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By coincidence, this article dropped about 6 hours after I published this: https://nationalpost.com/opinion/np-view-the-safer-supply-farce-is-unravelling

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You people are frigging brilliant.

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Not so much brilliant. I think the word is "loudmouth". We are the ones who are too blockheaded and stubborn to stay silent.

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Thank goodness!

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Brilliant and brave

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The words 'harm reduction' sounds rational, in that if you accept that drug addition will always exist (like prostitution) then via a series of social/mathematical equations, there is an optimized set of policies that reduce the overall 'harm' to 'society' (and the collection of individuals of which it is comprised). It sounds like an optimization problem. The problem is, the people behind these ideas are not rational at all, they are completely ideological, and these 'harm reduction' strategies are madness and magical thinking.

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The problem with every crazy idea is that there is usually a grain of truth in it. Believe it or not, even after 4 Substacks of diatribe, I'm not totally against all harm reduction at all times and in all places. Because it's true as you have brought up that addiction will always be with us to some extent.

I think where it harms more than helping is the mass deployment at scale: putting hundreds of thousands of free needles onto the street in my community of Sydney NS. Flooding the street with "free" dilaudid. Letting people set up permanent residence in public parks. Offering addicts burners to melt pills instead of information about absinence programs. We crossed a line a long time ago.

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Feb 10·edited Feb 10Liked by Pairodocs

Well I agree with you, I don't think the concept of Harm Reduction, per se, is necessarily bad. As an applied scientist, I am used to optimization problems all the time. The question is what the supposedly rational policies are, and it certainly seems to me that many of the choices being made related to drug addiction policy are based on wishful thinking, with a dose of bleeding hearts, and naivite, thrown in. As you say, the actual real life results and empirical data put the lie to the claims these policies work. Also, in my experience, the cohort who promote these ideas aren't especially strong in areas of data and quantification, so they while claim their policies are data driven, I don't think they necessarily have the skillset to properly determine this.

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Feb 11Liked by Pairodocs

So many good points made here, so much to think about. Seems the boosters of "harm reduction" are in league with the folks who couldn't see the obvious harm of the lockdowns. Rather than accept the obvious impact of what was being done, they spun what they saw to fit a narrative that distorted what was really going on. A simple enough analogy to the harm reduction concept: look at any movie from the 50s and 60s and see how many smoked cigarettes, how smoking was made to seem attractive and "normal". When did that stop? When the narrative was changed to include the reality of the harm cigarettes were doing and steps taken to reduce consumption despite corporate push for use/profits. Cigarettes were made to seem less attractive, less available, less socially acceptable.

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author

Great analogy about COVID policy and harm reduction. Rule by experts. Anyone who disagrees is a bad person who wants people to die. Lots of hard evidence of at best non-utility and at worst harm. And no coincidence IMO that in both examples, Big Business/Big Pharma/Big Government come out with more money, more power, bigger markets.

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Again, thank you, for shedding light and dialogue into the 'harm reduction' issue. This thing has more tenacles than an octopus. So many are 'taken in' by the words 'safe' - oh goodness just look at the 'safe and effective' jab they kept rallying for. This is another avenue. I really think when you make things so easy for people, they don't need to think. Ahh, could that be the motive? We are in a mess and who can possibly look at our governments, people like Bonnie Henry, or those advocating for more of these sites, without asking why and how are they benefitting anyone, especially the addicts?. Where I live, these 'tent' cities are alive and well and creating a monstrous outcome. In Belleville, ON this week, 14 OD's within 1 hour alone. Yeah, these safe injection sites are just peachy. :(

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I read that article about Belleville with great sadness. I worked in ER in Belleville and Trenton for about 4 years. When I left (2003) I don't recall one homeless person, and addiction issues were not a significant issue in ER. Actually, I can only recall one or 2 issues in my 4 years there. I note as well that there was no such thing as "harm reduction" at that time...

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Feb 10Liked by Pairodocs

I found this series to be exceptionally insightful and persuasive. Excellent work! Thank you for sharing such compelling content.

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Great series! Thank you 👍🏻

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Feb 11Liked by Pairodocs

Great article doc...I remember, maybe 10 years ago, watching a program that featured three addicts (I believe it was a John Hopkins study) who were addicted for many years to various substances (heroine, alcohol, tobacco) and they did a controlled study with each participant with psilocybin mushrooms. The result with one application was each participant lost/overcame their addiction. This amazed me. I never heard another word on it.

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I've followed the hallucinogenics craze with great interest. There has been a succession of magic drugs throughout medical history. (I recommend reading "Whiplash and Other Useful Disorders" - great book!) Every one was going to be "the answer" and every one was great in initial testing. From thorazine to valium to Prozac to Ritalin etc etc etc. I just don't think the solution to drug addiction is more drugs.

