Trudeau Popularity - or not. Nanos research

[brihard]

Take the drugs, throw them in rehab. No need to decriminalize it, simply change the sentence for it. Create a special court that can send them to rehab within a day or two. Hold them in jail until they receive that sentence. Leaving them on the street shooting up does nothing to protect the rest of the community who doesn’t deserve to be exposed to it. Coupled with the rampant crime some of these addicts commit, usually the drugs are a small part of the crimes they are actively committing.

Cops aren’t supposed to be fixing anything. Their job is to enforce the law. Fixing this problem requires a ton of resources, health care professionals, education, rehab, etc. Cops are at the opposite end of the spectrum dealing with the consequences of society not dealing with it. There is no silver bullet to this problem but decriminalizing it without making actual solutions will just result in more addicts. I feel this is going to be a massive failure, BCs healthcare system is already in dire straits.

Alcohol fuelled violence does exist however it is substantially more controlled than heroin or fentanyl. It is a lot more predictable on someones mental state than meth. It can be a evil but there is a substantial difference between alcohol and meth. How many people try meth and don’t get addicted vs how many people try alcohol and do?

As keen as you are to discard the presumption of innocence and the right to bail unless crown shows cause why you shouldn’t, these just aren’t approaches that would at all survive legal challenge. The only way Court is truly expedited is if someone pleads guilty quickly. Otherwise they have a right to full disclosure of the case against them, they have a right to meaningfully instruct defense counsel, and a simple reality is lawyers and courts aren’t sitting there with empty schedules. It’s uncommon to see a criminal trial booked less than a year out. And until you’re convicted, you’re innocent of the crime(s) you’re accused of. Short of someone being denied bail on the grounds established in our laws, we don’t get to just toss someone in jail til court’s done with them. Simple possession is almost never going to hit that threshold.

 

[Kat Stevens]

How about charging and incarcerating these fine upstanding citizens for the millions of dollars worth of crime they commit to obtain their drugs, instead of a couple of 8x10 headshots, a free bowl of soup and a return to the streets?

 

[brihard]

How about charging and incarcerating these fine upstanding citizens for the millions of dollars worth of crime they commit to obtain their drugs, instead of a couple of 8x10 headshots, a free bowl of soup and a return to the streets?

I’m completely fine with charging for theft (been there, done that), and would be happy to see them sentenced accordingly. Better still if we could put more resources and services in place so that it’s not just another spin of the revolving door, and the addictions and socioeconomic drivers of property crime get systematically tackled too.

 

[Eaglelord17]

Harms report by substance

And with likely over 20 million people using alcohol on a semi-regular basis in this country vs likely 300k or less using hard drugs regularly it isn’t even comparable in amount of damage per capita.

As keen as you are to discard the presumption of innocence and the right to bail unless crown shows cause why you shouldn’t, these just aren’t approaches that would at all survive legal challenge. The only way Court is truly expedited is if someone pleads guilty quickly. Otherwise they have a right to full disclosure of the case against them, they have a right to meaningfully instruct defense counsel, and a simple reality is lawyers and courts aren’t sitting there with empty schedules. It’s uncommon to see a criminal trial booked less than a year out. And until you’re convicted, you’re innocent of the crime(s) you’re accused of. Short of someone being denied bail on the grounds established in our laws, we don’t get to just toss someone in jail til court’s done with them. Simple possession is almost never going to hit that threshold.

We can lock people up instantly in Canada, look at the mental health act. Make drug possession and usage along the same lines. Put in the law if caught with illegal drugs a mandatory hair follicle test will be preformed. When it comes back positive coupled with the illegal drugs have them taken to the special court and sent to rehab.

If we want solutions we need to start getting these people treatment. I would consider that a reasonable restriction on their rights. Invoke the notwithstanding clause if needed. Pretending these people are sane and mentally capable well addicted to a substance is asinine. It is where our whole law system falls apart because it is based off them being rational people.

The other solution is to stop giving them narcan and let the problem sort itself out. The current lets play the middle ground and solve nothing approach we have taken doesn’t work. Decriminalizing drugs also won’t work because we still aren’t solving the problem.

