The Alberta Model: Who benefits from the Alberta government’s shift away from harm reduction to abstinence-only recovery

There have been 904 opioid poisoning deaths in Alberta in just the first 9 months of 2020, compared with 790 COVID deaths to date. There are two public health crises racking our province simultaneously but one of them doesn’t get a daily briefing and endless press coverage.

 And while the opioid crisis rages on Premier Jason Kenney and his United Conservative Party (UCP) have made good on their promise to support abstinence-only, privately-run recovery centres, cracking down on harm reduction programs while showering money on rehab facilities that lack oversight and public accountability. 

Statistics on the last five years of opioid poisoning deaths from a newly unveiled government of Alberta dashboard.

The UCP philosophy on addiction was summarized by Associate Minister for Addictions and Mental Health Jason Luan, who wrote in the Edmonton Journal that "addiction does not exist in drugs; it exists in people. Therefore, the solution exists in people and not in tinkering with the drug supply." 

According to this mentality, the problem is you, and the only way to get better is through a rigid regimen of abstinence. 

But, in reality, there is a problem with the drug supply. With three months of reporting time still left in 2020 Alberta has set a new record for opioid poisoning deaths, the previous high being 806 deaths in 2018. 

The pandemic has led to increasingly toxic drugs as borders close and illicit supply chains are disrupted. In October, police in Victoria seized a supply of fentanyl with a 90 per cent concentration, compared to the usual 10 per cent. 

Neighboring B.C. is tackling this issue with safe supply programs.  That approach appears unacceptable to the office of Minister Luan, which has embraced an extreme abstinence-obsessed strategy that runs counter to evidence-based practices.

“When we talk about reducing the shame and stigma, we’re talking about the shame and stigma of recovery,” Luan’s chief of staff, Marshall Smith — a key figure in this story — said in a 2015 interview with Talk Recovery Radio.  “I think that there is a certain shroud of stigma that needs to remain around addiction.” 

Luan's office didn't make himself nor Smith available for comment on this story.

The mysterious Mr. Smith

Smith has been a guru for the private, abstinence-only recovery model for more than a decade. He has a personal narrative that those looking to lend credibility to this particular approach to recovery have eagerly seized upon.

Smith was a rising star within the B.C. Liberal party tasked with assisting in the preparations for the 2010 Paralympic Games when he was twice busted for selling cocaine and crystal meth in 2004. 

“From 2004 to 2007, the one-time rising star became a sketchy street-level hustler, dealing drugs to get money to feed his habit, sleeping in Vancouver parks and alleys, and playing cat-and-mouse with police who knew about his former life in the loftiest circles of political power,” a sympathetic profile from 2009 in the Ottawa Citizen reads..

In 2007, he successfully entered rehab and afterwards became an evangelist for the abstinence-only recovery model. 

His first place of employment after rehab, the Baldy Hughes Therapeutic Community and Farm — a men’s recovery clinic — received a $1-million grant from the B.C. Liberal government in 2015 to open 20 new beds, 13 of which had already been filled by the time of the announcement. At that time, Smith was employed at another private, abstinence-oriented rehab centre, Cedars at Cobble Hill, rising to the ranks of executive director in 2016. 

Smith is, or at least was, the chairman of the B.C. Recovery Council, a mysterious entity that appears to only exist in the media and “Recovery Capital” lecture circuit, where Smith is depicted as an expert in the field.

In 2018, the Victoria Times Colonist reported that Cedars Cobble Hill and another private recovery centre had five publicly-funded beds between them. The story quotes Smith calling for more funding for recovery centres, identifying him not as the executive director of Cedars, where he worked until May 2019, but the chair of the B.C. Recovery Council. 

Rejecting harm reduction 

During the 2019 election campaign Premier Jason Kenney was intensely hostile towards supervised consumption sites. 

Kenney argued that harm reduction advocates were “helping addicts inject poison into their bodies” at “NDP drug sites.” Once elected, his administration commissioned a deeply-flawed report on the value of safe consumption sites. The report’s authors were only permitted to look only at the social and economic impacts of the sites—not their efficacy in reducing harm or saving lives.

North America’s busiest safe consumption site, Lethbridge’s ARCHES, was subject to a politically-motivated audit, which revealed gross financial mismanagement. Rather than working to keep the site open under new management, Kenney used the audit results as a pretext to shut it down in August. 

Opioid deaths in Lethbridge have more than doubled this year to 42 from 20 in 2019, according to data the government released Dec. 18, underscoring the urgent need for a harm reduction strategy in that city. 

“It is so inappropriate to have closed that place,” says Dr. Susan Adelmann, a physician who works at the Blood Tribe Medical Clinic’s detox facility in Standoff. “Lethbridge now has the highest opiate overdose rate in the country, and possibly North America. That site had more visits than the rest of the sites in Alberta combined.” 

Adelmann wrote an open letter to Luan lambasting the government’s decision to close the Lethbridge safe consumption site, which has unsurprisingly led to an increase in overdoses in the city and surrounding reserves, as well as more needle debris in the downtown area.  

In the letter, which is signed by three other physicians, Adelmann describes the inadequacy of the replacement mobile site, which has just two injection booths, as well as the lack of personal relationships between the staff and clientele. She also notes who all the government money for recovery is going to. 

Adelmann writes, “We have noted that these treatment centres are run by ‘friends of the UCP’ who also sit on the provincial Mental Health and Addictions Advisory Council. Who stands to benefit financially from an approach to addictions that is costing lives?”

