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The Man Behind Alberta’s Pull Away from Harm Reduction

As deaths mount, Marshall Smith has driven the province’s focus on abstinence over safer drug supplies.

Ben Mussett 12 May 2022TheTyee.ca

Ben Mussett is a B.C.-born journalist now living in Toronto. His reporting has appeared in the Globe and Mail, CBC News, Vice and the Capital Daily.

It could have been easy to miss Marshall Smith at the 2022 Recovery Capital Summit. Over two days last month, the Hyatt Regency Hotel in downtown Calgary buzzed with academics, addiction treatment professionals, Alberta government staffers and folks who identify as recovering addicts, all eager to chew over different ways to achieve abstinence from drugs.

But the nondescript Victoria native — clean-shaven, silver-haired, in a crisp white button-down — appeared onstage only briefly, sandwiched between long presentations, including a speech from Mike Ellis, Alberta’s associate minister of mental health and addictions and Smith’s boss, that received a standing ovation.

Despite his low profile, Smith held considerable influence in that room, where the price of admission was more than $500 a head. As Ellis’s chief of staff, the former BC Liberal aide with experience in the private treatment industry is a quiet driving force within the ministry. Some would argue the driving force. His views on substance use have coloured nearly every aspect of how the United Conservative Party has handled the issue since Jason Kenney came to power in the spring of 2019, when Smith moved to Alberta to serve as chief of staff for Ellis’s predecessor, Jason Luan.

This work means a lot to Smith. His Twitter banner trumpets "I [heart] Alberta Recovery." He was once a well-liked political aide in Gordon Campbell’s BC Liberal government. But by mid-2004, a dependence on crystal meth and cocaine had forced him out of politics and onto the streets of the Downtown Eastside, where he was homeless for a few years. The former prison guard sometimes dealt drugs to support his own use, and eventually landed in prison himself.

In 2007, Smith checked into a treatment facility, a decision he has credited in part to the Vancouver police. Shortly after, thanks to a political connection, Smith became director of a new private treatment centre in Prince George. For the next decade, while continuing to work in the industry, Smith was a passionate advocate for expanding government funding for recovery services. And for years, his combination of political connections and savvy helped him align the policy conversation around his views on substance use: abstinence-based recovery above all. That is, until fentanyl upended the illicit drug market, and the winds began to change.

That might be why, at times, it felt like the conference was taking place in a vacuum, untouched by the current reality of Canada’s toxic drug crisis. Less than two weeks before the summit kicked off on April 12, Alberta released data showing that the first month of this year had tied for the third deadliest on record in terms of drug-related deaths; 99 per cent percent of those deaths were attributed to apparent opioid poisonings. The two deadliest months in Alberta’s history? November and December 2021.

In the first half of last year, Alberta’s drug poisoning rate was 36 per 100,000 people. That number has climbed seven percentage points, to 43, in the last six months, matching British Columbia’s record rate in 2021. Six years ago, Alberta’s rate sat at 16.

B.C. has responded in recent years by embracing harm reduction, including introducing a provincial safe supply program, albeit one critic's charge is wildly insufficient and inaccessible.

Under Kenney, Alberta has gone in the opposite direction. The premier and others in his government have repeatedly questioned the effectiveness of evidence-based harm reduction services, like supervised consumption sites and safe supply, while curtailing them. All of this runs counter to the advice of public health experts, including Alberta’s own chief medical officer, Deena Hinshaw, who once co-chaired a commission that supported providing a “safer opioid supply.”

The so-called Alberta model instead places abstinence-based treatment at the forefront. Millions of dollars have been put towards the construction of five “recovery communities” around the province. The UCP has increased the number of fully-funded treatment beds by 40 per cent since coming to power. And, since late 2020, Albertans have no longer had to pay out of pocket to attend provincially-approved treatment centres.

When the Edmonton Journal recently asked Associate Minister Ellis whether his ministry measures success by a decrease in deaths or more people accessing treatment, he seemed to suggest the latter.

A recovery-oriented system

At last month’s conference, Smith could have given a moving speech about his own recovery journey. Instead, he spent much of his short time onstage speaking directly, off the cuff, to treatment centre operators about an upcoming app called My Recovery Plan. It aims to help people in recovery stay on track while providing treatment centres with user data to understand their individual goals and assess where facilities could improve their programs.

“If anybody has any other detailed operational questions, I’m happy to field them in the hallway,” Smith said as his remarks came to a close.

The United Conservative Party views the app as a crucial plank in the controversial “recovery-oriented” system it's building to address what the government views as an addictions crisis, not one driven by the increasingly dangerous and unpredictable drug supply.

Despite the rising deaths — and the fact that the UCP isn’t yet tracking the outcomes of people leaving treatment — conservative pundits have heaped praise on the Alberta model, with former Stephen Harper advisor Sean Speer recently crediting Kenney for innovating a “credible, policy-based alternative to the harm reduction consensus.”

But while the UCP might be trying to build a more accessible treatment system, it’s less of an innovation than a return to the War on Drugs-inspired, “Just Say No” principles that Nancy Reagan promoted in the 1980s, says Guy Felicella, a peer advisor at the BC Centre on Substance Use.

“It's the same ideology and belief from the past,” Felicella said. “Well, if ‘Just Say No’ worked, then why didn’t it?”

A few years ago, as drug-related deaths rose due to the spread of fentanyl, governments and the public became more open to certain harm reduction services, like supervised consumption sites, and eventually safe supply. It was a shift that seemed to worry Smith, then in a senior role at Cedars at Cobble Hill, a private treatment centre on Vancouver Island.

