Adam Zivo: Canada’s harm reduction regime is collapsing as disillusionment grows around decriminalized drugs

Up until as recently as a year ago, “harm reduction” ideology—which pushes for “safer supply” of opioids and the decriminalization of hard drugs—enjoyed a near-total stranglehold on Canadian addiction policy. But then, in a relatively short period of time, it has fallen out of favour as our politicians, responding to an increasingly fearful public, finally pivoted towards the rhetoric of treatment, recovery, and public safety. Nothing epitomizes this better than B.C.’s NDP government’s decision to re-criminalize open drug use in public spaces and the Trudeau government’s acceptance of that major reversal yesterday.

While this shift may have been abrupt and surprising to some, it was also inevitable. The grievous failures of the harm reduction movement could not be concealed indefinitely.

When a system is truly broken, a new vision eventually emerges, often despite Herculean efforts to maintain the status quo. This is especially true when the stakes are high, as is the case with the national opioid overdose crisis, which has killed more than 42,000 Canadians since 2016.

It should be noted that harm reduction is not inherently a bad thing. Its core idea makes some logical sense—there are some people who are not ready to quit using drugs, so we must mitigate the negative personal and social consequences associated with their ongoing use, without necessarily expecting abstinence.

This underlying reasonableness is why harm reduction is seen as a critical component of the long-popular “four pillars” drug strategy, which pairs it alongside treatment, law enforcement, and drug education. These pillars, when balanced correctly, have a proven track record of meeting the needs of drug users, and their surrounding communities, in a fair and comprehensive way.

Like most general principles, harm reduction also represents a broad umbrella of interventions and strategies, some of which are more helpful and evidence-based than others.

Canada’s problem hasn’t been that harm reduction exists, but rather that, over the past two decades, activists and ideologically motivated researchers have championed particularly radical forms of it. These approaches have been poorly designed, ineptly implemented, and shoddily researched. Worse yet, the other three pillars have been almost entirely abandoned.

Canadians are finally noticing this, which is why we are witnessing the current shift towards a more balanced, recovery-oriented paradigm.

Nowhere has the failure of the harm reduction movement been more glaring than with overdose prevention sites, safer supply, and drug decriminalization. All three of these interventions have the potential to save Canadian lives if executed correctly, which is perhaps why public support for them was initially so high. Yet, too often, Canada has championed models of care that have been shockingly irresponsible, much to everyone’s disillusionment.

Overdose prevention sites

Overdose prevention sites, which provide drug users with a supervised space to use their own substances in relative safety, can be quite useful if they are managed by addiction physicians, staffed by medical professionals, and if they provide clear pathways to recovery. Concurrently, these sites are only sustainable if they manage the crime that inevitably arises from concentrating addicts into one neighbourhood.

But in Canada, many of these sites are predominantly staffed by active drug users (“people with living experience with substance use”) rather than health-care professionals. Meanwhile, access to recovery-oriented addiction treatments is limited. More often than not, key medications like methadone and Suboxone must be sought elsewhere. While these sites are sold as “meeting people where they’re at,” in reality, they are effectively abandoned there.

This has often led to chaos and misery. For example, one site in Toronto’s Riverdale neighbourhood is facing serious allegations that staff permitted rampant criminality and drug trafficking in and around their premises. One harm reduction worker was even charged with being an accessory to murder. Similarly, in Vancouver’s Yaletown district, another overdose prevention site was shuttered after the city determined it was grossly mismanaged and had failed to adequately maintain public order.

“Safer” supply

The same dynamic played out with “safer supply”—a strategy that prescribes free pharmaceutical alternatives as alternatives to potentially tainted illicit substances. Many people initially supported safer supply, which was understandable. In theory, it can be a useful intervention—assuming, of course, that the provision of free drugs is carefully supervised and that clinicians make a serious effort to transition people into recovery.

However, over the past year, the public has discovered that theory and reality are two very different things. In truth, huge amounts of dangerous opioids are being distributed with minimal oversight and only a cursory emphasis on recovery. As a result, most of these drugs are being resold on the black market so that clients can buy even stronger street substances. This has only served to exacerbate the national addiction crisis.

Public health officials, along with their government allies, tried very hard to hide this. They consistently produced shoddy research papers that misrepresented the impacts of safer supply. They cherry-picked data. They bullied frontline addiction medicine practitioners into silence. They gaslit and ignored distinguished experts who raised legitimate concerns. But the public eventually came to understand the truth here, too.

Decriminalizing drugs in B.C.

As mentioned, we have now witnessed the catastrophic failure of B.C.’s drug decriminalization experiment, which permitted the open use and possession of small amounts of drugs like meth, cocaine, and heroin throughout the province via a three-year pilot program. Advocates promised this reform would mitigate overdoses and deaths. They assured us that “destigmatizing” addiction would actually encourage drug users to seek recovery-oriented treatment. It was repeatedly emphasized that decriminalization worked for Portugal in the 2000s and that it was only natural to follow Europe’s example.

But these benefits never materialized. Instead, public disorder exploded, and a sense of lawlessness set in. Needles appeared in parks and playgrounds. Addicts were allowed to openly smoke meth and fentanyl in hospital rooms, even if this endangered nurses and other patients. Overdoses and deaths failed to subside. The chaos of decriminalization was so obvious and widespread that the B.C. NDP was forced to reverse course after less than a year, only to be stymied by a questionable court injunction.

And amid this debacle, Canadians belatedly learned that the lauded Portuguese model of drug decriminalization had been misrepresented. Portugal had, in fact, invested significantly into recovery and had never allowed drug users to do whatever they wanted. In fact, the Portuguese model emphasized accountability and coercing addicts into treatment, elements that were missing from B.C.’s comparatively reckless approach.

The Canadian public has eyes. And people talk. Over the past year, the failures of harm reduction radicalism have become too visible to ignore. Many Canadians have run out of patience and now feel that their trust was betrayed. 

While there has been a shift in how the media is now covering addiction and public safety, which has certainly influenced public discourse, this would not have been possible had underlying material realities not permitted it. I say this as someone who greatly contributed to this shift through my own reporting on the failings of safer supply. My job was made much easier by the fact that clinicians and communities were exasperated and desperate to be heard. When harm reduction “experts” waged a retaliatory campaign of deceit, they failed to succeed because the truth was, and remains, firmly on my side.

So now the country is seeking a new direction—one which remains, for the moment, somewhat ill-defined. Alberta is currently leading the conversation by pioneering a recovery-oriented system of care, which recently received formal buy-in from both Ontario and Saskatchewan. But that model, while promising, has its own shortcomings, too. New treatment services are launching too slowly, and the system currently lacks mechanisms to coerce addicts into rehab. So is it any surprise that overdoses and deaths remain stubbornly high?

Meanwhile, the B.C. NDP is distancing itself from its old policies and openly discussing recovery and public safety. But their sincerity remains suspect, given it’s an election year and, according to polling data, support for the provincial government is collapsing.

Whatever the future holds, one thing is clear: the hegemony of harm reduction is ending. The Overton Window has shifted and we are entering a period of new ideas to solve a horrendous national problem.