Addictions
A conversation with Premier Smith’s outgoing chief of staff, architect of Alberta’s recovery-focused drug policies
Marshall Smith, Alberta’s Chief of Staff, sits in his office at the Alberta Legislature in Edmonton
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
BC Addictions Expert Questions Ties Between Safer Supply Advocates and For-Profit Companies
By Liam Hunt
Canada’s safer supply programs are “selling people down the river,” says a leading medical expert in British Columbia. Dr. Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University, says that despite the thin evidence in support of these experimental programs, the BC government has aggressively expanded them—and retaliated against dissenting researchers.
Somers also, controversially, raises questions about doctors and former health officials who appear to have gravitated toward businesses involved in these programs. He notes that these connections warrant closer scrutiny to ensure public policies remain free from undue industry influence.
Safer supply programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from accessing riskier street substances. Yet, a growing number of doctors say these programs are deeply misguided—and widely defrauded.
Ultimately, Somers argues, safer supply is exacerbating the country’s addiction crisis.
Somers opposed safer supply at its inception and openly criticized its nationwide expansion in 2020. He believes these programs perpetuate drug use and societal disconnection and fail to encourage users to make the mental and social changes needed to beat addiction. Worse yet, the safer supply movement seems rife with double standards that devalue the lives of poorer drug users. While working professionals are provided generous supports that prioritize recovery, disadvantaged Canadians are given “ineffective yet profitable” interventions, such as safer supply, that “convey no expectation that stopping substance use or overcoming addiction is a desirable or important goal.”
To better understand addiction, Somers created the Inter-Ministry Evaluation Database (IMED) in 2004, which, for the first time in BC’s history, connected disparate information—i.e. hospitalizations, incarceration rates—about vulnerable populations.
Throughout its existence, health experts used IMED’s data to create dozens of research projects and papers. It allowed Somers to conduct a multi-million-dollar randomized control trial (the “Vancouver at Home” study) that showed that scattering vulnerable people into regular apartments throughout the city, rather than warehousing them in a few buildings, leads to better outcomes at no additional cost.
In early 2021, Somers presented recommendations drawn from his analysis of the IMED to several leading officials in the B.C. government. He says that these officials gave a frosty reception to his ideas, which prioritized employment, rehabilitation, and social integration over easy access to drugs. Shortly afterwards, the government ordered him to immediately and permanently delete the IMED’s ministerial data.
Somers describes the order as a “devastating act of retaliation” and says that losing access to the IMED effectively ended his career as a researcher. “My lab can no longer do the research we were doing,” he noted, adding that public funding now goes exclusively toward projects sympathetic to safer supply. The B.C. government has since denied that its order was politically motivated.
In early 2022, the government of Alberta commissioned a team of researchers, led by Somers, to investigate the evidence base behind safer supply. They found that there was no empirical proof that the experiment works, and that harm reduction researchers often advocated for safer supply within their studies even if their data did not support such recommendations.
Somers says that, after these findings were published, his team was subjected to a smear campaign that was partially organized by the British Columbia Centre on Substance Use (BCCSU), a powerful pro-safer supply research organization with close ties to the B.C. government. The BCCSU has been instrumental in the expansion of safer supply and has produced studies and protocols in support of it, sometimes at the behest of the provincial government.
Somers is also concerned about the connections between some of safer supply’s key proponents and for-profit drug companies.
He notes that the BCCSU’s founding executive director, Dr. Evan Wood, became Chief Medical Officer at Numinus Wellness, a publicly traded psychedelic company, in 2020. Similarly, Dr. Perry Kendall, who also served as a BCCSU executive director, went on to found Fair Price Pharma, a now-defunct for-profit company that specializes in providing pharmaceutical heroin to high-risk drug users, the following year.
While these connections are not necessarily unethical, they do raise important questions about whether there is enough industry regulation to minimize potential conflicts of interest, whether they be real or perceived.
The BCCSU was also recently criticized in an editorial by Canadian Affairs, which noted that the organization had received funding from companies such as Shoppers Drug Mart and Tilray (a cannabis company). The editorial argued that influential addiction research organizations should not receive drug industry funding and reported that Alberta founded its own counterpart to the BCCSU in August, known as the Canadian Centre of Recovery Excellence, which is legally prohibited from accepting such sponsorships.
Already, private interests are betting on the likely expansion of safer supply programs. For instance, Safe Supply Streaming Co., a publicly traded venture capital firm, has advertised to potential investors that B.C.’s safer supply system could create a multi-billion-dollar annual market.
Somers believes that Canada needs more transparency regarding how for-profit companies may be directly or indirectly influencing policy makers: “We need to know exactly, to the dollar, how much of [harm reduction researchers’] operating budget is flowing from industry sources.”
Editor’s note: This story is published in syndication with Break The Needle and Western Standard.
The Bureau is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Dr. Julian M. Somers is director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University. He was Director of the UBC Psychology Clinic, and past president of the BC Psychological Association. Liam Hunt is a contributing author to the Centre For Responsible Drug Policy in partnership with the Macdonald-Laurier Institute.
An Ottawa mother, who lost her daughter to addiction, is frustrated by Recovery Care’s failure to help her opioid-addicted son
Masha Krupp has already lost one child to an overdose and fears she could lose another.
In 2020, her 47-year-old daughter Larisa died from methadone toxicity just 12 days into an opioid addiction treatment program. The program is run by Recovery Care, an Ottawa-based harm reduction clinic with five locations across the city, which aims to stabilize drug users and eventually wean them off more potent drugs.
Krupp says she is skeptical about the effectiveness of the support and counseling services that Recovery Care claims to provide and believes the clinic was negligent in her daughter’s case.
