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Addictions

Why can’t we just say no?

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From the Frontier Centre for Public Policy

By Susan Martinuk

Drug use and violence have become common place in hospitals. Drug-addicted patients openly smoke meth and fentanyl, and inject heroin. Dealers traffic illicit drugs.  Nurses are harassed, forced to work amidst the toxic fumes from drugs and can’t confiscate weapons. In short, according to one nurse, “We’ve absolutely lost control.”

“Defining deviancy down” is a cultural philosophy that emerged in the United States during the 1990s.

It refers to society’s tendency to adjust its standards of deviancy “down,” so that behaviours which were once unacceptable become acceptable.  Over time, this newly- acceptable behaviour can even become society’s norm.

Of course, the converse must also be true — society looks down on those who label social behaviours “wrong,” deeming them moralistic, judgemental or simply out of touch with the realities of modern life.

Thirty years later, this philosophy is entrenched in British Columbia politics and policies. The province has become a society that cannot say “no” to harmful or wrong behaviours related to drug use. It doesn’t matter if you view drug use as a medical issue, a law-and-order issue, or both – we have lost the ability to simply say “no” to harmful or wrong behaviour.

That much has become abundantly clear over the past two weeks as evidence mounts that BC’s experiment with decriminalization and safe supply of hard drugs is only making things worse.

recently-leaked memo from BC’s Northern Health Authority shows the deleterious impact these measures have had on BC’s hospitals.

The memo instructs staff at the region’s hospitals to tolerate and not intervene with illegal drug use by patients.  Apparently, staff should not be taking away any drugs or personal items like a knife or other weapons under four inches long.  Staff cannot restrict visitors even if they are openly bringing illicit drugs into the hospital and conducting their drug transactions in the hallways.

The public was quite rightly outraged at the news and BC’s Health Minister Adrian Dix quickly attempted to contain the mess by saying that the memo was outdated and poorly worded.

But his facile excuses were quickly exposed by publication of the very clearly worded memo and by nurses from across the province who came forward to tell their stories of what is really happening in our hospitals.

The President of the BC Nurses Union, Adriane Gear, said the issue was “widespread” and “of significant magnitude.” She commented that the problems in hospitals spiked once the province decriminalized drugs. In a telling quote, she said, “Before there would be behaviours that just wouldn’t be tolerated, whereas now, because of decriminalization, it is being tolerated.”

Other nurses said the problem wasn’t limited to the Northern Health Authority. They came forward (both anonymously and openly) to say that drug use and violence have become common place in hospitals. Drug-addicted patients openly smoke meth and fentanyl, and inject heroin. Dealers traffic illicit drugs.  Nurses are harassed, forced to work amidst the toxic fumes from drugs and can’t confiscate weapons. In short, according to one nurse, “We’ve absolutely lost control.”

People think that drug policies have no impact on those outside of drug circles – but what about those who have to share a room with a drug-smoking patient?

No wonder healthcare workers are demoralized and leaving in droves. Maybe it isn’t just related to the chaos of Covid.

The shibboleth of decriminalization faced further damage when Fiona Wilson, the deputy chief of Vancouver’s Police Department, testified before a federal Parliamentary committee to say that the policy has been a failure. There have been more negative impacts than positive, and no decreases in overdose deaths or the overdose rate. (If such data emerged from any other healthcare experiment, it would immediately be shut down).

Wison also confirmed that safe supply drugs are being re-directed to illegal markets and now account for 50% of safe supply drugs that are seized. Her words echoed those of BC’s nurses when she told the committee that the police, “have absolutely no authority to address the problem of drug use.”

Once Premier David Eby and Health Minister Adrian Dix stopped denying that drug use was occurring in hospitals, they continued their laissez-faire approach to illegal drugs with a plan to create “safe consumption sites” at hospitals. When that lacked public appeal, Mr. Dix said the province would establish a task force to study the issue.

What exactly needs to be studied?

