Addictions
Harm-reduction activists could find common ground with critics if they kept an open mind

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By Rahim Mohamed
The recovery-oriented PROSPER Symposium was protested by harm reduction activists.
A star-studded symposium on recovery-oriented drug policy went off without a hitch in Vancouver on Thursday, despite efforts by several prominent harm-reduction activists to sabotage the event.
Harm-reduction activists oppose the enforcement of criminal laws prohibiting public drug use and the prioritization of treatment and recovery-oriented policies.
Yet, if these activists had attended the symposium rather than undermining it, they likely would have found they agreed with many of the speakers’ points.
The PROSPER symposium — which stands for Policy Roundtable on Substance Prevention, Education, and Recovery — was moved to a new venue after organizers caught wind of credible threats to the event’s security. Audio recordings leaked before the symposium depicted activists brainstorming ways to disrupt the proceedings, including by dyeing fountains red, shouting down speakers and honking horns.
The last-minute venue change didn’t stop a handful of protestors affiliated with the group Moms Stop the Harm from picketing the event. Some held photographs of lost loved ones. Others commented to on-location news crews at various points throughout the day.
Fortunately, the event’s logistical challenges didn’t dissuade three high-profile elected officials — Official Opposition leader and leader of BC United Kevin Falcon, BC Conservative Party leader John Rustad and Port Coquitlam Mayor Brad West — from attending the conference.
Even though PROSPER was a success, one can’t help but lament the missed opportunity for the event’s organizers and detractors to come together to find common ground on sensible drug policy.
Speaker after speaker reaffirmed the importance of the 4 Pillars approach to combating drug addiction and dependence. This approach says harm reduction plays an important role in drug policy, but also recognizes the importance of three other pillars: treatment, prevention and enforcement.
No speakers denied the importance of harm reduction; they only said they would like to see a more balanced approach that is recovery-oriented and sees harm reduction as one tool among many.
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One presenter, Dr. Launette Rieb of the University of British Columbia, shared findings from her research on the efficacy of supervised opioid agonist therapy, which involves using medications such as Suboxone to help patients taper their opioid use.
While some harm-reduction activists have been critical of providers of this therapy, many others advocate for its use and want to expand access to it. Why boycott a presentation about this treatment option?
Dr. Pouya Azar, a psychiatrist with Vancouver Coastal Health, had audience members watch snippets from recorded interviews he conducted with opioid-addicted patients. One of the interview subjects told Azar that his mom also used, and noted that taking drugs was one of the few activities they still did together.
These clips underscored the significance of environmental and psychosocial factors in facilitating lasting recovery. This is an idea that harm-reduction activists, at least in theory, also recognize.
The conference placed a strong emphasis on Indigenous perspectives on addiction and recovery. Indigenous leaders shared stories of how addiction had impacted their families and communities.
Harm-reduction activists often emphasize the importance of ensuring Indigenous perspectives are incorporated in treatment approaches. It seems unlikely they would have been offended by these presentations.
“I think many harm-reduction activists are well-intended, hardworking and want the right thing,” said former senior White House drug policy advisor Kevin Sabet and one of the conference’s organizers.
“But they’ve also been led astray by a much smaller group of people who want to dress up radical ideas with sympathetic faces,” he said. “It is in that small band’s group of interest to distort the truth and spread lies about what we are about.”
Sabet and fellow conference organizers have promised to meet with some of the protesters, including parents who lost their children to overdose, at a later point to find areas of agreement.
In the spirit of protecting open discussion, PROSPER also admitted several individuals who work for organizations that were implicated in the leaked audio recordings.
In his closing keynote, Stanford psychology professor Dr. Keith Humphreys expressed cautious optimism about the future of drug policy. He noted that some of the US’ most drug-addled jurisdictions, such as San Francisco and Portland, have recently taken meaningful steps toward sensible drug policies, including ramping up law enforcement in neighbourhoods with high concentrations of drug users.
“I think reality is our friend,” Humphreys said. The past few years have shown that “people who live in an ideological world can recover,” he added, referring to hardline ideological approaches to drug use and other urban issues that have become less popular in recent years.
It’s a shame that some of the people who may have benefited most from Humphreys’ message weren’t in attendance to hear what he had to say. By protesting initiatives like PROSPER, rather than engaging in good-faith dialogue with those who hold different views, these activists are hurting their own cause.
It’s too bad that they’re too blinded by their own ideology to see this.
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Addictions
Canada must make public order a priority again

A Toronto park
Public disorder has cities crying out for help. The solution cannot simply be to expand our public institutions’ crisis services
[This editorial was originally published by Canadian Affairs and has been republished with permission]
This week, Canada’s largest public transit system, the Toronto Transit Commission, announced it would be stationing crisis worker teams directly on subway platforms to improve public safety.
