If you are just here for the actual article, skip ahead of this first section and go to section two, Denormalization Revisited. If you are already familiar with my writing on denormalization and caste-making, skip ahead to the Collapse of Vancouver’s Four Pillars.
Retention Fatigue or Why Drug Policy Now?
There is no doubt that many reading this blog have been faithful readers since before 2020, before I departed from the progressive consensus on gender identity. Since then, my reading audience has shifted and I have had to think carefully about how to manage this shift. Not only do I continue to lose readers who identify with the contemporary left, I keep gaining readers who are identified (often against their will) with the contemporary right. And there is no sign that this shift process is going to end any time soon.
Furthermore, as I continue to exit the left social scene, even as I grow more committed to some kind of Eco-Marxism as my personal politics, distance is allowing me to gain perspective on issues where I have not publicly questioned the orthodoxies of the left. When I discover another issue where I am now out of step with the left, I am faced with a practical dilemma: if I write about my thoughts, how many of my old readers will I lose? And how many new readers will I gain?
For that reason, I have been cautious about raising yet another issue on which I am out of accord with progressives, always worried that my next unorthodox opinion will be the final straw for someone and that I will lose another reader, another comrade or another friend.
But after three years of living like this, I am done. I am sick to death of walking on eggshells, wondering if my next unorthodox view will produce another cancelation campaign that gets me another blizzard of hate mail from people who were my friends until five seconds ago and gets my loyal friends harassed and threatened. I cannot handle this slow process of cancelation continuing indefinitely. For months now, I have actually been exaggerating how many conservative views and conservative associates I have just so that the people who are on the fence about canceling me will just get the fuck on with it. So now, fuck it! Drugs!
Denormalization Revisited
Two years into the Covid epidemic, I departed from the increasingly untenable progressive consensus concerning Covid vaccines, not with respect to their efficacy but rather the public policies concerning vaccination in my article, “Denormalization: From Failed Public Health Strategy to a Path to a Liberal Majority.”
In the fall of 2021, we learned that vaccine passes were not effectively limiting the spread of Omicron and later Covid variants because, while vaccination typically made Covid symptoms less severe, sometimes saving lives and preventing permanent disability, it did not have a significant impact on transmissibility. Governments’ reactions to this news were perverse, to say the least.
Rather than abandoning VaxPasses, our federal and provincial governments rolled out more restrictive policies, further abridging the assembly and mobility rights of unvaccinated or insufficiently vaccinated Canadians. When questioned about the efficacy of these policies in limiting the spread of Covid, our governments were disturbingly frank, largely admitting that these measures’ primary purpose was to stigmatize and punish those who continued to refuse the vaccines. Our leaders seemed eerily okay with just admitting the passes were a cudgel, designed to coerce recalcitrant holdouts.
Except that I refused to accept that this was even what was going on. What anyone with the most basic knowledge of the social science of public health knows is that by de-normalizing something, like smoking, for instance, you actually make that thing more popular with people who are already marginalized, who are already stigmatized and understood to be either at society’s margins or entirely outside society. And, as anyone familiar with the social determinants of health could have predicted, the Vaxpasses intensified and solidified both vaccine hesitancy and opposition to the passes themselves, ultimately culminating in the Freedom Convoy.
Had the government actually wished to promote vaccination among people of faith, manual labourers, rural Canadians and non-Indigenous racialized Canadians, it would have involved conservative faith leaders, popular rural politicians, grassroots labour leaders and small business owners in forestry, mining and oil, in making tailored appeals to vaccine hesitant populations.
But that was not, I believe, their agenda. It was instead, to create a group of pestilent “deplorables,” to engage in caste-making.
The Collapse of Vancouver’s Four Pillars
Canadian cities and those of America’s Blue State Pacific Coast are experiencing not just increases but increasing rates of increase in drug addiction, overdose deaths, homelessness and street violence, an increasing portion of which is disorganized violence of which individuals experiencing addiction and mental health struggles are both an ever-increasing proportion of both perpetrators and victims.
It is now twenty-five years since my city, Vancouver, adopted its Four Pillars policy on drugs as part of our decision to be one of the first cities in the Western Hemisphere to embrace harm reduction as the basis of our drug policy. I was one of the thousands of Vancouverites who chalked this up as a victory. Now, we thought, things will start turning around in the Downtown Eastside. At last, homelessness, prostitution, addiction, disease and misery will stop increasing and enter a slow, steady decline as drug users come out of the shadows and have their problems dealt with in the full light of day
Although these increases have a clear statistical correlation to de jure and de facto decriminalization of both soft and hard drugs, the response of progressives has been that we are just not making drugs legal, accessible and plentiful enough. In my city, purchasing and possession is no longer illegal for any drug, nor is dealing, provided one keeps one’s personal inventory low. Opinion leaders in my community are now advocating that the government get into the business of selling cocaine, heroin and other hard drugs and, when it comes to the most addictive and toxic drugs, my government is literally giving them away.
