Jen Gerson: Quit wine. Do heroin

Have our public-health communicators learned nothing from the pandemic? The audience isn't experts. It's normal people.

By: Jen Gerson

The bad news is that you're going to die. The good news is that you might be able to squeak out a few more good years if you cut out all the things that make not dying worth the effort. 

On that note, the latest recommendations from the Canadian Centre for Substance Use and Addiction are both totally unsurprising, and entirely in line with a long tradition of nebbish, joyless public-health officials telling normies what fun we ought not to be having. 

In case you missed it, the organization has radically revised how much alcohol Canadians should be consuming — from 10 to 15 drinks per week to basically none. No amount of alcohol is safe now, but if you absolutely must, try to keep it to two drinks per week. After that your risk of developing cancer and heart disease increases. 

I will admit that this news is easy for someone like me to manage. Since being impregnated with two children, I've lost the ability to enjoy alcohol, along with my freedom, ability to travel, eat at fancy restaurants, and to go for long solitary walks in the sunshine without anybody knowing where I am. I'm almost a teetotaller; if I have to go to a party, I'll nurse one or two drinks for the night like some kind of Early Modern Era Narc.  

Nonetheless, the new alcohol recommendations are a talker. Drastic, yes, and certainly likely to elicit eye rolls and scoffs among the boozers who take pride in their ability to hold their liquor. The obvious thing would be to agree, messy drunk that I am, and point out how low our collective tolerance for risk has become, particularly among the policy wonk set. Perhaps this is one of the unintended consequences of the comforts of modernity generally, and COVID specifically: we are less comfortable with sickness and death, and increasingly unwilling to honestly ask ourselves on what terms we are willing to live a life. 

However, something very different is bothering me about these recommendations, and it's not that we're less tolerant of risk, but rather which risks we are choosing to tolerate, and how bizarrely we are communicating this to the public.

We are increasingly clamping down, or advising clamp downs, on substances that are long-standing and “traditional” — alcohol and tobacco are key examples. At the same time, we're growing more liberal and incautious about those that are generally championed by progressives; here I will note cannabis, legalization of hard drugs, and harm reduction programs that promote safe supply — otherwise known as the prescribing of legal opioids and stimulants to addicts. 

Look, I get that all of these substances have different risk profiles. Further, I understand why we are getting tougher on substances that have long been easily accessible, while we’re loosening up on those that have been arbitrarily prosecuted under a misguided war on drugs. Some of this rebalancing is necessary, logical and overdue.

But it’s hard to look at the current state of drug policy and the related public communications and argue that any of this is consistent, rational, and non-ideological.

Take this recent statement from Minister of Mental Health and Addictions Carolyn Bennet, for example. 

"We understand that in order to save lives and turn this crisis around, we must prioritize a full continuum of supports to help people who use substances along their journey, including harm reduction, which unfortunately, some of our critics do not understand ... While there is no one-size-fits-all solution to preventing or reducing overdose deaths and substance use harms, it’s up to all of us to help people who use substances live safer and healthier lives, including by reducing stigma around drug use and embracing harm reduction as an essential pillar of the Canadian Drugs and Substances Strategy."

Okay, fair enough. 

But, hey, know what did need to be stigmatized? 

Tobacco. 

Here's a press release from Health Canada two days later:

“Today marks the start of National Non-Smoking week, an annual opportunity to educate people across Canada about the benefits of a smoke-free life and promote tools and supports that can help people quit smoking or make a plan to quit. …

While quitting smoking is one of the best things people who smoke can do for their health, quitting can be difficult and may take multiple attempts. By combining supports and tools, people who smoke have a better chance at making quitting possible. These could include seeking support such as a quit coach or using approved nicotine replacement therapies like gums, patches and lozenges, medication, or other less harmful sources of nicotine. Moreover, evidence suggests that while vaping products are not harmless, vaping exposes people who smoke to lower levels of harmful chemicals than continuing to smoke." 

As it turns out, stigma can be a powerful tool when used in the service of discouraging substance abuse. We engaged in a massive social stigma campaign against smokers, one that included kicking them out of bars and putting ugly pictures on all their cigarette packages, and it was bloody effective at reducing smoking over the course of a generation. 

Granted, tobacco is dangerous. Is it worthwhile to point out, here, that the opioids some provinces are now prescribing to addicts are also linked to cancer? Provincial governments are now literally handing out carcinogens. Anyone? Hello?

"The guidance is based on the principle of autonomy in harm reduction and the fundamental idea behind it that people living in Canada have a right to know that all alcohol use comes with risk," noted the CCSU and, hey, yeah! 

I like to understand my risks so that I can make informed decisions. 

But you know what else poses significant risk?

Lots of morphine and cocaine. 

I think this is generally known. But God help you if you want to engage in a conversation about the risks society might be courting with safe supply or even harm-reduction strategies, and have fun being labelled a Conservative troglodyte who just wants suffering addicts to die in the street. You're probably just a rich, callous asshole who opposes all of these evidence-based policies who blows second-hand smoke into the faces of your children while drinking your sixth beer of the night at the local pub. Just shut up and pick up those discarded needles in your yard, you monster. 

I was picking on Health Canada previously, but they're hardly the only ones who display a bizarre split-personality on these issues. Any story by or on the CBC on the matter of alcohol use now sounds like something straight out of the Women's Christian Temperance Union. Yet just try to find critical reporting on safe consumption sites or safe supply policies. Almost all of it is uniformly glowing.

Again, I am quite aware that these are all different substances. We accept a different level of risk for those facing death via an imminent overdose than we do for a bored soccer dad whose 10-pint a week beer habit may lead to a tumour over the course of decades. It’s just ironic that our language for the higher risk behaviour is now far more muted than the cautions we reserve for the longer-term and lower-risk habits of cigarettes and booze.

We saw a similar cognitive dissonance during COVID. The same tribe that was thrilled to see a legal cannabis store on every block in the name of harm reduction and a rational drug policy suddenly began wring their collective hands at the prospect of keeping liquor retailers open during lockdowns. (Guys, guys: You can distil alcohol using rotten apples and a homemade still cobbled together with supplies from your local Home Depot. With the minor side effect that some statistically significant subset of careless bathtub ginnies would likely go blind in the process.) 

Look, I’m not here to debate the particular merits of cannabis legalization or safe supply. I generally don't like governments telling me what to do. I'm ornery that way. If I want to drink homemade gin while smoking heroin, well, goddammit, I ought to have the right to do so. 

So I'm in favour of public-health approaches and government messaging that focuses on education and evidence-based risk assessment rather than judgement, prosecution, and abstinence. 

Obviously, I don’t think that our public-health officials are telling Canadians that heroin takes the edge off a hard day better than a glass of red or a pint of beer. But did we learn nothing over the course of the pandemic about the importance of consistent and clear public-health communications? The target audience for this is not those who have carefully studied harm reduction and substance use disorders. It’s people who just like to have a drink with dinner.

If our governments want to maintain any credibility, they can't be uptight about how many glasses of pinot noir we drink, and then appear to be loosey goosey on heroin. It’s just impossible to take that kind of suck-and-blow at face value, but that’s exactly how this messaging will come across to people who aren’t closely engaged with this issue. “The government wants to give free hard drugs to junkies but thinks my cocktail is a problem?”

The Canadian Centre for Substance Use's guidelines on alcohol aren't wrong, but if that's the approach, then could we just try to be consistent across the board? Let's not gloss over the risks presented by the favoured policies of one ideological tribe.

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