Tuviere Okome
In April 2024, it was announced that Montreal would be opening its first drug inhalation center in the Saint-Henri neighborhood[1]. This center follows the example of other safe injection sites across Canada, such as those in Vancouver. Having previously worked at a school in Saint-Henri, I quickly checked the neighborhood Facebook group to gauge residents’ reactions to this new addition. The response was mixed at best, with some expressing hostility toward the idea of providing a safe environment where people who use drugs can do so under the supervision of healthcare and intervention workers.
During my internship at the HIV Legal Network, I noticed a troubling trend: a growing rejection of harm reduction strategies in favor of a renewed “tough on crime” approach to the ongoing overdose epidemic in Canada. For example, British Columbia recently rolled back some of the harm reduction measures in its drug decriminalization program[2]. Following public pressure from conservative groups, the provincial government reintroduced laws that allow authorities to seize even small amounts of illegal drugs, such as less than 2.5 grams[3]. We know that the strategy of punishing and over-incarcerating people who use drugs has failed in the past[4].
Upon reflection, I believe this rejection of harm reduction stems from the mistaken belief that recovery and harm reduction are mutually exclusive. Marshall Smith of Alberta’s conservative party has heavily invested in recovery-focused initiatives, including introducing new treatment centers that are free for Alberta residents[5]. However, he has rejected any approach that leans toward harm reduction, assuming that offering treatment alone is sufficient for recovery[6]. My work with staff on the front lines of the opioid crisis has shown me that treatment centers, while important, do little to address underlying issues such as poverty, homelessness, and generational trauma. These issues disproportionately affect marginalized populations, who often experience generational trauma due to the legacy of colonialism and racism[7].
Before pursuing a career in law, I worked as an epidemiologist, and this situation strikes me as a classic case of efficacy versus effectiveness. Efficacy trials determine whether an intervention (such as treatment centers) produces the expected results under ideal circumstances. In an ideal world, without the traumatic realities of life, treatment centers might be highly effective. Unfortunately, we do not live in an ideal world. Effectiveness, on the other hand, measures the impact of an intervention in “real-world” settings. The truth is that the effectiveness of treatment centers is low. A study by the Canadian Centre on Substance Use and Addiction found that about 58% of people who entered treatment programs did not complete them, and nearly half of those who did return to substance use[8].
For people living extremely stressful lives, where day-to-day survival is a challenge, staying sober can be incredibly difficult. For many, harm reduction policies offer a way to stay alive and navigate the difficult road to recovery. This is the primary purpose of the drug inhalation center in Saint-Henri. Many people will need multiple attempts to achieve sobriety, and these centers are crucial in ensuring they do not die before they have a chance to recover.
Finally, there will be people who may never get sober. Harm reduction policies allow them to live dignified and safe lives. As someone deeply invested in the Saint-Henri community, I want this for my community.
As Montreal opens its first drug inhalation center in Saint-Henri, we must recognize that this initiative, while met with mixed reactions, is a critical step in addressing the complex realities faced by people who use drugs. Just as the initial reactions in the neighborhood varied, so too does the broader societal response to harm reduction strategies. Yet, the evidence is clear: punitive approaches have failed, and harm reduction offers a lifeline for those struggling on the margins. As we move forward, it’s essential to remember that creating safe spaces for drug use under medical supervision is not just about immediate survival—it’s about giving individuals the dignity and opportunity to reclaim their lives, one step at a time. This center, and others like it, represent a commitment to meeting people where they are, acknowledging the harsh realities they face, and offering them a chance to live, recover, and thrive in our communities.
[1] CBC. (2024). Montreal’s 1st supervised drug inhalation centre to open in Saint-Henri despite concerns. [online] Available at: https://www.cbc.ca/news/canada/montreal/montreal-supervised-inhalation-1.7171042 [Accessed 30 Aug. 2024].
[2] CBC. (2024). Mixed reviews as B.C. significantly rolls back drug decriminalization. [online] Available at: https://www.cbc.ca/news/canada/british-columbia/drug-decriminalization-roll-back-reax-1.7187035.
[3] Ibid
[4] Pendergrass, T. (2022). ACLU News & Commentary. [online] American Civil Liberties Union. Available at: https://www.aclu.org/news/smart-justice/the-war-on-drugs-failed-lawmakers-must-meet-the-fentanyl-crisis-with-new-solutions.
[5] The Way Out: Addiction in Alberta. (2023). CBC.ca. [online] 10 Feb. Available at: https://www.cbc.ca/newsinteractives/features/the-way-out-addiction-in-alberta-marshall-smith.
[6] Lambert, T. (2023). Despite soaring death rate from opioids, Alberta steers away from harm-reduction approach. CBC.ca. [online] 18 Feb. Available at: https://www.cbc.ca/news/canada/edmonton/alberta-approach-opioid-crisis-1.6750422.
[7] Lavalley, J., Kastor, S., Valleriani, J. and McNeil, R. (2018). Reconciliation and Canada’s overdose crisis: responding to the needs of Indigenous Peoples. Canadian Medical Association Journal, 190(50), pp.E1466–E1467. doi:https://doi.org/10.1503/cmaj.181093.
[8] Mcquaid, R., Malik, A., Moussouni, K., Baydack, N., Stargardter, M. and Morrisey, M. (2017). Life in Recovery from Addiction in Canada. [online] Available at: https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Life-in-Recovery-from-Addiction-Report-2017-en.pdf.