Can We Break The Barriers To Drug Policy Reform?

Breaking Out?

Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families

Today's Learning Moment – 11 13 22 Issue: Can We Break The Barriers To Drug Policy Reform?
Note: This is an opinion/commentary article reflecting the author's views – backed up with references.

Recently our Port Alberni Community Action Team hosted a town hall meeting. We invited the entire community, including representatives from all three levels of government. A fantastic cross-section of our community came out and attended. We heard viewpoints from the whole spectrum of beliefs and all the contributing social factors to substance/concurrent disorders.

As you can imagine, the input mirrored society's broader beliefs on addressing the toxic drug crisis in our community/province. They included traditional ideas like the ^{(3) (4) (5)} War on Drugs concepts from the mid-twentieth century. Punitive notions like charging drug dealers with murder when identified as the source of poisoned drugs that cause overdose deaths. Incarcerating or forcing treatment on people with a substance disorder, etc. 

At the other end of the spectrum, we also had input from many who see the crisis as a human health/social catastrophe.

The Port Alberni Community Action Team respects every voice that comes to the table. Even though the principles of our CAT are from an evidence-based, humanistic perspective, we understand that each person's journey is unique. In reality, there are as many positions on the poisoned drug crisis as there are people in BC. On top of this, the entire gambit around substance disorders is incredibly polarising. Every single person has an opinion. Exploring those differences can lead to fighting words. Similar to one of the most famous feuds in history, the Hatfields and McCoys, emotions can run high. As a result, finding consensus is often challenging, even among those already dedicated to substance policy reform.

The spectrum is wildly divergent. It encompasses beliefs that propose everything from the death penalty for dealers to having unrestricted access to all drugs without any control whatsoever.

There were some key takeaways from our town hall meeting. From a local perspective, the first and most important for most people is establishing a crisis/stabilisation unit. Many others felt a detox facility is also needed. The second broader goal is finding ways to provide education, especially to that part of the belief spectrum still entrenched in the traditional War on Drugs myth (the idea that retaliatory and punitive methods work).

Part of the outcome of our workshop was the recognition that we need to respond to beliefs not driven by the latest evidence-based information or a health-based model. Brainstorming education solutions gave us ideas like a Q&A website where we can point people to humanistic health-driven evidence-based answers.

There in lies the rub! We looked on the web and found nothing that currently fits this resource concept. A single place to send people for evidence-based answers to extreme points of view at either end of the spectrum. Possibly because those fighting for policy reform also can not agree on many of the proposed solutions. For example, even among the various Health Authorities in the Province, there is no universal agreement or acceptance on basic concepts like defining harm reduction and what that means in practice.

It should not be surprising that if substance reform policy people can not find consensus, creating resources that answer non-humanistic views on how to fix the toxic substance crisis becomes incredibly challenging. For example, building a Q&A resource usually starts with an agreement on the solutions.

Indeed, from a Community Action Team's perspective, we have embraced the concepts of safer supply, decriminalisation, reducing stigma, harm reduction and solving social factors that contribute to the whole mess. That puts CAT Teams, with some other progressive organisations, on the leading edge of the spectrum we mentioned before.

The dilemma, of course, is that many of our three levels of government – municipal, provincial and federal are not on the same page as us. Neither are some people in our health authorities, professional regulating bodies, service providers, criminal justice, and public safety officials.

We need the professionals (individuals in Government and Health Authorities) to step up and lead rather than wait for a top-down driven policy to arrive at their desks. Individuals in their fields need to speak out and be counted. Your voices matter as much or even more in driving change as organisations like CAT Teams or other progressive substance policy reform organisations.

It wasn’t surprising that the recent recommendations from the BC Select Standing Committee on Health Report – ⁽¹⁾ Closing Gaps, Reducing Barriers: Expanding The Response To The Toxic Drug and Overdose Crisis include some rather provocative recommendations. The first is 11a, on page 11 of the report – Ensure a prescribed safer supply of substances is available in all areas of the Province by:

a)    Urgently engaging with the regulatory colleges and professional associations of physicians, nurse practitioners, nurses, and pharmacists in BC to identify and resolve barriers to prescribing and providing a prescribed safer supply of substances.).

The second controversial recommendation is #2 on page 22 – Leverage and strengthen existing mechanisms to hold the health authorities accountable for rapidly expanding harm reduction and treatment and recovery services throughout the Province, including:

a)    additional quantitative targets in mandate letters and service plans;

b)    requiring public reporting on those targets at least annually;

c)    ensuring increased collaboration between health authorities.

In addition, the March 2022 ⁽²⁾ Special Report from the BC Coroner's Office is a complete roadmap of what needs to change. Yet, little or no action has begun.

These recommendations from these reports tell a story that reflects some of the potential root causes of inaction to resolve the poisoned drug crisis in our Province. Ask yourself why a bi-partisan committee would make such recommendations. What is not being done? Who is dragging their feet in implementing drug policy reform in our Province?

