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Christopher Dummitt: The harm reduction consensus is cracking

Commentary

The experts seem absolutely certain of one thing: that the Alberta government is clueless.

The Globe & Mail recently released a story that claimed that the government of Alberta was planning to “broaden the circumstances under which people with severe drug addictions could be placed into treatment without their consent.” Yesterday’s campaign announcement from the United Conservative Party confirmed this reporting and outlined the party’s plan, if re-elected, to grant families, legal guardians, and police the “last-resort” right to refer addicts to treatment in cases where they are considered a harm to themselves and others and are likely to keep reoffending.The UCP addictions plan also promises a “recovery-oriented system of care” and includes increased funding for addiction treatment centres and mental wellness centres.

The idea isn’t new. Even British Columbia’s NDP premier David Eby recently mused about adopting a similar approach. The epidemic of drug overdoses and the problem of mass homelessness with its ties to addiction and mental illness is pushing governments of all stripes to think about what can be done.

Yet the uniformity of the expert and media response is striking. 

To enforce treatment is many things, we are told, and none of them are good. Forcing someone into treatment is apparently just like torture. That’s according to Euan Thomson, the head of a harm reduction organization. “They’re put into severe withdrawal by going into these [treatment programs],” Thomson argues, “so it really is like torture.” 

Or it’s seen as a violation of basic civil rights. Lorian Hardcastle, a law professor at the University of Calgary has argued that enforced treatment is “a violation of your rights to…life, liberty and security of the person”. For what it’s worth, this is the same professor Hardcastle who is on the record arguing that vaccine mandates don’t violate Charter rights even though they too were a form of mandated medical treatment.

All the experts upset at the Alberta plan share a similar harm reduction approach. Harm reduction is ostensibly meant to reduce the personal health and social costs of addiction. It aims not to stigmatize addicts (even my use of the term “addict” might offend proponents). Most importantly it is not even about getting drug users to necessarily stop using drugs—certainly not if they don’t personally want to stop using. These experts claim that their approach is supported by the best scientific evidence and that it genuinely minimizes drug overdoses or, as advocates increasingly insist on calling them, drug “poisonings.” 

Should we then just trust the experts? 

If it hasn’t worked yet—if our streets and downtowns are filled with tents and needles, with drug users walking out into traffic as if a busy street is no different from a soccer field, and if the numbers of those using drugs and suffering overdoses is not in fact diminishing—should we just sit back and assume that this cadre of experts will be right eventually? Perhaps we just haven’t given it enough time yet? Or maybe things will improve if we move forward with “safe supply”—that is, turning the government into a legal pusher of hard drugs? 

This might all be fine if it weren’t for the fact that we’ve lived through several years of realizing just how politicized the field of public health expertise actually is. Gathering in large groups would spread COVID-19, we were told—unless you were gathering in a Black Lives Matter protest in which case, it’s all good. We should “follow the science”—unless, that is, the science showed that it would be fine to keep schools open because kids weren’t at serious risk from COVID-19.

In other words, the uniformity of expertise might be less worrisome if we could trust that experts valued truth ahead of politics. But that’s not the case. Instead, what we have is a group of experts who seem to be the intellectual equivalents of Henry Ford’s Model T: you can have all the expertise you want, as long as it’s a shade of harm-reduction. 

We know just how ideologically insulated our sources of so-called expertise have become. As a colleague and I showed in our report for the Macdonald Laurier Institute last year, our universities have become intellectual silos that vastly overrepresent left-wing viewpoints. Those with alternate perspectives self-censor at alarmingly high rates. 

This matters for public policy. People with different political orientations think differently about morality. Progressives have a generally rosy view of human nature based on an idea of the innate perfectibility of humans. They also increasingly focus on the virtue of victimhood above almost all other moral concerns. As Jonathan Haidt pointed out, progressives tend to be clueless about other kinds of moral matrices, often interpreting different moral choices as either being stupid or evil.

When we shape public policy it helps to test progressive solutions against other options, especially those based on more cautious views which assume the weakness of the individual, the darkness that we all contain inside ourselves, and the fact that we sometimes need to be saved from ourselves.  

The intellectual debate about addiction also needs to account for the social costs of rampant public drug use and addiction. It needs to think about the social costs of children being raised in cities where it’s normal to have drug users openly out-of-their minds on downtown streets—or where the public library is a way station for men and women who haven’t showered in weeks and who leer at patrons. 

The behaviour of individuals around us shapes what we see as acceptable. To the extent that harm reduction works—by de-stigmatizing drug use—this is itself a social problem. There is a danger of a cascading descent into social degradation where the terrible choices that addicts make become normalized and not stigmatized. As progressives seem to acknowledge in other areas—most dramatically in dealing with racism—stigma is socially useful. It indicates social disapproval. Would harm reduction activists suggest the same approach for hate crimes, suggesting we need to create reading rooms for racists stuffed with copies of Mein Kampf and old VHS tapes of Birth of a Nation? After all, if you follow their logic, we need to listen to the addicts and not violate their Charter rights.

Clearly, this approach wouldn’t be appropriate in the case of hate crimes and we ought to listen to those who see similar problems adopting the same approach with drugs.

Where is the Canadian version of Michael Shellenberger who has brought such dynamic debate to the United States? In his book San Fransicko, he exposed how a so-called progressive approach to urban problems had contributed to the explosion of homelessness and drug overdoses in San Francisco, hurting the people the advocates claim to want to help. 