The NDP government appears to be uninformed, at best, and dishonest, at worst. It has backed itself into a corner and is now taking frantic and even ludicrous steps to legitimize its experimental policy of decriminalization. The realities that show it is not working and is creating harm towards others and toward institutions that should be a haven for healing.

How quickly we have become a society that lacks the moral will – and the moral credibility – to just to say “no.”

Susan Martinuk is a Senior Fellow with the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.

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Addictions

Coffee, Nicotine, and the Politics of Acceptable Addiction

Published on

From the Brownstone Institute

By Roger BateRoger Bate  

Every morning, hundreds of millions of people perform a socially approved ritual. They line up for coffee. They joke about not being functional without caffeine. They openly acknowledge dependence and even celebrate it. No one calls this addiction degenerate. It is framed as productivity, taste, wellness—sometimes even virtue.

Now imagine the same professional discreetly using a nicotine pouch before a meeting. The reaction is very different. This is treated as a vice, something vaguely shameful, associated with weakness, poor judgment, or public health risk.

From a scientific perspective, this distinction makes little sense.

Caffeine and nicotine are both mild psychoactive stimulants. Both are plant-derived alkaloids. Both increase alertness and concentration. Both produce dependence. Neither is a carcinogen. Neither causes the diseases historically associated with smoking. Yet one has become the world’s most acceptable addiction, while the other remains morally polluted even in its safest, non-combustible forms.

This divergence has almost nothing to do with biology. It has everything to do with history, class, marketing, and a failure of modern public health to distinguish molecules from mechanisms.

Two Stimulants, One Misunderstanding

Nicotine acts on nicotinic acetylcholine receptors, mimicking a neurotransmitter the brain already uses to regulate attention and learning. At low doses, it improves focus and mood. At higher doses, it causes nausea and dizziness—self-limiting effects that discourage excess. Nicotine is not carcinogenic and does not cause lung disease.

Caffeine works differently, blocking adenosine receptors that signal fatigue. The result is wakefulness and alertness. Like nicotine, caffeine indirectly affects dopamine, which is why people rely on it daily. Like nicotine, it produces tolerance and withdrawal. Headaches, fatigue, and irritability are routine among regular users who skip their morning dose.

Pharmacologically, these substances are peers.

The major difference in health outcomes does not come from the molecules themselves but from how they have been delivered.

Combustion Was the Killer

Smoking kills because burning organic material produces thousands of toxic compounds—tar, carbon monoxide, polycyclic aromatic hydrocarbons, and other carcinogens. Nicotine is present in cigarette smoke, but it is not what causes cancer or emphysema. Combustion is.

When nicotine is delivered without combustion—through patches, gum, snus, pouches, or vaping—the toxic burden drops dramatically. This is one of the most robust findings in modern tobacco research.

And yet nicotine continues to be treated as if it were the source of smoking’s harm.

This confusion has shaped decades of policy.

How Nicotine Lost Its Reputation

For centuries, nicotine was not stigmatized. Indigenous cultures across the Americas used tobacco in religious, medicinal, and diplomatic rituals. In early modern Europe, physicians prescribed it. Pipes, cigars, and snuff were associated with contemplation and leisure.

The collapse came with industrialization.

The cigarette-rolling machine of the late 19th century transformed nicotine into a mass-market product optimized for rapid pulmonary delivery. Addiction intensified, exposure multiplied, and combustion damage accumulated invisibly for decades. When epidemiology finally linked smoking to lung cancer and heart disease in the mid-20th century, the backlash was inevitable.

But the blame was assigned crudely. Nicotine—the named psychoactive component—became the symbol of the harm, even though the damage came from smoke.

Once that association formed, it hardened into dogma.

How Caffeine Escaped

Caffeine followed a very different cultural path. Coffee and tea entered global life through institutions of respectability. Coffeehouses in the Ottoman Empire and Europe became centers of commerce and debate. Tea was woven into domestic ritual, empire, and gentility.

Crucially, caffeine was never bound to a lethal delivery system. No one inhaled burning coffee leaves. There was no delayed epidemic waiting to be discovered.

