'I thought we had more of an open forum for discussion'
'I thought we had more of an open forum for discussion'
A conversation on drug policy and open debate with Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University
Appears in this episode
One of the themes of the Lean Out podcast is open inquiry. And my guest on the program today has some thoughts on this. He’s concerned about the suppression of discussion and debate and viewpoint diversity in the field of addiction — and he points to specific actions from the B.C. government and the B.C. Centre on Substance Use. But, as we’ll learn at the end of today’s episode, both view the issue quite differently. (See below for statements.)
Julian Somers is a clinical psychologist, a distinguished professor at Simon Fraser University, and the director of its Centre for Applied Research in Mental Health and Addiction.
Julian Somers is my guest, today on Lean Out. Transcript to come for paid subscribers.
STATEMENT FROM BRITISH COLUMBIA CENTRE ON SUBSTANCE USE:
Presentations at conferences that influence public policy and clinical practice should be evidence-based and peer-reviewed. Concerns were raised with the subject of this particular conference presentation, which was based on a self-published rapid review of safer supply that was not peer-reviewed and, using a well-established measurement tool to assess the methodological quality of such reviews, was rated as being of “critically low-quality.” Among the primary issues with the review is a flawed search strategy that resulted in a number of studies unrelated to safer supply being included, and a number of important and highly relevant studies being excluded. Beyond these methodological concerns, other issues are evident with this review, including the misrepresentation of study authors’ expertise, a lack of a public health perspective, and the failure to acknowledge the current state of safer supply research and other publicly available data.
BCCSU LETTER ON THE RAPID REVIEW OF SAFER SUPPLY
STATEMENT FROM B.C.’S MINISTRY OF PUBLIC SAFETY AND SOLICITOR GENERAL:
This province strongly believes in the value of integrated data and academic research. The motivation to create a new Data Innovation Program (DIP) and transition the data previously stored within the Inter-Ministry Evaluation Database (IMED), to which Dr. Somers had exclusive access, was to establish a program that enables all academics in the province access to integrated data to conduct projects for public benefit.
The IMED steering committee began discussions about transitioning to the DIP in the fall of 2020. At that time, the chair of the committee spoke by telephone with Dr Somers and socialized the idea of this transition, including the rationales of allowing more academics in the province to access integrated data and supporting increased data collection from across various sectors of government.
The DIP brings together all the data from the previous IMED and more, and has enabled important research into homelessness, basic income policies, mental health and other social factors. Unlike the IMED, the DIP allows for equitable access to data for all academics who submit a research proposal, which BC Corrections has encouraged Dr. Somers to do, so that he may continue his important work.
'I thought we had more of an open forum for discussion'
With out going into details, I spent 20 years of my life crawling around in a database for a large homeless shelter tracking over 50,000 individuals. I came to the conclusion that homelessness is an ecology issue, and that we all exist in an ecology (otherwise known as society). When I looked at the people who's lives were tracked in this database, the only thing they had in common was that they had no community of support. In terms of education they went from functionally illiterate, to doctorate. Every race & creed known to mankind was represented. Some people were born with Golden Spoons in their mouth, while others were born in abject poverty. They all scored high with respect to ACE (Adverse Child Experiences) but that speaks more to the disfunction of their relationships than anything else.
I agree with Julian Somers that a wellness based approach is required, and would extend that to all of society. Creating a healthy social fabric for everyone is critical to ending this crisis. Not easy to do, as we have spent the last 100 years destroying the social cohesion in Canada. A good book to read on this is by Dr. Bruce MacDonald called "The Globalization of Addiction". Gabor Mate' references him often as they worked together.
I see all of us as first needing a community that we belong to, second as having something positive we contribute to that community, and finally having a physical place that is ours to return to (the place could be mobile such as behind the wheel of an 18 wheeler)
One final comment. The Academic Community has not done very well in research into addictions and homelessness. This is because of who they define as their peers. Researchers generally come from upper middle class and are highly educated. Often they have no connection to the communities being researched and have no feedback to reality in their research. So for them, peers are other academics, not "the reality based community".
With nearly 20 years experience working in the field of Mental health, substance use and homelessness, I can tell you, Julian is not wrong in his analysis. I've waited a long time to hear someone speak to the ridiculousness of the popular 'harm-reduction-only' approach to working with concurrent disorders and substance use. The pervasiveness of this political and ideological approach is rooted so deeply in the notion of 'anti-oppressive practice' that emerged in the early 2010's. Again, and just like harm reduction, it is essential to working with people, but it became this weaponized dogma that spawned terms like 'the right to live at risk', which people should have, but it became this twisted political stance where you weren't allowed to talk to your clients about 'recovery' because that word replicated structural violence... insanity.
And so here we are in BC today, where the failure of our political and ideological approach to substance use has effectively managed to hand over the responsibility of the users health (substance use) directly over the user, with limited options to enter into detox, treatment and recovery. "Here's some clean needles, naloxone and maybe some clean supply, if you're lucky enought to get your hands on it... good luck!" And the province wipes their hands of it. But we know, this only perpetuates and keeps the problem of substance use and mental health alive and well, while downloading the responsibility to untrained police and first responders, at an increasing cost.
The focus is on managing crisis (acute and complex care), not on creating pathways to recovery and wellness. That would be far too costly.
Finally, relational wellness is key to everyone's health and wellbeing and this must be continuously worked with throughout a persons life cycle. Mental health and substance use are ubiquitous. They touch everyone in some way and are positively impacted with upstream investments that create 'community and opportunity'. Trauma after compounded trauma can be worked with when people have a sense of belonging, safety and caring in their lives.