A Defense of Harm Reduction - Canada is (Not) Dying

Aaron Gunn, a filmmaker and social commentator, has recently gained attention with his Youtube documentary titled "Canada Is Dying." Known for producing videos geared towards a conservative base, he has also released content on subjects like "The End of Free Speech in Canada" and "Did China Steal the 2021 Election." His latest documentary takes aim at arguing against harm reduction, a viewpoint not uncommon among conservative social commentators.

With over 1.3 million views in just three months, Gunn's video has sparked considerable interest, prompting a need for review and critique. The documentary levies numerous accusations, many of which appear baseless, questioning the efficacy of harm reduction practices. For this blog, the focus will be on the portion of the video past the 24:15 mark. A separate blog will be necessary to delve into Gunn's perspectives on Bill C-5, C-75, and his claims regarding Canada's revolving door of justice. Given the multitude of bad faith and strawman arguments, it is not feasible to address every statement raised in the video. However, approximately 15 statements have been chosen for examination.

While many of Gunn's questions lack rhetorical coherence and are weak in substance, I have conducted some basic research to provide evidence and data that debunk his arguments. Nevertheless, it remains essential to conduct more studies in Canada to ensure our policies align with evidence-based practices. Admittedly, Canada is not flawless in its approach to safe supply and harm reduction, and experts acknowledge the need for improvement in certain areas. However, Gunn's proposal for a punitive stance and distancing from harm reduction is viewed as dangerous, costly, and counterproductive across almost every metric.

1. Drug usage is increasing due to decriminalization.

This is a generalization. While drug use may cause a temporary increase, it is essential to note that countries adopting less harsh measures have not necessarily experienced significant increases. Such an assertion could also be considered a false cause equivalency. Decriminalization might potentially contribute to changes in drug use patterns, but it is equally crucial to consider other influential factors, such as economic and social elements. Many of the observed increases in drug usage can be more strongly associated with other factors, particularly environmental influences during adolescence and the influence of socioeconomic status. This isn't to dismiss the role of decriminalization in shaping cultural norms and attitudes, but claiming it as the primary reason for the opioid epidemic is a faulty correlation.

Furthermore, the phrase stating that drug usage is increasing employs morally loaded language. It implies a direct link between decriminalization and a rise in drug usage, carrying possible moral implications and judgments. The use of the term "increasing" implies that higher drug usage is inherently negative. However, this argument fails to consider the fundamental principle of harm reduction. Even if we were to accept that drug rates have increased, the focus should be on analyzing overdose and recovery rates. What remains evident is that the criminalization of drugs has led to far worse outcomes concerning economic, social, and human impacts. Therefore, a broader perspective is necessary when evaluating the effects of drug decriminalization.

2. Decriminalization is insulting to people who have recovered via abstinence.

Feelings should not dictate health policies; decisions should be based on evidence, research, and expert analysis. Harm reduction, a method with a proven track record of success, aims to assist addicts while simultaneously reducing mortality rates. It is important to note that harm reduction is not solely limited to drugs; it extends to other areas like sexual activity, where it helps reduce teen pregnancy and sexually transmitted diseases.

When evaluating the effectiveness of harm reduction strategies, it is crucial to consider survivorship bias. Not every individual who achieves sobriety does so through abstinence; recovery is a complex and varied journey that requires contextual understanding. While a safe supply of drugs may exist, it may not be the recommended pathway to recovery for every addict.

In essence, health policies must be based on empirical data and a comprehensive understanding of various approaches. Harm reduction serves as a valuable tool to aid those struggling with addiction while working towards lowering mortality rates, but it is just one piece of the puzzle. Recognizing the diverse nature of recovery and considering individual circumstances is essential in crafting effective and compassionate health policies.

3. Public drinking can lead to charges, yet using hard drugs might not. Unfairness is evident.

This complaint raises a valid point about how alcohol consumption is treated by law enforcement in public spaces. However, note that advocates of drug decriminalization do not necessarily argue for criminalizing public drinking. Instead, they advocate for a harm reduction approach that can be applied to alcohol as well. Currently, harm reduction practices are already in place for alcohol consumption in establishments such as restaurants.

Proponents of drug decriminalization are requesting a similar approach for individuals who use hard drugs. The ideal scenario would involve the consumption of hard drugs taking place within controlled environments where potential risks can be minimized and harm reduction strategies can be implemented.

Drawing a direct comparison between the punishment for alcohol and hard drugs is not an effective argument. The distinction arises from the different risks and societal impacts associated with these substances. Public drinking regulations often aim to address public disturbances and safety concerns related to alcohol, while drug decriminalization seeks to address the underlying public health issues and provide support and treatment for individuals struggling with drug addiction.

