Since 2005, we have led the annual State of the Inner City research project, which has collaborated with Winnipeg over forty community-based organizations (CBOs) working in the inner city. The project researches issues that matter to CBOs and the communities they serve. It connects the personal struggles of the people who live in the inner city with the ‘big picture’-the structural and political realities that affect their lives. While socio-economic marginalization exists outside the boundaries of the inner city, the inner city is an area that has been historically divided by class and race.
In 2019 we published “Forest for the Trees” Reducing Drug and Mental Health Harms in the Inner City Winnipeg” under the guidance of CBOs. In 2016 the inner city community began to see increased attention to the startling number of opioid overdoses and deaths. That attention quickly shifted to the increased use of methamphetamine in Winnipeg. Community-based organizations (CBOs) working in the inner city told us that they are seeing many of their clients presenting with increasingly severe needs and in some cases behavioural challenges relating to meth use. People are arriving at their doors in states of emergency, but they have far fewer resources than already-stretched emergency rooms, and they are struggling to respond.
The ‘forest for the trees’ on the issue is that we need to understand and respond to root causes if we are ever going to achieve big picture change. We will never eliminate all drug use. Nor are such efforts necessary, as we know that drug exposure alone does not cause problematic substance use. If it could, the problem would occur in every person who tries drugs or alcohol. Unfortunately, that ‘old story’ seems to be guiding policy action, particularly relating to increased criminalization of drug use and people who use. This is not to make light of the problem, because as family members, community activists and CBOs have told us, there is indeed a problem. Responding with effective policy however demands that we fully understand what the problem is.
Harm reduction policies are supported by local, national and international evidence, and are practical, feasible and cost-effective. In two separate polls in 2021 and 2019, two thirds of Winnipeggers were in favour of a safe consumption site. As the report before you demonstrates, Manitoba is the only province without a SCS, aside from the Atlantic provinces.
There is a large body of research on safe consumption sites demonstrating efficacy in achieving health and social objectives, especially when clients are offered access to integrated health and social services, including primary care, treatment and housing alongside SCS. SCS have not shown to increase criminal activity beyond the use of illicit drugs according to the Government of Canada.
In the “Forest for the Trees: Reducing Drug and Mental Health Harms in the Inner City Winnipeg”, the State of the Inner City report, we examine the inequality of substance use, problematic substance use and drug-related harms. This research shows that people who experience socio-economic marginalization, including the effects of colonialism and inter-generational trauma, are more likely to develop problematic substance use and mental health issues and experience harms related to drug use that are more severe.
The Province’s focus on individualizing responses such as treatment, education and policing seeks to modify the psychology and behaviour of individuals with little attention or effort directed toward the larger environment in which individuals succeed or fail. This work draws on research which shows that for people with depleted family and community resources, individually- focused addiction treatment is often less effective. For those who lack protector factors against relapse, treatment may actually make people more vulnerable to relapse, overdose and death. In the case of increased policing, empirical evidence has shown little impact on reducing overall illicit drug use, yet people experiencing socio-economic marginalization are more likely to experience harms under a tough on crime approach, as the provincial government is advocating for.
In response to what many community members see as a lack of action on the part of government to meaningfully address the social crisis some communities are working to identify what a caring response could look like. One chapter within this year’s report by Erica Charron, outlines an on-going collaborative project in West Broadway. It demonstrates how one community is mobilizing in the face of ineffective government action.
The province’s response to date is concerning. During the 2019 provincial election, the PC party’s‘ comprehensive strategy’ to address methamphetamine, Safer Streets Safer Lives promised treatment, education and enforcement. Of the $20 million promised to mobilize this strategy, $8 million is directed to criminalizing responses. This strategy is informing the provincial government’s current response. Alongside this, other governmental documents such as the VIRGO Report and the Illicit Drug Task Force Report are also informing drug policy responses. It remains unclear however which recommendations within these documents are being prioritized, which in turn raises concerns about strategy, accountability and transparency.
Responses must be rooted in evidence and compassion rather than fear and punishment. A safe consumption site as described in the report is part of this response. Winnipeg and Manitoba must follow a clear and comprehensive drug strategy that is rooted in principles of public health. Ideally this would occur at the provincial level, but many municipalities have their own drug strategies and so we encourage the City of Winnipeg to follow this lead. Advocating for and supporting a Safe Consumption Stie is part of this work.
Harm reduction must be incorporated, as an official principle of any developed strategy because evidence also shows, that by and large, the harms associated with drug use is a result of structural harms, rather than the substance itself. This includes prohibition, which is linked to increasingly dangerous illicit substances.
Another common refrain we heard during community consultation was that there is a need for a shift around the idea of wellness, abstinence, sobriety and healing. Johann Hari (2015) encapsulates this sentiment well when he writes that ‘the opposite of addiction isn’t sobriety, it’s connection’. CBOs can act as important connectors that help develop and promote a sense of hope, meaning, belonging and purpose in their communities. But they must be properly funded and supported. Further, they cannot be expected to provide for people’s basic needs. That is the role of government.
Last but not least, the voices of those who experience mental health and substance use issues needs to be listened to when developing strategies and policy. They are the experts in their own lives and effective policy must meaningfully incorporate this knowledge and wisdom.
Ellen Smirl is the author of “Forest for the Trees: Reducing Drug and Mental Health Harms in the Inner City of Winnipeg”. This report was presented to the City Committee by Molly McCracken, CCPA Manitoba director.