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Feb 10Liked by Pairodocs

Thank you for the honest and brave words. Living in BC has been very frustrating, to say the least. It seems common sense has been left behind from the very people who should be aware of the damage they are doing. I don’t believe our leaders, political or health, want anyone to get off the drugs. I have an estranged son whose life is being destroyed by addiction. There are too many lives being destroyed by these harmful policies.

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Feb 10Liked by Pairodocs

Thank you for drawing attention to this lunacy. It is striking that safer supply, like pretty much all of Canada’s problems at this point, is a self-inflicted wound caused by leftist politics.

Also striking that the claim to be evidence-based, it is yet another situation where leftists are immune to evidence and reason. Instead of engaging with critics, we get patronizing lectures on our moral and intellectual failings. And of course these idiotic policies are universally supported by the bureaucracy and legal system.

I have little hope left for this country. It is too stupid to survive.

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Imagine the Inca’s saying “I know the weather was bad this year and the crop yields were terrible, but it would have been so much worse if we hadn’t sacrificed all those virgins on the mountaintop, in order to appease the Gods!”

Modern translation: “I know the drug crisis is bad and overdose deaths are rising, but it would have been so much worse if we hadn’t been handing out opioids like candy, sacrificing a whole group of drug virgins to appease Big Pharma and Public Health!”

As you say, if the strategy was working, things would be improving by some objective measure, but things are not improving. The places with the most liberal drug policies (including harm reduction) are the places with the biggest problems, so the correlation is there.

The zealots will argue that “desperate times call for desperate measures” (ie the drug crisis was there first and the crazy policies were a logical response) and then argue for even more desperate measures. They admit they have no evidence, but then say they are “following the science” - we’ve heard that before!

The realists will point out that the zealots are fuelling the fire and fanning the flames. We need more scholarly articles showing the harms of safer supply, etc. Good luck getting those funded or published! Thank goodness we have people like Adam Zivo leading the charge to get it out there in the public domain.

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author

Thanks Rick - I really enjoyed your Substack and I hope lots of folks will click the link at the end of my article here to check it out.

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Thank you for this series.

I’m in the music business and, therefore, know a lot of people who have pulled themselves out of addiction and many who have died because they didn’t.

Most who didn’t make it, even after getting sober, fell because it was too easy to get the drugs.

How can anyone think making it easier to get drugs helps?

I feel there must be money to be made in this so it persists

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Sadly, there is a LOT of money being made.

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Feb 10Liked by Pairodocs

Bravo! And I will find time to check out the other things you have referenced. The bottom line is that this madness to anyone with an ounce of common sense is just more neo-marxist social deconstruction. As with other nonsenses, many of the foot soldiers may think it's all wonderful. Those behind it are trying to destroy our society.

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Feb 10·edited Feb 10Liked by Pairodocs

Our addiction problems have been festering for decades and have several root causes. The misery on the native reserves, the loss of good-paying manufacturing jobs, automation in the natural resource industries, failure to provide foster kids support when they aged out of the system, relaxing penalties for criminal behaviour, closing the mental hospitals, shutting down the building of public housing and the loss of small affordable private housing all added to our present addictions problems.

I would add in two other issues. The long open border with the United States means that we can not keep out imported drugs.

I am surprised that we do not seem to realize that Canada is no longer such a rich country. Slowly but steadily, our working class has been getting poorer. Many now work two jobs; some three. In the late 1960's a minimum wage job would pay the rent on a room or a basement apartment, allow you to buy a used car and still have a little spending money. Not any more.

We haven't the means or the will to fix all of this. Instead, our different levels of government realizes that it is cheaper to let the addicts be and pay the Harm Reduction NGOs to "handle" this problem on our behalf. Want a few more millions of dollars? Sure thing, here is a cheque.

Take a good look at Food Banks. A temporary measure that was started 70 years ago and has never been fixed.

Portugal and Scandinavia don't have the answers to our drug problems. I wrote an essay on who did successfully take on addictions.

https://hollandmarshall.substack.com/p/solving-the-addictions-crisis

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The old Portugese model was the best I think anyone has ever come up with. Actual penalties, but lots of treatment options and help for addicts. Apparently their model is eroding though as the approach has been modified.

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Feb 10·edited Feb 10

Well written and convincing again! Having made the argument now, does part 5 offer meaningful, attainable solutions? It’s all too easy to retrospectively disparage the efforts of well-meaning professionals, and while that’s an important part of quality improvement, I think it’s then important to offer attainable solutions. A gradual phasing out of harm reduction would only work with alternatives that are attractive to human nature for buy-in. Addiction is a complex beast! There is a dearth of high quality research on this issue—a lot of conflating variables. I might suggest better early education about this subject in schools, to provide kids with emphasis about the importance of, and the right tools for, healthy self-care practices. Also, maybe look towards successful policies in other jurisdictions, such as Portugal and Scandinavia.

