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Advocates worry health policy change another government dismissal of harm reduction

A newly revised health policy has become the latest symptom of a provincial tug-of-war between government and harm reduction experts in Alberta. At the behest of the UCP government, Alberta Health Services has revised its strategy on substance use, where the phrase “harm reduction” has been crossed out dozens of times and references to a “recovery-oriented approach” have been written in. Though these are small changes within the text of a nine-page document, they send a loud signal about the ongoing debate between Alberta’s UCP government and substance use experts around the best way to tackle the province’s deadly struggle with addictions. “Language matters,” said Cameron Wild, a professor of public health at the University of Alberta who specializes in studying addictions. “It really sets a tone, internal to the organization, inside AHS, about what is tolerable to even discuss.” The Alberta government’s push to increase access to addiction recovery treatment has led some harm reduction advocates to worry that access to life-saving interventions could diminish. They say funding for needle exchange programs or supervised consumption sites could be at risk. The revisions, requested by the government last year, affected the AHS policy on harm reduction for psychoactive substance use, according to emails obtained by CBC News. “I think it demonstrates where we’re going in AHS to remove all language of ‘harm reduction’ from our organization, to align with government,” the AHS executive responsible for addictions and mental health said in a September email to staff. The revised policy, renamed the Psychoactive Substance Use Policy, was given some language adjustments that included a stronger focus on a “recovery-oriented approach” to care. By the policy’s definition, that approach can include harm reduction. According to a government spokesperson, the changes were not made to invalidate harm reduction approaches but to bring “balance” to how the health-care system handles addiction. “Ensuring Albertans have access to a balanced continuum of care, inclusive of harm reduction and the other components, is not ideological,” Kassandra Kitz, press secretary to the mental health and addictions minister, said in an email. “Harm reduction services play a significant role in our policy, but is balanced with the objective of ensuring all people who are struggling are represented and are receiving treatment where recovery and wellness is the goal.” Patients before politics Kerry Williamson, an AHS spokesperson, said harm reduction services like supervised consumption sites, needle exchanges and opioid replacement therapies are still available and that there has been “no change in practise.” The policy update, he added, sought input from addictions experts and people with lived experience of addiction. Harm reduction advocates argue access to those life-saving tools are more important than ever. By October 2020, Alberta had already set a new yearly record high number of opioid poisoning deaths. Overdoses surged near the beginning of the pandemic. Harm reduction approaches, including the mass distribution of naloxone kits to help reverse an overdose, were particularly important when opioid poisonings began to spike in Alberta about six years ago, said Dr. Robert Tanguay, a Calgary addictions psychiatrist and pain physician. But now, he added, Alberta needs a more comprehensive approach that leans on the “four pillars” of tackling addiction: harm reduction, recovery treatment, prevention, and reframing addiction as a health problem rather than a criminal one. The biggest hurdle is the currently fragmented system in which none of these pillars work well with the others, he said. A patient who injects herself under supervision should be able to get treatment for addiction at the same location instead of being referred somewhere else, he added. “Until we start working together we’re never going to be on the same page when it comes to the person in front of us,” he said. An unbalanced approach An increased emphasis on harm reduction during the opioid crisis swung too far for some publicly-funded services that embraced an abstinence approach to addictions recovery. Some feared their government grants were at risk. The government said this was one of the reasons the AHS policy needed to change — to protect organizations that required clients to be sober to participate in recovery programs. Since 1974, the Sunrise Healing Lodge in Calgary has led clients through a 12-step process to tackle addiction while integrating Indigenous cultural practices and traditions. The recovery centre is funded by AHS. Calgary’s Sunrise Healing Lodge requires patients to abstain from using any substances when they participate in the addiction recovery programming.(Sunrise Healing Lodge Society/Supplied) Executive director Leslie Big Bull, who has been in the role for 18 years, said AHS had always been pleased with the lodge’s work but said something changed in 2019. The inpatient recovery program requires clients to abstain from any mind- or mood-altering substances, she said. Suddenly, AHS managers wanted the program to accept patients who were taking suboxone as a drug replacement therapy. She said Sunrise was unwilling to do this as it conflicted with their philosophy. “I’m not saying harm reduction is a bad thing, because there ne