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Addictions

A conversation with Premier Smith’s outgoing chief of staff, architect of Alberta’s recovery-focused drug policies

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2 months ago

11 minute read

Marshall Smith, Alberta’s Chief of Staff, sits in his office at the Alberta Legislature in Edmonton

By Alexandra Keeler

Marshall Smith, on what he has learned as an addict and policy leader and what’s next for him

Alberta Premier Danielle Smith’s chief of staff, Marshall Smith, is leaving his post at the end of October.

Since taking office in 2022, he has been instrumental in shaping Alberta’s drug policies and developing the Alberta Model — a recovery-focused addiction treatment policy that has gained international recognition for enhancing access to mental health and addiction services.

Under his guidance, Alberta has prioritized building recovery communities over harm-reduction programs. Government data show a 53 per cent decrease in opioid-related overdose deaths in June 2024 from the prior year, which may suggest Smith’s initiatives are having an impact.

In a statement on social media, the Premier shared that Smith informed her of his decision to retire earlier this year, after dedicating 32 years to public service. His departure comes just ahead of the United Conservative Party’s leadership review on Nov. 2.

Smith met with reporter Alexandra Keeler on Sept. 10 to discuss his personal journey from addiction to recovery and how it has shaped Alberta’s drug policies. On Oct. 10, they spoke by phone to discuss his recent decision to step down and what lies ahead for him.

AK: What emotional and psychological impact did your addiction have on your sense of self?

MS: It makes you feel powerless. Addiction is an illness of isolation, despair, loneliness and powerlessness. One of the hallmarks of addiction is continuing to use a substance despite a complete lack of control over your using, and over the circumstances that you’re in.

AK: Do you think that sense of powerlessness impacts an individual’s ability to provide informed consent for involuntary treatment?

MS: I think that, over time, if addiction is left unchecked or untreated, or is allowed to progress to its very latter stages, you absolutely lose agency over your ability to make decisions.

I used to get the question a lot: ‘Is it a disease? Is it a choice?’ And I say it’s both. It’s actually a disease of choices, which is to say that it’s a disease or an illness that affects my brain’s ability to make good choices.

AK: Were you the driving force behind Alberta’s shift away from harm reduction towards a recovery-focused approach, or was there a broader change in attitudes within the community?

MS: Certainly I’m not solely responsible. I’m a member of a broad community of people in recovery who have been advocating for these policies for two decades. I think that I have a background [and] certain skills that have found me in positions like this, where I can be most effective helping my community advance these ideas and concepts and actually get them implemented into policy and action.

AK: Obviously your lived experience with addiction brings a valuable perspective to the table. But what data sources are the province using to inform its addiction and recovery policies?

MS: We have a very broad literature base that we use to inform a lot of our policy decisions … Alberta [also] has the most comprehensive data collection and data analytics system in North America, bar none.

A practical example of how that’s useful is … [if] the data shows us that a very high number of people who were in custody — whether that’s corrections or police custody — went on to fatally overdose in a period after their release, that tells us that we need to focus on correctional programs, and we need to focus on policing programs.

And we’ve done that. We have amazing new correctional treatment programs that are second to none. I don’t know of anybody in Canada that’s doing this — we’ve taken [jail units where inmates sleep and live] and turned them into treatment centres, and connected them with our new treatment centres outside of jails. We partnered with police, because police have probably the most amount of contact with people who are using substances, and we gave them the ability to help people get on to opioid-substitution medications.

We’re going to go even further. Minister [of Mental Health and Addiction Dan] Williams has just announced the creation of the Centre of Recovery Excellence (CoRE), which is a first of its kind in Canada. It’s a Crown corporation not beholden to pharmaceutical money, which is a big change for us, and we were very deliberate about that.

[CoRE] will give us the ability to pull in data from across systems in government and have that data analyzed … So we’re entering into a very exciting time in terms of data and analytics around this issue.

AK: Without CoRE fully operational yet, what made you confident the recovery-focused approach would succeed?

MS: I see hundreds of thousands of Canadians every day entering recovery and maintaining their recovery … What I see in the alternative is a lot of drug use, homelessness, despair, disease [and] crime.

We spend a lot of time talking about data and evidence and science, and all of those things are good and necessary … but it’s not the only component of the decision-making process. … The policies that we’re making and the pathways that we take also have to be informed by the values of the community that we serve. … For far too long in Canada, that hasn’t been a consideration.

I think that we are at a place in Canada where the country is saying to us it’s time to revisit the direction that we’ve been going. I think that they’re saying to us, as policymakers, that we gave this a chance. We had become convinced by experts and the media … to give [pro-drug, harm-reduction policies like safer supply] a try …

[A]fter 20 years of that, I think that Canadians are ready to throw in the towel and to say, ‘We’re done with this. We’ve given you enough time to prove out your thesis. It’s not worked, and now we’re looking for fresh ideas.’

