The opioid epidemic has claimed over 10,000 Canadians in the past three years. Supervised consumption sites (SCS) have been proposed as one part of the solution to stem the tide. There are over 40 SCS now operating in Canada—up from one just a few years ago.
Across Canada communities are debating the merits of supervised consumption sites. The basic question has been whether a SCS is worth some of the negative effects associated with them.
The opioid epidemic began when Alberta’s economy began to falter in 2014. Both issues likely link to the rising crime almost every Albertan city has seen since 2014. SCSs did not create these problems, but the issue has forced us to talk about increasing social disorder, of which drug addiction is part. This isn’t a simple problem to solve.
Each level of government has a role of play in understanding this epidemic and cooperating on solutions. But ultimately the Government of Alberta will have to make a tough judgment call regarding funding SCSs. If they fund SCSs I hope they think carefully about building local community support for these facilities. The Government of Alberta should also take care to explain how any SCS fits within a larger holistic effort to improve the current situation. If they don’t fund any new SCSs in Alberta, we will still need to collectively figure out alternative solutions—the status quo is hardly ideal.
This is not my decision. But my help, as a city councillor, will be necessary to keep this community together and to maximize benefits and minimize negatives for any decision. So I will support either choice, but let’s speak plainly about the pros and cons of any solution.
Here’s where we’re at.
HIV Community Link is the local organization contracted by the provincial government to implement a supervised consumption site (SCS) in Medicine Hat. A SCS requires three things:
funding, typically provided by provincial money
an exemption to the federal Controlled Drug & Substances Act (CDSA)
and a building.
In May the Government of Alberta suspended funding for any supervised consumption site under development pending a review. This includes proposed sites in Medicine Hat, Red Deer and Calgary. Operating SCS are currently unaffected. A public engagement session is scheduled for Medicine Hat for Tuesday, September 3 from 6 to 9 pm at the HomeStay Inn and Suites (954 7 Street SW). If your group or organization would like to present to the review committee follow the instructions here.
HIV Community Link’s application to the federal government for an exemption to the Controlled Substances Act is pending. If the Government of Alberta declines to fund the facility, HIV Community Link could still potentially operate a SCS in Medicine Hat—if they receive the federal exemption and provided they secured operational funding from another source.
HIV Community Link has signed a lease at 502 South Railway Street SE and still has plans to take possession of the building even if a SCS won’t be part of their services. HIV Community Link’s mandate is to support people living with, or at risk of HIV and hepatitis C. For instance, their needle exchange program was created to reduce the transmission of HIV and hep C. That program has been operating in Medicine Hat for 10 years previously at their 2nd Street SE location.
Here’s how we got here.
From 2003 to 2015 there was a single supervised consumption site in Canada. There are now over 40 SCSs open and operating across Canada. The roots of this dramatic increase begin in a troubled neighbourhood, Vancouver’s Downtown Eastside home to Canada’s first SCS, Insite. Its history is a good starting point and has lessons for our city.
The history below is from the Supreme Court ruling Canada v PHS Community Services Society. Prime Minister Harper was elected in 2006 and the Conservative government was skeptical of this controversial healthcare pilot project. He gave little assurance he would extend the exemption to the CDSA. The Portland Hotel Society, the operator of Insite, preemptively took the federal government to court arguing that the enforcement of drug trafficking and possession laws at Insite would block access to medical treatment and infringe drug users’ Charter rights.
“In the early 1990s, injection drug use reached crisis levels in Vancouver’s downtown eastside (“DTES”). Epidemics of HIV/AIDS and hepatitis C soon followed, and a public health emergency was declared in the DTES in September 1997. Health authorities recognized that creative solutions would be required to address the needs of the population of the DTES, a marginalized population with complex mental, physical, and emotional health issues. After years of research, planning, and intergovernmental cooperation, the authorities proposed a scheme of care for drug users that would assist them at all points in the treatment of their disease, not simply when they quit drugs for good. The proposed plan included supervised drug consumption facilities which, though controversial in North America, have been used with success to address health issues associated with injection drug use in Europe and Australia.
