On Drug Policy

Alberta in particular continues to ride the “War on Drugs” policy train from the 1980s.  In fact, in many ways the current UCP government has doubled down on it with an approach that basically says “recovery is the only option for addicts” - to the point of actually talking openly about using government coercive power to force people into treatment involuntarily.  

Their argument is largely based on a number of misguided notions about addiction, and how best to address it.  They largely view addiction as a personal moral failing - literally the addict is at fault for “putting the stuff in their body” in the first place, and should be grateful that we provide places for them to “get clean”.  

That is, to be charitable, a horribly naive way of looking at the issue.  I’m not going to spend a ton of time here reviewing the academic literature on addiction - if you want to get a taste of it, wander over to Google Scholar, and type in addiction and I think you’ll get a sense of the scope of the issues. 

However, since the 1980s, the illicit drugs world has changed a lot. Back then the most dangerous substances were things like heroin, or possibly freebasing cocaine.  Overdoses certainly happened, but compared to now they were rare. Today’s drug supply on the street is many orders of magnitude more dangerous, and compounds are being mixed together in ways that most of us can’t even begin to imagine. 

I do agree that addiction is a major problem for policy makers to address.  Where I disagree with policy makers across the board is in the simplistic, one (or maybe two) dimensional approaches to government policy being implemented.  We cannot treat this as a singular monolith issue any longer. 

We need to implement a package of policies to deal with the issues - and it will take significant resources on multiple fronts to do it right. 

A Proposal

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. 

And The Screws Tighten Further

As the Conservatives continue on their hardline "tough on crime" nonsense agenda, the next step unrolled in an announcement from Health Minister Leona Aglukkaq revealed new rules for managing medical marijuana:

Under the new regime, the government will no longer produce or distribute medical pot and medical marijuana users will no longer be allowed to grow the product at home. Instead, the government will allow patients to buy prescribed amounts only from licensed growers under strict conditions.

In previous versions of the regulations, pharmacies were to distribute the product just like other medications, provoking the anger of pharmacists who feared being robbed.

But the final version removes the pharmacists from the loop, forcing patients to rely on mail order for their medical marijuana. 

Once again, we see the government stepping in and not just regulating something, but instead putting up obstacles which are detrimental to the good that these programs actually do.

"While the courts have said that there must be reasonable access to a legal source of marijuana for medical purposes, we believe that this must be done in a controlled fashion in order to protect public safety," Aglukkaq said in a news release.

"These changes will strengthen the safety of Canadian communities while making sure patients can access what they need to treat serious illnesses."

 Of course, they wrap it in the cloak of "community safety", when there isn't a shred of evidence to suggest that medical marijuana use has caused any community safety issues.  I will point out that any evidence the government may have is guaranteed to be purely anecdotal at this point, since they have ever so conveniently hamstrung the ability of Statistics Canada to gather reliable data.

There are two enormous questions that have not been addressed yet.  First is what are the criteria to become a "licensed marijuana grower"?  I'm going to put money on the rules being so strict that virtually nobody will be able to become one - not unlike what the government has done with the proposed rules around safe injection sites.

What the government has just done is push the use of marijuana to mitigate symptoms back underground.  The vast majority of users will not be willing to purchase the stuff via "mail order" models and will resort to the purchase of marijuana "off the street" simply because it is easier and more convenient - whatever the legal risks that may be associated with it.

There is nothing like a government which refuses to pay attention to available evidence and instead insists upon governing from ideology alone.

Conservatives On Safe Injection Sites

So much fodder to blog about today.  I hardly know where to begin, with still more corruption oozing out of the Senate Expenses scandal, Brent Rathgeber bailing out of the CPC caucus and Leona Aglukakk tabling legislation on Safe Injection Sites.

It's no secret that the Conservatives weren't happy after the Supreme Court ruled against their move to shut down the Safe Injection site in Vancouver - in spite of multiple years of solid evidence of the effectiveness of the program.

Today, they tabled their response in the House of Commons in the form of Bill C-65 subtitled "The Respecting Communities Act".

I am not particularly surprised to see that what we have here is an act of legislation which is designed not to provide a meaningful framework upon which an organization wanting to start one of these sites could operate, but instead it sets up a complex set of hoops that rival those put in front of transsexuals in the days of rigid gender clinic programs in the 1970s.  ... and then it leaves the ultimate decision in the hands of the minister.

Consider the following list of no less than 24 categories of information that must be included in order to even begin the process of applying for the ministerial exemption that is required to open a safe injection facility.  There are no less than 24 different pieces of information, one of which is disturbingly open ended - the last one.

Some of these appear reasonable on the surface, and others are completely unreasonable.

(3) The Minister may consider an application for an exemption for a medical purpose under subsection (2) that would allow certain activities to take place at a supervised consumption site only after the following have been submitted:

(a) scientific evidence demonstrating that there is a medical benefit to individual or public health associated with access to activities undertaken at supervised consumption sites;

(b) a letter from the provincial minister who is responsible for health in the province in which the site would be located that

(i) outlines his or her opinion on the proposed activities at the site,

(ii) describes how those activities are integrated within the provincial health care system, and

(iii) provides information about access to drug treatment services, if any, that are available in the province for persons who would use the site;

(c) a letter from the local government of the municipality in which the site would be located that outlines its opinion on the proposed activities at the site, including any concerns with respect to public health or safety;

(d) a description by the applicant of the measures that have been taken or will be taken to address any relevant concerns outlined in the letter referred to in paragraph (c);

(e) a letter from the head of the police force that is responsible for providing policing services to the municipality in which the site would be located that outlines his or her opinion on the proposed activities at the site, including any concerns with respect to public safety and security;

