OPINION: Alberta government continues to disregard people who use drugs

A client waits to enter Calgary's supervised consumption site, Safeworks, on Tuesday Dec. 14, with a Calgary Police vehicle idling and police bikes hanging out. PHOTO: LAURA BALANKO-DICKSON

Ophelia is an intravenous (IV) drug user and who intends to pursue a Ph.D., says she never sees herself giving up drugs because of mental health issues. On her Instagram profile, @honest.addiction, she discusses why she never plans on quitting her drug of choice.

Her post reads, “In short, because I can’t function without my medication and have too much to lose to sacrifice my mental and physical health for the sake of sobriety,” adding, “on a chemical level, my brain does not work the way it should. My psychologist refers to this as having an extremely hyperactive nervous system, along with not having enough of certain types of neurotransmitters.”

The post from Oct. 10 goes on to share how her prescribed opiates helps her to live a more fulfilled and healthier life.

“My prescription absolutely helps me with managing my addiction and keeps me off heroin. But more importantly, I finally feel like I’m alive,” shares Ophelia. “I am able to be close to people without being unhealthily dependent on them. I stand up for myself. I have a healthy sleep schedule for the first time in my life. My mind no longer feels like a prison.” 

Ophelia shared more about her relationship with opiates during a phone call with an Article One reporter.

“I’ve been able to find a fantastic job,” says Ophelia. “I know what I want to do now. I want to get a Ph.D. in medical chemistry and psycho-pharmacology.”

When Ophelia isn’t studying working towards going to graduate school, she’s also an activist and advocate for people who use drugs in Calgary. For Ophelia, it’s not enough to share about why her drug use is beneficial for her health, she wants broad systemic reform on how the provincial government interacts with people who use drugs.

Ophelia and others fervently believe people who use drugs have continually been played as a wedge issue by the United Conservative Party, and see the UCP government continually backing ideologically-driven policy, despite a nationwide drug crisis. 

One example of this is how the UCP doubled the number of recovery-oriented care beds, despite a rising death toll caused by drug overdose, and Ophelia seems to think this is by design. 

“When the Alberta government is making policy surrounding people who use drugs, they don’t actually talk to people who are using drugs,” says Ophelia. “In regard to most groups, not all but most, when they are making a policy that impacts those groups in society, they will generally contact some people in those groups to act as representatives and they will actually talk to them about the policy.”

“With people who use drugs, they don’t do that. I feel like the way that some of these policies are going to impact people who use drugs is going to have a range of impacts. There will be people who it impacts fairly minimally, maybe they might make things a little bit more difficult, or a little easier. I want to be optimistic here, but I think some of their policies are going to have a devastating impact.”

Although the Alberta government says it wants “compassionate” and “sensible” solutions to the opioid crisis, it has introduced policies that make it mandatory to provide an Alberta Health Care number, effectively reducing accessibility to harm reduction services like Supervised Consumption Sites (SCS) in Alberta for anyone without valid ID, undermining the federal government’s authority in making policy on and related to drugs, and justifying it by suggesting it would be beneficial to relocate services with nebulous plans for relocation. 

“Through these regulations, they are erecting significant barriers for people who use safe consumption services, but also for safe consumption service providers to do their job.” 

Avnish Nanda

The UCP’s actions forced the closure of what was then called ARCHES (AIDS Outreach Community Harm Reduction Education & Support Society), an SCS that stopped more overdoses than any other SCS in the province.  

According to an article from 2019, ARCHES’ wrap-around services included a walk-in clinic, housing, a take-home naloxone program, counselling, and subsidization for people who are HIV and hepatitis C positive. Once ARCHES found out the provincial government closed its doors, it decided to contort its wrap-around service model into a mobile overdose prevention unit called the Lethbridge Overdose Prevention Society (LOPS). 

While the UCP caucus likes to suggest they have a plan for addressing this crisis, a lawsuit filed against the Alberta government on Aug. 20 suggests otherwise. The case is spearheaded by Avnish Nanda, on behalf of LOPS and Moms Stop The Harm. Despite repeated attempts for further comment from AHS and the Alberta government, the only statement from the Alberta government came from June of this year.

Justin Marshall, the then associate minister for mental health and addictions, defended the UCP’s position last June in an email. “Our approach is being supported by experts across the province and across the country,” he wrote. “Alberta’s government has made it a priority to ensure people living with addiction have access to top-quality care and a full continuum of services, from prevention to intervention, to treatment and recovery.”