 

[Booter]

So the issue causing the most damage isn’t relevant because more people are involved. Well formed.

I’ve tracked crimes at the request of both municipal and provincial governments now- and in a not surprising result- there are lots of communities- sub 20 thousand people admittedly- where the overwhelming amount of crime is generated related to or because of alcohol, I’m quite confident that larger communities will have the same or similar results. The majority of people using drugs like coke aren’t driving crime either- it’s the outliers with addictive abusive personalities.

I’m not for decriminalizing drugs OR banning alcohol. I just think it’s hilarious the mental gymnastics people will go through to make one okay but not the other. It doesn’t stand up to minor scrutiny.

 

[Kirkhill]

And with likely over 20 million people using alcohol on a semi-regular basis in this country vs likely 300k or less using hard drugs regularly it isn’t even comparable in amount of damage per capita.

We can lock people up instantly in Canada, look at the mental health act. Make drug possession and usage along the same lines. Put in the law if caught with illegal drugs a mandatory hair follicle test will be preformed. When it comes back positive coupled with the illegal drugs have them taken to the special court and sent to rehab.

If we want solutions we need to start getting these people treatment. I would consider that a reasonable restriction on their rights. Invoke the notwithstanding clause if needed. Pretending these people are sane and mentally capable well addicted to a substance is asinine. It is where our whole law system falls apart because it is based off them being rational people.

The other solution is to stop giving them narcan and let the problem sort itself out. The current lets play the middle ground and solve nothing approach we have taken doesn’t work. Decriminalizing drugs also won’t work because we still aren’t solving the problem.

The problem, in my opinion, goes back to the 1960s and the scandals associated with the Provincial mental asylums. The solution found was to "Defund the Asylums" and put the inmates out on the streets on their own recognizance.

The better solution would have been to do what was done with schools, hospitals and prisons and reform and modernize them and mix them in with some of the social care models that have been developed since.

I agree the best course of action is to get people treatment. I don't share your sense that we can lock people up instantly. That has not been my experience based on a mother, a sister-in-law and two great-nephews (too much THC too early in life).

 

[Booter]

The mental health act doesn’t work the way he’s suggesting anywhere in Canada im aware of.

 

[QV]

Hey, if someone is a problem in society just freeze their bank accounts. Problem solved.

 

[Brad Sallows]

So for any given threshold of criminal behaviour, is the fraction of alcohol users passing it more or less than the fraction of, say, narcotics users passing it?

 

[Colin Parkinson]

In Malaysia if your found high in public, it's straight to rehab. Their success rate is on average 15%. the Rehab centres there are sort of like our minimum security jails here, the purpose is to get clean not so much a punishment. You go through the process and then released. Repeat as required.
Here in BC, it seem the majority of the crime is done by the same individuals, this was certainly the case for car theft and it wasn't till ICBC put the screws to the AG that they formed a task group to go after these people and collect evidence and as I recall had a judge reserved for the case that they were able to get them long sentences. At which point car thefts in the Lower Mainland plummeted by around 85%

 

[Rifleman62]

How many people die as a result of firearms? Firearms are basically all prohibited by this government.

How many people die as a result of drugs? What is this government doing?

 

[Booter]

So for any given threshold of criminal behaviour, is the fraction of alcohol users passing it more or less than the fraction of, say, narcotics users passing it?

You’d have to assign arcs. If you take impaired driving and the percentage of people that just aren’t caught you’d be skewing the data.

Criminality and Addict behaviour crosses substances. Heck it goes into risk taking…pornography. It’s the person again,

There are meth and heroin users that manage their habits fine. I suspect they are a minority though.

We need to deal with the criminal aspects properly. We have to deal with our piss poor health care system (good intentions of the players aside).

We aren’t doing any of the pieces well, I guess that’s why the drug decriminalizing is frustrating because- it’s like having skin cancer and using concealer over the sore. You’ve done nothing.

Canadas issues are that of infrastructure and systems. And we want it in place- but we can’t produce people to work in it- and we don’t want to pay for it,

Magic rehabs staffed by people who aren’t in it for the money. Filled with drug addicts who want to get clean. Might as well put it on the moon.