Just to play devil’s advocate, I did find a study that appears reasonably well done, in support of OAT…

Lindsay A Pearce et al. BMJ. 2020

And there is the issue of abstinence based opioid strategies in treatment centres leading to rapid mortality upon release. Vincent Lam’s newest book “On The Ravine” alludes to this. It’s by no means scientific, but it is a lovely commentary illustrating the difficulties and intricacies of being on the frontlines of opioid treatment in Toronto, written by one who does exactly this.

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I've seen dozens of these small, local studies that show that as long as people stay in the programs and keep using the drugs they are given, they are better off by some measures (although, I will note, not happier). But that doesn't at all prove that they do more good than harm. Note as well that these studies exclude people who drop out. How many drop out? And what would that dropout rate be if the studies were longer?

My general approach to all of these big issues is that they should be worked out locally and individually. Centralized government control, and one-size-fits all programs that the whole province or nation is bound to, are worse than unhelpful. The approach that a clinic in downtown Ottawa might want to use is incredibly different than what might work in a rural farming village.

Perhaps my biggest suggestion is that none of this should be "free" (ie: taxpayer funded). If someone really thinks that giving free drugs to an addicted person is a good idea, and that addicted person is competent and wants to accept the offer, who am I to stand in the way? That said, I resent being forced to pay for it with my tax dollars, since I think it is misguided and harmful.

Big Government and the tyranny of The Experts™ is the problem, IMO.

The other important thing to take from what I'm saying is: harm reduction is in all likelihood harming, there is no GOOD evidence it's helping, so the first step to any solution is abandoning harm reduction as a universal (and primary!) policy.

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Fair enough, but the study I referenced was with 55000 participants over a 22 year period. It’s not a perfect study, but there is convincing evidence of significantly lower mortality for those who stayed on OAT. Does that mean addicts should stay on it forever? Honestly I don’t believe this is the best solution, but it does seem to keep people alive. Looks like we need a better, safer way to get people off of OAT, so that they don’t die.

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Can you break down the details of the study? What was well done about it? What was badly done? How did they deal with the issue of dropouts? Did addiction and OD death rates fall in that area over the timeframe? I'm happy to consider it, but it's critical to read it carefully and explain it if quoting it.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190018/

Free full text! You can see for yourself.

It’s quite an impressive effort, and shows that OAT seems to have a greater protective effect on participants since the rise of fentanyl on the streets. The authors do point out some limitations on their own, but I might suggest that having the wherewithal to stick to an OAT program does imply a certain degree of organization, motivation and responsibility, which in itself likely protects against death.

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So how did they deal with dropouts? What percent dropped out? What did overall rates of addiction and death in the area do? ie: if those in the program were better off but more people in the community got addicted or died (from the secondary effects I had pointed out in this article) then the program was almost certainlly more deadly than helpful.

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That’s an interesting conclusion to draw from what was in the study, and while I disagree, I respect your opinion. I enjoy these discussions, and I’m grateful that you’re pointing out some flaws in the current system. The sad silver lining is a ready supply of healthy, young organs for transplants, and I suspect a moratorium on OAT would lead to more healthy organs than we can transplant…

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I have one major solution— AA and NA and treatment centers that have AA and NA meetings

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Feb 10Liked by Pairodocs

Yes if followed to the letter, I believe these programs work. Among other things, they provide the connectedness and “third place” activity that is sorely lacking in our society.

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Feb 13Liked by Pairodocs

Solzhenitsyn said Alcoholics Anonymous is one of America's greatest ideas. Kurt Vonnegut called Alcoholics Anonymous "America's most nurturing contribution to the culture of this planet".

The foundation of Alcoholics/Narcotics Anonymous is faith, surrendering oneself to a higher power, accepting God as one's moral authority, or some deeply personal form of awakening to the value of one's own life and the lives of others. That is likely a significant reason why today's socialists "know better" than the AA model. To a socialist, The State is the moral authority, faith is anachronistic (or worse). Also, socialists cannot exercise any control over AA meetings, where political chatter is explicitly forbidden, nor are they able to rename Alcoholics Anonymous or reshape it into something it isn't, and there is no way to install DEI.

Consider, too, that Alcoholics Anonymous is not an industry or a government tentacle, rather AA is composed of people coming together to confront a common problem while committing to help each other. Nobody is in it for the money, AA is funded by voluntary contributions from its members, its gurus are people who have been through the exact addiction about which they freely offer council. In many ways the opposite of a government program, Alcoholics Anonymous is dedicated to harm elimination and has been around for 90-years, now established in 180 nations. That is impressive. Measuring the sobriety success rate of a group who values anonymity is obviously inexact but AA long-term sobriety success estimates typically range between 25% to more often 50%, which is impressive, and a New York Times article from 2014 claimed that up to 75% who joined AA remained a member for at least a full year, also impressive.

And I'm no expert, but I'm pretty sure they don't hand out booze at AA meetings.

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wonderful comment Matthew with a number of facts and ideas I hadn't known about or considered. Thanks for this.

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Wow this article is bang on! We need change ND what government is going to do it. That will be my question when anybody knocks on my door . Thank you for this information and confirming my own beliefs.

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