The Decibel - The man shaping Alberta’s controversial drug policy

Episode Date: May 29, 2024

Recently we’ve seen a shift in the national conversation around how to deal with Canada’s ongoing opioid crisis. B.C. all but cancelled their decriminalization trial. And the federal government rejected Toronto’s request to decriminalize possession of drugs. Decriminalization is part of a harm reduction strategy which advocates argue is the best short-term solution to save lives.Alberta is also moving away from a harm reduction model and it’s all because of Marshall Smith. He’s the man that’s overhauling the province’s drug policy with a plan that’s facing a lot of criticism.The Globe’s Marcus Gee is a columnist focusing on cities and the opioid crisis, and he recently spent some time with Marshall Smith. He’s on the show to tell us how Smith became so influential, his plan to upend conventional wisdom on how to deal with the drug crisis and whether we might see it replicated elsewhere.Questions? Comments? Ideas? Email us at [e-mail]

Almost every hour, someone in Canada succumbs to an opioid overdose. Advocates, including health care professionals and drug users, argue that harm reduction is the best short-term solution to save lives. But there's recently been a shift in the national conversation around the drug crisis. Last month, B.C. all but cancelled their decriminalization trial, which was part of the province's harm reduction strategy. And the federal government rejected Toronto's request to decriminalize possession of drugs. Amidst this shift, Alberta is trying something different. I think people are starting to get the scale of what's happening here

because the scale of change that we're embarked on is unparalleled in the world not just kind of unparalleled in Canada or whatever. This is where the most interesting drug policy work on the planet is going on right now. That's Marshall Smith, the chief of staff to Alberta Premier Danielle Smith, and the man who's overhauling the province's drug policy. Marshall Smith's strategy draws on his lived experience, because he himself used to be addicted to drugs. His plan for Alberta is controversial.

The Globe's Marcus G. is a columnist focusing on cities and the opioid crisis, and he recently spent some time with Smith, learning about Alberta's new policies. So today, Marcus is on the show to tell us about how one man is reshaping Alberta's approach to the opioid crisis, what critics are saying, and whether we might see this replicated elsewhere. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Marcus, great to see you. Good to see you. Good to see you. So Marshall Smith has an influential job in Alberta politics, and we're going to talk about that shortly. But first, Marcus, I want to talk about his unlikely path to get there, because at one point he was addicted to drugs.

So can you tell me about that part of his story? Yeah, sure. He grew up in California because his dad worked in Hollywood. He moved to Victoria when he was, I think, 18. He worked as a prison guard. He ended up kind of a bright young political staffer there, became quite well known. But all through this time, he was drinking quite heavily, partly because of the job, which is a high pressure job where you're going to a lot of receptions and dinners and drinks after work and so on. And so he was a heavy drinker. He could handle it for a while. Then he tried cocaine, and that took him to a next level. But even then, he could function. Then he tried methamphetamine, and that was really the end of the road for him. He became so addicted that he ended up on the

streets of first of Victoria, then of the downtown east side. He lost his job in Victoria. It was in all the papers there in Victoria, bright young political staffer arrested for drugs and so on. And he ended up living in a shipping container in the downtown east side for several years. Wow. Yeah. I think you said four years, basically, he was on the street. Yeah. And then what happened? How did he get clean? Well, this cop took an interest in him.

This cop had come across him during a bust. And they kind of kept checking in with him and kind of hounding him. They were saying, look, Marshall, you're better than this. You know, you've had a job. You can get better. You can get out of this life. And he blew them off for quite a while. But finally, he was in jail and this cop said to him, look, you go back out there, you're going to die. You know, Marshall realized at that point, he was right. He was flirting with death. So he agreed to go to a treatment program

near Vancouver and it worked for him. And not only did he manage to get over his addiction, he became involved in the recovery movement. He started working for recovery centers. He worked for several. He rose quite high in that industry. And so how did he turn that then into his political career again? Well, he became, because he's so well-spoken, he became well-known in that sort of community. And Alberta noticed what he'd been doing and noticed that he was taking a very different approach

than the B.C. government. The B.C. government was going very heavily into harm reduction, and he thought that was the wrong course. He thought, look, we have to focus on getting people well, as he would put it. So Jason Kenney, the premier at the time of Alberta, noticed him. So they said, look, can you come to Alberta and help us fix our treatment system? Of course, we know that Canada is dealing with an opioid crisis.

