We can't just tell drug addicts to buck up and get their lives together
‘It's a disease where some element of personal responsibility must still play some role’
By Jen Gerson, for CBC News Posted: Mar 11, 2018 7:00 AM MT Last Updated: Mar 11, 2018 7:00 AM MT
About The Author
Jen Gerson is a freelance journalist based in Calgary.
There is a reason the Alberta NDP announced it was opening up "supervised consumption sites" in Calgary late last year.
There's also a reason they avoided the more commonly known term: safe injection sites.
It's because while there may, indeed, be a plethora of evidence to suggest that these sites save lives and reduce the spread of disease for people suffering from addiction, they also raise concerns among people who feel we're moving more toward enabling addicts, than helping them live free of their demons.
While many of us have come around to the idea of drug addiction as a disease — it's a disease where some element of personal responsibility must still play some role.
Some never try drugs.
Some try, but never get addicted.
Some addicts try to get off drugs, and fail.
Some addicts try and succeed.
There is some combination of genetics, upbringing, trauma and, yes, choice, that we've yet to fully unravel in all of this.
But we are more than rats pulling a lever.
'Helping addicts inject poison'
Safe injection sites don't appear to raise the public ire as they once did — particularly now that the opioid epidemic sweeping Alberta is collecting exponentially more lives every year.
Or, rather, they didn't seem to be terribly controversial until United Conservative Party Leader Jason Kenney decided to make them so.
In a lengthy Facebook post last week, he wrote, "We absolutely need to show compassion for those suffering with addiction, and we need to help them get off drugs.
"But helping addicts inject poison into their bodies is not a long-term solution to the problem." And there's the dilemma.
Kenney was roundly lambasted for his comments.
But while the public outcry was apparent, the inner gut wrench was not.
An NDP MLA with more moral authority on the subject than Kenney responded: "He depersonalized anybody with an addiction and labelled them as this horrible person who was bent on doing this awful behaviour," Debbie Jabbour told Postmedia.
Her daughter died of an overdose in 2017.
Then, Kenney seemed to walk back his comments a few days later, acknowledging a Supreme Court case against the Harper government, which ensures consumption sites can't be denied a license by the government.
If this back-and-forth is indicative of all the deftness Kenney can muster to outmaneuver the NDP on social issues — well, bub's still got some work to do.
"I'm not saying I'm opposed to reasonable harm reduction efforts, but I am saying that we need to be realistic about this," Kenney told Global News.
But he did raise some fair questions about where the logic of such an approach will inevitably takes us.
A moral divide
If we are going to treat drug addiction as a chronic disease — no different in its moral dimension to other lifestyle-impacted illnesses like diabetes or hypertension — then the path becomes clear.
We should offer prevention and abstinence where possible, and ongoing treatment where it is not.
And this will mean providing some chronic addicts lifelong access to clean, regulated drugs so they can manage their addiction.
This, just as someone with a faulty pancreas injects insulin.
Lest anyone accuse me of slippery-slope fear mongering — it's currently happening.
There are already pilot programs in place to provide taxpayer-funded opiates for severe and chronic addicts.
And there's a reason.
We can't just tell drug addicts to buck up and get their lives together.
Nobody can kick a drug habit if they're dead.
Setting up potential overdoses
Recently, the CMAJ medical journal published new guidelines that encourages doctors to offer addicts prescription drugs in favour of detox programs.
The reason is that detox programs don't always provide inadequate after-care, setting up those who have successfully detoxed up for potentially fatal overdoses if they relapse.
The first line of approach, according to the guideline, is now Suboxone — a drug that should reduce opioid cravings.
But if that doesn't work, doctors are encouraged to switch to methadone, and in severe cases, slow-release morphine.
These latter two options require special training and federal exemptions.
Here is where we are going to run into problems with ordinary folk — those who have to wait for years to get hip replacements, or spend hours in emergency when their kids break their arms.
It's hard to stew in pain and not resent the resources marshaled to the aid of those who are the 'authors of their own misfortunes'.
We might all, at some time, quietly and privately feel those feelings.
That said, assuming that drug addiction is solely a matter of personal choice and failed will is what has led our society to its current state of opioid crisis.
Giving drug addicts drugs
There is no doubt that society has spent enormous sums of money trying to help people get off drugs — or to policing enforcement designed to do the same.
Yet the problem is getting worse, particularly as ever more potent forms of opiods like fentanyl hit the black market.
The moral challenge may come to this.
We know we have got to spend money on this crisis.
And while spending it on prevention sounds goods, we may also need to spend it on giving drug addicts drugs.
Abstinence programs for drug and alcohol addiction seem to be about as effective at getting people off drugs and alcohol as promoting sexual abstinence has been at preventing teenage sex.
The success rate of hallowed programs like Alcoholics Anonymous, for example, are highly disputed.
At the high end some claim it's 75 per cent.
At the low end, some studies suggest that between 5 and 10 per cent of those who enter such programs manage to stay sober in the long run.
Meanwhile, harm reduction is no panacea, either.
Naloxone is a life-saving drug when administered to an opioid user in the throes of an overdose.
Yet a recent study entitled, "The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime", came to a depressing conclusion.
To wit: "We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality." Drug addiction seems to be one of these areas of public policy that most closely hews to the depressing laws of unintended consequences.
Every good intention is met with some new ruin.
Until someone you love struggles and dies
What we are left with, then, is the need to become ruthlessly pragmatic about how we define success in our war on drugs, such as it is.
Does it make sense to send addicts to morally palatable detox programs again and again? Knowing full well that their chances of failure, or resorting to crime to pay for a fix, of using tainted drugs and overdosing are so high? That is a high cost for 'moral certainty'.
It's an easy one to have — until someone you love struggles and dies.
It may be an unpalatable truth that providing chronic addicts access to clean, subsidized drugs at managed and supervised doses, is what will allow those trapped by drug abuse the ability to function, to get jobs, to form meaningful relationships free of the need to steal or do God-knows-what else to earn their fix.
This may be the only way forward — the only way that actually works, anyway.
Public policy can't ever abandon the highest achievable goal — that it is better for addicts to not be addicted.
We need to provide the supports to ensure as many as possible can beat those addictions.
But we must also temper that hope with the bitter knowledge of what works.
We have a moral obligation as a society to value what is effective over what makes us feel better; but those who are asking the taxpayer to foot the bill for what looks an awful lot like enabling shouldn't be too quick to dismiss the collective unease this approach will elicit.
I'm not sure Kenney is so wrong to test the limits of this kind of compassion.
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