Operating a supervised injection site required an exemption from the prohibitions of possession and trafficking of controlled substances under s. 56 of the CDSA, which provides for exemption at the discretion of the Minister of Health, for medical and scientific purposes. Insite received a conditional exemption in September 2003, and opened its doors days later. North America’s first government‑sanctioned safe injection facility, it has operated constantly since then. It is a strictly regulated health facility, and its personnel are guided by strict policies and procedures. It does not provide drugs to its clients, who must check in, sign a waiver, and are closely monitored during and after injection. Its clients are provided with health care information, counselling, and referrals to various service providers or an on‑site, on demand detox centre. The experiment has proven successful. Insite has saved lives and improved health without increasing the incidence of drug use and crime in the surrounding area. It is supported by the Vancouver police, the city and provincial governments.
In 2008, a formal application for a new exemption was made before the initial one expired. The Minister had granted temporary extensions in 2006 and 2007, but he indicated that he had decided to deny the application. When the expiry of the extensions loomed, this action was started in an effort to keep Insite open.”
In 2011 the Supreme Court found in favor of the supervised consumption site on the Charter grounds, writing:
“On future applications, the Minister must exercise that discretion within the constraints imposed by the law and the Charter, aiming to strike the appropriate balance between achieving public health and public safety. In accordance with the Charter, the Minister must consider whether denying an exemption would cause deprivations of life and security of the person that are not in accordance with the principles of fundamental justice. Where, as here, a supervised injection site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption.”
"During its eight years of operation, Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada," the Court said. "The effect of denying the services of Insite to the population it serves and the correlative increase in the risk of death and disease to injection drug users is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics."
The court found that SCSs were a legitimate public health service and if certain conditions were met the federal government should grant an exemption. The court’s decision left some questions open.
The Minister should consider impacts to public safety that a SCS might cause though at the time there wasn’t much information regarding negative impacts. Our understanding of impacts associated with SCS has grown since then.
The Supreme Court’s decision does not settle the question of what type of strategy a province should adopt in combating a drug epidemic—only that SCSs are a legitimate public health service.
The delivery of healthcare is provincial responsibility and the province determines what is publicly funded. Provinces are not obligated to fund SCSs. The practical effect of the ruling is that though SCS require intergovernmental cooperation provinces have most of the power because funding is now the key component.
Approximate comparative amounts of opioids for a fatal overdose
The Opioid Epidemic
The opioid epidemic began a few years later. There are two main causes. Doctors began overprescribing new opioid painkillers thought to be less addictive. Then beginning this decade powerful synthetic opioids entered the black market. Fentanyl is significantly more powerful than heroin, making it difficult for drug users to gauge potency without overdosing. A couple grains too many is all it takes.
Between January 2016 and September 2018 10,300 Canadians died as a result of an apparent opioid-related overdose. Faced with an alarming number of overdose deaths provinces looked to Insite as a model and now had a clear precedent with the federal government.
Benefits and Impacts
The question of whether or not you support supervised consumption services cannot be answered in isolation. Like most decisions a SCS solves some problems, while potentially creating others. We must weigh these against the benefits and drawbacks of the status quo or other alternatives.
In the narrow sense supervised consumption services are logical and straightforward. There are currently people overdosing on opiods in homes, public washrooms, and alleyways. Some are saved by first responders, others die. Creating a place where drug users consume opioids, under the watchful care of healthcare professionals, decreases the risk of death for drug users.
A wider perspective muddies the waters. The increased concentration of drug use at one location is an intended feature of supervised consumption sites. A SCS is intended to pull drug use away from homes, public washrooms and alleyways into one location. But concentrating drug users may also lead to negative impacts. How should we balance these competing interests?
Should crime increase in the surrounding neighbourhood does that outweigh the lives that may be saved? What if crime doesn’t increase?
Should nearby businesses suffer financial losses as a result of a supervised consumption site does that outweigh the lives that might be saved? How would we measure this?
Should property values decrease in the neighbourhood does that outweigh the lives that might be saved?
Does the number of lives saved matter? Would a single life saved be worth any economic pain?
If we can mitigate or compensate for these ill effects on the neighbourhood is that a fair balance to strike? Is there any mitigation that would maintain the confidence of the neighbourhood?
What are the alternatives to judge SCSs against?
It seems cold hearted to perform such calculus when human lives lie in the balance, but this is what societies must do all the time. If public safety was our only concern we would reduce traffic speeds on all roads and highways to 15 km/h. That would reduce traffic fatalities to near zero, but this would also result in significant economic drain with transportation time lost. As a society we have balanced some speed and efficiency over public safety.
