Chris Selley: Harm-reduction advocates need to accept defeat, regroup and refocus

The first golden era of harm reduction for opioid addiction, such as it was, is fading rapidly into history — not just in Tory Ontario, which is where progressives are naturally focusing their ire, but in NDP British Columbia as well. There is so much blame to go around for this, everyone can have seconds. But where should we go from here?

Ontario recently issued de-facto eviction notices to 10 supervised injection sites, nearly half of the province’s total, under new rules that prohibit such facilities within 200 metres of a school or daycare.

This comes months after B.C. effectively ditched its approach to decriminalizing hard drugs, largely in response to a moronic court decision that essentially ruled addicts should be able to consume drugs wherever in public they want. In a fight for his political life, Premier David Eby — a long-time harm-reduction proponent — this week ordered a review of a vending machine outside Nanaimo General Hospital that distributes clean needles and pipes and the overdose-reversal drug Naloxone.

Clean paraphernalia. Overdose prevention. Out of a machine, no less. To my mind that’s about as anodyne as harm reduction gets. Just three years ago, federal Conservative leader Erin O’Toole had taken a balanced position on this issue: Yes to treatment, absolutely, and more money for it; but yes also to keeping people alive in the meantime, even if it makes us uncomfortable. Conservatives often pride themselves on seeing the world as it is, not as they would like it to be, and the reality of addiction is that the first or second stab at treatment very often doesn’t take.

But O’Toole’s successor Pierre Poilievre is not at all of that ilk. B.C. Conservative Party leader John Rustad thinks it’s “appalling and irresponsible to have a vending machine handing out drug paraphernalia outside a hospital.” And Eby is desperate enough to pretend he thinks Rustad might have a point.

As someone who has long argued for supervised-injection sites — on the basic premise that no one ever dies from overdosing in one, while they die in their thousands from overdosing elsewhere ― I find this enormously frustrating. But it is what it is. We are where we are. Perhaps this is still a moment where we might unite around some shared realities.

One: Harm reduction is not the be-all and end-all of opioid deaths.

The highest rate of accidental opioid overdose deaths in Canada in 2023 was in British Columbia, at 46 per 100,000 population. British Columbia is essentially the spiritual home of harm reduction, and many (including Poilievre) want you to see a causal connection there: Harm reduction has actually increased harm, both to the addicted and to the communities they live in.

The problem there is that the second-highest rate of accidental opioid overdose deaths in Canada in 2023 was in Alberta, at 39 per 100,000, and Alberta proudly eschews the harm-reduction approach. Many conservatives, including Premier Danielle Smith, want you to see the opposite causal connection there: The lack of harm-reduction programs in the province has actually saved lives.

Except that Ontario (16 per 100,000) and Quebec (six per 100,000) both report far fewer deaths than Alberta and B.C., and both have been relatively receptive to supervised-injection sites.

In other words, harm reduction neither causes nor prevents the majority of opioid-related harms.

Two: All of that said, closing supervised injection sites will almost certainly contribute to accidental opioid overdose deaths.

Between January 2020 and May 2024, Ontario’s supervised-injection sites reported seeing more than 178,000 separate patients, who made more than 1.1 million visits, 22,000 of which involved an overdose, and none of which were fatal. The chances one of those patients won’t fatally overdose somewhere else are vanishingly small, surely. And we’re more likely than usual to meet them as human beings as well, even if it’s only in the news after they pass away.

One of the problems with mustering public sympathy for drug addicts is that far too many of the nearly 8,000 Canadians who died from an accidental opioid overdose in 2023 did so pretty much anonymously. They’re often estranged from their families and friends, sometimes for years. But the people who use supervised-injection sites regularly are well known to the nurses and doctors who work there, and they are well known to the wider down-on-luck community as well.

Expect to meet them, posthumously, in the near future.

Three: Harm reduction hasn’t done what it promised.

The basic goal of a supervised-injection site is to keep a person alive until the next sunrise. It’s an entirely honourable goal, in my mind. But the concept was sold to the average neighbourhood resident as a win-win-win scenario: Not only would we save people’s lives, but there would be fewer needles on the street, fewer people using in public, less of the wretched forms of commerce that provide addicts with the money they need to feed the beast.

That hasn’t happened, for various reasons including lack of resources. But harm-reduction proponents have far too often simply claimed the harms associated with harm-reduction simply aren’t occurring, which anyone with functioning eyeballs and a bedtime past 10 p.m. can easily see. If you’re going to demand the government accept reality, you need to accept it yourself.

Four: As always in Canada, we need more data.

At the risk of sounding rather cold, the current population of supervised-injection-site users offers up an intriguing study group. What happens to them once the sites they use close down? Do they end up dead, as harm-reduction proponents predict? Do they end up in rehab, as people like Poilievre and Ford promise? Or do they end up on a waiting list with everyone else who needs medical care in this country?

If Ford, Poilievre and Rustad believe in their position, they should want the statistics to back it up.

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