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What’s Behind the Right-Wing Backlash Against Harm Reduction?

Ideology and money are driving a campaign against measures that could save lives.

Carlyn Zwarenstein 2 Aug 2023The Tyee

Carlyn Zwarenstein is the author of On Opium: Pain, Pleasure and Other Matters of Substance. Find her on her website. This article was originally published by Filter, an online magazine covering drug policy and human rights through a harm reduction lens. Follow Filter on Facebook or Twitter, or sign up for their newsletter.

To harm reductionists in the United States, Canada can sound like a bastion of progressive, evidence-based drug policies. Naloxone is available over-the-counter at pharmacies, sometimes for free; cannabis is legal everywhere and widely available; a growing number of safe supply programs provide opioids of known dosage and composition; safe consumption sites exist across the country.

The harm reduction gains are real, even if programs don’t reach nearly enough people and far more remains to be done. Each has only been won through painstaking activism, often civil disobedience or legal challenges, by people who use drugs and their allies.

But Canada’s gains also face — increasingly, perhaps — an organized, ideologically right-wing backlash. Opponents of harm reduction vigorously seek to link progressive drug policy with social strife, stoking moral panics that translate to votes and then to deaths, as life-saving interventions are weakened or eliminated altogether.

Benjamin Perrin should know. A conservative from his early teens, he rose through party ranks to become advisor on public safety issues for former Conservative prime minister Stephen Harper in 2012, just as the toxic drug supply saw a dramatic surge in overdose deaths.

He’s not the first person to become more progressive upon leaving their position of leadership or influence (the pro-decriminalization Global Commission on Drug Policy is full of former presidents who upheld prohibitionist or punitive policies while in office).

But Perrin’s change of heart was a bit more like a transplant. After close personal encounters with the lived realities of intergenerational trauma, addiction, disability and mental health challenges, he “found freedom and peace in Jesus Christ,” according to his website. And he began to take an interest in the impact of poverty and other forms of marginalization on people he once saw as the problem.

Perrin now speaks across the country about the need for compassionate, evidence-based policies, and wrote a progressive-minded, if not radical, book on the subject. But he doesn’t believe more evidence is likely to change people’s opinions.

“Ideology is firmly in the driver’s seat,” he told me. In fact, it’s not an old-fashioned conservative ideology that he describes — although he draws links to the traditionally conservative idea that people should “pull themselves up by the bootstraps” — but moralism, what he calls “moral panic.”

Most worrying, drug policy has joined other hot-button issues as the subject of massive misinformation campaigns, which Perrin describes as mob-like and fear-based.

“Substance use has become enmeshed in right-wing narratives such as homelessness,” he said.

This has played out most recently in relation to safe supply, in stories that illustrate complicated connections between anti-harm reduction rhetoric, people making money from unregulated addiction treatment and the right wing in Canada and beyond.

In January, Last Door Recovery Society, a private, abstinence-only addiction treatment centre in Vancouver, provoked a national-level debate with an inflammatory press release alleging “diversion” of safe supply hydromorphone in the city.

Although these allegations have been debunked, Conservative party Leader Pierre Poilievre seized on the issue. In doing so, he aped U.S. global warming apologist Michael Shellenberger’s argument in his 2021 book, San Fransicko: Why Progressives Ruin Cities that unhoused people and permissive drug policies are to blame for urban problems.

This draws liberally from the playbook of right-wing activist and journalist Aaron Gunn, whose incendiary documentary, Vancouver Is Dying, came out in October. The film takes direct aim at the federal government and politicians who have promoted harm reduction policies. It interviews cops, people with histories of addiction and victims of crime to advance the debatable view that crime in that city is out of control, and the baseless assertions that it results from harm reduction policies and is perpetuated by unhoused people who use drugs (but not by policies that result in homelessness).

A frequent, nonsensical analogy made in the film — which has garnered millions of views — is that providing opioid safe supply is like encouraging people with alcohol use disorder to drink and drive.

On the back of the Last Door tempest, a swarm of poorly informed articles flooded Canada’s mainstream right-wing media. In May, the National Post dedicated 10,000 words to an opinionated investigation of safe supply “diversion” that was deeply careless with the facts. On the further reaches of far-right media that have spread in recent years, the trifecta of violent crime/homeless encampments/harm reduction has become an almost constant bugaboo.

