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It’s Time to End Canada’s Simplistic Approach to Drug Policy

Abstinence works for some people. Harm reduction for others. Why can’t we support both?

Karen Urbanoski, James Fraser, Stephanie Arlt and Marilou Gagnon 3 Oct 2019TheTyee.ca

Karen Urbanoski is the Canada Research Chair in Substance Use, Addictions and Health Services and a scientist with the University of Victoria’s Canadian Institute for Substance Use Research.
James Fraser and Stephanie Arlt are research assistants and graduate students at the institute.
Marilou Gagnon is also a scientist with the institute and the president of the Harm Reduction Nurses Association.

“We will have more to say on addictions in general, but our focus is getting people off of dangerous drugs, not maintaining a lifetime of addiction.” — Conservative Party of Canada Leader Andrew Scheer

Andrew Scheer offered a preview of his party’s position on substance use last week.

Scheer repeated the claims that providing harm reduction services is “enabling” people to use substances and that we should instead focus on getting people off them. These types of claims are consistent with a broader narrative that is spreading across Canada, notably in Alberta and Ontario.

Alberta’s United Conservative government recently created a panel to review the supposed socioeconomic impacts of supervised consumption sites. Last fall the Ontario Progressive Conservative government cut funding for overdose prevention sites, rebranding them as “consumption and treatment services” with the obvious intent of pushing people toward abstinence-based services.

But the evidence is already clear. Research shows supervised drug consumption facilities save lives, improve health, reduce costs and increase the number of people seeking treatment.

As we face an overdose crisis that has claimed more than 12,800 Canadian lives since 2016, we have seen harm reduction and treatment pitted against each other on the campaign trail.

We are here to say these two ideas are not opposed; they can, and should, work together to save and improve lives.

Abstinence is not an alternative to harm reduction — it is one approach to it.

But it is not the only way and it is not the best way. There is no single best way. Services for people who use substances come in many forms, with different goals — keeping people alive and healthy, connecting them with supports, or providing access to treatment when they choose.

Despite this, the pervasive narratives perpetuate a division between treatment and harm reduction models.

This division is based on an idea that all harm reduction does is keep people alive, while treatment moves them into “recovery” (often code for abstinence).

These narratives have infiltrated media discourses, common understandings and public policy. They are not merely incorrect, but harmful. They contribute to stigma, obscure understandings of what treatment is, impede service implementation and create a destructive perception of competition between services.

“Recovery” is a term people define for themselves. “Abstinence” also has many different meanings — you no longer use the substance that was once causing you harm, you’re using substances therapeutically, or you no longer use psychoactive substances.

And treatment doesn’t mean getting people “off” drugs. It’s about improving health and well-being. The scientific evidence finds the greatest benefits come when people achieve treatment goals they have identified, which can include reducing substance use or using more safely, as well as abstinence from one or more drugs.

Evidence supports the idea of meeting people where they are at, without moral judgment, and the need for health systems to offer a range of services and supports.

Treatment programs, no matter what their goal, are not a panacea. In the context of an overdose public health emergency, rhetoric that prioritizes complete abstinence (to the point of not supporting treatments such as opioid agonist therapy), risks aggravating harms by quickly tapering people off opioids, reducing their tolerance and increasing overdose risk.

Listening to politicians such as Scheer, or reading media coverage coming from Alberta and Ontario, the public may incorrectly believe certain forms of treatment are superior to others.

While policies can differ between provinces, there is a consistent narrative in national media that says harm reduction efforts are supported at the expense of recovery or treatment — a dangerous false dichotomy.

There is no hierarchy of services; they are all part of a spectrum of care. There is a pernicious notion that harm reduction is only valid if it moves people toward complete “abstinence.” But this should not be a requisite of treatment; it is just sometimes one of the many potential benefits.

Harm reduction is treatment. Reducing risk behaviours is treatment. Opioid agonist therapy is treatment. Safer supply is treatment.

Will harm reduction “solve” the opioid crisis? Of course not, but neither will relying solely on treatment that supports complete abstinence.

There is no silver bullet to address the current crisis, but we need evidence-based approaches, and not regressive, evidence-adverse understandings of substance use.  [Tyee]

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