Harm reduction or recovery? We need to be doing both

When it comes to drug use I strongly suspect there's broad agreement on what Albertans want.

They don't want to see anyone get addicted to dangerous drugs. They want to see users treated firmly if they break laws and harm others, but also with compassion and generosity. Most agree that users are sick and need help.

Are you all still with me? I suspect so, even those on either side of the now huge partisan political divide on how best to deal with drug addiction in Alberta.

Rachel Notley's NDP bashes the UCP for doing the wrong things, and the UCP bashes the NDP for having the wrong ideas.

But could it be there's not so much separating the two factions? That's how I see it after having dug into the ideas of Alberta's two most influential addictions policy experts, Marshall Smith, chief of staff to the UCP'S associate minister of mental health and addictions, and Prof. Elaine Hyshka, assistant professor at the University of Alberta's School of Public Health, who the NDP appointed as co-chair of its Opioid Emergency Response Commission in 2017.

Smith is an activist-turned-policy guru who strongly pushes for addictions recovery programs. Hyshka gained prominence pushing the harm reduction model of safe infection sites across Alberta. She now advocates for a safe supply of drugs to counteract the toxic street drugs that are poisoning users to death in record numbers.

We've gone from about 100 opioid deaths per year a decade ago to more than 1,700 last year.

How best to deal with such misery? For a start, how about our political class tone down the bickering? For her part, Hyshka decries the partisan turn the debate has taken.

“It's unfortunate that it's become very polarized and politicized,” she said in an interview.

“What I really hate seeing right now and what is really frustrating to me is this idea that harm reduction and recovery are at odds.”

The reason so many more people are now dying is because drug users have switched from the abuse and illegal use of legal opioids, which was rampant a decade ago, to novel street drugs like fentanyl, she said.

She criticized the government for limiting supervised consumption sites and programs, which are known to reduce drug deaths. But she also supports recovery programs.

“I personally support people seeking total abstinence from all psychoactive substances. I think that works very well for many people. But I also support those who are looking to moderate their use, or reduce the negative consequences of their use.”

As for Smith, he's a government employee now so he's not able to speak freely, but we can get some sense of his views from a lengthy 2015 radio interview he gave about his life as an addict and policy maker.

He was an up-and-coming provincial Liberal political operative in Victoria, B.C., when he became addicted to cocaine and meth, lost his job, was twice sent to jail and spent 2004-07 on the streets.

He's OK if there's stigma attached to drug use, he said.

His goal isn't to see drug use normalized, it's to get folks off of drugs. “Drug use is harmful. Just wishing it wasn't isn't going to make it so.”

Nothing would make him happier, he said, than to live in a world where all people can get high quality addictions treatment.

Addiction is a disease that impairs your ability to make good decisions, he said, so it's incumbent on rational-thinking community members to push hard to get users into treatment.

“Their brains are completely hijacked by chemicals. We have to be more assertive in moving people along that continuum of care.”

In the interview, he also decried how the concept of abstinence was being derided as a “word of oppression.”

But if the debate has become too partisan in Alberta, it could be that Smith is part of the issue. In the 2015 interview, for example, he was dismissive of many other drug treatment workers.

“There is a lot of people out there who are attempting to help addicts that really don't know what the hell they're doing.”

Hammering on those with opposing ideas can be satisfying, but it can also get in the way of testing, refining and building support for your own good ideas, such as Smith's focus on recovery.

Alberta needs to keep its eyes on the prize when it comes to this new crisis in addictions.

The goal is to keep users alive and help them recover. They're not contradictory processes and it's time to fully embrace both, rather than squabble about who has got what wrong.