On Oct. 22, the Ottawa mother testified before the House of Commons Standing Committee on Health, which is studying Canada’s opioid epidemic.
In her testimony, Krupp said her daughter was prescribed 30mg of methadone — 50 per cent more than the recommended induction dose — and was not given an opiate tolerance test before starting the program. Larisa received treatment at the Bells Corners Recovery Care location.
Krupp’s 30-year-old son, whom Canadian Affairs agreed not to name, has been a patient at Recovery Care’s ByWard Market location since 2021, where he receives a combination of methadone and hydromorphone, another prescription drug administered through the treatment program.
“Three years later, my son is still using fentanyl, crack cocaine and methadone, despite being with Dr. [Charles] Breau and with Recovery Care for over three years,” Krupp testified.
“About four weeks ago, I had to call 9-1-1 because he was overdosing,” Krupp told Canadian Affairs in an interview. “This is on the safer supply program … three years in, I should not be calling 9-1-1.”
Open diversion
Founded in 2018, Recovery Care is a partner in the Safer Supply Ottawa initiative. The initiative, which is led by Ottawa Public Health and managed by the nonprofit Pathways to Recovery, provides prescription pharmaceutical opioids to individuals who are at high risk of overdose.
Pathways to Recovery works with a network of service providers throughout the city — including Recovery Care — to administer safer supply.
Krupp says she supports the concept of safer supply, but believes it needs to be administered differently.
“You can’t give addicts 28 pills and say ‘Oh here you go,’” she said in her testimony. “They sell for three dollars a pop on the street,” she said, referring to the practice of some individuals selling their prescribed medications to fund purchases of more intense street drugs like heroin and fentanyl.
Krupp says she sees her son — and other patients of the program — openly divert their prescribed medications outside of the Recovery Care clinic in ByWard Market, where she parks to wait for him.
“[B]ecause there’s no treatment attached to [my son’s safer supply], it’s just the doctor gives him all these pills, he diverts them, gets the drugs he needs, and he’s still an addict,” Krupp said in her testimony.
Donna Sarrazin, chief executive of Recovery Care, told Canadian Affairs that Recovery Care has measures to address diversion, including security cameras and onsite security staff.
“Patients are educated at intake and ongoing that diversion is not permitted and that they could be removed from the program,” she said in an emailed statement.
“Recovery Care works to understand diversion and has continued to progress programs and actions to address the issues. Concerns expressed by the community and our teams are taken seriously,” she said.
Krupp says she has communicated her concerns about her son reselling his prescribed medications to his doctor, Dr. Charles Breau, both in-person and through faxed letters. “I never hear back from the doctor. Never,” she said.
Krupp also said in her testimony that police have spoken to her son about his diversion.
Breau did not respond to inquiries made to his clinical teams at Recovery Care or Montfort Hospital, a teaching hospital affiliated with the University of Ottawa.
Sarrazin said Breau is not able to comment on patient or family care.
In Krupp’s view, the safer supply program would be more successful if drug users were required to take prescribed medications under supervision.
“If he was receiving his hydromorphone under witnessed dosage and there was a treatment plan attached to it, I believe it would be successful,” she said.
Dr. Eileen de Villa, the City of Toronto’s medical officer of health, reinforced this point at the Oct. 22 Health Committee meeting. She said Toronto Public Health’s injectable opioid agonist therapy program — which combines observed administration with a treatment plan — has seen “incredible results.”
De Villa shared a case of a pregnant client who entered the program. “She went on to have a successful pregnancy, a healthy baby, has actually successfully completed the treatment, and is now housed and has even gained custody of her other children,” she said.
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‘An affront to me’
Krupp also says Recovery Care fails to deliver on its promise of supporting patients’ mental health needs. Recovery Care’s website says its clinics offer “mental health programs which are essential to every treatment plan.”
Krupp and her son’s father have both requested a clear treatment plan and consistent counselling for their son. But he was started on safer supply after participating in only one virtual counselling session, she says.
She says Recovery Care has only one mental health counselor who services four of Recovery Care’s clinics. “If you’re getting $2-million-plus a year in funding, you should be able to staff each clinic with one on-site counselor five days a week,” she said.
Instead of personalized assistance, her son received “a sheaf of photocopies” offering generic services like Narcotics Anonymous and crisis helplines. “It’s almost an affront to me, as a taxpayer and a mother of an addict,” Krupp said.
Krupp says that, following her testimony to the parliamentary committee, Breau reached out to offer her son a mental health counseling session for the first time.
Sarrazin told Canadian Affairs that patients are encouraged to request counseling at any time. “Currently there is no wait list and appointments can be booked within 1 week,” she said in her emailed statement.
Class actions
Today, Krupp is considering launching a class-action lawsuit against Health Canada and the Government of Canada, challenging both the enactment of safer supply and the loosening of methadone dispensing requirements in 2017. She believes these changes contributed to her daughter’s death in 2020.
She is also considering joining an existing class-action lawsuit in B.C., which alleges Health Canada failed to monitor the distribution of drugs provided through safer supply programs.
The Pathways to Recovery initiative received $9.69-million in funding from Health Canada from July 2020 to March 2025. In June 2023, Health Canada allocated an additional $1.9 million to expand Ottawa’s safer supply program across five sites and improve access to practitioners, mental health support, housing and other services.
“I want to see that money being put to a recovery based treatment, not simply people going in and out and getting their medications and just creating this new sub-layer of addicts,” Krupp said.
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.
Subscribe for free to get BTN’s latest news and analysis, or donate to our journalism fund.
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