If things had gone differently, by now we would have safer neighbourhoods throughout Calgary.

The current story being told about Calgary’s sole supervised consumption service (SCS) has erased a great deal of history.

In 2018, a trailer was parked in the paved lot behind the Sheldon Chumir Health Centre. It was a stopgap while a space inside the building was renovated to permanently house the SCS.  It was recognized at the time that the drug poisoning crisis was only growing, and the science showing the efficacy of SCS to save lives was unquestionable. 

Even the tiny trailer, though far from adequate, gave the community of people who use drugs and those who care for them — like me — new hope.

It was well known at the time, given the frightening trajectory and geography of mortality, that a single site, even a new permanent one, was insufficient.  It was a starting place.  While visits to the Chumir site steadily increased, additional sites were urgently being planned to increase access to those most in need.  That was back before the province started keeping neighbourhood-level data, about where poisonings were most common, a state secret. 

As I was present at many meetings, who do I recall being involved in planning the expansion of SCS in Calgary?  AHS (Safeworks), the DI, Alpha House, CUPS, the Alex, and what is now SafeLink.  One single fearless and persistent University of Calgary researcher, Dr. Rebecca Saah.  Mostly, I worked on policy and procedure for mobile SCS, having agreed to be its medical resource, and wrote applications for approvals to Health Canada.  We supported all shelter staff in being trained to respond to poisonings with naloxone. 

Our group, dubbed the Calgary Coalition for Supervised Consumption, designed a variety of models of care that would meet everyone’s needs, including inhalational use.  Many smaller sites, tailored to specific communities, would relieve the pressure off a single site.  It was recognized that, to be most effective in reducing deaths while minimizing impacts on neighbourhoods, the needs of community – both members who do not use the service and those who do – had to be considered. 

I recall, at one of many community consultations, a lengthy conversation with a couple of Calgary Police Service officers.  They were very supportive, in fact, relieved.  Many of the neighbours who stopped by for a tour of the fully-equipped mobile unit asked questions but also expressed support and interest.

Bureaucracy gets in the way of healthcare

When the UCP took power in 2019, the mobile SCS was ready to go – fully staffed and gassed up.  Although the shelters and community centres were nervous, with the right support they were keen to do their part, too.  They were then seeing only the prologue of what was to grow into an epic tragedy of thousands of poisoning events that would occur in and on their premises.

But then, the City of Calgary hindered approvals to park the mobile in needed locations (like Forest Lawn and Bowness).  That delay proved fatal:  It is far easier for a government to prevent a program from starting than it is to shut it down after it has already saved lives.  The UCP took advantage of the delay.  In July of 2019, it seized the mobile SCS and stymied its funding.  Paramedics and peer outreach workers lost their jobs. 

‘That the strategy did not directly support harm reduction initiatives nor address the drug poisoning crisis seems a glaring omission.’

Dr. Bonnie Larson – Clinical Associate Professor – UCalgary Department of Family Medicine

By 2020, barriers had been erected by ALL levels of government – none are blameless, but it is the provincial government that holds the balance of power in health care, a problem of which we are now all too aware.  A jurisdictional hot potato is how people, disproportionately Indigenous people in this and many other cases, fall through the cracks of systems meant to deliver care. 

Then the pandemic made everything worse.  There was no capacity in any of the agencies or healthcare facilities to build new programs besides what was being implemented – temporarily – to respond to COVID-19.  Post-pandemic however, City Council could have given SCS a much-needed boost within its $25 million-dollar Mental Health and Addiction strategy. 

That the strategy did not directly support harm reduction initiatives nor address the drug poisoning crisis seems a glaring omission.

What could have been different?  Provincial, municipal and federal governments should have collaborated instead of passing the buck.  If they had, we would by now be seeing not only far fewer drug poisonings but also those safer streets for which we had all worked. 

If non-profits had banded together collectively rather than competitively, they could have swayed funders and boards of directors to stand up to the UCP’s harm reduction bulldozer.  Lastly, if the most powerful healthcare workers — dare I say, doctors – had bothered to peek in on and protect this extremely vulnerable population instead of worrying about their bank balance, there might now be more than a handful of physicians writing op-eds ad nauseum, being vilified as “activists” by both politicians and peers and slowly sinking under the accumulating years of this ever-worsening nightmare. 

So, what is the story that we should be telling now? 

It begins with:  We screwed up and failed Calgarians who are at the highest risk of poor health outcomes.  It continues: We are sorry and will commit to fighting the closure of essential health services. 

It ends like this: Supervised consumption services in our city are expanded to meet the need. Done right, we are all safer and healthier. 

Most importantly, many families of the future will need not grieve.

• Dr. Bonnie Larson is a Clinical Associate Professor at the University of Calgary’s Department of Family Medicine, and Preclerkship Education, Cumming School of Medicine