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

Commentary

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.

A man walks past a mural by street artist Smokey D. about the fentanyl and opioid overdose crisis, in the Downtown Eastside of Vancouver, B.C., on Thursday December 22, 2016. Darryl Dyck/The Canadian Press.
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.

Sean Speer: What is Canadian conservatism?

Commentary

On April 26, The Hub’s editor at large, Sean Speer, participated in a panel discussion at the Civitas conference on basic ideas of the Canadian conservative tradition. Below is a reproduced version of his opening statement. 

I’ve chosen to interpret our panel topic as defining Canadian conservatism. Defining conservatism—especially in a handful of minutes—is a rather presumptuous task. 

It’s a bit apocryphal but apparently William F. Buckley Jr., who I’d argue is the most important conservative public intellectual in the twentieth century, started on a book to define conservatism but never finished it. 

He used to speak regularly on college campuses and whenever he was pestered to provide a succinct definition of conservatism, he would define it as “a paradigm of essences toward which the phenomenology of the world is in continuing approximation.” That usually shut down the exchange with an overconfident student or faculty member. 

As a young person, I was consumed by the search for what one might describe as an indigenous Canadian conservatism distinct from American conservatism. The search was inspired in large part by Samuel Huntington’s famous observation that conservatism isn’t a universal ideology. It’s contingent and particularistic. It’s committed to conserving a set of ideas, institutions, and values that are unique to a particular jurisdiction or group. A Saudi Arabian conservative is different from a French conservative because he or she is aiming to conserve something different. It stood to reason therefore that there must be something that made Canadian conservatism inherently distinctive. 

I must say that as I’ve gotten older, I’ve become less motivated by the search for a unique Canadian conservatism. That’s because I’ve come to the view that English Canadian conservatism is essentially part of a North American project—its purpose, by and large, is to conserve a liberal (by which I mean classically liberal) inheritance. It follows therefore that, at least in broad terms, we’re trying to conserve the same ideas and values—if not the same institutions—as U.S. conservatives. 

I see the centre of gravity of English Canadian conservatism as “ordered liberty” or what modern American conservatives call “fusionism.” It represents a basic synthesis of Burkean traditionalism and new world dynamism. It involves a conception of liberty, personal freedom, and individual autonomy that’s rooted in an understanding of institutions, traditions, and norms that impose non-coercive yet powerful constraints on base human instincts and channels them in constructive directions. 

As Stephen Harper said to this conference in 2003: “The truth is that strong economic and social conservatives are more often the same people—and with reason. Except at the extremes…the philosophical fusion is deep and widespread.”

The more interesting question for me, then, is less about what’s distinct about Canadian conservatism per se and more about the differences between English Canadian conservatism and Quebec conservatism. 

But if I may leave that question aside perhaps for our discussion, I thought that I’d spend my remaining minutes reflecting on my own intellectual journey and how I’ve ended up here to the extent that it resonates with others. 

My personal worldview has become somewhat dichotomous. It reminds me of Jonah Goldberg’s frequent point that conservatism might be best defined as “comfort with contradiction.”

As a father, I’ve become more conservative in my life and outlook. Yet, as a matter of government and politics, I’ve become more libertarian or liberal. 

There are two main reasons for these developments. First, I’ve become so highly skeptical of state action in the face of such a string of government failures that I have to be careful at times not to succumb to anarchistic thinking. Second, reaching mid-life, which invariably comes with the reflection of one’s mistakes, wrong choices, and inherent fallibility, has caused me to be a bit humbler about politics. 

It’s an interesting consequence of hard-earned wisdom. At the precise moment that I’ve become confident in my own views about virtue and the good life, a reckoning with my own failings makes me skeptical of imposing them on others. My conservatism, in other words, is increasingly rooted in a crooked timber view of humanity. 

A statue of former Canadian Prime Minister Sir John A. Macdonald is pictured on Parliament Hill in Ottawa on Thursday, June 3, 2021. Sean Kilpatrick/The Canadian Press.

In this sense, I think of Canadian conservatism (and indeed North American conservatism) as fundamentally pluralistic. It’s about preserving a large swath of space for as many of us as possible to seek virtue, live out our conception of the good life, and pursue individual prosperity and stability as members of a liberal democratic polity. 

But I’m not quite a Buftonian libertarian. I’m happy to make some accommodations within this framework that nod to normative judgements about the common good including: 

  • A broadly liberal political economy ought to have limits concerning trade and commerce with hostile states. 
  • A broadly liberal view of personal autonomy ought to accommodate constraints on individual freedom like age verification for online pornography, the criminalization of illicit drugs, or other instances where prudence causes us to intervene on behalf of children and the vulnerable. 
  • We ought to push back against the growing non-neutrality of public institutions as we’ve seen play out on university and college campuses across the country. 
  • A pluralistic public square doesn’t necessarily mean a relativistic one—there’s plenty of scope to argue that certain ideas are better than others and in some cases, this may even require legislating against illiberal actions or cultural practices. 
  • And, of course, I don’t believe that private institutions themselves need to be pluralistic. 

Ultimately, though, my conservatism—and I believe Canadian conservatism (or at least English Canadian conservatism)—is about conserving the principles of the country’s founding ideas and institutions which were liberal and pluralistic. 

We shouldn’t be disappointed by such a heritage. It’s one that had served us rather well for more than 150 years.