Good intentions survived 15 minutes in Vancouver. When you find that a segment of people WANT to be homeless and they like doing drugs. We don’t live in that headspace so we don’t admit it’s a thing. All our solutions want people to want better. They don’t. (In all cases)

I’m my experience in homeless camps
It looks that way. There ARE genuine bad situation people and families in them- they aren’t the norm. Which makes their situation even more scary and dire that they are in it.

 

[mariomike]

[/QUOTE]

How much should we the average law abiding citizenry be expected to take before we decide the law system isn’t working?

Bronson put it this way,

It's like killing roaches – you have to kill 'em all. Otherwise, what's the use?

It was Hollywood entertainment. Not to suggest there should be vigilantes.

 

[brihard]

We can lock people up instantly in Canada, look at the mental health act. Make drug possession and usage along the same lines. Put in the law if caught with illegal drugs a mandatory hair follicle test will be preformed. When it comes back positive coupled with the illegal drugs have them taken to the special court and sent to rehab.

If we want solutions we need to start getting these people treatment. I would consider that a reasonable restriction on their rights. Invoke the notwithstanding clause if needed. Pretending these people are sane and mentally capable well addicted to a substance is asinine. It is where our whole law system falls apart because it is based off them being rational people.

The other solution is to stop giving them narcan and let the problem sort itself out. The current lets play the middle ground and solve nothing approach we have taken doesn’t work. Decriminalizing drugs also won’t work because we still aren’t solving the problem.

That’s… That’s not how the Mental Health Acts work. I know because I’ve used it plenty of times. More often than not the person I apprehended and brought to a doctor - because that’s what it let me do - was released after a brief assessment barely before I could finish my notes. Most of the rest of the times, they weren’t held very long. Someone in custody under MHA has the same Charter rights. The most succesful instances were those where I was charging criminally, and persuaded crown to get the court to view the matter through a mental health lens and refer the accused to the provincial review board. The charges I laid were legit, but I also knew that they wouldn’t be the ‘fix’, and would serve better to more seriously route the accused into the forensic mental health system. But such cases are uncommon.

Anyway- abundantly clear that in the case of those addicted to drugs, you’re willing to casually discard the right to presumption of innocence, and to not be arbitrarily detained. But that’s simply incongruent with the system of right that all of us enjoy. We need a much smarter and more ethical approach than what you propose. The existing criminalization of addiction hasn’t worked to solve it. A more aggressive and still dumber approach isn’t likely to be any better.

 

[Eaglelord17]

That’s… That’s not how the Mental Health Acts work. I know because I’ve used it plenty of times. More often than not the person I apprehended and brought to a doctor - because that’s what it let me do - was released after a brief assessment barely before I could finish my notes. Most of the rest of the times, they weren’t held very long. Someone in custody under MHA has the same Charter rights. The most succesful instances were those where I was charging criminally, and persuaded crown to get the court to view the matter through a mental health lens and refer the accused to the provincial review board. The charges I laid were legit, but I also knew that they wouldn’t be the ‘fix’, and would serve better to more seriously route the accused into the forensic mental health system. But such cases are uncommon.

Anyway- abundantly clear that in the case of those addicted to drugs, you’re willing to casually discard the right to presumption of innocence, and to not be arbitrarily detained. But that’s simply incongruent with the system of right that all of us enjoy. We need a much smarter and more ethical approach than what you propose. The existing criminalization of addiction hasn’t worked to solve it. A more aggressive and still dumber approach isn’t likely to be any better.

At the end of the day I don’t care what they do as long as it works. This decriminalizing initiative will not work as it doesn’t have anything behind it. We can do it like Portugal, but they aren’t putting the resources needed into it.

 

[YZT580]

Ever see what meth does? It ain’t good.

That’s… That’s not how the Mental Health Acts work. I know because I’ve used it plenty of times. More often than not the person I apprehended and brought to a doctor - because that’s what it let me do - was released after a brief assessment barely before I could finish my notes. Most of the rest of the times, they weren’t held very long. Someone in custody under MHA has the same Charter rights. The most succesful instances were those where I was charging criminally, and persuaded crown to get the court to view the matter through a mental health lens and refer the accused to the provincial review board. The charges I laid were legit, but I also knew that they wouldn’t be the ‘fix’, and would serve better to more seriously route the accused into the forensic mental health system. But such cases are uncommon.

