'A methodical approach': Addictions expert applauds Sask. shifting policies on illicit drug use

A leading addictions and recovery expert is applauding Saskatchewan's new approach to illicit drug use issues of moving focus away from harm reduction and towards recovery.

Carson McPherson, originally from Shaunavon, Sask. and CEO of ROSC Solutions Group, was one of many people who helped advise the province in advance of last fall's Mental Health and Addictions Action Plan.

"What you're seeing is, in my opinion, something that everyone in Saskatchewan should be happy with," he said.

"This government's taking a methodical approach. They're not racing like a lot of other jurisdictions in the country have and sort of throwing things to see what works."

McPherson has spent years designing, implementing, and delivering addiction treatment programs in Canada.

Recovery-oriented system of care (ROSC) is one of the new principles of the province's shift in dealing with mental health and addictions impacts.

ROSC's purpose is to integrate a variety of services and coordinate them interchangeably as a person progresses towards health and well-being.

For example, if a person has chest pain, they present to the emergency room and are seen by a doctor who works through a series of protocols to eventually map out a treatment plan.

ROSC introduces that model of care to addictions and mental health.

"In addictions and mental health, that isn't the case, so you have a really fragmented, siloed system of care," McPherson said.

The province announced the new approach Thursday. Distribution of pipes will no longer be funded by the Ministry of Health or the Saskatchewan Health Authority, and needle exchanges will be required to operate on a one-to-one exchange basis, meaning a used needle must be returned before another is provided.

For years, public health and addictions researchers have argued adding barriers to safe supply access doesn't prevent the spread of bloodborne viruses like the province is touting, it potentially does the opposite.

"It's a giant waste of everyone's time and energy. This system will not be effective for achieving the goals that they are seeking," Barb Fornssler, a professor at the University of Saskatchewan's School of Public Health, said.

"The drug use doesn't go away because someone doesn't have a sterile syringe -- what happens is the one syringe available gets shared amongst many people."

McPherson challenged that notion. As substance use issues become more prevalent and more severe in jurisdictions implementing harm reduction best practices, he says expanding supply is only part of the solution.

"You really can look at this issue from sort of a demand side or supply side approach," he said. "When you expand the availability of substances, and the enabling factors to use those substances, the use of them equally expands."

McPherson pointed out how the province isn't abandoning harm reduction, but instead is trying to move people along its continuum of care. He says giving people access to safe drug supplies isn't the only avenue of addiction treatment.

"It's fine to meet someone where they're at, but you can't leave them there," McPherson said. "When we expand those supply measures, they tend to work but that's not necessarily what we should be hoping for.

"What we're hoping for is to return someone to a state of life that we would all aspire to."

The province focused on three key points as its rationale for making the change: safe drug use supply sends the wrong message to people seeking recovery, preventing the spread of bloodborne illnesses and a transition to ROSC.

Fornssler says Saskatchewan's policy of putting its focus into acute care at the expense of harm reduction is the opposite of near-consensus evidence from peer-reviewed research from world-leading experts

Citing best practices from the Canadian AIDS Treatment Information Exchange. Fornssler says Saskatchewan's new policy is not only the most expensive, but also the least effective pathway to recovery from addiction.

"To provide a sterile needle to someone is less than 30 cents. Even if we provided 100 needles a day, every single day for the year, we are saving immense amounts of money," Fornssler said.

Saskatchewan leads the country in new HIV cases, according to December 2023 data from the Public Health Agency of Canada.

The rate of new cases of HIV in Canada is 4.7 per 100,000 people. In Saskatchewan, the rate is 19.0 per 100,000 people. Fornssler worries that number will worsen with the reintroduction of the one-to-one needle exchange policy.

Fornssler says some drug users aren't ready to engage with a treatment plan because of barriers to access, previous trauma and a lack of trust with the health system.

"We are basically severing a line of connection by stopping the distribution of the supplies," she said. "We have a huge gap in our continuum of care, and many, many people are going to fall through that gap."

McPherson says Saskatchewan is charting a different course to combat the effects of addictions and mental health issues. While he doesn't believe substance use disorders will ever be eradicated from society, ROSC can help the province meet the needs of evolving health challenges moving forward.

"I would look at evidence more from a critical lens than some of the ways that we hear today," he said.

"We get all these breaks along the system. Now what we're doing is saying, 'Look, we want to close those, we want to have continuity of care,'" McPherson said.