Likewise if saving lives during this opioid epidemic was the overriding value the Government of Alberta would have funded supervised consumption services in Medicine Hat to the tune of $2 billion instead of $2 million. A society is always balancing competing values and limited resources.
Impacts
Though SCSs have been established in many cities and countries there is disagreement over their effectiveness and impact. The Supreme Court ruling references the neutral impact of Insite on the surrounding neighbourhood, but this highlights how little we actually know about impact. We are in uncharted waters.
The majority of research on supervised consumption sites in Canada relates to Insite. A commonly cited study on its impacts was led by Evan Wood in 2006. It found no increase in crime in the adjacent neighbourhood.
The British Columbia Ministry of Health’s Supervised Consumption Services Operational Guidance cites this study as demonstrating the neutral impact of supervised consumption services. But this study suffers from a number of flaws.
There is no description of police service levels in the area nor does it describe the change in police activity after Insite opened. Part of the widely coordinated effort to create this pilot project was increased police presence in the area. It’s not clear what impact the police factor had on the findings.
Second, the transferability of this study to other cities is almost zero. This is acknowledged in the study. The Downtown Eastside a unique neighbourhood bearing little resemblance to the small and mid-sized cities where supervised consumption services are being rolled out.
The baseline for this study was the crime rate in arguably the worst neighbourhood in the country by every measure. That no crime increased probably speaks to the sorry state of the neighbourhood.
However, our collective knowledge about SCS and their impact is growing. The news from newly opened supervised consumption services in Alberta has been mixed.
Lethbridge received a lot of bad press when its supervised consumption site opened. The negative impacts there was due to a number of issues unique to that city. The bigger part of the story is the severe limitation of access to other services (shelters, detox, treatment, and housing) which is creating an overreliance on the SCS. The number of unique service users at the SCS in Lethbridge is relatively low compared to other cities, but the people access the service multiple times a day because they don’t have anywhere else to go. It is currently the busiest SCS in the world. Although Medicine Hat and Lethbridge are similarly sized cities in southern Alberta, when it comes to the drug epidemic we are not comparable. But some issues that Lethbridge has seen would likely occur in Medicine Hat. Lethbridge has found that property crime has increased in the adjacent area, but often these are crimes of opportunity. A car left running, bicycles or other valuables left outside. Increased police presence and/or security patrols have helped maintain public safety, but residents have to be more mindful.
Calgary made news with their report on increasing crime and calls for services surrounding the SCS at the Sheldon Chumir Clinic. Here is the actual 2018 police report. I would encourage you to glance at the report. It breaks things down by different categories: calls for service, disorder, drugs, violence, break and enters and vehicle crime. It measures 2018 stats (the year the SCS opened) and compares them against a three year average. Some of the increases happened in 2017, before the SCS opened. Though methodology points to the SCS as the cause this report should come with caveats.
The news from Red Deer is more encouraging. That city’s temporary overdose prevention site—the precursor to permanent SCS—opened on October 1, 2018. The surrounding area has not seen any increase in crime in the surrounding area, but Red Deer also included a robust mitigation plan when this site opened.
A Community Based Report on Alberta’s Supervised Consumption Service Effectiveness is another useful report in understanding impact of SCS in Alberta.
Crime and low level nuisance
Increased crime cannot all be attributed to addicts, but there is a strong correlation between increased property crime and drug addiction. Take for instance, this local Medicine Hat News story.
This map was taken from a lawsuit from New York State against Purdue Pharma, the company behind OxyContin. Their claims about the safety of this new opioid allegedly initiated the epidemic in America. Purdue’s own research overlays centres with high prescriptions of OxyContin against reported burglaries and robberies. There is a strong correlation between the two. This makes sense. Not all addicts need to steal to support their habit, but many do.
Criminal behaviour is a high bar for weighing the impact to a neighbourhood and shouldn’t be the only standard. There is plenty of behaviour detrimental to a neighbourhood that doesn’t reach the level of criminality. I haven’t found any research studying impacts of low level nuisance, perhaps because it’s hard to capture this information.
Most of us know of suspected drug houses in our neighbourhoods and what comes with them. We’ve been affected by property crime or know someone who has. We also experience just weirdo behaviour.
