The Social Experiment of Safer Supply
Alberta embraces recovery-oriented care, supported by author of San Fran-sicko, Michael Schellenberger. BC doesn’t.
“So if your vision of a good society is where you have large numbers of people who have effectively stopped working, cut off relationships with their family, and are using very intoxicating, very addictive, very hard and dangerous drugs all day long, if that’s your idea of a good society, there’s no amount of science that’s going to change your view.”
Transcript of Alberta Safe Supply Panel, Feb 16, 2022
Mr. Shellenberger:
Thank you, sir. Thank you very much for inviting my testimony. It’s an honour to be with you all today, and I look forward to our conversation.
I am an investigative journalist, the author of a new book called San Fransicko. It came out from HarperCollins last October. It’s about the drug crisis in the United States, particularly in west coast cities, but I do think it has many similar lessons for Canada. The book is based on interviews with hundreds of addicts, including homeless addicts, dozens of experts from around the world, and field work, really, all over the United States but including the Netherlands and California. As background, in the late 1990s and early 2000s I worked for the George Soros foundation advocating decriminalization of drugs, harm reduction. I organized civil rights leaders to support needle exchange so heroin users would not get or transmit HIV/AIDS. It’s a policy I still support.
I continue to support the treatment of addiction as a public health and medical problem, not as fundamentally a criminal justice one.
Where I left off in the late 1990s, early 2000s was with an understanding that the goal was recovery from addiction, not addiction maintenance, and that there would always be a very small percentage of folks who may not be able to achieve recovery but that the goal of recovery was the right one, that addiction is paralyzing. It’s dehumanizing for people. Sometimes it’s not avoidable, but often it is, and that should be our goal.
I raise this because that is also the goal of European nations, including the Netherlands. The Netherlands, I think, is a great model for what we should be doing in the United States and perhaps as well in Canada. It’s a very liberal country. It’s not a country that has used significantly coercive measures such as the Philippines in addressing the drug crisis. They’ve decriminalized marijuana. They’ve tried to separate marijuana as a so-called soft drug from harder drugs like heroin. The Dutch system is not perfect. They still have problems with drug trafficking. They still have addicts, but they are mostly in pockets. They have broadly succeeded in moving folks out of addiction and towards recovery.
The mandate of your committee is quite limited to this concept of “safe supply,” whether there is evidence that “safe supply” would reduce overdoses, the diversion of drugs, would have other impacts, what other risks it would create, what other advantages or disadvantages there might be. I don’t think I’m the first, and probably not the last, to really draw attention to the ways in which the framing of this issue around so-called safe supply – I think it’s very problematic.
I think that using the word “safe” itself associated with very dangerous and potentially deadly and addictive and intoxicating drugs risks being very misleading. I think it’s been used in a very misleading way, and I’ve documented the ways in which words have been, I think, used to advance a political agenda without people knowing it, with people using language and it resulting in particular policy entailments that people did not sign up for.
Because one is in favour of giving clean needles to people using heroin, that does not necessarily imply that we should be doing similar things to maintain addiction. One might give people clean needles but also use more coercive measures to encourage or compel some amount of recovery. I think one of the most insidious myths I encountered in my research is this idea that nothing can be done to encourage recovery. I think there is a lot of truth to the fact that addicts need to choose recovery, but on the idea that people will hit bottom and then choose recovery, I don’t think it’s the case that that bottom is fixed.
If you basically give people drugs to use and make their lives very comfortable to just use drugs all day, you’re effectively lowering the bottom whereas if you have consequences for behavioural disorders, including public drug use, public camping, public defecation, you may raise the bottom and help people to get into recovery.
I think it’s obvious, too, and worth being said that this is not simply a scientific issue in the sense that it would just be determined by science. It’s mixed up with questions of values. So if your vision of a good society is where you have large numbers of people who have effectively stopped working, cut off relationships with their family, and are using very intoxicating, very addictive, very hard and dangerous drugs all day long, if that’s your idea of a good society, there’s no amount of science that’s going to change your view.
I worry that there’s been a strategy to frame the issue here as narrowly as possible around simply avoiding deaths. I think avoiding deaths is obviously an important goal, but it’s not the only goal. There are many ways to get there. I would hope my role here and the role of other experts providing testimony is to play the role of honest broker rather than stealth policy advocate. An honest broker would describe for policy-makers a range of potential policy solutions in service of different goals and different values.