It's killed, I think it's 43,000 Canadians since 2016. BC has a harm reduction approach to this issue. So let's just establish, what does that mean? What is a harm reduction approach to this issue. So let's just establish, what does that mean? What is a harm reduction approach? Well, the philosophy there is that, look, the problem here is what's called a poison drug supply. In other words, there used to be heroin, there used to be cocaine, and of course there were overdoses, but fentanyl came into the scene, this synthetic opioid, many times more powerful than heroin, causes overdoses at a much greater rate. So they said, look, we have an emergency here. Getting people better is fine. Treatment is fine. And BC, to its credit, has lots of treatment. But in the meantime, we just have to save lives. So that

means a supervised site where you can go into a booth with a nurse nearby. So if you do overdose when you're using, there'll be somebody there to revive you. Things like handing out clean needles, handing out other drug supplies, having naloxone, this drug that reverses overdoses readily available everywhere, and eventually got into this idea of safe supply, which is giving people a prescription for basically opioid painkillers. You know what's in them, basically. You know what's in them. I guess they're regulated prescription drugs.

Because the problem with fentanyl is it's often poorly mixed by dealers. And so it has what's called hot spots in it that cause overdoses. So the idea then is that this approach is based on, I guess, what we've actually seen work. And so medical professionals are saying this is the way to do it. Advocates for drug users are saying this is the way to approach this then. Yeah, I would say it's the reigning approach in Canada. Canada has gone further along this line than just about any other country in the United States, for instance. There are, I think, maybe two safe consumption sites in the whole country. We have, I think, around 100 in Canada, BCS the most. So it's really the established approach, I guess you would say. So Marshall Smith then takes a different approach to this crisis. What does he see

as the problem and the solution? I mean, the problem he sees with harm reduction is it's gone too far. He's saying we're almost saying to people it's okay to use drugs. We're making it easier to use drugs. And in his view, the whole thrush should be, no, let's not make it easier for you to use drugs because yes, it may be safe today, it might be safe tomorrow, but in a month, a year, a few years, you might overdose and die. So let's really focus on helping people get over their addictions instead. And so for him, the solution is what then? For him, the solution is treatment like the kind he got, but even better treatment.

If you ask me now that I'm healthy to look back and with clarity tell you what I needed, I will tell you I needed to get out of there. I needed to get the drugs away from me, right? I need order and boundaries in my life. His argument is that it's not that treatment doesn't work because a lot of advocates for drug users in the harm reduction field will say, look, treatment doesn't always work. And that's true, of course. It doesn't always work. Sometimes people take several times to get better and never get over their addiction. But that's true, of course, it doesn't always work. Sometimes people take several times to get better and never get over their addiction. But he's saying if we have really high level, really good, heavily resourced addiction treatment, we will be able to make

progress and get more people off drugs. And we're going to talk about kind of what he's established in Alberta, the Alberta model. But I guess first, I just want to linger for a second on his position really in Alberta politics, because he is the in Alberta, the Alberta model. But I guess first, I just want to linger for a second on his position, really, in Alberta politics, because he is the chief of staff to the premier. What does it say about the amount of influence that Marshall Smith has in Alberta politics? Well, it's very unusual for somebody like this, like chiefs of staff are usually sort of there to whisper in the premier's ear, but not to be public. He's very different. He's very high profile. Danielle Smith says he's a very important part of their government.

And at a recent conference in Calgary, she said he was kind of the spiritual leader for her government. He's not only well-known and becoming well-known in Alberta, across the country, he has all these sort of friends and contacts. He's in touch with the addictions minister of Ontario. He's in touch with Pierre Polyev, the opposition leader, and so on. So he's quite an influential figure now. And you mentioned Pierre Polyev. He actually, people might remember that video that Polyev did in Vancouver. Can you tell me about it?