(f) a description by the applicant of the proposed measures, if any, to address any relevant concerns outlined in the letter referred to in paragraph (e);

(g) a letter from the lead health professional, in relation to public health, of the government of the province in which the site would be located that outlines their opinion on the proposed activities at the site;

(h) a letter from the provincial minister responsible for public safety in the province in which the site would be located that outlines his or her opinion on the proposed activities at the site;

(i) a description of the potential impacts of the proposed activities at the site on public safety, including the following:

(i) information, if any, on crime and public nuisance in the vicinity of the site and information on crime and public nuisance in the municipalities in which supervised consumption sites are located,

(ii) information, if any, on the public consumption of illicit substances in the vicinity of the site and information on the public consumption of illicit substances in the municipalities in which supervised consumption sites are located, and

(iii) information, if any, on the presence of inappropriately discarded drug-related litter in the vicinity of the site and information on the presence of inappropriately discarded drug-related litter in the municipalities in which supervised consumption sites are located;

(j) law enforcement research or statistics, if any, in relation to the information required under subparagraphs (i)(i) to (iii);

(k) relevant information, including trends, if any, on the number of persons who consume illicit substances in the vicinity of the site and in the municipality in which the site would be located;

(l) relevant information, including trends, if any, on the number of persons with infectious diseases that may be in relation to the consumption of illicit substances in the vicinity of the site and in the municipality in which the site would be located;

(m) relevant information, including trends, if any, on the number of deaths, if any, due to overdose — in relation to activities that would take place at the site — that have occurred in the vicinity of the site and in the municipality in which the site would be located;

(n) official reports, if any, relevant to the establishment of a supervised consumption site, including any coroner’s reports;

(o) a report of the consultations held with the professional licensing authorities for physicians and for nurses for the province in which the site would be located that contains each authority’s opinion on the proposed activities at the site;

(p) a report of the consultations held with a broad range of community groups from the municipality in which the site would be located that includes

(i) a summary of the opinions of those groups on the proposed activities at the site,

(ii) copies of all written submissions received, and

(iii) a description of the steps that will be taken to address any relevant concerns that were raised during the consultations;

(q) a financing plan that demonstrates the feasibility and sustainability of operating the site;

(r) a description of the drug treatment services available at the site, if any, for persons who would use the site and the information that would be made available to those persons in relation to drug treatment services available elsewhere;

(s) relevant information, including trends, on loitering in a public place that may be related to certain activities involving illicit substances, on trafficking of controlled substances and on minor offence rates in the vicinity of the site, if any;

(t) information on any public health emergency in the vicinity of the site or in the municipality in which the site would be located that may be in relation to activities involving illicit substances as declared by a competent authority with respect to public health, if any;

(u) a description of the measures that will be taken to minimize the diversion of controlled substances or precursors and the risks to the health and the safety and security of persons at the site, or in the vicinity of the site, including staff members, which measures must include the establishment of procedures

(i) to dispose of controlled substances, precursors, and any thing that facilitates their consumption, including how to transfer them to a police officer,

(ii) to control access to the site, and

(iii) to prevent the loss or theft of controlled substances and precursors;

(v) a description of record keeping procedures for the disposal, loss, theft and transfer of controlled substances and precursors — and any thing that facilitates their consumption — left at the site;

(w) the name, title and resumé, including relevant education and training, of the proposed responsible person in charge, of each of their proposed alternate responsible persons, and of each of the other proposed key staff members;

(x) a document issued by a Canadian police force in relation to each person referred to in paragraph (w), stating whether, in the 10 years before the day on which the application is made, in respect of a designated drug offence or a designated criminal offence, the person was

(i) convicted as an adult,

(ii) convicted as a young person in ordinary court, as those terms were defined in subsection 2(1) of the Young Offenders Act, chapter Y-1 of the Revised Statutes of Canada, 1985, immediately before that Act was repealed, or

(iii) a young person who received an adult sentence, as those terms are defined in subsection 2(1) of the Youth Criminal Justice Act;

(y) if any of the persons referred to in paragraph (w) has ordinarily resided in a country other than Canada in the 10 years before the day on which the application is made, a document issued by a police force of that country stating whether in that period that person

(i) was convicted as an adult for an offence committed in that country that, if committed in Canada, would have constituted a designated drug offence or a designated criminal offence, or

(ii) received a sentence — for an offence they committed in that country when they were at least 14 years old but less than 18 years old that, if committed in Canada, would have constituted a designated drug offence or a designated criminal offence — that was longer than the maximum youth sentence that could have been imposed under the Youth Criminal Justice Act for such an offence;

(z) any other information that the Minister considers relevant to the consideration of the application; and

(z.1) any prescribed information that is submitted in the prescribed manner.

The requirement for a "letter of consent" from not just one level of government, but all levels of government _and_ from the head of the police department in the area seems to be beyond ridiculous.  For all intents and purposes, it strikes me as highly unlikely that you would ever get all of these levels of government to agree.  

I suspect that the burden of evidence that is being demanded here is far beyond the means of most community organizations that would be interested in getting a safe injection site started.

This is not surprising.  Where the Conservatives cannot use their standard hard-line punishment-above-all-else approach to governing, they will throw up as many walls as they can possibly get away with.  In this case, the final wall is that of the government itself.  When the final decision is left ultimately to the minister, it becomes fundamentally a political decision, regardless of how many tons of supporting documentation is demanded and provided.

This bill is a way for the Con$ to prevent another InSite being created.  They failed in their attempts to shut InSite down, but they are bound and determined to continue the mindless failure of the Republican 'War on Drugs' model rather than constructively addressing the situation.