Again, if you think that maintaining someone’s addiction is just as positive an outcome, just as good an outcome as helping them achieve recovery, well, you’re making a values choice there. I think it’s important to be explicit about: what’s the values choice being made? You might reduce drug deaths, either from poisoning or overdoses, by simply administering drugs to them in a palliative way for the rest of their lives. You might also achieve that goal through recovery. The latter provides people, I think, with a full life, a life of human connection, of family, of romantic relationships, of children, of meaningful work. Again, a values judgment is being made there. Nonetheless, it’s one that I think most people would agree is a better outcome than simply having your addiction maintained for the rest of your life.
Let me say something about the experience in the Netherlands. It’s also a similar experience in other European cities. In fact, one of the most important papers on addiction in general, in my view, is a paper about the experience of five European cities – Amsterdam, Frankfurt, Lisbon, Vienna, Zurich – all of which in the late 1980s and early 1990s had a heroin epidemic. That heroin epidemic manifested as what researchers call open drug scenes.
“Open drug scenes” is, I believe, more accurate than the words that we use in the United States and, I think, also in much of Canada, which are the words “homeless encampments.”
Homeless encampment makes it sound like what draws people there fundamentally is a kind of camp-out. In fact, these open drug scenes draw people because these are places where drugs are bought and sold and used. People, because of their addiction, are there. They’ve lost ties with family and friends. Disaffiliation is a key part of it. They’ve lost housing because of their addictions.
This paper on open drug scenes that was done by Helge Waal for the Norwegian government – I believe it came out about five or six years ago – finds that all of these cities did the same thing, which is that they disallowed public drug use, they disallowed public camping, they broke up the open air drug markets, and they did not allow congregations of drug buyers and sellers in their cities. The goal was recovery, not addiction maintenance.
Now, there’s been a lot of publicity about the fact that in some European cities, including Amsterdam, heroin is provided for a small number of addicts. I investigated this question. Of course, it’s of great interest to me. I went to the Netherlands twice to investigate, interviewed their top drug policy expert. I did the same for Portugal, by the way.
There are, according to the Dutch government, 120 people who receive heroin maintenance, and I think it should be considered a kind of palliative care. These are people for whom methadone, the opioid substitute that helps many people to end their heroin addictions – a very small number of people, 120 people in total in all of the Netherlands. So I really think the Dutch have done a great job.
I think Germany, France, Japan, other countries have also done, obviously, a much better job than the United States or Canada based on drug deaths alone, not to mention the open drug scenes.
Nonetheless, you can see that in the Netherlands the so-called, quote, unquote, safe supply of heroin by the government to a small number of addicts is a tiny part of a much broader effort, that included moving thousands of heroin addicts into recovery, with personalized plans overseen by social workers, involving families and friends. That’s the basic pattern for how I believe all civilized nations and cities have dealt with drug epidemics similar to the one that we’re experiencing in the United States and Canada.
There are differences between the Dutch system and the Portuguese system. Portugal: it’s a different culture than the Netherlands. There are stronger family ties. They do use still a coercive apparatus that they call a commission for the dissuasion of addiction. The head of the Portuguese program, João Goulão, who I interviewed at length several months ago, said very clearly: we do not normalize hard drug use.
I think it’s also important to point out that even in the Netherlands, where you can smoke marijuana in specialized cafes, it’s still not normalized, not to the extent to which things like alcohol have been.
I think that when you get to these questions of normalization, it’s fair to say that in most developed nations like ours, we’ve tried to denormalize or stigmatize cigarette smoking, to great effect.
I think there’s been this idea that somehow stigma is simply a bad thing and should never be done, but I think that what we see from the Netherlands, what we see from Portugal is something quite different, which is that they are putting coercion on people to get out of addiction and into recovery.
There’s only a very small number of people for whom addiction maintenance is considered a priority.
They have their policies and their strategies aimed at a values-based goal, which is recovery, not addiction maintenance.
Thank you very much.
The Chair:
Thank you very much.
First up for question and answer we have MLA Frey.
Mrs. Frey:
Hi, Mr. Shellenberger. Sorry. I’m coming to you through Zoom, so if my sound is poor, let me know. I just want to say thank you very much for coming today to be with us. As you know, this committee has been meeting for a few days. We’re meeting about three days this week to talk to experts such as yourself about the issues regarding things like safe supply. We’ve been criticized pretty widely, especially by another party, for using quotations around the word “safe,” and what I got from your presentation today was that you are of the same mindset in that we shouldn’t be using normalizing language for something that is an illicit practice.
