If I Were Minister of Health: Best Advice for Addressing Substance Use and Addiction

Editor:  This story has been edited to clarify Mr. Garner’s remarks that poverty and substance use should not be linked.  Also, quotes attributed to Mr. Garner originally used the term ‘abuse’ which should have been ‘use’. We apologize for the error.

Canada has a new minister of health, Patty Hajdu, who says that the ongoing opioid crisis is one of her top priorities. Sixth Estate’s Spotlight series, in conjunction with the Canadian Centre on Substance Use and Addiction (CCSA)’s 2019 conference, assembled a panel of public health, enforcement, youth and Indigenous experts and stakeholders to hear the top recommendations for the minister when it comes to how best to address substance use and addiction.

Host David Akin, chief political correspondent for Global News, noted the importance of using language that avoids stigma as part of the discussion.

Ian Culbert, executive director of the Canadian Public Health Association, noted that Health Canada has little ability to directly influence issues because healthcare delivery is a provincial and territorial jurisdiction, but did note that they do have certain levers, some of which are related to funding.

“We need to take a whole-of-government approach to this,” said Culbert. “Problematic substance use is really complicated, and it requires a lot of different players to come up with solutions that are actually effective, and because we’re dealing with human beings, the solutions are neither right nor wrong — they’re just better or worse, and the chances of having a complete solution are pretty small.”

Culbert suggested a deputy-minister level body at the federal level that could bring together multiple departments at the federal, provincial and local levels, as well as non-governmental organizations. Those departments would include early childhood education, housing and poverty reduction, among others. He also suggested decriminalizing small amounts of drugs and offering sentencing alternatives, as well as safe supply of substances.

Stephanie Lake, doctoral candidate at the School of Population and Public Healthat the University of British Columbia, said that there was an immediate need to decriminalize drug possession in Canada, which would have knock-on effects on other policies and institutions.

“Decriminalizing drug possession may lead to certain institutional policies at youth group homes or emergency shelters, or even schools and workplaces to rethink zero-tolerance policies around possessing drugs or even drug paraphernalia, which affects youth who are already on the margins of society,” said Lake. “The federal government definitely sets the tone and has the capacity to sway a lot of these things down the line.”

Lake added that there should be an expansion of drug-checking programs where youth gather, and that youth may not feel comfortable in harm reduction spaces that were designed with adults in mind.

Tom Stamatakis, president of the Canadian Police Association, who was a police officer in Vancouver during the period that led up to the Four Pillars approach (harm reduction, prevention, treatment and enforcement) and the inception of the county’s first safe consumption site, said that safe supply is a critical issue.

“From a policing perspective, that is the biggest issue with respect to addiction in communities across this country,” said Stamatakis. “We create this environment where people who are involved in problematic substance use have to commit crime to get the drug that they need, the drugs they get are killing them, and we’re in this circle that I’ve watched now for twenty years where nothing is getting better.”

Stamatakis said that there needs to be an increased capacity so that police who encounter marginalized people can take them somewhere to get them the help they need — something they can’t do currently.

Petra Schulz, whose son, Danny, died of an accidental overdose at 25 in 2014, is co-founder of Moms Stop the Harm. Schulz said that there is a need for a paradigm shift in the country; that the problem needs to be redefined as a drug policy crisis.

“The problem with our current drug policies is they were drafted without people’s lived experience, who are too often absent from the conversation,” said Schulz. “I would appoint a person from the community of people who use drugs as a deputy minister and would have that person at the table in a decision-making capacity because they have the knowledge that [the minister] would need.”

Alternatively, Schulz suggested a task force that includes people who use drugs, their families, health professionals, researchers, and policy-makers to guide the needed actions to implementation. Schulz also called for decriminalization of drug use, safe supply with easy access, and easier access to harm reduction.

Guy Freedman, president and senior partner of the First Peoples Group, said that he would recommend the reinstatement of the Aboriginal Healing Foundation, which was part of the work of the Truth and Reconciliation Commission, as well as to recognize the role of culture in treatment, particularly on-the-land treatment for Indigenous people, and equated it to treatments, both Indigenous and Western, that he received for cancer.

“The traditional treatments were all love-based: prayer and song, animal and birch and love,” he said. “And the Western ones were all warlike: radiation, chemotherapy and surgery if required,” said Freedman.

Freedman also spoke about the need to tackle racism as part of the broader solution.

Gord Garner, executive director of the Community Addictions Peer Support Association, said that there needs to be more compassion and more empowerment for community action among allies. Garner also addressed the need to eliminate the perception that poverty is linked to addiction.

“Please read the DSM (Diagnostic and Statistical Manual of Mental Disorders) on substance use disorder and tell me where in there it talks about poverty,” said Garner. “It doesn’t. 200,000 homeless people, not all of them with substance use disorders…but it’s not the diagnosis of substance use disorder that’s the problem, we’re leaving the 1.2 million Canadians with substance use disorders behind.”

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