Dr. Julian Somers, a clinical psychologist and expert on addiction, addressed the crowd at the Free Speech in Medicine conference in Baddeck, Nova Scotia, where he addressed the limitations of safe supply programs in reducing addiction-related issues.
“Harm reduction as a practice started as a way of engaging people that otherwise would have not been engaged,” Somers explains. “But it has lost sight of that opportunity to play a role in advancing people into increasingly better positions of health and overall well-being. And the main failing of harm reduction following its inception has been to lose sight of that opportunity for continuous progress.”
Elaborating on the conflation between harm reduction and safe supply – the idea that supplying people with safe and controlled drugs will reduce or mitigate the negative effects of drug use – Dr. Somers says that while safe consumption has played a role in reducing HIV/AIDS, there are more effective strategies that have been successful internationally.
Dr. Somers highlights Portugal as one example.
“Portugal is well known for markedly reducing street drug use related crime, related HIV and other infectious disease transmission rates. And they did all of that with not a single consumption site in the whole country. It's not an indictment of consumption sites as an idea, [but rather] it's a recognition, an illustration, that there are other ways of addressing the harms faced by people who would otherwise use consumption sites. And in particular, if we can provide them with decent places to live where they feel stable, or for some, it was therapeutic communities.”
Therapeutic communities are, in essence, a model of supporting people, Dr. Somers says.
“If we start with our death statistics in Canada, there are people who are overwhelmingly unemployed, fully unemployed, and they're disproportionately young men. That should turn our attention to the fact that not only are they people who for their long-term health, would likely benefit from assistance in learning how to live differently, with drugs.”
Dr. Somers differentiates between abstinence and a more controlled use of drugs.
“I’m not talking about abstinence,” he says, “I'm just talking about a much safer way of living with drugs, if that's how they're going to live, but also with employment.”
That’s because there is a well-established relationship between employment and protection from addiction, or, at least, an advantage in overcoming harmful addictions.
“Therapeutic communities combine two things that would be directly relevant to our problem. One is they provide places for people to live for between one and two years usually, where they can develop daily habits that involve different practices than getting high all the time; and part of it also is that they usually have some kind of vocational focus, so that by the time people are leaving the therapeutic community, they have not only some confidence in having learned new habits of daily living, but they also have a book, they have a vocational credential that is going to make them marketable in employment in whatever community they move into subsequently.”
Meanwhile, provinces like British Columbia have next to no therapeutic communities but over forty (and counting) consumption sites.
“We have to reflect on whether the direction we're going in has any sort of long-term likelihood of success,” says Somers. “Unfortunately, from the evidence we have elsewhere and here, it doesn't look like it.”
Somers highlights a lack of direct cost comparisons between therapeutic communities and standard care but notes how the current model has shown limited improvement in overall outcomes.
The cost-effectiveness of an improved care model, such as therapeutic communities, must be shown alongside its long-term benefits. These include reducing medical and criminal justice costs with a strong potential for those in recovery to become taxpaying, contributing members of society.
This is a broader picture of the social determinants of health that sadly many political leaders seem to ignore.