Anyway- abundantly clear that in the case of those addicted to drugs, you’re willing to casually discard the right to presumption of innocence, and to not be arbitrarily detained. But that’s simply incongruent with the system of right that all of us enjoy. We need a much smarter and more ethical approach than what you propose. The existing criminalization of addiction hasn’t worked to solve it. A more aggressive and still dumber approach isn’t likely to be any better.

Seems like there is no solution. If you arrest them for the crimes they are committing to get their drugs our crime rate will stay high because it will be at least a year before they come to trial on the first charge; nevermind the half dozen subsequent charges accrued whilst out on bail. Our legal system won't tolerate mandatory rehab on arrest and much as I would like to agree with that concept it is an unacceptable solution. That is what we did with the truckers and that was dead wrong. All addicts are sick. Addiction has no known cure unless the addict desperately wants to be cured and has the fortitude, family backing and financial resources to carry themselves through the time required and that is a very unusual combination.



backing and financial resources to carry themselves for the time required.

 

[lenaitch]

That’s… That’s not how the Mental Health Acts work. I know because I’ve used it plenty of times. More often than not the person I apprehended and brought to a doctor - because that’s what it let me do - was released after a brief assessment barely before I could finish my notes. Most of the rest of the times, they weren’t held very long. Someone in custody under MHA has the same Charter rights. The most succesful instances were those where I was charging criminally, and persuaded crown to get the court to view the matter through a mental health lens and refer the accused to the provincial review board. The charges I laid were legit, but I also knew that they wouldn’t be the ‘fix’, and would serve better to more seriously route the accused into the forensic mental health system. But such cases are uncommon.

Anyway- abundantly clear that in the case of those addicted to drugs, you’re willing to casually discard the right to presumption of innocence, and to not be arbitrarily detained. But that’s simply incongruent with the system of right that all of us enjoy. We need a much smarter and more ethical approach than what you propose. The existing criminalization of addiction hasn’t worked to solve it. A more aggressive and still dumber approach isn’t likely to be any better.

Back in the day in n/w Ontario, persons who had been assessed by a doctor and committed to a mental health facility would be transported to Thunder Bay. We would often stay overnight (big city, nice restaurant, etc.) and when we got back home the person would have beaten us back. Not only released by the mental health professionals, but driven to the bus station.

 

[Retired AF Guy]

Since everyone is talking about drug addiction and treatment here are two articles by Gen Jerson (The Line) interviewing the head of Alberta's drug treatment plan and comparing it to British Colombia's approach.

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?​

Jan 12




Pierre Poilievre @PierrePoilievre
Everything feels broken. But we can fix it.

2:08 PM ∙ Nov 20, 2022

---

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.”

Link

 

[Kirkhill]

That’s… That’s not how the Mental Health Acts work. I know because I’ve used it plenty of times. More often than not the person I apprehended and brought to a doctor - because that’s what it let me do - was released after a brief assessment barely before I could finish my notes. Most of the rest of the times, they weren’t held very long. Someone in custody under MHA has the same Charter rights. The most succesful instances were those where I was charging criminally, and persuaded crown to get the court to view the matter through a mental health lens and refer the accused to the provincial review board. The charges I laid were legit, but I also knew that they wouldn’t be the ‘fix’, and would serve better to more seriously route the accused into the forensic mental health system. But such cases are uncommon.

Anyway- abundantly clear that in the case of those addicted to drugs, you’re willing to casually discard the right to presumption of innocence, and to not be arbitrarily detained. But that’s simply incongruent with the system of right that all of us enjoy. We need a much smarter and more ethical approach than what you propose. The existing criminalization of addiction hasn’t worked to solve it. A more aggressive and still dumber approach isn’t likely to be any better.

Perception only - I don't know if it is reality

But

This cynical geezer's sense is that it is getting harder for the state to take people in ward to prevent them harming themselves and others at the same time the state is making it easier to relieve the suffering of their wards by helping them commit suicide.