In summary, while acknowledging the issue of how alcohol consumption is treated in public, it is important to recognize that proponents of drug decriminalization advocate for a harm reduction approach that can be extended to alcohol as well. Comparing the punishment for alcohol and hard drugs oversimplifies the complex issues involved and fails to consider the distinct risks and objectives associated with these substances.

4. Decriminalization attempts to diminish stigma, although drug users often remain unaffected by it, a success that has been observed in the case of tobacco.

While shame may have an impact on some individuals, it is generally not an effective way to bring about lasting behavioral change. From an outsider's perspective, it may appear that drug users have given up on their appearance and solely focus on obtaining their next fix. However, stigma significantly influences their willingness to seek help. Moreover, stigma not only affects drug users but also creates a harmful cycle of vilifying individuals who continue using drugs, further hindering efforts to provide support.

Using shame as a tool has also shown limited effectiveness in addressing other substance use issues, such as smoking and less potent drugs. Instilling shame and stigma has not been proven to be a successful strategy in promoting lasting change.  Even in the context of smoking, the stigma surrounding it has led to more quit attempts but has not been very successful in promoting successful quitting. Moreover, this stigma has had a counterproductive effect by making smokers more hesitant to seek help. Therefore, it is evident that stigma hasn't been beneficial even in the context of tobacco use.

5. Harm reduction is like throwing in a life preserver but leaving addicts in a river.

Indeed, you are correct. Simply providing a safe environment for drug use is just one aspect of the solution. It requires a comprehensive, multi-pronged approach that includes providing safe housing, access to basic needs, and easily accessible healthcare. Dismissing harm reduction because it does not completely solve addiction oversimplifies the issue.

6. Shame and stigma helps people seek treatment.

While it is true that stigma and shame may prompt some individuals to seek help, it is crucial to recognize that criminalizing hard drugs can have the opposite effect, discouraging individuals from reaching out for the support they need. Stigmatizing drug use leads to delayed treatment, which can worsen health outcomes and hinder recovery.

Stigma not only deters individuals from seeking help but also cuts off their support networks. The fear of judgment and discrimination isolates individuals, making it difficult for them to access the necessary support and understanding from friends, family, and the community. This lack of support perpetuates harmful behaviors and impedes recovery.

Moreover, the notion of using criminalization as an ultimatum to force people into rehab lacks evidence to support its effectiveness. Instead of addressing the root causes of addiction and providing comprehensive treatment options, punitive approaches can further marginalize individuals and create barriers to seeking help. A more compassionate and evidence-based approach is needed to ensure individuals receive the necessary support and treatment.

In summary, while stigma and shame may prompt some individuals to seek treatment, the broader consequences of criminalization and stigma outweigh the potential benefits. By adopting a more supportive and non-punitive approach, we can reduce stigma, encourage early intervention, and provide the necessary resources for individuals to address their addiction and achieve better health outcomes.

7. Hydromorphone is addictive. 

It’s a pharmaceutical grade opioid that has a shorter duration to other opioids like methadone so it allows for more frequent dosing and closer monitoring in a safe consumption site setting. The pharmacological properties also make it a suitable choice for supervised administration and overdose prevention. Hydropmorphone is also already approved for medical use in various countries. It has also been effective in studies for being a substitute that helps improve outcomes.

No one is denying the addictive nature of these substances; that argument is not being made. In our society, individuals have the autonomy and freedom to make their own choices. Addressing addiction prevention is a complex policy issue that cannot be solved solely by banning a substance. Simply prohibiting a drug does not effectively resolve drug addiction.

8. Nothing about hydromorphone is safe.

The term "safe supply" refers to a harm reduction approach that offers a safer alternative to using dirty needles and contaminated drugs. It is not merely an appeal to emotions but a practical strategy aimed at addressing the risks associated with opiates. Advocates of harm reduction do not downplay the dangers of opiates; rather, they are focused on reducing the spread of diseases and preventing overdoses.

Once again, this statement carries a moral undertone, which might obscure the true essence of harm reduction. Hydromorphone primarily serves as withdrawal management due to fentanyl's potent nature. In Canada, the usage of hydromorphone tablets has successfully reduced fentanyl consumption, providing a safer alternative. It's essential to clarify that no one argues hydromorphone is entirely safe, but rather, it is considered a safer option compared to fentanyl, with lower risks of contamination when supplied by a pharmacist.