Moreover, as the CBC reported earlier this month, the government plans to fund 8,000 drug treatment beds, double what they pledged earlier. Premier Jason Kenney told the CBC, “The bottom line is this: if a single-minded focus on so-called harm reduction, including so-called safe supply, really worked, then how do we explain the total disaster of the Downtown Eastside in Vancouver?”

While Kenney and the UCP like to frame harm reduction initiatives in Vancouver as a “total disaster,”  Ophelia says the recovery-oriented policies, or policies that prioritize treatment over harm reduction, will “alienate” people who use drugs. 

“When they announced the new regulations for [SCS],” Ophelia says, “first of all, you have to display a healthcare card in order to get in. Second of all, they want to switch safe sites to be recovery-oriented. Because, according to them, they’re not opposed to harm reduction per se, they just feel that harm reduction should be to get recovery as the end-goal.”

According to the AHS website, harm reduction, “refers to policies, programs and practices that aim to reduce risks and harm associated with the use of psychoactive substances. It acknowledges that abstinence is not always a realistic goal for some people. It is about meeting people where they are and identifying the goals they wish to achieve based on their individual needs and circumstances.”

Whether you agree with harm reduction or not, the data is there and it not only saves lives but reduces transmission of some diseases like hepatitis C and HIV. Ophelia suggests only supporting harm reduction as a means to get into recovery will alienate people who use drugs.

“If you only support harm reduction so that the end goal is recovery, then you really don’t understand what harm reduction is because the point of harm reduction is it meets people where they are at,” says Ophelia. “If they are going to make these services based on recovery, then that’s going to alienate lots of people, and having to show a healthcare card, that’s going to alienate them even more.”

Additionally, a peer-reviewed journal article titled, Awareness and access to naloxone necessary but not sufficient: Examining gaps in the naloxone cascade, suggests that while barriers to naloxone have been widely reduced, “they are not sufficient. Changing norms about possession and using with individuals who have Naloxone is an important component to overdose prevention and naloxone programs especially as we are experiencing an increase in fentanyl and other synthetic opiates in the illicit drug market.”

While this flies in the face of what the Alberta government claims its policy is about, officials have yet to comment directly on the issue. 

Avnish Nanda, a litigation lawyer practicing in Alberta and British Columbia, is leading the lawsuit against the Alberta government. At a press conference, Nanda spoke about how the provincial government is not only limiting the way potential clients interact with supervised consumption sites, but also stifling how people working at supervised consumption sites serve their community.

“Through these regulations, they are erecting significant barriers for people who use safe consumption services, but also for safe consumption service providers to do their job.” He says in his view, the UCP government is “absolutely” undermining those service providers in determining what is best practice for the community they serve. 

“Overdose prevention service providers, they go to people who use substances, who are the most vulnerable, and can’t make it downtown, to [Calgary’s] Beltline to access Safeworks, they go out to them and provide services there. So, these folks are not going to get access to these safe consumption services. They are more likely to use alone, overdose, and die because of this.”

“Going cold-turkey or recovery-oriented approaches fail most of the time and they’re not recommended to be the primary thing someone starts out with.”

Avnish Nanda

Moreover, Nanda explained how reducing access to harm reduction services in Lethbridge was followed by a surge in overdose deaths across most of the province. As the Calgary Herald reports, “Alberta marked its deadliest year on record in 2020 with 1,144 opioid-related deaths – an 83 per cent increase from the year before.”

“Once they tried to restrict ARCHES, once they tried to restrict LOPS from operating, that’s doubled the overdose death rate of most jurisdictions in the province,” says Nanda. “I genuinely think that they don’t think supervised consumption services aren’t good things. I genuinely think that they think that addiction is a thing people can overcome, or address substance use by going cold-turkey or this recovery-oriented care when the science and the research and the medical knowledge say that that is not that case.”

Despite an abundance of evidence to counter the UCP’s policy decisions, Nanda thinks they are abandoning an approach that will ultimately save lives.

“Going cold-turkey or recovery-oriented approaches fail most of the time and they’re not recommended to be the primary thing someone starts out with. It’s these other programs, it’s harm reduction. It’s remarkable that they are willing to abandon this approach,” says Nanda.

At the time of this writing, both parties had submitted their affidavits and were scheduled to appear in court. 