Also, even within the people/organisations leading the spectrum of drug policy reform, there is no consensus on the answers, never mind the questions. For example, most drug policy reform folks believe that language used to describe people who use substances must be person-first driven and respectful. Policy reform organisations generally want to set an example using first-person language. Words like addict need to change to people who use substances. Addiction changes to a person with a substance disorder. Remember that it is crucial to know your audience and target your messages to those audiences.

I am reminded of a recent experience of a friend who went to an AA meeting as a guest speaker. He decided to use the latest substance disorder first-person language and immediately alienated first the old-timers and then, because of their response, pretty much everyone else at the meeting. There was a nod or two, but the looks the old timers sent his way (by default, the most respected members) along with some head shakes and eye rolls. That ended any attempt at introducing progressive new language that night.

Of course, from the perspective of leading-edge policy reform organisations, this was just a speed bump and will not stop our introduction of language that reduces stigma. However, it points out the importance of understanding your audience and responding appropriately to their needs. Change happens slowly. I suspect that we'll be talking about language for decades to come.

For example, the title of International Overdose Awareness Day is a learning lesson for policy reform because of the word (overdose) in the title. Many in the drug policy reform movement do not see the crisis as an overdose crisis. They see it as a poisoned drug supply crisis. The word (overdose) does not work for them.

As the drug policy reform movement struggles with language, questions, and defining answers, we flounder in our messages to the most critical demographic that needs to hear our vision – the general public. Frankly, most people in the broader community still think in substance disorder terms created in the mid-twentieth century or earlier. Addiction, addicts, junkies, alcoholics, drunks etc., to name a few.

It's hard work shifting people's mindsets. However, to achieve success, we have to stay relevant. We need to talk in terms people understand while at the same time bridging our words to new language and thinking. This article is an example of just that. First, deliberately using old terms and then providing more recent respectful and non-stigmatising language.

In our Community Action Team's work, we've found that sometimes we hesitate to jump on educational opportunities because we've become sensitive to being politically correct in our language and ideas.

Where does that leave us? The enemy of drug policy reform is inertia. It does not matter if it is due to burnout, feeling overwhelmed, or being too sensitive to the feedback of others. It is easy to forget we're on a journey and that there are no shortcuts. Every step matters and must be taken if we are to move forward. Every person and organisation fighting for drug policy reform have their place on the journey. The complexity of drug reform makes it inevitable that mistakes will be made. The way forward is to take a step, any step. Learn from those steps that do not work, and then take another. How do we move forward? The simple answer is to be courageous, do something, re-evaluate, modify and do again.

Here is a personal challenge for everyone who reads this article. It does not matter who you are. Politician, bureaucrat, health professional or citizen. What is YOUR plan? What will you do today, tomorrow or in the coming weeks to end this health crisis? Everything to date is not decreasing deaths from the poisoned drug supply. How does that saying go? – I am paraphrasing here. "Doing the same thing over and over and expecting a different result means you are the problem." Write a letter to your MP or MLA, if you're in the system, call your boss, and tell them you support safer supply/decriminalization. Challenge your past preconceived ideas by learning the latest evidence-based concepts on substance disorders. Talk to other people. Do something, anything, because we are that deep in trouble now. There is no more time to waste. Every day we do not act kills six more British Columbians.

All our past articles are here: https://ptalbcat.blogspot.com/ 
The link to this specific article is https://ptalbcat.blogspot.com/2022/11/can-we-break-barriers-to-drug-policy.html. You can SHARE by copying and pasting this link everywhere you want.

Author: Ron Merk  – Ron advocates for families with loved ones who suffer from concurrent disorders. He also writes on various topics driving understanding of substance use policies in British Columbia and Canada based on the latest evidence-based information available.

Families Helping Families is an initiative of the Port Alberni Community Action Team. We regularly send out "Learning Moment" articles to help folks understand substance and mental health illnesses. Knowledge is vital in understanding these disorders. You may copy, distribute or share our articles as long as you retain the attribution. Add yourself to our distribution list by dropping us a note at - albernihelp@gmail.com

Resources/References:

1.    BC Government Select Standing Committee on Health Report - Closing Gaps, Reducing Barriers: Expanding the response to the toxic drug and overdose crisis Nov 2022

2.    BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths March 2022

3.    Hannah LF Cooper (2015) War on Drugs Policing and Police Brutality, Substance Use & Misuse, 50:8-9, 1188-1194, DOI: 10.3109/10826084.2015.1007669

4.    The War on Drugs – A War on Drug Users
Buchanan, Julian and Young, L (2000) The War on Drugs – A War on Drug Users.

5.    B K Alexander 1990 - Peaceful Measures: Canada's Way Out of the "War on Drugs"6.