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Q&A, Part 1: 'It’s the furtherance of a highly liberalized drug legalization agenda.'
In a recent video, Conservative leader Pierre Poilievre highlighted the drug crisis, in British Columbia. He suggested Alberta provided a solution. How different are the two provinces, really?
Marshall Smith has followed a circuitous route to his current position, the chief of staff of the Alberta premier. He began a career in government two decades ago — until he became addicted to drugs and wound up on the streets of Vancouver. He recovered, and from there, spent time working in senior roles in addiction treatment. About three years ago, he was tapped by then-premier Jason Kenney to serve as the chief of staff to the province’s Minister of Mental Health and Addiction; in that role, he became one of the architects behind Alberta’s emerging approach to the addictions epidemic now sweeping the country. He is credited — or blamed — for adopting a treatment-focussed approach to addiction, one that is notably more skeptical about harm reduction measures like Safe Consumption Sites, and Safe Supply.
Alberta’s approach was highlighted in a recent — and heavily criticized — video posted by Conservative leader Pierre Poilievre. As B.C. moves forward with its plans to decriminalize small amounts of drugs as part of a three-year experiment, The Line chatted with Smith this week to get a better sense of just how different the policies of B.C. and Alberta really are. We believe it offers insight into much of the behind-the-scenes thinking on the Conservative side of drug policy.
This Q&A has been edited for length and clarity, and will run in two parts. Watch for the second part tomorrow.
Jen Gerson: I wanted to chat with you in response to that video that came out from Pierre Poilievre in which he namechecked Alberta and Alberta’s drug strategy, specifically in contrast to what was going on in British Columbia. This was a really controversial video. A lot of people criticized him for it. I don’t really want to get into the pros or cons of the video itself, but I thought it was a very interesting thing that he presented Alberta as a contrasting approach to a mental health and addiction policy. What exactly is Alberta doing differently, if anything, from what B.C. is doing with regards to addiction policy?
Marshall Smith: I think that’s a great question and I think that there are some striking differences in philosophy. The vision in Alberta is deeply rooted in a belief that people have the right to recover. They have the right to be supported in their recovery. That the pursuit of a drug-free life with improved health and a return to positive engaged citizenship should lead the way in our policy discussions. That we should always be mindful that people have the ability to get well from this illness no matter how ill they have become. And that there is a lot of evidence to support that, and that with the right treatment that this is a highly treatable illness. With the right treatment properly applied recovery should be expected.
JG: And is that not B.C.’s approach? What is B.C.’s approach?
MS: It is not B.C.’s approach. B.C.’s approach is very much rooted in a public-health model accepting the fact that people are going to use drugs and that’s their choice, and it’s none of our business if they want to continue doing that. The government’s job is to simply keep them safe while they continue to use drugs — right up to decriminalization, and providing the drugs to use. Really, it’s the furtherance of a highly liberalized drug legalization agenda.
They’re very, very stark contrasts.
That’s not to say that British Columbia doesn’t make some investments in treatment and recovery. They do, but it’s on a very, very small scale, and they haven’t made investments anywhere close to what the population of British Columbia requires at this point. As a result, they have shockingly high fatal overdose numbers.
And fatal overdose is not the only measurement of harms to the community as a result of these policies. Forty-six per cent of harms due to substance use come from lost productivity in the workplace. That comes in the form of loss of jobs, benefits, consumption, workplace accidents, employee turnover, et cetera.
There’s harms to the health-care system in terms of utilization of health resources and, of course, the justice system which is a smaller portion of that. So, anybody that thinks that the response to the addiction crisis is simply about street disorder, that is not the case.
JG: I want to pause right there because we can talk about Alberta, or B.C. hasn’t made enough of an investment in, for example, recovery or treatment but Alberta hasn’t exactly abandoned harm reduction as a philosophy. We still have how many safe consumption sites?
MS: Eight. With more planned.
JG: We can talk about the difference philosophically but would it be really that wrong to say that in terms of what kinds of resources are available to people on the ground there’s not that striking a difference between the two provinces?
MS: Well, I think that where the devil’s in the details. In British Columbia they have upwards of 45 to 50 supervised consumption sites (SCS). Sites in British Columbia are unregulated by the province. They do not have the type of regulatory oversight or quality assurance standards that we have brought in. [SCS in B.C.] are typically run by advocacy and activist organizations that champion a very liberal use of drugs, a very liberal drug policy.
JG: Aren’t they regulated by the federal government?
MS: So, there’s overlapping jurisdiction. The Section 56 exemption to the Canadian Drugs and Substances Act is obtained by the federal government. In British Columbia that’s it. That’s all. You just have to get the Section 56 exemption and you can go pop one up wherever you want. There are really no rules around that.
In Alberta we have taken the extra steps to say we are going to regulate in addition to what the federal government requires for approval. We are going to have a regulatory package in addition to that. So, in Alberta, yes, you must still get the Section 56 exemption, but you must also apply to us for a license to operate a SCS. And along with that license comes some very stringent standards.
Before we’ll give you a license you must conduct a comprehensive community engagement session. You must have good neighbour agreements, written agreements in place with the businesses around the area of how you will conduct yourselves. When there is a dispute between what is going on at the SCS and the community, there’s a dispute resolution process. You must have a approval of the local police. You must have the employees who work in the facilities subject to a criminal vulnerable sector record check. You must have a toilet. You must have your staff trained by professionals.