“I think we’re going way far into a public health model and moving away from a personal health model,” he said in a 2015 interview on a radio show produced by the Last Door Recovery Society, a B.C.-based treatment centre that organized last month’s conference.

Smith worried this change could normalize drug use: “I think that there’s a certain shroud of stigma that needs to remain around addiction,” he said.

The Tyee requested an interview with Smith but wasn’t successful.

A persistent theme in that 2015 radio interview is Smith’s strong opposition to giving people who use drugs a role in crafting drug policy.

“The reality is that they’re high,” said Smith. “Engaging people who are addicted to drugs… in a policy conversation about what to do about the addiction problem makes about as much sense as engaging a stakeholder of drunk drivers to write new traffic laws. It is just nonsensical.”

Smith said he’d rather talk to people who have no familiarity with addiction than people who use drugs, or the people who love them. “Just because you have this going on in your family does not make you an expert.”

Without citing evidence, he later insinuated that parents who’ve lost children to fatal overdoses were being paid to promote policies like safe supply by Big Pharma. Despite repeated requests, the UCP has yet to meet with Moms Stop the Harm, a national organization of mothers who’ve lost children to drug poisoning, according to Petra Schulz, a co-founder who lives in Edmonton.

“Our opposition,” Smith said later in the interview, “They sit in a place where they promote the hopelessness of this situation, and we need to be the antidote to that hopelessness.” This kind of talk is all too familiar to Nicole Luongo, who researches drug legalization and regulation at the Canadian Drug Policy Coalition. Luongo spent a lot of time in treatment facilities around B.C. when she was younger.

“My worldview was wholly shaped by the 12 Steps,” she said. “You're trained to view yourself as an unreliable narrator. It was instilled in me that I had a broken brain, that I couldn't trust my thinking, and that any point of agency I had was a symptom of my illness.”

Now in its 83rd year, the popular 12-Step model for addiction recovery was originally founded on Christian ideals. The abstinence-only program, of which Smith is a fierce defender, remains the basis of most treatment programs, along with recovery groups like Alcoholics Anonymous. One reason why it’s endured this long is because it has worked for some people. But in Luongo’s experience, the 12 Steps come with “a lot of disparaging of people for whom it doesn’t work — and a lot of groupthink and ostracization.” Proselytizing is actually the final step: “Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”

It’s a message that doesn’t sit well with Felicella.

“You can't just say to people, ‘This is the path,’” he said. “Because it's bullshit.”

What works for one person won’t work for everyone, he continued. Context — like whether someone has a place to live or a job waiting for them after they leave treatment — matters. And if a person is interested in pursuing abstinence, research shows that it often takes several tries before sobriety sticks, if it indeed does. Felicella estimates he attended around 15 treatment centres before he stopped using drugs.

Attempting recovery today, however, is different. In the absence of safe supply, a person with a history of opioid use could be at a greater risk of dying if they relapse than they were before they attempted recovery, according to Elaine Hyshka, Canada Research Chair in Health Systems Innovation at the University of Alberta.

A call for nuance

Near the end of Smith’s 2015 interview on Talk Recovery Radio, one of the hosts said what governments need is someone like him, someone who’s “been through it,” to push policy-makers in the right direction.

Less than four years later, Smith found himself in that very position. Shortly before heading to Alberta, he had reportedly resigned from an advisory role at the BC Centre on Substance Use after the organization endorsed the idea of heroin compassion clubs. Alienated by the direction his home province was taking, Smith saw a vehicle for his views in the UCP.

And he’s not the only one in Alberta’s Ministry of Mental Health and Addictions who identifies as a person in recovery.

That came as a shock to Mike, a road paver from Calgary who credits his own recovery to the 12 Steps but remains a steadfast supporter of harm reduction. To protect his privacy, Mike asked The Tyee not to disclose his last name.

“All these years, I was thinking, 'Well, one day somebody who's been in addiction will make it into the government, and then we can actually have some real change,’” he told me. “It's sort of a big blow knowing that there's already people there, and they're doing the opposite.”

“Recovery capital,” the namesake of last month’s conference, is a broad and somewhat slippery term. In essence, it refers to the resources, tangible and otherwise, that a person can draw upon to achieve and safeguard their abstinence. Someone with, say, secure housing, a supportive social network and job experience would likely be considered “rich” in recovery capital and more likely to stay sober, according to this framework.

It would make sense to add access to a range of harm reduction services to that list as well, because as I’ve been told by many harm reduction advocates, you can’t recover if you’re dead. Felicella, now nine years abstinent, knows he wouldn’t be here without harm reduction.

“If you've been in recovery,” he said, “the chances are, you've used a damn harm reduction facility in your life, and it saved your life, or it saved you from having hep C or HIV.”

“You can't sacrifice harm reduction for recovery, and you can't sacrifice recovery for harm reduction. You need both,” he said.

For Luongo, Alberta’s recovery-oriented approach isn’t about maximizing so-called recovery capital and giving struggling people a greater chance to overcome substance use. A system built around traditional addiction treatment, she says, serves to instead “depoliticize and individualize social problems.”

“It does not take into account race and class-based oppression,” she said. “It does not take into account Indigeneity and the unique traumas that emerge from colonialism.”

Nor does it seem geared towards a drug supply that experts, including people who use drugs, say is more toxic than ever before.  [Tyee]

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