Meanwhile, Alberta’s United Conservative Party has been vociferously opposed to safe consumption sites; defies the evidence by promoting abstinence-based treatment for opioid use disorder; and has thrown lives into chaos with its recent reduction of access to an existing safe supply program.

April was Alberta’s worst month on record for overdose deaths. Yet in May, instead of rethinking her attacks on harm reduction, Premier Danielle Smith — selective in her libertarian opposition to government overreach — promised to legislate forced addiction treatment. She stated, without evidence, that this “will allow us to save the lives of addicts who are at risk of dying from an overdose and protect those who are at risk of being randomly attacked in our communities.”

It’s not clear, however, that anti-harm reduction positioning reflects the views of the average Canadian.

A photo shows a tidy assortment of medical supplies and a row of desks and chairs, separated by stainless steel dividers.
The inside of the newly opened Fraser Health supervised consumption site in Surrey in 2017. Photo by Jonathan Hayward, the Canadian Press.

“I think that generally speaking, the Canadian public tends to be fairly supportive of harm reduction,” said Elaine Hyshka, an associate professor at the University of Alberta’s school of public health. “I think for most people it is becoming increasingly, like, common sense that in order to reduce the harms of substances in society, we need to take multiple different approaches. And one of those approaches is harm reduction.”

In support of this, Hyshka cited her recent work on public opinion about safe supply. Even in Alberta and Saskatchewan, the relatively conservative provinces she polled, Canadian public opinion didn’t follow anti-harm reduction rhetoric: in Alberta in 2021, for example, a full 63.5 per cent of respondents were in favour of programs that replace illegal drugs with pharmaceutical alternatives for people who haven’t been able to stop using.

“We found that the majority of people were supporting the idea of prescribing pharmaceutical alternatives or providing pharmaceutical-grade alternatives to illegal drugs for people who are dependent on the illegal drug supply,” Hyshka said.

Nonetheless, Canada’s right-wing backlash to harm reduction is loud, determined and politically powerful. Perrin now looks at the movement a bit like someone who has escaped a cult — even as it goes further in a direction set by the government he served.

To understand the appeal of that cult to at least a significant proportion of Canadians, consider the “right-wing authoritarian personality,” as defined by Canadian-American social psychologist Robert Altemeyer. He describes a personality type submissive to authority, highly adherent to social conventions endorsed by authorities and quick to condemn, and aggressively punish, supposed enemies identified by assertive leaders. Typically these “enemies” are outsiders, or people perceived as morally degenerate.

“One kind of theory is that Canadian drug policy is very dictated by these oscillating moments, of panic and then indifference,” Alex Betsos noted. A PhD student studying Canadian drug history at Rensselaer Polytechnic Institute, he’s also an international working group member for the harm reduction organization Youth RISE.

Betsos pointed to the wave of limited but progressive initiatives that governments got behind for a couple of years, as a result of panic about surging overdose deaths around 2016. Over this period, increasing public understanding of the evidence supporting safe consumption sites and other harm reduction interventions was evident, as borne out in polls like Hyshka’s.

Since then, though, many Canadians have returned to the indifference part of Betsos’ cycle, the COVID-19 pandemic having seized everyone’s attention (and severely worsened the overdose crisis).

Perhaps this sense of comparative indifference created a vacuum into which right-wing advocates of prohibitionist, punitive drug policy could step, gathering up a mob of vocal followers to unleash a pattern of online, often transnational mobilizing, with right-wing media outlets stoking local and in-person outrage — seen around everything from safe consumption sites and immigration to the use of gas stoves.

“Regardless of what crime statistics say, people’s feelings about the city and crime go up and down,” Garth Mullins told me. A longtime drug-user activist and member of the Vancouver Area Network of Drug Users and the British Columbia Association for People on Methadone, he also hosts and produces the award-winning drug-war podcast Crackdown.

And then, when those feelings take a downward turn, he continued, “drug users or people without housing get the blame for it. And we’re seeing one of those cycles happening.”