The thinking of the people backing an amplification of our already-failed policies is based on three main fallacies: (a) that the number of drug users is essentially fixed, that public policy cannot change the number of people who want to use drugs or who do use them, (b) that simply increasing the purity, affordability and accessibility of the drug supply actually is “harm reduction,” and (c) that drug use is not strongly conditioned by material and cultural factors.
To review, the Four Pillars policy Vancouver city council adopted to great fanfare in 1998 were (1) Prevention, (2) Treatment, (3) Harm Reduction and (4) Enforcement. This tetrad of policy reforms were based on a pre-existing model which showed promising results in Australia, Switzerland and Germany in the 1990s. But did Vancouver, in fact, follow the four pillars approach?
Prevention?
Prevention, i.e. policies designed to prevent people from falling into problematic substance use, were of two main types: material and educational. Material prevention policies in the places where the Four Pillars had succeeded included the provision of housing and other basic material supports to people who might otherwise become homeless or enter into survival sex work, given that homelessness, especially street homelessness and prostitution, especially survival prostitution create powerful incentives for habitual hard drug use in order to survive in these extremely damaging and challenging circumstances.
Instead, the provincial government, which provides these services to Vancouverites undertook a series of austerity programs in 1993, 1997 and 2001 to reduce income supports for housing and food. Following a 10% cut in 1993, income assistance rates in British Columbia were capped at 1993 levels for the next twenty-four years, not even permitting increases to keep pace with inflation.
As all federal and nearly all new provincial investment in affordable housing ended in 1993 and did not resume for a decade or more, the effective supply of housing continued to contract, especially as, when provincial investment did start again in the late 00s, it was increasingly directed to what is called “supportive housing,” of which there were essentially two types: (a) housing projects composed entirely of hard drug users and (b) housing projects that summarily evicted tenants for drug use, drug possession, overnight guests, etc.
Furthermore, the “shelter allowance” for those on income assistance remained capped at $375.00 per month from 1993 to 2023. Still dire but not as dire, the minimum wage remained capped at $8.00/hour from 2001 to 2011 and did not exceed $15/hour until 2021. Given that state-subsidized housing was so scarce as to be nigh-impossible to obtain for all but those in the most extreme straits, low-income people at risk of losing their housing saw their incomes decline relative to inflation while housing costs often increased at double the overall inflation rate.
In other words, government policies with respect to poverty did not merely fail to prevent substance abuse and addiction; they actively facilitated it.
Of course, we older folks do not immediately think of poverty when we hear the word “prevention.” We remember the school assemblies, the tone-deaf public service announcements, the awkward classes with our high school guidance counselors. Prevention, for us, conjures up the “scared straight,” “just say no,” and “this is your brain on drugs” after school specials and TV ads, designed to make kids frightened to try drugs, especially the harder stuff.
These traditional campaigns are denormalization campaigns. And that means that they produce perverse effects on people who already consider themselves to be marginalized. Amy Salmon and Fred Bass, the health scientists who made the empirical case studied anti-smoking de-normalization campaigns and found that they functioned like highly effective cigarette adds for young, low-income Indigenous women and girls.
De-normalization continues to be our main form of above-ground public “prevention” campaign but these campaigns are taking place in the dual context of an increasing portion of the population being economically marginalized and an increasing portion of the population receiving strong incentives and “identifying into” identities understood to be marginal, e.g. “trans,” “queer,” etc.
And it appears that both groups, both those materially marginalized by structural factors and those adopting boutique identities they believe make them marginalized, are experiencing the perverse effects of de-normalization and becoming more attracted to street drugs of all kinds. To an ever-increasing proportion of our population, our anti-drug propaganda is experienced as ads for the very drugs that we are supposedly discouraging.
Treatment?
Supposedly, there were going to be a whole lot more in the way of treatment facilities, approaches and services by now. But, as with housing and income, the reality has been escalating austerity and chronic labour shortages, compounded, most recently, by BC’s decision to be the only province in Canada that has refused to hire back its unvaccinated health care workers and, instead, to stand by as the BC College of Nurses and other healthcare syndical regulators proceed with internal witch hunts to deprive unvaccinated members of their professional accreditation, as though losing their jobs was not enough.
When it comes to the medically adjacent caring professions, like social work, the story has been even bleaker. There were mass layoffs of social workers in 1993, 1997 and 2001. And, when it comes to psychiatrists and psychologists, there are almost none remaining in the public system. I, myself, have been trying to obtain a psychiatrist through the public system for the past thirty-six months and have yet to have my first appointment.