But I also liked your comparison to the Netherlands. In the Netherlands I know it’s still illegal to carry illicit drugs, I believe, but you have safe places for soft drugs like marijuana and such in coffee shops. I’m just curious. In what you said, how we cannot normalize hard drugs, how do you think Canada is doing on that side of things? How do you think our verbiage, our discourse around drugs in Canada – do you see us going down the wrong path, or do you think that we need to change course?
Mr. Shellenberger:
Well, first of all, thank you very much for the question. I think that Canada and the United States are both going down a terrible path in terms of the normalization, the destigmatization of hard drugs, including open drug use, open drug sales. These are things that are simply not allowed in the vast majority of other developed nations. As I mentioned, those five cities – Amsterdam, Frankfurt, Lisbon, Vienna, Zurich – did have open drug scenes. They shut them down.
By the way – and I didn’t have a chance because we just didn’t have a bunch of time – the impact of open drug scenes on communities is devastating. It’s destructive to the fabric of a community. It’s dangerous.
Now, we spend a lot of time talking about opioids, but we are in two drug epidemics: one is on opioids; the other is on methamphetamine.
We are seeing very extreme and bizarre and often dangerous and deadly behaviours by people suffering from meth-induced psychosis associated with these open drug scenes, so I think we’re going down a terrible path.
I feel personally responsible for – I actually spent most of the last two decades working on energy and the environment. I came back to this issue because I worried that I had contributed to the normalization through my work in the late 1990s for the George Soros foundation.
The normalization was not what I believed we had signed up for. My view was always that recovery was the goal, that addiction maintenance was not the goal, so I feel personally deceived.
I think that, really, what is being proposed is palliative care for all addicts. Palliative care I do think is appropriate in some cases. I mean, if you think of somebody who’s 75 years old and has been using heroin for 35, 40 years, I think it may be very hard for those folks. But we’re treating 25-year-olds suffering from opioid addiction, either heroin or fentanyl, as though they’re 75-year-olds at the end of their lives or something. I think it’s crazy.
I think that it was entirely appropriate to put safe supply in quotation marks. I would even call them scare quotes because what scares me are the ways in which we have seen efforts to really normalize not just addiction but, really, expanded use. If you’re expanding supplies, you’re going to be expanding use both among the people using but also the number of users.
The Chair:
Supplemental, MLA?
Mrs. Frey:
Yes. Thank you for your answer. On that vein, I would just be curious what you think about opioid alternatives such as Suboxone and naltrexone in that lens given what you’ve said. I know you mentioned methadone once, which is different, but how do you feel about those other two?
Mr. Shellenberger:
Very, very positive. I mean, I think that the thing we have to keep in mind is that many of the tools – I see the United States and Canada, different cities and states, differently – that we’re using are great.
Again, in the Netherlands – I just researched it, I just investigated it with my folks there – there are apparently something like 28 places where drugs can be used so-called safely, supervised, but those are in a system where the goal is recovery. I think it’s important to keep our eyes on the prize here. Our goal should be recovery, not palliative care, not addiction maintenance. That means that there is a role, certainly, for methadone and Suboxone.
But my source in the Netherlands, who’s now a senior drug policy expert, who was a nurse working in those areas, said to me, quote: in the ’80s we just wanted to help people; we started with methadone programs and medical treatment; we did a lot of work without much of a carrot and a stick; it was a real disappointment; they just used the methadone to stay addicted; they dealt drugs and committed other crimes; they lied and cheated about it; we were just supporting a different kind of market; we had to learn the hard way.
In other words, they tried an approach of just providing alternative supplies, including in that case methadone, and it didn’t work. The addicts would use heroin in addition to the methadone. The same kinds of problems could be seen with Suboxone.
You have to have a goal, and the goal should be recovery for the vast majority of addicts. Again, there may be some cases where palliative care is necessary, but even for those individuals I think most psychiatrists and addiction specialists would tell you that it’s not obvious who those people are, and it shouldn’t be an easy decision to put somebody on palliative care. That’s a very, very serious question, and there are reasons why governments and policy-makers have put into place safeguards everywhere palliative care is an option.
The Chair:
MLA Yao.
Mr. Yao:
Thank you so very much, Chair. Mr. Shellenberger, thank you so much for appearing before us. I find you to be one of the more interesting folks that we have presenting before us because of the fact that you’re an investigative reporter. I’m just going to give a little backgrounder story that backs up my question. Several years ago the CBC wrote an article on this very issue, and they investigated Vancouver’s scene. They had guests from Portugal’s drug rehabilitation come visit, and in the article they said that the folks from Portugal were absolutely appalled at what was going on in Vancouver. Later on, when I went back to the article, they took out that portion of the article, and then a few days later, after that, they actually pulled the entire article, and I never saw it on the CBC’s website again.
