First Do More Harm
Faced with a difficult problem, Saskatchewan Minister decides to make it worse.
When Saskatchewan Minister of Mental Health and Addictions Tim McLeod says that the existing policy to prevent overdose and transmission wasn’t working, he’s not wrong. The province had a record 237 new cases of HIV diagnosed in 2021, up from 184 the year before. At 19 new infections per 100,000, Saskatchewan’s provincial rate of new cases is not only the highest in Canada, it’s over four times the national rate (4.7/100,000), and nearly ten times the rate of British Columbia (2.5/100,000), once the epicentre of Canada’s HIV epidemic. As for overdoses, there were an estimated 484 fatal drug poisonings in 2023, another record-setting year. And with more dangerous drugs on the street, including fentanyl cut with “tranq” that doesn’t respond to overdose treatment eith naloxone, things are only getting worse.
So the Minister isn’t wrong when he says what we’re doing isn’t working. The problem is, he’s decided to make it worse. Not satisfied with his previous choice to discourage safe consumption sites, he has now decided to stop distributing pipes – intended to encourage people to use these instead of needles - and limit access to clean needles. McLeod was “unable to point to a single piece of evidence that helped the province make the decision to changes its policies,” but there’s plenty of evidence against it.
As the US Centers for Disease Control and Prevention (CDC) reports, needle distribution programs, also known as syringe service programs (SSPs), have not been shown to increase community drug use, crime or public needle litter. In fact, they do the opposite. People who access SSPs inject less frequently and are five times more likely to go into treatment than users who don’t use the programs. They also decrease the risk of contracting HIV or Hepatitis C by 50% and increase connection to health services and the possibility of engaging in recovery. Just as his government had internal reports in 2020 that showed safe consumption sites would save money and lives but chose not to follow them, I’m sure McLeod has seen this information. He will have been briefed and know that making SSPs harder to access, especially in the province where HIV is spreading the fastest, means more people will get sick, more lives will be lost, and our health system will be under greater pressure.
Harm reduction is complex. We do need to find the balance between programs that results in diversion and increased use and reduction of overdose and disease transmission. There are problems with the current approach and changes needed to improve community safety and make sure that we move more people toward recovery. This means using evidence-based ways of getting people safe and supportive housing and working with the people providing frontline services to help link users to addictions treatment and recovery. I dug into these issues in previous posts (see below) on harm reduction and homelessness, and I continue to be reminded of the call to humility in the face of such a wicked problem.
Instead of showing that humility and learning alongside those folks on the frontlines, the province is choosing to ignore their experience. They’ve chosen a path that will result in more people dying from overdose and more people contracting chronic and potentially fatal diseases. This government is fine with that outcome, so long as it can appeal to people’s assumptions and prejudices about users. It’s a deliberate choice to do more harm. It’s hard not to hear the echoes of the worst days of COVID-19, as described in this paragraph from my 2022 book, A Healthy Future.
Whether it’s the failure to take the pending fourth wave seriously or to address the overdose and addictions crisis, the same principles are at play. An evidence-based approach to policy that uses health outcomes as a guide would dictate different choices, ones that would leave more people alive and well. Messages of intolerance toward those who have found themselves in trouble with the law or dealing with substance dependency may be more popular than investing dollars in getting them help. Declaring the pandemic over despite clear evidence to the contrary may be an easier sell than continued sacrifices. So long as the politically easy and expedient trumps what is wise and effective, so long as leaders put political gain ahead of people’s lives, we will continue to spend more to get worse results.
Here we are again with a government whose actions fly in the face of the medical evidence, that comfortably puts vulnerable people at greater risk. It’s cynical and cruel. And tragic.
Since 2020, over 1600 people have lost their lives to toxic drugs. That’s more than the population of Shellbrook, Scott Moe’s hometown. Of course some communities and families have been hit much harder, but in a province as small as ours, that means nearly everyone knows someone who has died or lost a loved one. As distressing as that is, to know that so many young lives have ended so suddenly, that so many families are grieving, perhaps therein lies the hope. If everyone who knows someone speaks up, if calls to avoid further senseless loss and cost turn into political pressure, maybe that’s evidence an otherwise uncaring government can hear.
It’s a sad commentary when governments let ideology determine policy.
As someone who suffers from mental health and HIV. The system is crumbling for those who need it most. I have to drive an hour to get the blood work I need.