Street CCRED – Initial Op-Ed Draft

The whole is greater than the sum of its parts, even in addictions care.

Danielle Smith has it wrong from the outset in her attempt to set us up to understand a
swiss-cheese argument against an evidence-based public health intervention (Calgary
Herald Aug. 9). Nobody ever claimed that ‘safe’ consumption is the ‘solution’. Supervised
consumption services are one small but crucial part of a system that has been chronically
neglected for many decades as a result of political apathy, short-sightedness, racism,
elitism, and lack of compassion.

We should not blame supervised consumption for the ills of current society, nor should we
assume that getting rid of it will somehow cure those ills. We have created such a deeply
flawed system in the first place that until we can see that system and its gaps wholistically,
realistically, and scientifically, we will continue to flounder in pathological fear of having
to look at what we don’t want to see. Red-faced and scared someone will see the truth of
how we treat those who are struggling the most, we simply scapegoate supervised
consumption rather than get to the hard, dirty work of fixing and entire system. If only we
had done better in the first place taking care of chronic diseases, including chronic mental
health conditions. If only we had supported the front line workers who pour their hearts,
energy, skills and knowledge into supporting citizens day after day outside of hospitals. If
only we encouraged non-profits to innovate and respond to community needs, rather than
needing to hunker down and protect their meager assets from rampaging ideologues of
political leaders … if only we had done those things, we would have today much less need
for expensive hospitals, emergency departments, and harm reduction, in the first place.

“Treatment” (which, in medical practice, includes harm reduction though in lay terms
refers to the industrial complex of relatively unstudied and non-evidence-based residential
addiction treatment programs) and “recovery” are terms and constructs that have been co-
opted by politicians and media for their own gain and ideological advancement. Reflecting
the messy reality of human life, there are no such neat boxes but only shades on a
continuum that is a circuitous and obstacled path towards wellness, dignity, or whatever
goals are identified by the patients themselves who are living with chronic disease.

If we continue to insist on having an argument that pits harm reduction against treatment
and recovery, we will never dance with a solution for the complex problem of substance
use disorders. If approaches to addiction are compartmentalized and reduced to a zero-
sum analysis of investing in either harm reduction or recovery, it is either because we don’t
have the intellectual resources to problem-solve at an appropriate level of complexity or
we are unwilling to view the problem in its entirety. If we take harm reduction out of the
system of care for mental health and addictions because we think that money should be
used for “treatment and recovery”, then we should also take the emergency departments
out of our health care system … and also while we are at in in these times of fiscal restraint,
remove fire trucks from our public safety system. Come to think of it, providing clean
water is really expensive so maybe we should reconsider whether it would be better to just
let people drink from the river and let the strongest survive.
The era of Donald Trump is upon us. We have been given blanket permission, as a global
society, to let our true colours show. Where the lives of the “other” are deemed of less
value than the elite’s comfort. What a relief to be able to safely say we should just simply
let drug users die, to not be burdened any longer by the weight and inconvenience of
political correctness, or actually that annoyance of moral reflection.

We can put human beings into space, but we can’t solve problems like homelessness and
substance use disorders? We can fund new arenas but we can’t afford to treat sick patients
with both emergency AND chronic care? The opioid crisis is not caused by a lack of
resources or imagination, but rather a failure of society to look at ourselves, grittiness and
all, squarely in the mirror, and admit that we are from some angles quite ugly. What we
need right now is not more polarizing rhetoric but compassion, honesty and courage to trust
in the need for emergency care for anyone with a chronic disease including addiction.

Our society already decided that everyone has a right to health care and that nobody’s life
is worth less than another’s. These things should not be up for debate in the year 2019 and
yet that is exactly what the conversation over supervised consumption reflects. Our
country already decided that democracy means that politicians are public servants, and yet
we are allowing them to scare the individuals and agencies that care for our most vulnerable
citizens to keep quiet on harm reduction, for fear of losing their funding. Are we accepting
this? Tell me now and I’ll move to a warm State in the U.S. If the politics are the same,
at least the weather can be nice.