9. Pharmacies are pushed by big pharma to sell more opiates.

This criticism of big pharma can indeed be addressed by implementing stricter regulations on conflict of interest. However, it is essential to recognize that this critique is not specifically targeted at harm reduction alone. The influence of big pharma extends far beyond the issue of opiates and encompasses almost every other medication. While it is true that big pharma has been negligent in promoting opioids for pain management, this argument lacks a solid foundation when applied to hydromorphone tablets sought by drug addicts. The contexts and purposes for these medications are significantly different.

Additionally, there is no incentive for the government to overspend taxpayer money on safe supply without valid reasons. Unless concrete evidence of a conflict of interest with big pharma exists, this claim may be nothing more than a baseless conspiracy aimed at fostering further distrust within our institutions. The most appropriate solution lies in the implementation of stricter regulations, not in discarding an evidence-based practice altogether. By focusing on enhancing oversight and transparency, we can foster a more trustworthy and effective approach to harm reduction.

10. Hydromorphone increases the usage of fentanyl because users are selling it to buy fentanyl. 

The fact that some individuals may sell their provided hydromorphone to obtain fentanyl does not invalidate the broader harm reduction approach. Instead, it indicates the importance of continually improving and tailoring harm reduction strategies to address such challenges. The purchase of fentanyl would still occur even without a safe supply of drugs. In the absence of a regulated and supervised approach, individuals struggling with addiction may resort to engaging in criminal activities and theft to obtain the necessary funds for their drug use.

11. Young people are buying hydromorphone. This means that harm reduction is creating more addicts. 

Harm reduction advocates recognize that the concern of young people purchasing hydromorphone is valid. However, it is essential to note that there is no data supporting the notion that safe supply has significantly increased drug usage among youth. In fact, harm reduction also benefits youth struggling with opioid addiction. This approach is not limited to adults but extends its positive impact to younger demographics as well.

Advocates and young people from Vancouver to Lisbon have united in urging for improved systems, including harm reduction measures. It is crucial to understand that this concern is not an inherent flaw of harm reduction itself. Similar challenges exist with alcohol and other illicit drugs that teenagers may already have access to.

Historically, outright bans on substances have proven ineffective in reducing access, as young people often find alternative means to obtain what they desire. Instead of pursuing prohibitive measures, harm reduction offers a more pragmatic and evidence-based approach to address these complex issues. By fostering a comprehensive harm reduction strategy, we can better support young people and work towards more effective solutions for drug-related challenges.

The solution lies in increasing education and awareness among young people, empowering them to make informed choices and understand the risks associated with substance use. By providing accurate information about the dangers of drugs and offering support systems, harm reduction initiatives can help mitigate the risks and encourage responsible decision-making.

It's important to note that the increased drug usage among young people is a complex issue influenced by various environmental factors. Simply attributing it to harm reduction programs oversimplifies the situation. It is more accurate to view the correlation between harm reduction efforts and increased drug usage as a reflection of the broader societal context and multiple factors at play.

To effectively address the issue, it is necessary to implement comprehensive prevention strategies, including evidence-based education, accessible mental health services, supportive social environments, and community engagement. By addressing these underlying factors, we can create a more holistic approach to tackling substance abuse among young people and promote healthier choices.

Rather than dismissing harm reduction outright, it is crucial to recognize its potential benefits in reducing overall harm, preventing overdose deaths, and providing avenues for individuals to access necessary support and treatment. By combining harm reduction with targeted prevention efforts, we can work towards a more comprehensive approach that addresses the complex factors contributing to youth drug usage.

12. Harm reduction is a bad strategy because big pharma has used deceptive tactics to hook patients on addictive oxycontin. How is BC’s supply any safer if they’re using drugs from the same companies responsible for the opioid crisis?

The assertion that harm reduction is ineffective due to deceptive tactics used by big pharma in promoting addictive substances like OxyContin is a non-sequitur. While it is true that big pharma's unethical practices are concerning, it does not negate the benefits of harm reduction strategies. Instead, it calls for increased regulation and changes in the supply chain to mitigate these risks.

One potential solution is for the state to take a more active role in producing opiates, reducing the profit incentive for big pharma and ensuring a safer and regulated supply. By implementing stricter regulations, robust oversight, and accountability measures, we can work towards a system that prioritizes public health and safety over corporate interests.

13. Receiving a safe supply of a drug is the same thing as a doctor prescribing powerful opiates as painkillers.

The assertion that receiving a safe supply of drugs is equivalent to a doctor prescribing powerful opiates as painkillers is a false equivalence. Deceptive prescription practices employed by certain pharmaceutical companies to address patients' pain cannot be equated with harm reduction efforts aimed at providing a safe supply of drugs to individuals struggling with addiction.