The waiting list for detox and drug rehabilitation beds lengthens by the month and those that are available are often situated in neighbourhoods like Vancouver’s downtown Eastside, directly adjacent to the most active drug distribution and consumption scenes in the entire country.
Today, Vancouver has an “assessment centre,” to which one must be referred by a doctor, where one signs up to apply to be allowed to see a psychiatrist. If your case is urgent, the wait to see a social worker there is still two months; if it is not urgent, it is more like four to six. If you convince the social worker you are in serious distress, you wait another month or two to be interviewed by a psychiatrist. And even if you get the go-ahead, it is no one’s job but yours to somehow find you a psychiatrist who remains in the public system who is still taking clients and, if you do find one, your job to get them a referral not just from the centre but from the physician who referred you to the centre.
In other words, treatment options have declined significantly and remain out of reach for all but the most persistent and sophisticated, whereas you’re always just a phone call or taxi ride away from a baggie of heroin, cocaine, fentanyl, lorazepam or methamphetamine any hour of the day or night.
Harm Reduction?
The term “harm reduction” refers to the reduction in harms associated with the purchase of an illegal product, such as conflict with the law, adulteration or poisoning of said product, the need to pay increased costs because criminalization has increased prices, the spread of infection through unsafe consumption practices, and the use of drugs with unsafe equipment or in unsafe settings.
In this area, we experienced early and obvious gains. Our safe injection site did reduce the transmission of AIDS and hepatitis. The addition of a supervised site from crack use also appeared to produce tangible public health dividends generally.
But we have not seen commensurable improvements in public health once the state moved from creating supervised spaces and began to enlarge its own role in drug distribution while looking the other way as non-profit organizations, left-wing political parties and for-profit dealers became more public and ambitious in handing out drugs. Instead, the deterioration of the whole scene has sped up.
To help us understand why this is the case, it may be helpful to begin with Ricky from Trailer Park Boys in the episode where he trains school children to steal barbecues as part of their “Junior Achievers” after school program for aspiring entrepreneurs, “it’s the same whether you’re breaking the law or not. Profit, capital. Supply and command.” Or let me introduce this idea another way: if Canadians are really excited about an issue, the first thing they decide is that the laws of supply and demand don’t apply to it.
You will notice that people who are excited about liquefied natural gas (LNG) and believe that fracking more of it will help us save the planet make the following argument: for every joule worth of LNG we produce and export, the country to which we send it will reduce the amount of coal they burn by the same amount. They assert that the quantity of fossil fuels that are burned in the world is a fixed amount and that no matter what the price is or how large or small the supply is, the exact same amount will be burned.
But of course that is not how the market for any commodity works. If you supply the same amount of coal and simply increase the amount of LNG, prices for both commodities will fall and the total amount of fossil fuels consumed will increase. This is the first thing you learn in a first-year economic class. It is called “the Law of Supply and Demand.” If you make something cheaper, more plentiful and easier to obtain, the more of it will be consumed.
This idea that increasing the amount of legal fentanyl or cocaine on the market will lead to precisely commensurate reductions in illegal use is insane. It is stupid. It is contradicted by the evidence we receive every month as overdose deaths continue to climb and it is contradicted by everything basic economics predicts.
Drug users do not have a fixed quantity of their drug(s) of choice they need or desire in a day, after which there are satiated. The more cocaine you do, the more you want. The cheaper the price, the more you can do. The easier to access, the more you can do. The state is actually promoting the consumption of illegal fentanyl by providing free or low-cost fentanyl. Doing so depresses fentanyl prices both by flooding the market and by fixing a low cost with which for-profit dealers must compete.
Enforcement?
In the original design of the policy, new approaches to enforcement were supposed to focus policing on drug production and distribution points, to target major dealers and producers, especially of drugs that can be synthesized in urban settings. In other words, it was premised on the idea that restricted supply was a goal in the policy.
But now that we have adopted increased supply rather than restricted supply as our approach, the police are rudderless in this area, left with a legacy policy functioning in direct opposition to current approaches.
Why would anyone expect to see outcomes in Vancouver in the twenty-first century based on the Four Pillars, if only half of one pillar is even standing? We are not practicing the Four Pillars. We are not even practicing harm reduction. We are just throwing more drugs and easier, faster access to drugs into a rising tide of human misery.
Culture: the Mastodon in the Room
But missing in all of this is a much bigger factor, something that had already walled-off the Swiss, German and, more recently, Portuguese approaches to drug policy, even as we began to consider reform in the 1990s: culture. How you interact with a drug is strongly conditioned by the larger cultural context of your society and by the more local subcultural context of your drug use community.
Anglo America does not have the same culture as Portugal, Germany or Switzerland. How one engages with drugs is about something more than the material and public policy factors I laid out above. But that is for the second part of this short series, where we look at distinctive experience of substance use in a young city shaped by colonization.