 

[Retired AF Guy]

Part 2

Q&A, Part 2: 'Our fatal overdose numbers have gone down dramatically off the peak.'

Alberta is pursuing a very different path toward treatment of drug addiction. In this interview, a top provincial official explains why, and what kind of help Ottawa can offer.​

Jan 13

This is the second part of a two-part interview with Marshall Smith, chief of staff to Alberta premier Danielle Smith, and himself a recovering drug addict. Please find part one of this interview here. What follows has been edited for length and clarity.

Jen Gerson: Is safe supply off the table in Alberta or is that something that the province may consider offering in certain circumstances?
Marshall Smith: No, safe supply is off the table … We have regulated the provision of full agonist opioids to people who have a substance use disorder.

JG: We do provide methadone, for example.
MS: That’s different. That’s different. We have a schedule of opioids, the bad ones, and we have said that no person in Alberta may provide, prescribe or dispense any of these scheduled opioids to a person that they know is addicted to them.

That is in contrast to British Columbia where their express goal is literally to hand it out. Their goal in British Columbia is to replace the illicit drug supply with a pharmaceutical drug supply. They want these things flooded onto the streets. They will say [that’s not the case]. I have documentation that proves otherwise.

We take a much more measured, data-driven and evidence-based approach to this.
The term “safe supply” is not a medical term. It’s a marketing term. Like clean coal. It doesn’t appear anywhere in medical evidence. It’s a term that was created in a boardroom with drug-user groups and communications professionals to market policy. If you strip away the marketing term of “safe supply” you’re left with what it actually is. And what it actually is, is the wide-scale distribution of opioids to the population.

Now, Alberta recognizes that there is very likely a population of addicts who have been heroin addicts for 20-30 years or they’re very seriously addicted. We don’t expect them to just recover. That’s not reasonable. And that they may require the provision of hydromorph or a list of these drugs that they may require that for a period of time before they’re able to transition. What we’ve done is we have adopted the Swiss model in Alberta and we have clinics that we call Narcotics Transition Services. So, not safe supply. Narcotics Transition Services.

And not anybody can do this. If you’re a doctor in a strip mall and you believe that you have a patient in front of you for which nothing is working, you have to refer them to the specialty clinic just like any other area of medicine. This is a highly specialized area of medicine. It requires a specialty doctor and a specialty clinic.

JG: Is it an inpatient clinic?
MS: No, it’s an outpatient clinic. We’ve created eight of these clinics in Alberta called Narcotics Transition Services. When you get there they assess you, they provide wraparound supports. They will give you the hydromorph, but it’s a witnessed dose. You have to take the dose in front of someone, so there’s no opportunity to divert the drugs into the community. And then they actually work with the patient to bring them along. They monitor them. They come in every day to do that.

JG: In an environment where you have your illicit opioid supply being routinely adulterated by fentanyl or other types of toxins or potentially lethal adulterants, is there not there an argument for a pharmaceutical alternative that is not going to poison people?
MS: What we’ve done in Alberta is we’ve examined actual evidence. The international evidence which we weigh a lot heavier here in our model than locally British Columbia-driven evidence.

And so what the strong evidence tells us from years of harms relating to the oxycontin crisis is when you allow ambulatory prescriptions of opioids to flow freely into the community, that extreme harms come to the population. I am not necessarily concerned that a heroin addict takes a tab of morphine. That is not the public-health concern with safe supply.
The concern with safe supply — and the problem with the literature that’s being generated by the people who are running the safe supply programs — is that none of the things that they’re measuring examine harms beyond the harms done to the addict that they’re studying.

The big problem with safe supply is the diversion of these drugs into the broader population. For example, if you live in a home where one person in that home has an opioid prescription, everybody in that house is five times more likely to develop a substance use disorder. We know without a shadow of a doubt that the more opioids you put into a population, the more harm comes of it. Full stop.

We also know that addicts who are going to collect safe supply drugs more often than not leave the clinic and sell the drugs or divert them for other purposes.
And the reason for that is that in an addict’s perspective fentanyl is not poison. Fentanyl is the good stuff. They ask for fentanyl. They want fentanyl.

