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
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.
I found this to be a profoundly insightful and measured presentation of the situation by Dr.Somers. A couple of observations: 1) Portugal’s implementation of their legalization of possession of street drugs included major increases to efforts to arrest and punish dealers; 2) while Singapore gets a lot of flac for the severity of their drug laws and the supposed ease of governing a city-state, it is a place of remarkable beauty, cleanliness, safety and good management that, to be frank, makes Canadian cities look slummy and chaotic. In my many visits there I have never seen a single ”person experiencing homelessness”. I found that Dr. somer’s decision not to call the BC government folks who “exaggerated” the actual access to the data they are suppressing for their own personal gain “liars” was the behaviour of a gentleman. The most cynical aspects of my personality suspect that the people pushing harm reduction believe that the resulting increases in deaths (yeah, they know) will be good for the planet because of fewer carbon-based footprints.