So Alberta is here leading that conversation of fresh and different ideas, and we’re happy to have that role.

The remainder of this interview took place on Oct. 10.

AK: Premier Smith announced your retirement at the end of October. What prompted your decision to step down?

MS: My time in Alberta has been a lengthy and intense role of system transformation over two premiers and standing up government twice.

While there’s still a lot of work to be done here, we have a tremendous team in Alberta that is leading that work under Minister Williams. I just felt that it’s time for me to step out of the role and continue to serve in other capacities.

AK: Looking ahead, what aspects of the Alberta Model will you carry with you into your future endeavours?

MS: I would say all aspects of the model need to be expanded across Canada, for jurisdictions that are interested.

Where I can be of the most assistance to other governments is talking to them about how to effectively organize themselves to be successful in this area. I think that governments across the country are struggling to figure out how to do that.

AK: What new opportunities do you hope to pursue that you haven’t been able to explore during your time in this role? Will your focus continue to be in addiction and drug policy?

MS: The majority of my focus will be on addiction and drug policy, but I have other areas of interest.

I’m passionate about the work that we’re doing with Indigenous people … I’m also very passionate about emerging technology and how we’re going to use that to uncover some of the answers that we’re looking for on these models.

I’m looking forward to having a little bit more freedom and focus.

This interview has been edited and condensed for clarity.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

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Addictions

London Police Chief warns parliament about “safer supply” diversion

Published on December 7, 2024

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London Police Chief Thai Truong testifies to House of Commons Standing Committee on November 26, 2024.

By Adam Zivo

“Vulnerable individuals are being targeted by criminals who exchange these prescriptions for fentanyl, exacerbating addiction and community harm,” said London Police Chief Thai Truong.

Thai Truong, the police chief of London, Ontario, testified in parliament last week that “safer supply” opioids are “obviously” being widely diverted to the black market, leading to greater profits for organized crime. His insights further illustrate that the safer supply diversion crisis is not disinformation, as many harm reduction advocates have speciously claimed.

Truong’s testimony was given to the House of Commons Standing Committee on Health, which is in the midst of an extended study into the opioid crisis. While the committee has heard from dozens of witnesses, Truong’s participation was particularly notable, as safer supply was first piloted in London in 2016 and the city has, since then, been a hotbed for opioid diversion.

“While the program is well intentioned, we are seeing concerning outcomes related to the diversion of safe supply medications… these diverted drugs are being resold within our community, trafficked to other jurisdictions, and even used as currency to obtain fentanyl, perpetuating the illegal drug trade,” he said in his opening speech. “Vulnerable individuals are being targeted by criminals who exchange these prescriptions for fentanyl, exacerbating addiction and community harm.”

He later clarified to committee members that these vulnerable individuals include women who are being pressured to obtain safer supply opioids for black market resale.

Safer supply programs are supposed to provide pharmaceutical-grade addictive drugs – mostly 8-mg tablets of hydromorphone, an opioid as potent as heroin – as an alternative to riskier street substances. The programs generally supply these drugs at no cost to recipients, with almost no supervised consumption, and have a strong preference for Dilaudid, a brand of hydromorphone that is manufactured by Purdue Pharma.

Addiction experts and police leaders across Canada have reported that safer supply patients regularly divert their hydromorphone to the black market. A recent study by Dr. Brian Conway, director of Vancouver’s Infectious Disease Centre, for example, showed that a quarter of his safer supply patients diverted all of their hydromorphone, and that another large, but unknown, percentage diverted at least some of their pills.

Truong’s parliamentary testimony, which mostly rehashed information he shared in a press conference last July, further corroborated these concerns.

He noted that in 2019, the city’s police force seized 847 hydromorphone pills, of which only 75 were 8-mg Dilaudids. Seizures increased after access to safer supply expanded in 2020, and, by 2023, exploded to over 30,000 pills (a roughly 3,500 per cent increase), of which roughly half were 8-mg Dilaudids. During this period, the number of annual overdose deaths in the city also increased from 73 to 123 (a 68 per cent increase), he said.

Relatedly, Truong noted that the price of hydromorphone in London – $2-5 a pill – is now much lower than in other parts of the province.

As an increasing number of police departments across Canada have publicly acknowledged that they are seeing skyrocketing hydromorphone seizures, some safer supply advocates have claimed, without evidence, that these pills were mostly stolen from pharmacies, and not diverted by safer supply patients. Truong’s parliamentary testimony dispelled this myth: “These increases cannot be attributed to pharmacy thefts, as London has had only one pharmacy robbery since 2019.”