“You know, if people are feeling unsafe, then it starts with a genuine feeling,” Mullins said. “And then it pivots to blame new enemies. And that’s how right-wing and far-right propaganda often works.... When there’s a complicated situation, to find enemies you can point to — like Pierre Poilievre, you can just point to ‘Look, look here, these people on the street who are completely visible, that’s what’s causing the problem,’ instead of something like the price of food or the inequality in the system or the Controlled Drugs and Substances Act.”

Betsos noted that attribution of “urban blight” and visible homelessness to failed progressive drug policy isn’t a new thing. But, he said, it wasn’t until recently that it gained new traction. “It’s taken a while to get off the ground, I think, and that’s maybe why we’ve been really caught off guard.”

What seem like spontaneous reactions and inadequate education — and what harm reductionists have typically countered, in good faith, as such — are increasingly arising from the larger anti-progressive movement that specializes in disinformation and is eager to find a way to be partisan about everything.

“People can have views about things, but if they’re not organized, they haven’t found each other and co-ordinated their messaging and actions, [it’s] not very effective,” Mullins said. “But now, right-wing politicians and commentators in the media have all found each other, and they’re co-ordinating their action. And so they’re being very effective about it.”

“This is all [rooted in] a sort of nationwide or continent-wide law-and-order backlash,” he added. “When it first came to my attention that this is a continent-wide thing that was gonna affect us was when that Shellenberger guy was getting ready to write his book.”

When he saw how San Fransicko fuelled pundit and public outrage — by attributing public homelessness, similar to Vancouver’s, to compassionate drug policy — Mullins knew that this argument would have a lot of currency in Canada.

Another line of thinking: At the bottom of this, it isn’t really a debate about the pros and cons of harm reduction at all. Some Canadian harm reductionists have begun looking into the links between would-be privatizers of Canada’s public health-care systems, right-wing influencers and movements across North America, and government or political party workers on the Canadian right who benefit financially from private addiction clinics and services.

Bringing such connections to light clarifies narratives that benefit those for whom deaths and suffering among certain groups of people who use drugs are the cost of doing business. In this case, it’s not really views on harm reduction that are driving policy, but right-wing ideology acting as a justification of profiteering.

Last Door — the residential addiction treatment facility that set off a storm in Canadian politics — is, as various harm reductionists have carefully traced, deeply enmeshed in a network of anti-harm reduction advocates who are also entrenched in U.S. right-wing movements. And, in contrast to publicly accountable harm reduction programs, unregulated treatment centres like Last Door take public funding but make private profits.

Euan Thomson, executive director of Each + Every: Businesses for Harm Reduction, a coalition of small businesses promoting evidence-based responses to the overdose crisis, points out in his newsletter that Last Door’s director of community development is the chair of Recovery Capital Conference of Canada, which runs the influential and prohibitionist Alberta Recovery Conference.

This annual conference, open to those who can pay $500 to attend, draws speakers from among the most outspoken North American opponents of harm reduction. These have included U.S. doctors Keith Humphreys and Anna Lembke; Julian Somers, a British Columbia psychiatrist known for his conflation of homelessness, addiction, drug use and crime; and Marshall Smith, chief of staff to Danielle Smith and an advisor to the United Conservative Party on addiction and recovery.

Smith, who comes from B.C., experienced homelessness and addiction to methamphetamine and alcohol in the early 2000s. Shortly after receiving residential treatment himself, he became the director of a private treatment centre. Later, he was a senior staffer in an abstinence-based “therapeutic community.”

Since leaving B.C., he’s parlayed his combination of political influence and experience into a career as a driving force for the so-called "Alberta Model." U.S.-based pundit Sean Speer, a fan of Margaret Thatcher and Ronald Reagan’s “coherent and intellectually rooted policy agenda,” is another former Stephen Harper advisor who has praised the Alberta model.

Thomson additionally flags a network of public and governmental organizations in Alberta that provide massive funding to Last Door — for example, a 2021 contract worth over $1.2 million to create a phone app. Another sponsor of the conference, Edgewood Health Network, was awarded tens of millions of public money by Alberta’s UCP government to open residential “therapeutic communities.”

The inaugural ARC sponsor, meanwhile, was Our Collective Journey — a UCP-funded, Medicine Hat-based recovery coaching organization. Our Collective Journey is a member of North America Recovers, a transnational organization that has run ads in Washington, D.C., calling on President Joe Biden to shut down safe consumption sites.

