction as "well, they (the addict) chose to take the stuff in the first place", I suppose it's possible to arrive at the conclusion that addiction is purely a matter of poor choices and that continued stigmatization and marginalization should be a message to users to "clean up their act". 

Reality, of course, doesn't work that way at all. There are many paths that lead to addiction, and it's overly optimistic to think that simple bromides like shaming people is going to motivate them to seek treatment (quite the opposite, actually, as the doors to treatment facilities come to be seen as judgments themselves by some).  

Although conservative politicians have long talked about addiction as a dichotomy between harm reduction and treatment, that was never the idea in the first place. Harm reduction strategies exist to reduce the number of dead bodies found on the streets. A dead addict cannot be treated or recover from their addiction. Harm reduction strategies seek to reduce the danger to the addicts until they are ready to seek treatment. It was always intended to be an ecosystem approach.  

Poilievre's rhetoric is a repeat of what we have experienced in Alberta, and while it has perhaps driven addicts a little further underground again, it has returned us to the 1980s "war on drugs" model that simply never worked. Just because you don't see the problem doesn't mean it isn't there. 

The only place I agree with Poilievre on is the handling of illicit drug makers and dealers. Especially those who are selling lethal combinations on the street. The focus of enforcement needs to be on catching up with, and punishing them for what they are doing. 

But that cannot happen in the absence of access to safe supply, and safe places to consume. If the treatment ecosystem doesn't have accessible safeguards in place, when enforcement ramps up, all that will happen is the criminal system moves further into the shadows. The addicts will still die, it will just take longer to find their remains. 

An intelligently designed approach that recognizes the addict as a human being worthy of respect but vulnerable to the predations of the streets is essential. Come down on dealers and underground suppliers that feed these toxic concoctions into the streets. But, between here and there, we have to take steps to address the deaths happening because dealers don't give a shit about killing their customers. 

Conservatives: Punish, Punish, Punish

Canada's Harper Government once again revealed the ugly side of its views this past week.

First up, we have the Harper Government axing the pittance that inmates are paid for their labour while in prison.

The government began deducting the money from prisoners’ paycheques as part of a move to recover costs under the federal government’s Deficit Reduction Action Plan. The move was first announced in May 2012 by Public Safety Minister Vic Toews.

Until now, the top pay an inmate could earn was $6.90 a day, but only a small percentage of inmates received that. The average is $3 a day.

This is being done in the name of "cutting the deficit".  Sounds reasonable, doesn't it?  Well, let's take a look at how much is being cut, shall we?

According to correctional service figures, the move will save about $4 million a year out of the total budget of more than $2.6 billion.

So, the government is going to save a whole $4 million.  That is 0.15% of the corrections budget in savings.  That's right - less than 1% - the equivalent of a penny with respect to a hundred dollar bill.

The amount of money that is involved is peanuts.  This kind of "budget cutting" is simply mean-spirited.  While the government is trying to balance the books, with a projected deficit of $18.7 billion for this fiscal year, taking this money out of the prison system seems petty, and pound-foolish.  The amount prisoners get paid hasn't been changed since the current rate was set in 1980 - so it's not exactly like the prisoners are getting anything more than a bit of "mad money" to spend at the commissary once in a while.  If it helps keep the peace in the prisons - and after they are released, that's pretty damn cheap.

The second part of the nastiness of the Conservatives came in the form of Health Minister Rona Ambrose changing  the rules on a special, limited access drug program "so that drug addicts can't be prescribed heroin".

The ban comes a few weeks after Ambrose slammed her own department's decision to authorize some British Columbia doctors to prescribe heroin to 20 addicts for whom other treatments had failed. 

The doctors were conducting a research study looking at whether the opioid painkiller hydromorphone is as effective as heroin in treating long-term addicts. 

A previous study by the same researchers had concluded prescription heroin is a safe and effective treatment for the small group of addicts who did not benefit from conventional treatments such as methadone.  

 So, what the minister has done is take away a tool that is effective for the subset of addicts that do not benefit from conventional treatment.  Given that heroin addiction is a physiological addiction, there is a significant biological aspect to it which means that every addict is going to be somewhat different, and the ability of one addict to stop taking it tells us very little about whether or not someone else will be able to do the same thing.  This ham-handed change does nothing but punish those whose addiction to heroin is the most debilitating.

Then the minister came out with a whopper of an assertion to support her position:

In an interview with the CBC yesterday, Health Minister Rona Ambrose said there was “no evidence” to suggest heroin-assisted treatment was a safe and effective option. Actually, she used variations on the phrase seven times in the space of seven minutes. 

There is no evidence at this point that heroin—giving heroin to heroin addicts—is any way an effective treatment… 

As I said, there is no evidence that this is an effective, safe treatment… 

There is no evidence at this time, no clinical evidence… 

There is no clear evidence to suggest that this a safe treatment and it’s not a good idea for Health Canada, for Health Canada, to be supporting giving heroin to heroin addicts when there’s no scientific evidence that this is a safe treatment… 

There is no evidence at this time…

 As Maclean's writer Aaron Wherry points out, the minister is full of it:

Here is a 176-page report that was released last year by the European Monitoring Centre for Drugs and Drug Addiction. It was prepared by researchers with the National Addiction Centre at King’s College in England. In addition to considering the history and context around heroin-assisted treatment, the authors review the results of six randomized controlled trials, conducted in Switzerland, the Netherlands, Spain, Germany, England and Canada respectively.

In short there is evidence - it just happens to contradict the Harper Government's assumptions.  That they would disregard it is no real surprise - since coming to power, Harper has done everything he can to remove meaningful data from policy making.  Whether that is axing funding to Status of Women related research funding, killing the long-form census, or turning NSERC research funding into "industrial product development",  Harper has moved consistently to hobble anything which would objectively challenge his assumptions.

The motto of this government might as well be "Let no fact challenge our assumptions".