Because Marshall Smith actually had a role to play in that video. That video was quite notorious at the time. It was titled Canada is Broken. And here's Polyev walking around the streets of Vancouver, seeing 10 encampments, seeing people kind of slumped on the street. In that tent city are people hopelessly addicted to drugs, putting poisons in their bodies. They've probably lost their homes, their families. And saying something is not working here. And he says, look, basically, Justin Trudeau is giving out free drugs to people and he praises what Alberta is doing. And in the background, you see this guy kind of showing him around, this guy in a windbreaker, and it's Marshall Smith.

Wow. So he was Polyev's guide for that video. We'll be back in a minute. So Marshall Smith is the chief architect of something called the Alberta Model, which is basically the province's approach to drug policy. Marcus, what is the Alberta Model? The thrust is on recovery. And really what Marshall Smith says is that when he came to Alberta, he found and he looked at the treatment system because he couldn't find out how many beds there were, treatment beds.

He had a little clicker like bouncers use at bars. And he clicked and said, OK, 10 here, 20 here. So that's what he had to do. And he realized that if he had to do that to find out what kind of treatment system Alberta has. It wasn't that there was a poor system. There was no system. And this is true, I think, almost everywhere, is that there's private treatment, there's public treatment, there's expensive, there's less expensive,

and it's not under one umbrella and it's all a bit uncoordinated. So his idea is let's set up a true system of care. He took me to a center in Red Deer, which is the first of 11 what are called therapeutic communities. And so these are high-level treatment programs. You can stay up to a year. Most programs, most treatment programs are 30 to 60 days. This is much longer. And so it's a big commitment. It's a communal setting in which you're supposed to be part of the effort. You get job training.

You get therapy of various kinds. You are expected to do chores. By becoming part of this community, you kind of rebuild your capacity to live life. So the idea is not just to get over your addiction, beat your addiction, but to kind of learn how to live a normal life again. So besides treatments, what else does this program say it's doing? I understand there's also a virtual part of the program as well. The virtual program is a way to get on this substitute drug like methadone, which is the more traditional one, and a more modern one called suboxone.

You can even get a shot now called sublicate that is a month-long shot, so you don't have to keep taking it. So they've got a 24-hour hotline where you can call to say, look, I need to get on addiction medicine. It's a way of kind of reducing barriers because people who are using drugs on the streets don't have a family doctor. Usually they might be reluctant to go into a hospital to start on a program. So it's a nudge for people to get on these medicines. Do we know how much the province is spending

on this initiative on mental health and addictions? Yeah, they tell me it's roughly tripled since 2019, which is obviously substantial. Not only that, they say that the addictions used to be a small department in the health ministry. Now it's the seventh largest ministry in the whole government. So a lot of the things that we've talked about here, Marcus, seem positive. They seem like they could be really helpful for someone who is looking for this treatment. But I have to ask, what if someone doesn't want to go to treatment?

What did Marshall say about that? So I'm a big proponent of intervention for people that are really a harm to themselves or a harm to other people because of their addiction and who just simply are not motivated, you know, to look after their health. And so we're having big conversations right now. Alberta is going to lead this national conversation. So Alberta has an initiative. They're drafting a law called the Compassionate Intervention Law. So the idea is that a lot of people are essentially so far gone,

either in addiction or often mental illness as well, that they really can't make the decision or won't make the decision to get treatment. So he's saying in extreme cases like that, where people are a danger to themselves or others, the government would step in and mandate, look, you have to go to treatment. We're going to detain you for treatment. So this is legislation that is still in the works then, this compassionate intervention law. We haven't actually seen it yet. But from what you're saying then, it would have this lower barrier of being able to actually essentially kind of detain someone and force them into treatment. Yeah, I think that that's the idea. As you say, we haven't seen the details. There is a big pushback

because it's a very controversial thing. Obviously, it's a question of rights and autonomy of the individual. A lot of people said, look, we shouldn't be throwing mentally ill and addicted people kind of in jail or in detention. So the government has gone back and it's drafting legislation. We'll see what happens. So it sounds like there are some critics. We've talked specifically about this part of the legislation. But let me ask you broadly, Marcus, what have experts said about Marshall Smith's approach here?

