Governments wield power over the implementation of harm reduction services, but their impacts aren’t limited to their own jurisdictions. For better or worse, their views can have much wider influence.
The government of Alberta, Canada, currently formed by the province’s United Conservative Party (UCP), provides one example of this. In March 2020, it released a report that cast Alberta’s safe consumption sites (SCS) in an entirely negative light.
UCP opposes harm reduction in favor of abstinence-based approaches, as its 2019 election campaign made clear. After winning power, it went on to pull funding from North America’s busiest SCS in Lethridge later in 2020, forcing its closure.
Its report on SCS—“Supervised consumption services review,” produced by a specially convened panel—drew scrutiny from Albertan harm reductionists and academics, who criticized it as baseless, unscientific and harmful.
Elaine Hyshka, an assistant professor at the University of Alberta’s School of Public Health, was one of them. She found the report to be full of bias and divisive rhetoric, broadly as she had expected.
“It was a deliberate political choice to make supervised consumption a component of their campaign,” Hyshka told Filter. “It wasn’t much of a surprise to see that in August of 2019 they announced that there would be a panel that would examine the sites that have been implemented in Alberta.”
The report’s key findings were increases in crime, needle debris and opioid-related 911 calls in the areas surrounding SCS, plus inconsistencies in facilities’ record-keeping. (This last point was also one of the reasons Lethbridge’s SCS was shuttered last year.)
“There’s no systematic analysis of any of the information they claim to have collected.”
While such findings would be matters of public concern, they would also be far from the whole picture when the evidence of many years indicates that SCS save lives and reduce the spread of blood-borne diseases.
“It’s important to note that the scope of the review was very limited,” said Hyshka. “The assumption was that the panel was looking at the pros and cons of these services, whether there were things that needed to change or stay the same. They weren’t allowed to take into account or examine the health benefits of supervised consumption services, they were only allowed to focus on socio-economic impacts in the surrounding community.”
And as for the negative findings the authors claimed, “they didn’t report the methods that were used to gather the survey data they presented,” said Hyshka. “We don’t know what controls were in place for people doing the survey twice and we don’t know if the participants were residing in the community … There’s no systematic analysis of any of the information they claim to have collected.”
The report has since been used in UCP’s efforts to reduce and threaten safe consumption services in Alberta. But it has also been raised elsewhere in North America.
“I’ve seen [the report] in media coverage across other jurisdictions. Safehouse in Philadelphia is an example of that,” Hyshka said. “I’ve also heard from some colleagues that work in the field across the country,” she added, mentioning Manitoba and Saskatchewan, “and the United States that it’s being raised by opponents of proposals of SCS as reasons to not move forward.”
Safehouse, the Philadelphia-based overdose prevention nonprofit that Hyshka mentioned, has been involved in a long-running battle in federal courts over its efforts to open the first sanctioned SCS in the United States.
Ronda Goldfein, who serves as vice president on Safehouse’s board (she is also executive director of the AIDS Law Project of Pennsylvania), confirmed that the Alberta report cropped up in United States v. Safehouse, the high-profile case in which the federal government fought to block her organization’s plans.
“The US Attorney for the Eastern District raised it in their motion for a stay regarding Safehouse,” Goldfein told Filter. “After ruling in their favor, the judge gave it the negligible weight it merited in his opinion granting the stay. It’s important to note that in granting the stay, the judge stood behind his analysis that Safehouse’s proposed activities were lawful. He even entered into the record the public health research supporting efficacy of SCS. During the hearing on Safehouse, the judge didn’t allow the introduction of public health research, but in responding to the stay request, he cited it.”
The “negligible weight” that he attached to the Alberta report can likely be pinned to the fact that it did not adhere to standard practices of peer-review and research methodology and relied on a loose community survey, as Hyshka noted.
“Philadelphia is still interested in exploring [SCS] … and no, nothing in Alberta has changed our minds.”
Haphazard methodology, she emphasized, was worsened by bias. “It was clearly designed to support a foregone conclusion [about] these services.”
James Garrow, communications director with Philadelpia’s Department of Public Health, indicated that the report wouldn’t carry much weight with the city, either.
“Philadelphia is still interested in exploring OPS [Overdose Prevention Sites, another term for SCS] and working with partners, and no, nothing in Alberta has changed our minds,” he wrote in an email.
Government sources in Manitoba and Saskatchewan—Canadian jurisdictions where Hyshka heard the report has been raised—did not respond to Filter’s requests for comment by publication time.
The real-world impact of the Alberta report beyond Alberta has been, as far as we know, very limited. But it has figured in numerous debates, and harm reduction organizations have been keeping a close eye on it.
“It has been showing up in the discourse, but luckily, it hasn’t had much influence. Due to the fact that it is not evidence-based, it’s a political document,” Laura Thomas, director of harm reduction policy at the San Francisco Aids Foundation, told Filter.
“We have a state bill here in California, Senate Bill 57, that would allow San Francisco, Oakland and the county of Los Angeles the ability to open overdose prevention services, and so it has come up in the context of that legislation specifically,” she explained.
An email from a Californian government spokesperson in response to a question about the Alberta report’s potential influence stated that “The Department of Health is unable to comment on pending legislation.”
So who is using the Alberta report to oppose SCS?
“The law enforcement opposition to that bill has attempted to use the Alberta report to sow confusion about the evidence base,” Thomas said. “They have not been very successful because the advocates pushing for this bill have been able to show ways in which the report is a thoroughly political and intentionally misleading document.”
“We have to explain to legislators what it is and why it exists. So it’s taking time away from [talking] about the benefits of supervised consumption services.”
“In the US, when it comes to pushing for harm reduction … generally the discourse is full of fear, stigma and stereotypes,” she continued. “So it’s certainly not the first time that opponents have tried to misuse information or have just manufactured information.”
One key player in this battle is the California Narcotics Officers Association, which according to Thomas routinely shows up to bat for the opposition when any harm reduction legislation is on the table. “This is the fourth year we’ve done a bill on this and they opposed it,” said Thomas.
Although Californian harm reduction advocates have worked to slow the drip-feed of disinformation, the Alberta report’s influence is not making things any easier.
“It’s frustrating to me that it exists because it is a political document,” said Thomas. “We have to explain to legislators and their staffers what it is and why it exists. So it’s taking time away from being able to talk about the very clear and concrete benefits of supervised consumption services.”
The Alberta report’s clear flaws limit the damage it can cause. Yet the way it has crossed borders into other provinces and into US cities, despite this lack of credibility, is nonetheless striking. Those who are using it as ammunition against harm reduction may just be firing blanks, but even blanks can make a lot of noise.
Photograph of SCS in Alberta in 2018 by Government of Alberta via Flickr/Creative Commons 2.0