The proposed SCS in Medicine Hat touched a nerve in our community because we have all had to deal with the effects of increasing social disorder. There are increasing numbers of people in need of help. The wait list at the Medicine Hat Community Housing Society grows and outstrips our resources to help. The majority of calls to police in Canada are not for criminal code violations, but for help with mental health issues or other social disturbances. The opioid epidemic is the tip of the iceberg—a symptom of larger societal challenges.
Though a SCS is open to all it is likely to be used by people on the fringes of society. The explicit aim of a SCS is to reach people who don’t trust traditional healthcare services. Thus it’s likely a neighbourhood will experience some negative effects that have to be mitigated. The silver lining is that mitigation efforts can help a great deal to minimize negatives. But the simple fact is that the neighbourhood will see more poor people around.
This proposed supervised consumption site has forced us to confront an ugly truth about our community. That we have challenges around addiction, poverty and mental health that we are struggling to solve.
4 Pillars
There are four strategies to combat the opioid epidemic:
Prevention (this includes drug education)
Treatment (detox and rehab options)
Harm reduction (supervised consumption services, needle exchange)
Enforcement (drug busts)
We typically think of drugs as an enforcement issue. Our society makes certain drugs illegal. Police and the federal government catch people who make, buy and sell them. But the opioid epidemic is a reminder how badly the war on drugs in going. It’s a never ending battle because people are endlessly inventive. When there is a market for something, people find a way to get it.
A holistic strategy does not rely only on enforcement. It understands why people use drugs and how to prevent addiction. It helps people who seek treatment and recovering. And it helps minimize harm while drug use occurs.
But it’s not unreasonable that communities prioritize certain strategies over others based on their values. Enforcement over prevention. Treatment over harm reduction. There is no right or wrong here.
Supervised consumption advocates will emphasize the importance of increasing funding not only for harm reduction services, but also the three other pillars. Implementing only supervised consumption services without increased treatment options or enforcement and prevention will not be enough to fight this epidemic. SCSs helps keep addicts alive, but without enough treatment beds available when an addict is ready to seek help it keeps them and the community in a terrible limbo. The damage from the life of an addict is rarely confined to the individual. Drug addiction takes it toll on friends and family. It’s not surprising addiction also tests the patience of the wider community. The longer a person is addicted to drugs, the more issues we must contend with.
A valid question regarding the funding of a SCS is whether increased funding has also been secured for the other three strategies. From my conversations Alberta is still lacking sufficient and suitable detox and rehabilitation services.
Mayor Chris Spearman, of Lethbridge, expressed frustration in July 2019 that additional treatment supports have not been increased. “We lack all the facilities to deal with addiction—we don’t have what the big cities have. We don’t have detox, we don’t have supported housing (and) we don’t have treatment in the capacity we need it. We’ve been advocating for five years for those facilities. The only thing that we’ve got in five years is federal approval for the supervised consumption site. The only things provided to us, really, is the harm-reduction piece in the supervised consumption site,” he said. “Without the others—without a detox facility, without supportive housing—the situation never gets solved.”
Medicine Hat does have treatment and detox options at the new AHS recovery centre on Kipling Street. I don’t know how sufficient these resources are.
The philosophy of harm reduction
Harm reduction accepts the imperfection of our world—it begins with the acknowledgment that people use drugs. And that until drug users are ready to seek treatment we should minimize the health risks (death and disease) and costs associated with drug use.
Needle exchange programs are helpful in understanding the pros and cons of harm reduction. These established harm reduction programs have received new scrutiny because of our debate over supervised consumption sites.
Our healthcare system does not discriminate. A person could contract HIV through no fault of their own or through reckless disregard for their own safety. Both get the same treatment and our society covers the cost of both treatments equally. Needle exchange programs aim to reduce the risk of transmission of disease. The cost of a disposable needle is small versus the cost to treat a new patient for chronic diseases.
But in order for this program to work vast amounts of needles are distributed. You must make it easier for a drug user to use a new needle than reuse or share an old one. And the more needles out there, the increased risk of improper disposal.
The consequence of this program is that some cities, including Medicine Hat, must deal with needle debris. Not something particularly pleasant to come across in our parks, yards and alleys. Perhaps the worst case scenario occurred in Lethbridge, where a child found a needle in a park and was accidentally pricked. As far as I can tell, other than the scare, the child is okay, but it was a wake up call for the tradeoffs of this program. A risk to the public, but is that risk worth the money that these prevention programs save?