Well, certainly people who are in the harm reduction camp, I guess you'd call it, are very against what Alberta is doing. You know, they think by taking the stress off harm reduction, we're putting people in danger. We're making it harder for them to get this kind of interim help. And furthermore, I mean, what the real argument is, first of all, we don't know if this is going to work. And we still haven't seen much in the way of evidence or results from the Alberta government at so early. They don't have a good beat yet on how many people are going to recover, actually, what their success rate will be. They don't even have a good beat on wait times, what the wait times are for treatment right now.

So you mentioned it's a little early to kind of know if this model is working. But what do we know, I guess, from this stage? Like, are there promising signs that it is having a positive effect? Well, I talked to a bunch of people, addiction doctors and so on. Most people I talk to think it's a good thing, A, that Alberta is investing so heavily in this huge health problem. The government sort of exaggerated its success so far. For instance, it made the claim that death rates were dropping, or at least were lower in Alberta than B.C. Alberta just had its worst year yet. Just recently announced that they'd had over 2,000 deaths last year, which is

the first time they've gone over that figure, 2,000 ever. How did they square that then, though? They're saying death rates are dropping, but the fact is that they're not. How did they square that? Well, initially, they were just kind of brazenly saying, look, we've got better results. And they don't. Now they will say, look, this is going to take time. So I think they would say, one, it's a national problem. Everybody's facing these terrible

death rates. Second of all, they would say, look, we're only really halfway through creating this model. They would say, too early to tell, but promising signs. I think it's interesting, Marcus, because we started off talking about Marshall's own story, which is quite compelling. And it sounds like he's basing his approach to this issue on his own experience with addiction. But fentanyl wasn't really an issue when he was going through all of that, right? This crisis is very different today. So why not include more of the harm reduction approach along with recovery? Like, what does he have to say about that? I mean, he would admit that harm reduction is useful.

He's definitely against a safe supply. He thinks that's been a disaster. I don't think he would argue with that word. He is against decriminalization. He is okay with supervised consumption sites. Alberta has seven of them and he's not planning to close them down. So he would say, yes, harm reduction has its place and it does save lives in the interim, but it's gone too far. And the emphasis has been almost exclusively on that in his view. Just in our last couple of minutes, Marcus, I want to ask you, because you've been following the opioid crisis, you've been reporting on it for a number of years now. And I guess given that experience and the time that you spent with Marshall Smith,

what is your takeaway for what he's trying to do in Alberta? Yeah. I spent most of my time during the few years I've been covering this talking to people in the harm reduction field. And many of them are simply heroic figures. They're people, they're mothers who have lost children and have become very invested in the problem. They're outreach workers working on the streets of Vancouver or Toronto or Edmonton. And they really care and they've done a tremendous amount of good in terms of reminding us all that people who use drugs and whether on the streets or not are real people and with complex stories

and that it's not a simple matter of saying, tut, tut, don't use drugs. It's more complicated than that. Recently, we have seen a shift in the national conversation on the way that we approach the drug crisis, right? I'm thinking of BC and the change with decriminalization there. Will we see something similar to this model be potentially adopted in other provinces? Yes, I think quite possibly. Saskatchewan is looking quite seriously at it. So is Ontario. In fact, those three provinces, Alberta, Ontario, Saskatchewan, recently formed a kind of alliance to push recovery. And I think you have seen a change

in the national mood on this, especially in British Columbia, but elsewhere too, because people are noticing there are more people on the streets using drugs quite openly. That alarms people. They see kind of urban disorder, I guess you would call it, that is making people feel worried about their safety and so on. And so that all plays into this idea that, look, we need to take a different approach. And so Marshall definitely has kind of the wind at his back with Pierre Polyev at the federal level taking an interest, Ontario, Saskatchewan taking an interest, B.C. taking quite a sharp reversal on decriminalization. So, yeah, the momentum is very much on his side. Marcus, thank you for being here today.

My pleasure. That's it for today. I'm Maina Karaman-Wilms. intern is Aja Sauter Our producers are Madeline White Cheryl Sutherland and Rachel Levy-McLaughlin David Crosby edits the show Adrian Chung is our senior producer and Matt Frainer is our managing editor Thanks so much for listening and I'll talk to you tomorrow