What they’ve done is they’ve created a market commodity. Give addicts bottles of morphine and they take to the street and they sell it and either get cash and buy fentanyl, or they take the bottles of morphine to the dealer and they trade them for fentanyl.
In my day when I was on the street a tab of morphine cost about $20 for one tablet. Today on the streets of Vancouver you can pick up a tab of morphine for $1. That’s how much of it is on the street. That’s how much flooding of the market they’ve done.

By the way, that dollar that they sell the pill for is less than it costs the government to dispense it. The government is paying a premium to dole this stuff out into the street. They’ve put so much on the street that the cost of it has gone below what it cost them to dispense it: The dealers collect it up in duffel bags and just take it to a different jurisdiction and sell it and make 20X their profit.

They’ll take these pills to places like university campuses, high school campuses, et cetera.

JG: So, essentially what we have here is a natural experiment playing out in Alberta and B.C., roughly the same size provinces, different demographic realities, different socioeconomic realties, but it’s an interesting natural experiment and obviously the proof is in the pudding. Can you talk a little bit about the success, from your perspective, that you’ve seen as a result of Alberta’s approach. I’m talking about mortality rates, overdose rates, those sorts of things.
MS: I think that it’s early days. We’re three-and-a-half years into an eight-year strategy so we’re halfway through and we’re just now getting around to our urban strategies. We’ve been doing a lot of work in our midsize communities building treatment centres and whatnot. We are also opening 11 brand new recovery communities which are large, long-term treatment facilities. They’re about the size of a football field. We’re opening the first one in Red Deer.

The treatment spaces that we have in Alberta are fully funded and accessible. In Alberta if you want to go to treatment all you have to do is swipe your care card. There’s no paying out of pocket. You see a lot of this in B.C. and Ontario where families are confronted with wracking up $30,000 bills to send their loved one to treatment. That’s not acceptable to us. That’s not what a health-care system should look like.

JG: How many beds are there just off the top?

MS: We have about 1,300 beds and with the 11 recovery communities that we’re building we’ll be doubling that. Really this isn’t rocket science. The people who are out there on the streets who are very sick they need health care, they need treatment, they need to get into recovery. And when there are no treatment beds available for them to go into, that backs up the system in detox and when there are no detox beds that backs up into the shelter system. And then if they don’t want to go to shelter or there’s no shelter capacity available they wind up tenting on the streets.

JG: I just want to get a straightforward answer on this one and that is what have we seen in terms of overdose and fatality rates in Alberta compared to B.C.?
MS: Our fatal overdose numbers have gone down dramatically off the peak, at the height of our fatalities which occurred sort of mid-pandemic last November.

JG: Is there any comparable data coming out of B.C?

MS: Well, B.C. releases their data monthly so if I go to new tab and I go to B.C., opioid deaths, October 2022 … They had 179 deaths compared to our 92.

Now nobody here for a moment is saying good job. There are still 92 people that died in August which is still way too high. The point of what I’m putting on the table is that Alberta’s numbers are going down. B.C.’s are continuing to go up despite the fact that it’s the same drug supply, it’s the same sort of circumstances.

B.C. and Alberta have experienced COVID. We’ve come out of it in the same way. The things that are different is when we’ve been very busy over the last three years while the rest of the world was doing pandemic, mental health and addiction and our government have been busy retooling our addiction care system. As people come back now that the pandemic is waning, they are coming back to a very different system of care than the one that they left when they walked themselves out.

JG: The person who is skeptical of your approach and is an advocate of B.C.’s approach might say these aren’t apples to apples comparisons. By adopting different philosophical approaches, what you’re doing is ensuring that the most chronic addicts are going to be incentivized to go to British Columbia. A, because the weather is milder, so if you’re going to be sleeping rough, you’re going to have an easier time of it. And, B, because if you have a safe supply jurisdiction right next to a non-safe supply jurisdiction, people are going to go to B.C. So, of course the numbers are going to be higher in B.C., of course you’re going to see more overdose deaths, of course you’re going to see more tent cities in B.C. because you’ve created a situation where the Alberta addicts who become chronic or who otherwise would have struggled into this system are just getting sucked into the next one.
MS: I would say that there’s no evidence of that, and I would say that if you think that I would welcome you to join me on a walk through Edmonton’s downtown and I will show you that we have a population of addicts there that are every bit as severe as British Columbia.