Last week, Canada’s largest library, the Toronto Public Library, announced it would be increasing the number of branches that offer crisis and social support services. This builds on a 2023 pilot project between the library and Toronto’s Gerstein Crisis Centre to service people experiencing mental health, substance abuse and other issues.
The move “only made sense,” Amanda French, the manager of social development at Toronto Public Library, told CBC.
Does it, though?
Over the past decade, public institutions — our libraries, parks, transit systems, hospitals and city centres — have steadily increased the resources they devote to servicing the homeless, mentally ill and drug addicted. In many cases, this has come at the expense of serving the groups these spaces were intended to serve.
For some communities, it is all becoming too much.
Recently, some cities have taken the extraordinary step of calling states of emergency over the public disorder in their communities. This September, both Barrie, Ont. and Smithers, B.C. did so, citing the public disorder caused by open drug use, encampments, theft and violence.
In June, Williams Lake, B.C., did the same. It was planning to “bring in an 11 p.m. curfew and was exploring involuntary detention when the province directed an expert task force to enter the city,” The Globe and Mail reported last week.
These cries for help — which Canadian Affairs has also reported on in Toronto, Ottawa and Nanaimo — must be taken seriously. The solution cannot simply be more of the same — to further expand public institutions’ crisis services while neglecting their core purposes and clientele.
Canada must make public order a priority again.
Without public order, Canadians will increasingly cease to patronize the public institutions that make communities welcoming and vibrant. Businesses will increasingly close up shop in city centres. This will accelerate community decline, creating a vicious downward spiral.
We do not pretend to have the answers for how best to restore public order while also addressing the very real needs of individuals struggling with homelessness, mental illness and addiction.
But we can offer a few observations.
First, Canadians must be willing to critically examine our policies.
Harm-reduction policies — which correlate with the rise of public disorder — should be at the top of the list.
The aim of these policies is to reduce the harms associated with drug use, such as overdose or infection. They were intended to be introduced alongside investments in other social supports, such as recovery.
But unlike Portugal, which prioritized treatment alongside harm reduction, Canada failed to make these investments. For this and other reasons, many experts now say our harm-reduction policies are not working.
“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist recently told Canadian Affairs.
Yet, despite such damning claims, some Canadians remain closed to the possibility that these policies may need to change. Worse, some foster a climate that penalizes dissent.
“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” Rieb said.
Second, Canadians must look abroad — well beyond the United States — for policy alternatives.
As The Globe and Mail reported in August, Canada and the U.S. have been far harder hit by the drug crisis than European countries.
The article points to a host of potential factors, spanning everything from doctors’ prescribing practices to drug trade flows to drug laws and enforcement.
For example, unlike Canada, most of Europe has not legalized cannabis, the article says. European countries also enforce their drug laws more rigorously.
“According to the UN, Europe arrests, prosecutes and convicts people for drug-related offences at a much higher rate than that of the Americas,” it says.
Addiction treatment rates also vary.
“According to the latest data from the UN, 28 per cent of people with drug use disorders in Europe received treatment. In contrast, only 9 per cent of those with drug use disorders in the Americas received treatment.”
And then there is harm reduction. No other country went “whole hog” on harm reduction the way Canada did, one professor told The Globe.
If we want public order, we should look to the countries that are orderly and identify what makes them different — in a good way.
There is no shame in copying good policies. There should be shame in sticking with failed ones due to ideology.
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Addictions
No, Addicts Shouldn’t Make Drug Policy

By Adam Zivo
Canada’s policy of deferring to the “leadership” of drug users has proved predictably disastrous. The United States should take heed.
[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]
Progressive “harm reduction” advocates have insisted for decades that active users should take a central role in crafting drug policy. While this belief is profoundly reckless—akin to letting drunk drivers set traffic laws—it is now entrenched in many left-leaning jurisdictions. The harms and absurdities of the position cannot be understated.
While the harm-reduction movement is best known for championing public-health interventions that supposedly minimize the negative effects of drug use, it also has a “social justice” component. In this context, harm reduction tries to redefine addicts as a persecuted minority and illicit drug use as a human right.
This campaign traces its roots to the 1980s and early 1990s, when “queer” activists, desperate to reduce the spread of HIV, began operating underground needle exchanges to curb infections among drug users. These exchanges and similar efforts allowed some more extreme LGBTQ groups to form close bonds with addicts and drug-reform advocates. Together, they normalized the concept of harm reduction, such that, within a few years, needle exchanges would become officially sanctioned public-health interventions.
The alliance between these more radical gay rights advocates and harm-reduction proponents proved enduring. Drug addiction remained linked to HIV, and both groups shared a deep hostility to the police, capitalism, and society’s “moralizing” forces.