My question to you. Portugal, from my understanding, is considered one of the leaders in the world on addressing these addiction issues, and they’ve gone through all the experimentation on this issue. Can you summarize or clarify some of the other differences that Portugal does in regard to drug rehabilitation? I also want you to expand on the concept of destigmatizing these addictions because I feel that the stigma around these drugs helps to prevent people from actually trying them in the first place. Like, I think it’s not an ideal thing to destigmatize these things.
Thank you.
Mr. Shellenberger:
Thank you. Well, there’s a lot packed in there, but let me say that I think that many of the journalists are very biased in favour of pretty radical drug decriminalization and harm reduction measures. I don’t think that that’s because they’re bad people; I think in many ways it’s because they’re very compassionate. I think there have been many instances where we simply used all sticks and no carrots for addressing addiction.
Simply incarcerating people suffering from drug addiction, many of whom may have some underlying mental illness that’s not being treated, is often a terrible thing to do, a real violation of their humanity. It’s not getting them the proper treatment. So I think there’s some amount of empathy and compassion and concern about just a law enforcement or incarceration response to addiction. That’s totally understandable.
But as these things go, people go too far: they become dogmatic; they become ideological; they see what they want to see. They take away from Portugal that it’s just about decriminalization. They overlook the fact that they have these commissions for the dissuasion of addiction, which couldn’t be clearer about the purpose of those commissions.
Now, when you interview the head of the Portuguese drug program, João Goulão, or other European officials, those officials are attempting to speak both to people who err on the side of overincarceration and people that might err on the side of just overliberalization. You can pull from them different parts of it, but what they’re saying, both in the Netherlands and Portugal, is that they’re putting pressure on addicts for recovery. They’re not making addiction illegal, or they’re not criminalizing addiction, and I share this view. If someone is maintaining their addiction in the privacy of their home without disruption to the broader community, no breaking of laws, I don’t think that should be a law enforcement priority. I don’t think we need to be evangelical about this.
But the problem is that addiction means that people end up no longer working, no longer paying rent, being kicked out of their friends’ and families’ homes, end up on the street committing crimes. This is a very similar pattern around the world, so it makes sense to address the addiction in helping that person to achieve recovery and achieve a better life. There is a value statement here that we have to acknowledge.
Now, on this issue of stigmatization, even more than just stigma I think we should be frightened of these drugs. Methamphetamine and fentanyl are extremely – these are some of the most toxic, intoxicating, addictive, and deadly drugs ever invented. They make the heroin and cocaine epidemics of the past look like child’s play in comparison. I mean, the poly drug use is rampant. When I interview homeless people – and I’ve been continuing to interview them in recent weeks, as I have for months before the book came out – people are using methamphetamine and fentanyl combined, and they’re smoking them all day long. That’s incredibly destructive, and we should be afraid of that.
You know, there’s an old saying: love the sinner; hate the sin. I think that’s still the right view, which is that we should have compassion and love for people who are fundamentally ill and whose behaviours are so self-destructive, but we should really understand that these are very dangerous drugs. There should be stigma on the use of them, particularly on the behaviours that result from them, so I think that’s totally fine. I think there’s no need to shame the person who’s sick, because often they’ve lost control of their behaviours.
The Chair:
Supplemental?
Mr. Yao:
No. Thank you.
The Chair:
MLA Stephan.
Mr. Stephan:
Thank you. I bought your book, and I’ve read part of it. I appreciate you coming and speaking today. I know that in my community we are wrestling with some of these issues related to a desire to help those who are suffering under addictions. One of the arguments that I hear in favour of self-supply is that everyone agrees that recovery should be the focus, but if a person is dead, you can’t help them towards recovery. I’m wondering: how would you answer that argument that is made in favour of safe supply?
Mr. Shellenberger:
Well, I refer back to the – again, I think as experts here our role as honest brokers is to increase the policy options for policy-makers, not reduce them. So I find there’s something really manipulative when somebody says something like that. It suggests that the only way to save lives is by giving people drugs. That’s not the only way to save people’s lives. There are many other ways.
One of them is to address the addiction. It’s to do what they do in Portugal. When I asked João Goulão, the head of Portugal’s drug program, what would happen to me if I shot heroin in public in Lisbon, he said: “You would be arrested. You would be arrested and brought to the police station, and if you had more than the amount allowed for under the law, you would be prosecuted for drug trafficking. If you had less, you would be brought before a commission for the dissuasion of addiction.” He did not say: we would make sure that you had pure heroin or pure fentanyl to use. Nor did he say: we would give you a private room where you’d be supervised to use drugs.