First established in Seattle just this year with the aim of also shutting down encampments of unhoused people, North America Recovers promotes abstinence-based treatment, with a distinctly right-wing philosophy that draws on ideas similar to San Fransicko.

Like the UCP, North America Recovers advocates mandatory medication for mental health issues and forced treatment for addiction — including treatment known to increase the risk of death, relative to other options, for people with opioid use disorder.

In this vision of the world, encampments should be razed and unhoused people forced into emergency shelters even at risk of disease, overdose or other harm. Human rights like safe shelter should be conditional on abstinence or compliance with mental health and addiction treatment. And drugs should remain illegal, even as the lucrative treatment industry lines its proponents’ pockets.

During an earlier overdose crisis in the 1990s, drug-user activists who had argued for a range of solutions, including decriminalization — which might have prevented the later rise of illicit fentanyl — were forced to compromise on their demands. They wound up with a single safe consumption site in Vancouver.

A single site was deeply inadequate given that prohibition was already worsening overdose risk in an illicit drug market centred in the Downtown Eastside. The site also bought into a medical model many drug-user activists would prefer to avoid. Yet it was better than nothing, and viewed as a first step. And so, despite these concessions, they later had to defend it, and other imperfect responses, from attacks by Stephen Harper’s Conservative government.

“When Harper came to shut it down, we had to defend it,” Mullins recalled. “And there was a whole bunch of myths fabricated around the safe injection site as well. And we had to clarify those myths.”

While Harper’s former advisor Perrin tries to convert Christians to the harm reduction cause, those in the harm reduction trenches and others see it as less about cajoling compassion and more about claiming rights.

Betsos, for example, argues that while harm reduction initiatives are falsely characterized as not working because they are too radical, in fact, the reason they don’t work as well as they could is that they don’t go far enough.

“We’re always... trying not to step on toes,” he said, “and so we’re making all these compromises.”

Hyshka believes the same. In her research, she’s found that while generic harm reduction rhetoric is often used by governments, there are still relatively few substantial harm reduction policies in any of the provinces or territories.

“I actually think that in some cases, the fact that these programs have been implemented incrementally [is] providing critics an opportunity to say, well, we’ve tried that and it doesn’t work,” she said. “They have not been scaled to the size that they need to be.”

Like Hyshka, Betsos points to the backlash against very restricted hydromorphone programs, which were developed in response to some evidence that some people can’t distinguish hydromorphone from heroin under certain conditions. Critics of such programs say sarcastically that you might as well give everyone heroin, or fentanyl. In fact, Betsos agrees.

While hydromorphone, like methadone, works very well for those for whom it works, it was yet another compromise for drug-user activists and harm reductionists. It was simply easier to seek approval for hydromorphone than the less politically palatable diacetylmorphine, the pharmaceutical version of heroin.

“We’ve been kind of stymied by the potential for conservative backlash,” Betsos said.

Harm reductionists know that many people who use opioids now seek not heroin, but more potent, shorter-acting fentanyl. As a direct substitution, prescription fentanyl programs — some isolated examples are emerging — would be more likely to retain people and help them stabilize their lives.

Perhaps, Betsos suggests, harm reduction advocates need to go not smaller in their demands, but bigger — lining up more squarely behind evidence and a holistic grasp of the dynamics in which people are suffering.

“One point is [the potential of] meeting the political moment as a moment to open up possibilities,” he said.

Mullins is focusing on building coalitions to make common cause with labour movements, civil rights groups and others against the right-wing momentum across North America. These efforts seek to bring drug-user voices into the conversation, and to educate the public — including his fellow VANDU members, whose lives are directly affected by the rhetoric — to see through right-wing talking points.

At a recent VANDU meeting, Mullins played video clips from the House of Commons debate on Poilievre’s (eventually defeated) motion seeking to defund nationally funded harm reduction programs like safe supply.

“Everyone is like, booing [Poilievre], but also kind of shocked to see our issues being lied about in the most powerful room in the country,” he said.

It’s not easy countering the lies, though. “The problem is, we have to explain the system, and they have to just point to a scapegoat… so our job is a little harder,” Mullins explained. “That’s the great thing about the invisible hand of the market. It’s invisible… so those market forces that are making everybody’s lives so much more difficult are hard to just point to directly.”  [Tyee]

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