According to Nanda, the government of Alberta’s affidavit sums up to, “We can do this because we’re the government and we are doing this to help people.”

While Nanda’s evidence counters that claim by emphasizing the barriers recent UCP legislation has erected to the most marginalized people who use supervised consumption sites, he knows that in a court setting, he has a slim chance of winning. 

“The thing is, in court cases like this, the government is given so much benefit of the doubt that in most cases, most of the time, they can just say that ‘Yeah. We’re the government. We’re doing this to help people. You can’t question our democratic legitimacy,’ and then the court will accept this,” says Nanda. “Winning in court, we have a 10 per cent chance. But, maybe we can push them in other ways. Our hope is that this case will get better results for [people who use drugs].”

So, while Nanda and the people he represents are not expecting to win this court case, they are eagerly waiting for a response from the UCP government to see if they can influence their policy decisions, and according to Nanda, the UCP government is planning to announce what they will do on Jan. 3, 2022, a date that was pushed back because of the lawsuit.

“We are taking the government to court over their new regulations for consumption sites, which will require anyone using the site to provide an Alberta health care number,” says Petra Schulz, co-founder and vice-chairperson of Moms Stop the Harm, adding, “We know this is going to create barriers for people who use the site so this is why we are going to court.”

Moms Stop the Harm is a Canadian network of families impacted by substance use harm or death. Additionally, they provide peer support for grieving families and advocate to change failed Canadian drug policies. 

Schulz says the UCPs policy has not only closed supervised consumption sites in Edmonton and Lethbridge but led to the downtown Edmonton area observing “some of the worst overdose rates in the province.”  

“What the UCP is doing is waging a war against harm reduction,” says Schulz. “They think that they offer treatment and recovery, but there are a few issues there.”

“First of all, you can’t recover if you’re dead. We have to keep people alive, and not everyone needs treatment. There are people that only use once or maybe use very occasionally, and not everyone is willing and able to engage in treatment.”

Schulz suggests the UCP is continuing to sit on their hands when it comes to making effective drug policy. She thinks the Alberta government should offer both harm reduction services as well as treatment for those that need it.

“First make sure people are alive and well. That’s the area where the UCP has a colossal fail because they don’t see it, they don’t do it, they cut it,” says Schulz. “It’s not that they’re not taking it seriously, it’s that they are not taking an evidence-based approach, they are taking an ideological approach … The actions they announce are not going to save lives.”

“The ideological approach is that nobody should ever use drugs, and which is really hypocritical if you think about it,” says Schulz. “We all use substances in different forms. Some people drink coffee and tea, which are two stimulants, other people drink alcohol which is albeit legal, a very harmful substance. One that the government engaged in during COVID, during their infamous dinner at the Sky Palace. So, they feel that people should not engage in any substances, but they don’t practice what they preach.”

According to Schulz, the UCP is pitting harm reduction as a counterclaim to treatment, when both are needed.

“What people don’t understand is that when there is homelessness and crime and social disorder, there are a number of factors that have to do with that. People that are homeless often use substances, but that doesn’t cause the homelessness, you know, it doesn’t cause poverty. Any sort of problem that arises is blamed on the substance use,” says Schulz. “One could say they are using it as a wedge issue.”

Because of this, Ophelia thinks it’s important for people to consider the nuance of the situation before a knee-jerk reaction like, “Don’t people go to recovery to get better?” 

“Since I’ve been on prescribed opiates that I’m injecting, and my doctor is aware of that, ever since that my heart rate has been healthy, I’ve been able to sleep properly every night at 11, wake up at 7, and more than that I feel emotionally stable.”

A bike missing a wheel and the seat is propped up against the entrance to Safeworks, Calgary’s only supervised consumption site, on Dec. 14, 2021. PHOTO: LAURA BALANKO-DICKSON

Aside from her personal experience, Ophelia claims that harm reduction improves rates of abstinence-based recovery.

“Harm reduction, as a movement, it increases abstinence-based recovery. If someone wants to recover and they want to quit, harm reduction will give them all the resources in the world,” says Ophelia, “However, if someone doesn’t want to quit, and make their use safer, harm reduction still supports them.”

“Essentially, whatever a person wants to do, harm reduction talks about their options, meets them where they’re at, and makes sure to support them as best as possible. Whereas abstinence-oriented recovery only supports quitting,” Ophelia says. “That leaves a lot of people unsupported and alienated, and frankly, in danger.”