The police chief declined to answer repeated questions about the efficacy of safer supply, or to opine on whether the experimental program should be replaced with alternative interventions with stronger evidence bases. “I’m not here to criticize the safe supply program, but to address the serious challenges associated with its diversion,” he said, noting his own lack of medical expertise.

The chief emphasized that, while more needs to be done to stop safer supply diversion, the addiction crisis is a “complex issue” that cannot be tackled solely through law enforcement. He advocated for a “holistic” approach that integrates prevention, harm reduction and treatment, and acknowledged the importance of London’s community health and social service partners.

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In response to Truong’s testimony, NDP MP Gord Johns, an avid safer supply advocate, downplayed the importance of the diversion crisis by arguing that “people aren’t dying from a safer supply of drugs; they’re dying from fentanyl.”

While it is true that 81 per cent of overdose deaths in 2024 involved fentanyl, addiction physicians across Canada have repeatedly debunked Johns’ argument as misleading. The dangers of diverted hydromorphone is not that it directly kills users, but rather that it easily hooks individuals into addiction, leading many of them to graduate to deadly fentanyl use.

Johns previously faced criticism when, in a September health committee meeting, he seemingly used parliamentary maneuvers to reduce the speaking time of a grieving father, Greg Sword, whose daughter, Kamilah, died of drug-related causes after she and her friends got hooked on diverted hydromorphone.

There is currently no credible evidence that safer supply works. Most supporting studies simply interview safer supply patients and present their opinions as objective fact, despite significant issues with bias and reliability. Data presented in a 2024 study published in the British Medical Journal, which followed over 5,000 drug users in B.C., showed that safer supply led to no statistically significant mortality reductions once confounding factors were fully filtered out.

An impending update to Canada’s National Opioid Use Disorder Guideline, which was recently presented at a conference  organized by the Canadian Society of Addiction Medicine, determined that the evidence base for safer supply is “essentially low-level.” Similarly, B.C’s top doctor acknowledged earlier this year that safer supply is “not fully evidence-based.”

This article was syndicated in The Bureau, an online media publication that investigates foreign interference, organized crime, and the drug trade.

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Addictions

Parliament votes for proposal recommending hard drug decriminalization

Published on November 25, 2024

By

From LifeSiteNews

By Clare Marie Merkowsky

Canadian MPs have voted 210 to 117 in favor of a proposal to decriminalize simple possession of heroin, cocaine and all other illegal drugs across Canada despite the disastrous effects of lax drug policies already observed.

Canada may be one step closer to decriminalizing hard drugs as the majority of MPs voted in favor of a proposal recommending the move.

According to information published November 25 by Blacklock’s Reporter, MPs voted 210 to 117 in favor of a proposal recommending the decriminalizing of the simple possession of heroin, cocaine and all other illegal drugs across Canada. While the proposal is non-binding, it could point to how MPs would vote on a future bill seeking to augment the law.

“Why has it come to this?” Conservative MP Jacques Gourde, who opposes such a move, questioned. “We have reached the end of the road and nothing better lies ahead if we continue down this path.”  

The recommendation, which received a House majority with only Conservative MPs voting against it, suggested “that the Government of Canada decriminalize simple possess of all illicit drugs.”  

Prime Minister Justin Trudeau’s cabinet was noncommittal in their response to the suggestion, saying, “The government recognizes there are increasing calls from a wide range of stakeholders to decriminalize the simple possession of drugs as another tool to reduce stigma that can lead many to hide their drug use and avoid seeking supports including treatment.” 

“The government is exploring policy approaches and a broader framework that would ease the impact of criminal prohibitions in certain circumstances,” the Cabinet continued. 

The Trudeau government’s consideration of nationwide decriminalization comes despite drug-related deaths skyrocketing in the province of British Columbia after decriminalization was implemented there by the Trudeau government in 2023. In fact, the policy was considered so damaging by the left-wing controlled province that it had to ask to have certain aspects of the policy, such as the public use of drugs, rescinded earlier this year.

Other soft-on-drug policies have already been implemented by the Trudeau government, including the much-maligned “safer supply” program.

“Safe supply” is the term used to refer to government-prescribed drugs given to addicts under the assumption that a more controlled batch of narcotics reduces the risk of overdose. Critics of the policy argue that giving addicts drugs only enables their behavior, puts the public at risk, disincentivizes recovery from addiction and has not reduced – and sometimes even increased – overdose deaths when implemented.    

Gunn, who has since become a Conservative Party candidate, previously noted that his film shows clearly the “general societal chaos and explosion of drug use in every major Canadian city” since lax policies were implemented.  

“Overdose deaths are up 1,000 percent in the last 10 years,” he said in his film, adding that “every day in Vancouver four people are randomly attacked.”  

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