I think the most controversial part of our regulations is that we require the facilities to obtain the personal health number of the people who come and use the site. For that, we were sued all the way up to the Supreme Court of Canada. The Supreme Court of Canada refused to hear it but we won all the way up to the Alberta Court of Appeals.
The reality is that the political left, whom you would typically associate with being the operators of such a site, have told conservatives for the last 20 years that these are vital health-care services. And so all we have simply done is say “Okay, well if these are vital health-care services, we’re going to require you to behave like a health-care service which means that you need to know who are the patients who are coming into your service.” There are really valuable health metrics that we need to understand about the population that are using these sites.
JG: Of course the flip side to all of this is a concern that the reliance on government ID, particularly for a vulnerable population that may or may not have obtained or may have lost their government ID, might restrict use of the service or access to the service.
MS: They made that argument initially and that’s what they argued in court. The judges did not see it their way and since then, it has not proven true. In fact, when we talked to users of the site when we were implementing, the addicts were shocked to know that we wouldn’t collect that information in the first place. And the great majority of them had absolutely no problem providing it.
Now, we don’t reject people if they refuse to provide a personal health number. They can still come in and use the site, but the onus is on the operator to ask for it. And by the way, they only need to provide it the first time they come in. We don’t ask them for it every time they come in.
And if if they don’t have their health card on hand, we have a dedicated phone line to help [SCS operators] find it. If [users of the service] don’t have [a number], then this is a tremendous opportunity for our government to help them get one. To help them get one the key instruments of citizenship. If we have really sick people who are on the street what could be more fundamental of a responsibility of government than to help them get the tools that they need to access health care?
Now, these are protected health care documents. But we do get aggregate health data. So I can now phone Alberta Health Services and say, “Can you run me a report of everybody in the last year who used a supervised consumption site who has hepatitis or who has HIV.” Or a host of other health metrics because we, as a government, need to be able to decide what more can we do for this population.
Advocates of these systems suggest that [SCSs are a vital] way for us to connect with these users and give them additional health care. They’ve sold these by convincing the population that one of the key things about these sites is that you can use it to leverage a connection with people to get them connected with other health services.
And yet when you try and do that they sue you all the way to the Supreme Court.
Nobody in Alberta rejects the notion that supervised consumption or overdose prevention services can be an effective part of a continuum of care when they are properly regulated and supervised, and when they are part of the health-care system generally. Where they become problematic is when they’re unsupervised with no rules being run by activist organizations and they’re just left to run amock as a revolving door drug-using facility.
JG: So, do we have a sense of what the usage statistics are here in Alberta versus other more liberal jurisdictions?
MS: Well, you absolutely can. In fact, we’re one of the only jurisdictions in Canada where you can actually do that because we keep track of this information.
They don’t do that in other jurisdictions. Alberta has one of the most sophisticated substance use data analytics systems anywhere in North America. We’re the envy of North America. It’s called the Alberta Substance Use Surveillance System. It’s available to the public.
I’ll give you an important anecdote in a second but we post our data, our raw data, online for everyone to see and we post it without comment. British Columbia, in the alternative, puts out a news release and a couple of graphs every month and they use those opportunities to advance a narrative, to tell people what they should be thinking about that data. We think that people who study these issues should be free of that type of influence and so we post the data without comment.
JG: Let’s talk a little bit also about recovery versus a non-recovery modality. Do we have a sense of how much Alberta is investing per capita in recovery services versus British Columbia?
MS: Well, that’s a good question. I don’t know the answer on a per capita basis. But I can tell you that since taking office that in Alberta we spend around $1.9 billion a year in mental health and addiction. Since coming to office we have seen I think very close to a $400 million new spend on, in particular, capital and operational funding for treatment-oriented programs. And treatment isn’t necessarily just inpatient. There’s a whole spectrum of care.
We are spending a good chunk of money.
I think one of the other key things is in our mental health and addiction offices, if I go down the hall to the Minister’s office — and this was true when I was there and it’s true now — everyone in the office is an addict in recovery. Everyone from the press secretary to the chief of staff to the ministerial assistant. They’re all in recovery. And now, of course, the premier’s chief of staff is in recovery.
We hear people talk about that sort of lived experience. I’m quick to say it’s the lived experience of people in recovery who are guiding that advice in Alberta, versus in British Columbia where it is the living experience of people who are in addiction who are guiding the policy conversation in B.C.
If you ask people who are current drug users what the policy should be, what they need, what do you need, they will say “Well, I need free safe drugs. I want a free hotel room or an apartment, and I want the police to go away.” And that is what you’re seeing in B.C.’s policies.
On the other hand, in Alberta you have a government with a vision for something else and you are advised by people in recovery who have overcome addiction to go onto lifelong recovery. If you ask us “What did you need to be successful?” That picture will look very different. We will tell you, “Well, I needed access to treatment, I needed good quality care, I needed follow ups, I needed to be out of a drug-using environment, et cetera.”
Watch for part two tomorrow, where Jen asks if
“safe supply” is off the table in Alberta. (Spoiler: yes.)
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