Social licence: not just for pipelines?
It’s always been my posi tion that pipelines shouldn’t be too easy to build. That’s not a popular thing to say in Alberta, but it is so. If you are going to undertake a project for the general public benefit, you assume a duty to take care of the communities that it resides directly upon or near. Yes, this does means consulting with them. It means anticipating undesirable effects from your undertakings — not only effects on the immediate environment, but social ones, too. It means continuing to check for those effects when you’re done, using any tools you have at hand to quantify them. It’s just common sense, right?
Well, the Alberta government has just done its best to apply the same principles to supervised drug consumption services. We shall see how popular that proves.
The Conservatives pulled together an eight- person panel to prepare a report on the social and economic impacts of the province’s seven safe consumption sites, all of which are somewhat controversial in their cities (Edmonton, Calgary, Lethbridge and Grande Prairie; a “temporary” site is also operating in Red Deer). The panel featured two cops, two criminologists, a finance consultant who lost a child to fentanyl and three doctors with credentials in addiction medicine.
The Tories are sometimes thought to be intent on shutting down the safe consumption sites. Given that the Supreme Court has endorsed their lawfulness, and that their exemptions from drug laws are a matter of federal statute, the province would not simply be able to swoop in and raid them like speakeasies. But the facilities are so dependent on provincial funding, and on the co-operation of medical and legal authorities, that Alberta could make life difficult or impossible for them if it wished.
The new panel report vacillates back and forth between insisting on its own limited scope — it does not claim to evaluate safe consumption as a health intervention — and asking barbed little questions about how helpful the sites are, as currently constituted. The province does seem to want to move some of the rougher ones. And the panel, in a recommendation tucked away near the end of the report’s main body text, comes out actively against a proposed consumption site for Medicine Hat and a second one for Calgary.
The big cities that don’t have sites yet, the report notes, don’t show any differences in patterns of drug mortality from the places that introduced them in 2017. ( They could have added that the picture of opioid deaths, with its unnerving 2018 peak and signs of decline since, looks similar in Saskatchewan, where no consumption sites yet exist.)
The report tacitly discloses something of which the public might not be generally aware: the medical profession is somewhat at odds with the safe- consumption movement, which has been pioneered by the same community-organizer types who were on the front lines of fighting AIDS in the 1980s and ’90s. Among the facts in the report that might be surprising is that the consumption sites don’t have doctors on the premises, with the exception of a small-volume one in Edmonton’s Royal Alexandra Hospital that serves in-patients only.
The doctors who helped write the report think this should change. They want their own kind in charge of all the sites, and they think the sites ought to be better integrated, with options for rehab and detox, with social work and with drug courts. (“Better integrated” means more integrated with other institutions than they are now, which is not at all.)
This is recognizable, I think, as empire-building or perhaps professional chauvinism. Consumption site creators and staff think of their sites’ disconnection from the apparatus of law, the administrative state and bourgeois life as an advantage when it comes to saving lives, which is something they are very sure they are achieving. Anyone can walk into a safe injection site without being interrogated or even identified; if this weren’t true, the people who need
this lack of bourgeois inhibition has some spillover effects.
them most might never visit.
But this lack of bourgeois inhibition has some spillover effects. The police, whose very existence is regarded as a goad, are made to feel unwelcome when they have to accompany paramedics inside a site. People who have houses and apartments near safe injection sites are almost unanimous in describing a battle with medical waste, filth and petty crime. They are typically told they must be imagining it, or exaggerating it. I would mention the need for “social licence” here, but I already used up my joke about pipelines.
Most interesting to me is the documentation of endemic mission creep at the sites. Initially envisioned as spots for needle exchange — in some cases they sprouted from HIV- fighting needle programs — they evolved into supervised spaces for actual opioid use, which found acceptance by the courts and by a public increasingly aware of Canada’s horrendous overdose crisis.
But “safe injection” is turning into “safe consumption,” and methamphetamine use now accounts for anywhere from 25 to 50 per cent of visits at most sites. This leads to the colonization of the surrounding areas by a different clientele. Some sites have added “inhalation booths” and fume hoods specifically for meth. The report all but asks, “What’s the f--king point of that?” since meth carries a fraction of the overdose and infectious disease risk of injectable opioids; and if there’s an answer I would love to hear it. National Post Twitter. com/colbycosh