It’s also a risk that can be mitigated. The City of Lethbridge has funded a needle pick up hotline. There is a Clean Sweep program created by the downtown businesses to patrol and keep streets clean. Parks staff have been trained for safe handling of needles. There is even a city webpage for advice for needle advice for parents of small children. This education and awareness helps further reduce the risk of needle debris. But again the tradeoff is that children need to be taught about needles.
HIV Community Link also has a needle pick up hotline and does proactive needle debris sweeps in areas where known public drug consumption occurs. Our parks staff are also trained with the safe handling of needles.
Axing needle exchange programs may lessen the need to teach our children about needle safety and we wouldn’t have to be confronted with needle garbage. Perhaps our children could maintain their innocence longer, but we also might have a HIV and hep C epidemic to accompany the overdose epidemic.
The cost to our healthcare system due to overdoses is analogous to other health care epidemics. Emergency services also do not discriminate. When people call for help, they answer. SCSs are promoted as a key way to help with overdoses in public settings and reduce the high number of 911 calls. A SCS will not prevent every death, but it’s one tool meant to be part of the solution.
These are the tradeoffs that society must weigh. We have a bad habit of only talking about the positives of the programs we support and only the negatives if we don't support it. But we should talk of both. There is no right or wrong choice. The important point is that we’re aware of the consequences of our choices and acknowledge these are tough decisions.
Addiction is a disease
The philosophy of harm reduction runs in tension to the philosophy of personal accountability. Shouldn’t we face the consequences of our actions? How do we square this with the view that addiction is a disease?
After the Insite ruling Chief Justice McLachlin said, serious drug addiction is not a moral choice; it is an illness which essentially negates the notion of "choice" altogether. I agree that addiction is a disease, but the former Chief Justice should be careful in describing drug addiction this way, because it is a disease unique in many respects.
It’s important to study the patterns of addiction and the larger forces that bear on individuals. Many addicts are victims of abuse and childhood trauma. 75% of overdose deaths are men. Young men in particular outpace other groups for risk of addiction. But I’m also wary of eroding the concept of personal accountability too much. Addiction begins with a choice—a choice those with genetic diseases don’t get to make.
If addicts have no choice in the matter as Chief Justice McLachlin suggests, then they are not accountable for their actions. If addicts can’t help their addiction is our society allowed to force them into treatment? If a person is not accountable for their actions they shouldn’t be allowed freedom in our society. Society only functions because of the foundation of personal accountability.
However, those residents who would prefer boosting treatment services instead of a SCS should understand this strategy would not be devoid of controversy. If addiction is a disease certain addicts may need to be on opioid replacement therapy like suboxone perhaps for the rest of their lives. Or perhaps opioid blocking medication. It’s likely that an abstinence only solution will not be sufficient for many addicts.
Medicine Hat Coalition on
Supervised Consumption Services
In 2016 the Province of Alberta asked this local group to study the local drug environment to understand how the opioid epidemic was affecting Medicine Hat. 185 drug users participated in this survey. Drug users indicated that traditional health services were too judgmental and were thus unlikely to use them. The previous city council was informed that this study was initiated and its results.
The results of the survey and the growing overdoses in Medicine Hat convinced the previous Government of Alberta to fund a SCS. Research from other SCSs has shown that drug users will not travel more than one kilometer to use this service. A heat map from first responders indicates where the most overdoses occur in our city.
Location of overdoses in 2018
Location of overdoses in 2017
Drug activity occurs across the city and the downtown area isn’t the only hot spot as you can see. But while other spots move around the downtown is a consistent area for overdoses. This is the main rationale for HIV Community Link’s decision to place this facility downtown.
Some residents have asked that the SCS be placed in lightly populated areas to minimize impact on any neighbourhood. That would decrease impact, but might also lead to decreased use of a SCS. Hence the catch-22. Place it where drug users are more likely to use it and we may create negative impact for its neighbours. Place it away from established neighbourhoods and we minimize impact, but also may minimize its intended use and benefits.
City Council
While municipal governments have the authority to regulate land use this power comes with limits. We set general rules for different classifications of properties, but we cannot single out a service or organization and treat them differently. Supervised consumption services are designated as health care facilities. As such these services can be placed in any building where a doctors office can be. Yes, even though it’s clear that the impact of a doctors office versus a SCS differs widely.