Look, there’s always going to be a conversation about the fact that Victoria has better weather than Edmonton. And I am frequently perplexed as somebody who has lived on the streets, I’m frequently perplexed by how somebody can tent in minus-35 weather, but there they are right out my window. I don’t know how to respond to that other than to say that I would challenge anybody to put evidence in front of me that that’s what’s happening because I’m not sure that that is provable.

JG: It would be interesting to me if B.C. could track how many of their addicts are local versus coming from the rest of Canada, and whether or not that’s changed over time.
MS: B.C. can’t even track how many treatment beds they have. It is so chaotic out there the things that they’re able to track, good luck.

JG: Bringing this conversation back full circle I initially got interested in this conversation as a result of Pierre Poilievre’s video. Obviously, as I mentioned Pierre Poilievre’s approach and video got heavily criticized. What would you like to see a federal government, Conservative or Liberal, what would you like to see a federal government be doing differently in its approach to mental health and addiction.
MS: Sure. I guess at a 30,000-foot level I would say that we would like the federal government to respect the direction that a province wanted to go in and work with those provinces to further that. Now, that doesn’t necessarily bode well for my fellows in British Columbia, but it sure would be nice to have the federal government respect the fact that Albertans want to go in a different direction than British Columbia, and be supportive of that.

JG: That means that if Pierre Poilievre becomes prime minister that would entail a Conservative government respecting B.C.’s safe supply.
MS: Look, part of the problem is that the only money that the federal government is handing out right now is money for safe supply programs. In the absence of any other options provinces are grabbing for the money that is there and getting on that bandwagon. We have not. I can tell you that as chief of staff to the minister for mental health and addiction and now chief of staff to the premier, being in these offices for the last three-and-a-half years since 2019, I have not ever received a single phone call from Health Canada. Not once has the federal minister’s office ever reached out for a conversation. Now, we’ve met with her once when she came to town. It was very brief. But as a regular workaday thing my phone has never rung from them to ask how they could be of assistance.

JG: It seems like you’ve had more conversations with contemporaries in the United States than you’ve had with Health Canada.
MS: And other provinces. We talk on a very regular basis with Manitoba and Saskatchewan and Michael Tibollo in Ontario. He’s lovely. We have conversations amongst our colleagues and when we do that, when we get together and talk about these issues everybody is shaking their head going this is crazy. What is going on. And a lot of other provinces are looking at Alberta and wanting to follow those things. You should phone Manitoba and ask them about the degree to which they’re pursuing the Alberta model.

JG: What specific support could the federal government provide?
MS: Look, I think the type of support they could provide is capital. One-time capital money to help us build treatment centres. Certainly you want to have the provincial government provide the operating money. That’s a health delivery, that’s our responsibility. But instead of providing grants to activist organizations they should be providing grant money to provinces to help build the infrastructure that we need for our care system in the province.
That would go a long way. We need beds. We’ve got decay happening in our urban cities. This is not just Vancouver or in the case of British Columbia this is going on in Kelowna and Kamloops and Prince George and Victoria. It’s spreading all over the place. It’s happening in Edmonton and Calgary. It’s happening in Winnipeg. It’s happening in Saskatoon and this is ripping right across the country.

We have people in LRT and transit stations across the country who are afraid to ride transit, who won’t send their kids on the public system because of the dangers of people who are addicted to meth or who are in psychosis attacking them or things like that. So, we’re in trouble and we have to get very, very serious about building a system for the future if we are to have a hope of having communities that are livable. My fear is that what is coming from British Columbia or others is just more of the same and it does not seem to be working.

I mean 20 years ago they were doing this, starting this process. Here we are 20 years later and everything is markedly worse. What they’re doing just simply isn’t working and so I think we would be negligent not to pause and say whatever else is true about individual things that are going on, as a system this isn’t getting us the results that we’re looking for and we’ve got to start charting a new course. And that’s what we’re doing in Alberta.

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