By Lethbridge Herald Opinon on October 21, 2020.
Open letter to minister Jason Luan from Lethbridge medical professionals:
In response to Minister Luan’s open letter (Lethbridge Herald, Sept. 29) we would like to state unequivocally that the minister obviously did not hear our patients or frontline staff, did not investigate truly, and is choosing to act in absence of facts with a plan that runs contrary to time-honoured principles of medical ethics.
We agree that the financial mismanagement at ARCHES is disappointing and unacceptable, but to blame the supervised consumption site (SCS) for issues in the community, and to claim that the replacement services are adequate, is simply untrue.
The SCS was not “the cause of many issues in the community.” While the site was running, there were fewer needles on the ground and fewer injections being done in public places. Incidents of crime were already climbing every year since at least 2014, long before the site ever opened. In fact, during the year the SCS was open, the rate at which crimes increased fell compared to the previous year, and was the second lowest it had been since 2014. What some Lethbridge citizens were complaining about was the shift in location of the more visible aspects of poverty, addiction and homelessness. Suddenly, it was closer to their own backyard.
The replacement “mobile site,” currently located outside of the Lethbridge Shelter, is not adequate by any means. The SCS was open 24 hours, had 13 injection booths and two inhalation rooms accommodating four people each, serving up to 21 people at a time. The van that the minister has brought to replace this facility is open 17 hours daily and can accommodate only two people at one time. This is a 90 per cent reduction in capacity. How is this “more than adequate” to accommodate the thousands of daily visits? If the mobile site is not being used to capacity, that is because the minister is missing a structural element: when it first opened, clients who tried to access this service waited five to six hours for their opportunity to use in a supervised setting. Many of our patients need to use every two to three hours to prevent severe withdrawal symptoms. If the mobile site cannot accommodate their immediate need, they will simply go elsewhere. And they have.
Additionally, this mobile site has no waiting area, which does not convey a very stable atmosphere. We wouldn’t be surprised if the mobile site closes due to weather conditions in the winter.
Most importantly, the care model at the SCS was non-judgmental and based on relationship building. Relationships are an imperative in the recovery from addiction. The mobile site has no relationship with clients and is viewed with mistrust. As a condition of service, clients are forced to agree to referrals for detox and treatment.
Addiction and overdose do not discriminate based on race, but Indigenous people are disproportionately affected in southern Alberta. This government’s approach to addictions completely ignores the substantial role that historical trauma plays in this crisis, and the role that traditional healing can play. It sees substance use as a moral failing, rather than what it truly is for so many Indigenous people: a collective, suppressed scream resulting from feelings of helplessness and frustration at being born into a society experiencing so many injustices, past and present.
The minister’s approach to the disease of addiction is foolish, flawed and coercive.
Foolish, because it ignores the evidence for harm reduction beyond only naloxone distribution, and it fails to address root causes of addictions.
Flawed, since it doesn’t deliver services that are acceptable and effective for a large percentage of the people needing them.
Coercive, because it makes essential medical care and treatment contingent on sobriety.
Harm reduction is everywhere in society already, from legalizing alcohol and ensuring its safe supply, to choosing the “least unhealthy” option when eating out. We all do this and our worth as human beings is never called into question. We would never tolerate deaths from poisonings due to tainted alcohol or tobacco supply. Why are we tolerating this with any other substance?
If this government insists on fighting the (failed) War on Drugs by using an approach that is not supported in the research and runs contrary to medical practice and ethics, then they need to consider us defectors from the army. We will continue to support supervised consumption sites and overdose prevention sites. We will do this while treating our patients with real, judgment-free compassion, regardless of their race or interest in attending a treatment centre. With or without this government, we will continue to respect the principles of medical ethics that existed well before the current UCP regime, and will continue to exist long after political careers are over. We will continue to do no harm.
Susan Adelmann, MD, CCFP
Blood Tribe Medical Clinic
Janine Karpakis, MBChB
Bigelow Fowler Clinic South
Arlene Oishi, MD, CCFP
Prairie Treatment Clinic
Jillian Demontigny, MD, CCFP
Bigelow Fowler Clinic East