Canadian federalism allows us to test various public policies in different jurisdictions. It’s one of the benefits, amidst the many drawbacks, of federalism. We ought to be keen to allow provinces to test out decidedly different approaches to the addiction crisis. 

Harm reduction advocates emerging out of the homogenous cookie-cutter world of academia offer one solution. It’s for all intents and purposes been the only one on offer in much of our public policy debates on these issues. But other approaches are possible. After ceding a decade-long monopoly on this debate to progressives and their preferred policy prescriptions, conservatives in Alberta are offering a coherent strategy and alternative framework to address these issues—one that other like-minded national and provincial leaders searching for solutions can build upon.

I offer no prediction on whether the Alberta approach will work. Experts who make predictions are wrong as often as they are right. But it certainly seems like a bright spot on the Canadian horizon to see governments testing out starkly contrasting policies.

Patrick Luciani: When it comes to poverty, good intentions aren’t enough

Commentary

Review of: Poverty, By America
Author: Matthew Desmond
Publisher: Crown Publishing Group, 2023

Following his best-selling book Evicted, which earned him a Pulitzer Prize, sociologist Matthew Desmon now tackles the nature of poverty in his latest book, Poverty, By America. Desmond says he wrote the book to get to the root causes of why the United States has around 38 million men, women, and children who live under the poverty line and can’t afford decent health care, enough to eat, and secure housing. Why so much misery in the world’s richest country? Poverty, By America argues poverty isn’t an accident or bad luck but intentional by those that benefit from it. 

He doesn’t take the traditional economic causes blaming structural changes in America’s economy, globalization, immigration, or even the behaviour of the poor. The book’s essence is that poverty exists because too many people gain from the misery of others. Poverty exists because, as Desmond says, too many are warming their hands on the fire that fuels poverty. It’s a system designed to help the rich at the expense of the poor. Desmond, who teaches at Princeton University, speaks from experience, having grown up poor. Once trapped in poverty, it is almost impossible to escape the shame and degradation of wasted lives. And though all races suffer, Blacks and Hispanics suffer even more than poor Whites. 

Poverty, by America is a story with enough scholarship to support his claim that greed and cruel indifference are the villains in America’s tale of woe and shame. And these villains are corporations, rapacious landlords, indifferent bureaucrats, and a general indifference by a public that has become numb to the misery of others. 

Corporations come in for a significant part of the blame by limiting workers’ right to join unions such as Starbucks and Amazon. He believes unions were the backbone of America’s working classes, contributing to higher productivity and secure, well-paying jobs, and he longs for their return. He also believes higher minimum wages create more jobs. Desmond comes down hard on laws that allow corporations to hide profits offshore and landlords who earn more by renting to the poor in ghettos than those in wealthier neighbourhoods. Banks prey on the poor with exorbitant fees for short-term loans keeping them in a perpetual cycle of debt, while governments sit on millions of unallocated funds meant for low-income people. 

He blames poorly designed support programs that never get to those in need, such as those who qualify for food stamps but never apply. He has a particular animosity toward those living in comfortable, safe communities while denying the same benefits to poor children through housing restrictions. Put these together, and we have a political and economic system perpetuating poverty. Desmond believes the U.S. could afford to house all the poor in America if only the rich paid their legal share of taxes.

Professor Desmond’s solution is to get angry and direct that anger at conditions that oppress the poor. At this point, he starts to sound more like Howard Beal in the movie Network when he cries out, “I’m mad as hell, and I’m not going to take it anymore.”

But is he right about poverty and its causes? And are his solutions the right ones?

Americans should be angry, especially at the rising level of homeless and the misery they bring. But the causes of poverty are more complex than those outlined by Desmond. Every year, millions fall below the poverty line, but millions rise above it, just as he did. Then there’s the question of defining poverty. A recent book, The Myth of American Inequality, argues that the correct number of poor is much lower when all transfer payments are included. This doesn’t diminish the need for more imaginative poverty programs, but it’s essential to understand the dimensions of the problem. Desmond believes that rising minimum wages is also a cure and hangs his hat on a 30-year-old economic controversial study. Minimum wage legislation benefits some workers but too often hurts small and marginal businesses, just as rent controls often help the wrong people. And even if the rich paid all their taxes hidden in offshore accounts, there’s little assurance they could pay for the mounting costs of subsidized housing, as California is discovering. 

Desmond disparages recommendations that lower poverty, such as the conservative American Enterprise Institute’s study emphasizing education, stable families, and the ability to hold a job. AEI isn’t unique in its recommendation. The more liberal Brookings Institution says the same thing. He then patronizingly comments that such a formula might work for Whites but not Blacks. But we know that poverty will surely follow if teenage girls from poor families have children out of wedlock, depriving them of a chance for a better life. Perhaps Canada’s leading poverty expert, economist Chris Sarlo says that “bad choices are the dominant initiating cause of poverty” in the U.S. and Canada. 

Deep poverty is a tragedy wherever you find it, even in rich countries. Desmond advocates that the poor aren’t getting the money they need to survive. Fair enough, but he ignores advice about behavioural changes that helped him escape poverty. Why deny others the same advice that gave him the good sense to become the success he is today? He ends his book by claiming, “We don’t need to outsmart this problem. We need to out-hate it.” Unfortunately, that’s not a plan; that’s an aspiration.