Advocates of harm reduction recognize and acknowledge the harmful impact that big pharma has had on society. However, the goal of harm reduction is to minimize the immediate risks associated with drug use, such as overdose and the spread of diseases, while also providing individuals with access to support and treatment.

It is crucial to distinguish between medical prescription practices and harm reduction strategies. Prescription of powerful opiates for pain management is a complex issue that requires careful consideration of patients' needs and the potential for addiction. On the other hand, harm reduction programs prioritize harm reduction as a public health approach, aiming to mitigate the risks associated with illicit drug use and provide a safer environment for individuals.

Rather than drawing false equivalences, it is more productive to address the issues surrounding deceptive prescription practices separately while continuing to advocate for harm reduction strategies that focus on saving lives, reducing harm, and connecting individuals with the support they need to overcome addiction.

14. More people have died from legally prescribe opioids than illegal ones.

There is a false equivalence being made between legally prescribed opioids for pain management and harm reduction strategies. While it is true that a significant number of people have lost their lives due to the misuse or overuse of legally prescribed opioids, one must understand that harm reduction strategies and the provision of a safe supply of drugs target a different population and serve a distinct purpose.

Legally prescribed opioids are intended for medical use and are regulated by healthcare professionals to manage specific health conditions. The challenges surrounding the misuse of prescribed opioids highlight the need for improved prescribing practices, education, and comprehensive healthcare approaches.

On the other hand, harm reduction strategies aim to address the immediate risks faced by individuals who use illicit drugs. The provision of a safe supply, along with other harm reduction measures, seeks to reduce harm, prevent overdose deaths, and promote the overall well-being of individuals struggling with addiction.

It is crucial to separate the two contexts and recognize that harm reduction strategies are not responsible for the misuse or abuse of legally prescribed opioids. Instead, they offer an alternative approach to minimize the harms associated with illicit drug use and support individuals in accessing necessary care and treatment.

By addressing the root causes of the opioid crisis, implementing evidence-based prescribing guidelines, and promoting harm reduction alongside comprehensive healthcare strategies, we can work towards effectively addressing both the legitimate medical needs for pain management and the harms associated with illicit drug use

15. The “Alberta Model” of arresting drug addicts and forcing them into jail or rehab is similar to Portugal’s model.

That's incorrect. Portugal's approach of decriminalizing drug use is not the same system being pursued in Alberta. Also, characterizing harm reduction policies in BC as openly encouraging drug use is a strawman argument and a misrepresentation of the objectives of harm reduction.

It's important to note that the United Conservative Party (UCP) in Alberta has not expressed any plans to decriminalize drugs or adopt a model similar to Portugal's. In fact, their approach has been in the opposite direction, focusing on increased arrests and placing additional strain on the prison system, which raises ethical concerns.

Portugal's model is known for its emphasis on treating drug addiction as a public health issue rather than a criminal one. It involves decriminalizing the possession and use of drugs while redirecting individuals towards treatment, rehabilitation, and harm reduction services. The goal is to reduce harm, promote health and social integration, and improve overall well-being.

Drawing a parallel between the Alberta Model and Portugal's model is inaccurate and misleading. The principles and objectives of harm reduction differ significantly from an approach that relies primarily on arrest and incarceration. It is essential to understand the distinctions between these models and to consider evidence-based approaches that prioritize public health and the well-being of individuals struggling with addiction.

Common Sense Isn't Always Right

Gunn's proposed solution of discarding harm reduction practices, instead of seeking answers to prevent the diversion of safe supply drugs and enhancing oversight of big pharma, is both nonsensical and harmful. This stance is hardly surprising, given the conservative track record on drug addiction and the subpar health outcomes in conservative countries and states. Even among professionals who oppose safe supply, their viewpoints vary, and yet many still endorse the principles of harm reduction.

For individuals against safe supply, the concept of harm reduction might seem counterintuitive, which is entirely understandable as it doesn't align with common sensibilities. This appears to be the crux of the issue. Gunn's recurring approach to his political solutions is to champion the return of "common sense." However, when dealing with intricate matters, common sense often falls short in providing comprehensive solutions.

The Alberta Model

It's crucial to clarify that advocating for a complete withdrawal of funding from policing, as Gunn frequently frames it, is not the responsible approach. The nature of these systems necessitates gradual and measured changes. Nevertheless, the suggestion put forth by Gunn and his supporters to allocate more funding to policing in order to address a health crisis is an ill-informed notion that has proven ineffective in practice. 

The implementation of the Alberta model by the UCP has encountered challenges, with a noticeable increase in drug overdoses, in contrast to the decline seen in BC. The UCP's propensity for pursuing ideological battles and their contrarian approach to various issues are having real consequences, even at the cost of lives.