Who benefits from the Alberta Model?

The UCP convened a panel on mental health and addiction, co-chaired by Pat Nixon. Pat Nixon is the father of Environment and Parks Minister Jason Nixon and UCP MLA Jeremy Nixon, and is the founder of the Mustard Seed Ministry.  

The mental health and addiction panel includes three people in the top echelons of the private recovery sector — Poundmaker’s Lodge executive director Brad Cardinal, Fresh Start Recovery Centre executive director Stacey Pederson, and Andy Crooks, a lawyer and founding director of Simon House, who was also a director with the Canadian Taxpayers Federation while Premier Jason Kenney was its CEO. 

All three are abstinence-only 12 step recovery centres, and two have since received government funding. Fresh Start, which is for men only, received  $1.56 million to fund 294 beds over three years. In the same announcement, Lloydminster’s Thorpe Recovery Centre received $2.21 million per year to fund an additional 1,722 treatment spaces and Sunrise Healing Lodge received $518,300 to fund 156 beds, both over three years. 

“This kind of support for abstinence-based treatment and long-term recovery is unprecedented,” Pederson said, calling it a “game changer” in a February news release which didn’t identify him as a member of the government’s advisory council. An Edmonton Journal op-ed touting the recovery-centric approach identifies Pederson as co-chair of the Alberta Addictions Service Providers, a coalition of 30 private recovery clinics, which includes Thorpe, Fresh Start, Oxford House and Sunrise. 

Thorpe’s development coordinator, Sara Fox, says their 42-day recovery program has a 79 per cent completion rate, but beyond that it’s difficult to determine a definitive success rate. 

“For, what is success? One day of abstinence? One month? One year? It is misleading to claim that someone will be “cured’ after programming,” Fox said. “Continued dedication to one’s wellness is necessary for a prolonged life in recovery.”  

None of the other clinics that have received money responded to requests for comment. 

In December 2019, the government announced $1.4 million in funding for Poundmaker’s Lodge’s Iskwew Healing Lodge to fund 28 new beds and seven existing beds. 

“This government needs to be acknowledged for its commitment to UNDRIP, TRC recommendations, MMIWG recommendations and its concerted effort to addressing the opioid crisis,” Cardinal said in the news release, which again neglects to mention his status as a panel member. 

Poundmaker’s, which is built on the site of a former residential school, is under investigation by the Morinville RCMP and Edmonton Police Service for allegations of sexual impropriety against staff.

Luan also committed $25 million in July to build five new recovery centres with a total of 400 beds across the province. Luan did not announce who will own or operate these centres. 

Luan and the UCP haven’t been so generous with the public system. In August 2019, the UCP government told staff at the AHS-operated McCullough Centre for homeless men in Gunn, Alta., to stop taking in patients as its programming will be defunded by February 2021 to save provincial coffers just $3 million. Its program goes beyond the old school 30-day recovery model to give their clientele time to get their lives on track. As of October, the facility had just 11 of 75 beds filled, with a waiting list of 150 people. 

The government recently announced it was eliminating the $40 per day fee for room and board at 72 licensed clinics, making it easier for people who use drugs to attend recovery, whether it’s at a public Alberta Health Service facility, or private not-for-profit. But it is the private facilities who are receiving a major windfall while public facilities, like the McCullough Centre, get shut down.

This stands in stark contrast to the UCP and its allies’ stated commitment to recovery writ large. Their policy is about supporting private recovery facilities at the public’s expense.

Illustration by Karen Mills

Abstinence-only doesn’t work

The Alberta model that the UCP advocates seems to focus on maximizing the number of available recovery beds and hoping they fill up. It isn’t working..

“A one-size fits all approach isn’t really effective,” Adelmann says. “I don’t know if it was designed with the client’s experience in mind. There’s people with addictions from all walks of life.” 

And the scholarship in this issue backs that up.  

“Individual patient characteristics and preferences should be taken into consideration when choosing a first-line opioid agonist treatment," reads a March 2017 review in Canadian Family Physician of the literature that compares abstinence-only treatment with opioid treatments, such as methadone and buprenorphine-naloxone. “However, the most important factor to consider is that opioid agonist treatment is far more effective than abstinence-based treatment.” 

Despite the government’s agenda, Alberta Health Services has an explicit harm reduction policy, which “acknowledges that abstinence is not always a realistic goal for some people.”

Ultimately, the long-term siphoning-off of resources from the public sector has created a void for private actors to fill, from charter schools capitalizing on the defunding of the public school system to 12 Step recovery centres receiving funds that should go towards the public healthcare system. 

But in the case of recovery, the effect is two-fold — transferring functions from the public sector to private charities while also putting up barriers towards a sensible drug policy that includes harm reduction. 

A 2013 master’s thesis from Andrew Longhurst at the University of British Columbia, speaking of the situation in Surrey in particular, argues that this network of private, abstinence-only recovery clinics form a “shadow welfare state”, which provides the rationale for further reductions to the public sector alongside superficial relief to those looking from the outside. 

This siphoning away of the public sector, in turn, manufactures an apparent need for more private actors, who can then receive public largesse, particularly for those who are well-connected. It’s a vicious cycle — cut, privatize and then cut and privatize some more. 

But the stakes are exceptionally high with regards to addictions and mental health issues. You can throw as much money at empty recovery beds as you like, but it leaves those who haven’t yet made the step towards recovery out in the cold, highlighting the need for a strong harm reduction policy that allows people living with addictions the space to go into treatment when they’re ready. Anything less is negligence. 

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