Red Deer City Council took the most aggressive stance in fighting the placement of a SCS in their city. However, after a string of overdose deaths former Minister of Health Sarah Hoffman forced a temporary, but fixed location in their downtown for a overdose centre to stem the deaths. It was an indication to me that municipal councils aren’t in a position of strength on this issue. The province holds the hammer on this issue.
But through this process it has become clear to me that municipal councils need more power with these controversial decisions. Regardless of where you stand on this issue in order for a SCS to be successful it needs the support of the community.
Insite has the unified support of city council, local police and the provincial government. That greatly helps in maximizing benefits and minimizing impacts.
Locally, the situation is very different. Our city council did not choose this strategy for the drug epidemic, so has no stake in ensuring its success. We have not been assured by the province that additional funds for mitigation strategies for any negative impacts will be provided. Likewise we did not have a role to play in determining its location. And yet containing the negative effects of a SCS maybe beyond the power of HIV Community Link and thus council support will be necessary to coordinate and mitigate potential issues.
But council is not blameless. Even if we don’t have much power in the matter we could have done a better job communicating to the public the process for establishing a SCS in Medicine Hat.
Accidental ghettos
Local councils are important partners because it’s our job to look at issues from a wider perspective. HIV Community Link’s main focus is saving lives, but my focus is the general well being of the city.
Social service organizations tend to choose their location by proximity to the clients they serve. ‘Don’t make people come to you, go to them’ is a common mantra. The consequence of this mindset is that social services end up concentrating in particular neighbourhoods—creating a reinforcing loop. People who need help are drawn to social services and social services locate where people in need are.
I lived in Vancouver for five years and this is essentially the story of the Downtown Eastside. This city has tried to solve the issues related to poverty and drug addiction for decades with no shortage of social service funding. Yet you would be pressed to find anyone who considers the DTES a success story. In many ways, city leaders there have created an unintentional ghetto.
It’s not clear when the scales tip in a neighbourhood, but concentrating too many social services increases the risk. Our downtown is small enough that ill effects in one area are felt throughout. The provincial building (mental health supports and employment assistance), Medicine Hat Community Housing, the food bank, the courthouse, our homeless shelters and drop in centres form the core of our social services and they are all located in a single neighbourhood.
It’s a common sight to see groups of people waiting for the food bank or shelter to open. Or moving from social service to another. None of this has diminished my compassion to help people. But we need to be mindful of the consequences of certain planning decisions. Perhaps municipal councils need to be more intentional in locating social services, but to do that we need to creative solutions that allow city council more influence.
Tough choices
This is not my decision. In the end the Government of Alberta will have to make a judgment call.
If the Government of Alberta declines to fund a SCS in our community we still need to work together to figure out how to improve the status quo and what an alternative strategy might be.
If the Government of Alberta chooses to fund this SCS I ask that:
Municipal councils are given the power to set location.
Adequate funds are provided for mitigation. Enough to maintain the confidence of area residents and businesses.
Demonstrated commensurate funding for the other three drug fighting strategies.
There are also additional important questions to settle before a SCS is established:
How long will this facility be necessary? If the epidemic improves to a predetermined degree will this site be shut down?
The drug of choice in Medicine Hat is meth, not opioids. If the primary drug consumed at the SCS is meth, not opioids, how does that affect our view of this service? If the primary goal of a SCS is to prevent overdose deaths, that's a lot of extra baggage to carry for this goal. If you’re trying to build trust with marginalized clients who most likely take multiple drugs, it makes sense to allow the consumption of any drug. But if you’re trying to build trust with community we need to be upfront about what the drugs consumed are. Most prairie cities have a larger meth problem. Meth is a powerful and addictive drug that causes you to feel powerful and euphoric. It also causes severe psychological problems. Overdosing from meth is not a key concern.
Supporters and skeptics of SCSs should be united on one thing—the existing SCSs represent an opportunity. We should ensure on great data collection and research in Alberta to maximize what we can learn from harm reduction initiatives. Life is an experiment. We try things, sometimes they work, sometimes other things work better. This won’t be the last drug epidemic our community will face. As we face the immediate challenge we should also play the long game.