In the 1990s, harm-reduction proponents imitated the LGBTQ community’s advocacy tactics. They realized that addicts would have greater political capital if they were considered a persecuted minority group, which could legitimize their demands for extensive accommodations and legal protections under human rights laws. Harm reductionists thus argued that addiction was a kind of disability, and that, like the disabled, active users were victims of social exclusion who should be given a leading role in crafting drug policy.
These arguments were not entirely specious. Addiction can reasonably be considered a mental and physical disability because illicit drugs hijack users’ brains and bodies. But being disabled doesn’t necessarily mean that one is part of a persecuted group, much less that one should be given control over public policy.
More fundamentally, advocates were wrong to argue that the stigma associated with drug addiction was senseless persecution. In fact, it was a reasonable response to anti-social behavior. Drug addiction severely impairs a person’s judgement, often making him a threat to himself and others. Someone who is constantly high and must rob others to fuel his habit is a self-evident danger to society.
Despite these obvious pitfalls, portraying drug addicts as a persecuted minority group became increasingly popular in the 2000s, thanks to several North American AIDS organizations that pivoted to addiction work after the HIV epidemic subsided.
In 2005, the Canadian HIV/AIDS Legal Network published a report titled “Nothing about us without us.” (The nonprofit joined other groups in publishing an international version in 2008.) The 2005 report included a “manifesto” written by Canadian drug users, who complained that they were “among the most vilified and demonized groups in society” and demanded that policymakers respect their “expertise and professionalism in addressing drug use.”
The international report argued that addiction qualified as a disability under international human rights treaties, and called on governments to “enact anti-discrimination or protective laws to reduce human rights violations based on dependence to drugs.” It further advised that drug users be heavily involved in addiction-related policy and decision-making bodies; that addict-led organizations be established and amply funded; and that “community-based organizations . . . increase involvement of people who use drugs at all levels of the organization.”
While the international report suggested that addicts could serve as effective policymakers, it also presented them as incapable of basic professionalism. In a list of “do’s and don’ts,” the authors counseled potential employers to pay addicts in cash and not to pass judgment if the money were spent on drugs. They also encouraged policymakers to hold meetings “in a low-key setting or in a setting where users already hang out,” and to avoid scheduling meetings at “9 a.m., or on welfare cheque issue day.” In cases where addicts must travel for policy-related work, the report recommended policymakers provide “access to sterile injecting equipment” and “advice from a local person who uses drugs.”
The international report further asserted that if an organization’s employees—even those who are former drug users—were bothered by the presence of addicts, then management should refer those employees to counselling at the organization’s expense. “Under no circumstances should [drug addicts] be reprimanded, singled out or made to feel responsible in any way for the triggering responses of others,” stressed the authors.
Reflecting the document’s general hostility to recovery, the international report emphasized that former drug addicts “can never replace involvement of active users” in public policy work, because people in recovery “may be somewhat disconnected from the community they seek to represent, may have other priorities than active users, may sometimes even have different and conflicting agenda, and may find it difficult to be around people who currently use drugs.”
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The messaging in these reports proved highly influential throughout the 2000s and 2010s. In Canada, federal and provincial human rights legislation expanded to protect active addicts on the basis of disability. Reformers in the United States mirrored Canadian activists’ appeals to addicts’ “lived experience,” albeit with less success. For now, American anti-discrimination protections only extend to people who have a history of addiction but who are not actively using drugs.
The harm reduction movement reached its zenith in the early 2020s, after the Covid-19 pandemic swept the world and instigated a global spike in addiction. During this period, North American drug-reform activists again promoted the importance of treating addicts like public-health experts.
Canada was at the forefront of this push. For example, the Canadian Association of People Who Use Drugs released its “Hear Us, See Us, Respect Us” report in 2021, which recommended that organizations “deliberately choose to normalize the culture of drug use” and pay addicts $25-50 per hour. The authors stressed that employers should pay addicts “under the table” in cash to avoid jeopardizing access to government benefits.
These ideas had a profound impact on Canadian drug policy. Throughout the country, public health officials pushed for radical pro-drug experiments, including giving away free heroin-strength opioids without supervision, simply because addicts told researchers that doing so would be helpful. In 2024, British Columbia’s top doctor even called for the legalization of all illicit drugs (“non-medical safer supply”) primarily on the basis of addict testimonials, with almost no other supporting evidence.
For Canadian policymakers, deferring to the “lived experiences” and “leadership” of drug users meant giving addicts almost everything they asked for. The results were predictably disastrous: crime, public disorder, overdoses, and program fraud skyrocketed. Things have been less dire in the United States, where the harm reduction movement is much weaker. But Americans should be vigilant and ensure that this ideology does not flower in their own backyard.
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