Emily Doerksen discusses a number of the policy failures affecting people who use drugs in Canada, up to and including the Alberta UCP government’s decision to close multiple safe consumption sites across the province.
When the Boyle Street Supervised Consumption Site in Edmonton closed this past April, community members and harm reduction specialists worried about the negative impact this might have on people who use drugs. Their concerns were warranted. Within a month, 3 bodies were found in the area. These deaths were from fentanyl-induced overdoses. Boyle Street was neither the first nor the last closure of a Supervised Consumption Site carried out by Alberta’s United Conservative Party (UCP). Among the sites, ARCHES Supervised Consumption Site in Lethbridge, one of the busiest on the continent, was unceremoniously closed following claims by the UCP that it was misusing funds. This allegation was ultimately disproved, yet the site remains closed. Now, Calgary’s only Supervised Consumption Site will meet a similar fate as the UCP government prepares to close the city’s Beltline neighbourhood site operating out of the Sheldon Chumir Centre. Once again, the Government’s justifications behind this decision are unclear, as are the explanations of how and when this closure will happen.
The province has stated they will open two new, “more appropriately” located, Supervised Consumption Sites in Calgary in the Sheldon Chumir’s stead. However, they have given no clear indication as to when or where the centres will open. Nor have they explained what led to the conclusion that the centrally located Beltline neighbourhood is not “appropriately” located for people who use drugs. With their Recovery-Oriented Overdose Prevention Guide, the UCP insists that the string of closures are working towards the goal of reducing neighbourhood crime, minimizing debris and drug paraphernalia, and improving harm reduction efforts. But harm reduction experts criticize the rationale behind the UCP’s guide, as well as the closures. Among their criticisms is, first, that there is no reason to believe people will stop using drugs near the Sheldon Chumir after its closure. The site is now a long-established place to use drugs. Second, the very act of closing a Supervised Consumption Site threatens the relationships between health care professionals and users, as well as degrades what little trust drug users have in the health care system. Thirdly, harm reduction experts criticize the newly proposed UCP policy that requires Supervised Consumption Site patrons to present identification to access services. All such actions will undoubtedly deter people from using the new facilities, once operational.
These policy changes are coming on the heels of Alberta’s deadliest year in the fentanyl-induced opiate epidemic. We might wonder, why is the UCP implementing policy that is not evidence-based, advocated for by experts, nor in the interest of the people it means to benefit? As it turns out, people who use drugs have been asking these questions of academics and politicians for many years.
The 2005-2007 North American Opiate Medication Initiative (NAOMI) trial conducted in Vancouver’s Downtown Eastside helped spur the conversation about failing harm reduction policies. During this trial, people who use opiates in the Downtown Eastside were invited to participate in a “Heroin Assisted Trial” for 1 year. Participants were offered a safe place to use drugs 3 times a day in addition to shelter and food. The trial was generally a success. Findings demonstrated the clear benefits of heroin- assisted trials for people who use drugs. Regardless, once the trial ended, participants were offered no further support or life-saving heroin-assisted treatment. In fact, Canada’s heroin-assisted trial is the only one in the world that failed to continue to offer treatment after the end of the study. In response, trial participants formed the NAOMI Patients Association and worked with organizations like the Vancouver Area Network of Drug Users to propose suggestions for future trials like the North American Opiate Medication Initiative. These groups and others have since generated documents, recommendations, and manifestos. All contribute to outlining drug user’s expectations of the policy and research concerning them, in addition to offering up their expertise to combat the opioid epidemic. And yet, Canadian harm reduction policy continues to directly contest community demands. The closures of Alberta’s Supervised Consumption Sites show that Canadian governments are not listening to the expertise of users, and they do not care to.
Harm reduction exists to save the lives of people who use drugs. This goal can only be achieved as far as trauma-informed policy allows it to be. Supervised Consumption Sites and other harm reduction efforts are beneficial exactly as much as the people who use drugs in our communities want to access them. Policy which marginalizes the voices of people who use drugs, which excludes their perspectives and downplays their expertise, is not only suffocating but deadly. Many of Canada’s harm reduction policies continue to fail the people they are meant to protect. Unquestionably, this warrants a new community-centred approach to harm reduction – that is, an approach which is removed from the current failing policies of our governments and the likes of Alberta’s UCP.
Emily Doerksen is a graduate student in Human Genetics and Bioethics with the Centre of Genomics and Policy and the Biomedical Ethics Unit at McGill University. @emily_doerksen