So there you go. In the signature country, the country that is the most cited by advocates of decriminalization, of so-called harm reduction, of so-called safe supply, safe supply is not what comes to mind when they first seek to address open drug use and drug addiction.
It’s a similar story with people suffering overdose or at risk of overdose. It is not the case that just giving them pure drugs is the only solution. It’s one possible solution, but it’s also a potential response with many downsides.
You know, again, I think that there is a role in the way that the Dutch have used it for some amount of so-called heroin maintenance, addiction maintenance for a small number of people as palliative care, but I think that what we’re not seeing in those countries is some large-scale effort to provide thousands of addicts with heroin, with methamphetamine, with fentanyl. That has not been a response that’s been tried around the world.
What is being proposed in Canada and has been pioneered in San Francisco is a radical experiment, and it’s an experiment on people that I do not believe are providing their consent. Simply agreeing to accept drugs from government officials or to use those drugs in a government site is not the same as providing consent to participate in an experiment.
The Chair:
Sorry, Member. You’re muted, Mr. Stephan.
Mr. Stephan:
Sorry. Thanks. Just a supplemental question. You had mentioned the experiment that has been done in San Francisco in respect of safe supply. Based on your investigations, what have been the results of using this policy? What have you seen from it where it’s been used?
Mr. Shellenberger:
The San Francisco city government is currently operating an illegal supervised drug-use site in downtown San Francisco. It’s resulted in an expansion of open-air drug dealing just across the street. It has basically devastated the farmers’ market that existed in United Nations Plaza, which is the location of the supervised drug site.
The government officials involved in it have misrepresented the site, citing their violation of state and federal laws. The people inside the site are smoking methamphetamine and fentanyl. They’re concentrating users. It’s normalizing drug use. I think it’s a very unethical experiment that does not have proper controls on it.
I find it disturbing and scary, and I think that where the advocates of that experiment are headed is towards wanting to provide the people that go into that site with so-called safe supply. I find this very Orwellian.
It feels like a horror movie that we’ve seen. It’s simply not how the Dutch or the Portuguese or any European nation or Japan or South Korea or any other country in the world has dealt with addiction. I think it’s rash. I think it’s irrational. It’s being pursued by people with a kind of religious zeal that seems completely unmoored from any scientific or ethical traditions.
The Chair:
MLA Rosin.
Ms Rosin:
Thank you. I’ve got a question based on your work as an investigative reporter. I think it’s almost paradoxical. You’ve worked in some of the most major cities all over the world studying this issue. It does seem quite paradoxical to me that we’ve seen governments all over the world for decades really launching well-funded campaigns against the tobacco industry and trying to reduce the use of tobacco, accepting that using tobacco is not healthy for a human body, but on the flip side we are now seeing those very same governments go out and almost launch campaigns for the use of other illicit substances like opioids.
I think it’s safe to say that the campaign against the tobacco industry by government has been waged and promoted and driven primarily by the medical industry, but I would think, and from what I’ve heard from other presenters as well, that if the medical industry is against promoting tobacco, the medical community would also be against promoting opioid use. On that vein, then, I’m curious who you think or who you’ve seen through your investigative research is behind the campaign for the decriminalization, almost, or the promotion of illicit substance use if it’s not the medical community.
Mr. Shellenberger:
Yeah. Thank you for your question. Yes. What you said: it’s crazy that here we did this beautiful campaign to reduce cigarette smoking and have these positive results, and now here we are creating a special meth and fentanyl smoking section in one of our most important public plazas in San Francisco.
Look, this campaign to expand the supply of drugs is coming from a particular ideological tradition. It’s not coming from the medical profession. It’s coming from what we would call the radical left or what we, I think, rebranded in the United States as progressive. It’s based on a victim ideology that people suffering from addiction and mental illness are victims to whom everything should be given and nothing requested. It’s based on very simple ideology that kind of classifies people, does not view people as going through a particular journey. I think it’s very cynical. It’s very dark. It’s not based on, really, the last 150 years of experience dealing with opioid epidemics. It’s not based on modern addiction science or psychiatry.
The Chair:
Thank you, Mr. Shellenberger, for joining us this morning and for your presentation. We sincerely appreciate your time, and unfortunately we’ve run out of time.
Mr. Shellenberger:
Thank you very much.