As industrial capitalism expanded, caffeine became a productivity tool. Coffee breaks were institutionalized. Tea fueled factory schedules and office routines. By the 20th century, caffeine was no longer seen as a drug at all but as a necessity of modern life.

Its downsides—dependence, sleep disruption, anxiety—were normalized or joked about. In recent decades, branding completed the transformation. Coffee became lifestyle. The stimulant disappeared behind aesthetics and identity.

The Class Divide in Addiction

The difference between caffeine and nicotine is not just historical. It is social.

Caffeine use is public, aesthetic, and professionally coded. Carrying a coffee cup signals busyness, productivity, and belonging in the middle class. Nicotine use—even in clean, low-risk forms—is discreet. It is not aestheticized. It is associated with coping rather than ambition.

Addictions favored by elites are rebranded as habits or wellness tools. Addictions associated with stress, manual labor, or marginal populations are framed as moral failings. This is why caffeine is indulgence and nicotine is degeneracy, even when the physiological effects are similar.

Where Public Health Went Wrong

Public health messaging relies on simplification. “Smoking kills” was effective and true. But over time, simplification hardened into distortion.

“Smoking kills” became “Nicotine is addictive,” which slid into “Nicotine is harmful,” and eventually into claims that there is “No safe level.” Dose, delivery, and comparative risk disappeared from the conversation.

Institutions now struggle to reverse course. Admitting that nicotine is not the primary harm agent would require acknowledging decades of misleading communication. It would require distinguishing adult use from youth use. It would require nuance.

Bureaucracies are bad at nuance.

So nicotine remains frozen at its worst historical moment: the age of the cigarette.

Why This Matters

This is not an academic debate. Millions of smokers could dramatically reduce their health risks by switching to non-combustion nicotine products. Countries that have allowed this—most notably Sweden—have seen smoking rates and tobacco-related mortality collapse. Countries that stigmatize or ban these alternatives preserve cigarette dominance.

At the same time, caffeine consumption continues to rise, including among adolescents, with little moral panic. Energy drinks are aggressively marketed. Sleep disruption and anxiety are treated as lifestyle issues, not public health emergencies.

The asymmetry is revealing.

Coffee as the Model Addiction

Caffeine succeeded culturally because it aligned with power. It supported work, not resistance. It fit office life. It could be branded as refinement. It never challenged institutional authority.

Nicotine, especially when used by working-class populations, became associated with stress relief, nonconformity, and failure to comply. That symbolism persisted long after the smoke could be removed.

Addictions are not judged by chemistry. They are judged by who uses them and whether they fit prevailing moral narratives.

Coffee passed the test. Nicotine did not.

The Core Error

The central mistake is confusing a molecule with a method. Nicotine did not cause the smoking epidemic. Combustion did. Once that distinction is restored, much of modern tobacco policy looks incoherent. Low-risk behaviors are treated as moral threats, while higher-risk behaviors are tolerated because they are culturally embedded.

This is not science. It is politics dressed up as health.

A Final Thought

If we applied the standards used against nicotine to caffeine, coffee would be regulated like a controlled substance. If we applied the standards used for caffeine to nicotine, pouches and vaping would be treated as unremarkable adult choices.

The rational approach is obvious: evaluate substances based on dose, delivery, and actual harm. Stop moralizing chemistry. Stop pretending that all addictions are equal. Nicotine is not harmless. Neither is caffeine. But both are far safer than the stories told about them.

This essay only scratches the surface. The strange moral history of nicotine, caffeine, and acceptable addiction exposes a much larger problem: modern institutions have forgotten how to reason about risk.

Author

Roger Bate

Roger Bate is a Brownstone Fellow, Senior Fellow at the International Center for Law and Economics (Jan 2023-present), Board member of Africa Fighting Malaria (September 2000-present), and Fellow at the Institute of Economic Affairs (January 2000-present).

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Addictions

Manitoba Is Doubling Down On A Failed Drug Policy

Published on

From the Frontier Centre for Public Policy

By Marco Navarro-Genie

Manitoba is choosing to expand the same drug policy model that other provinces are abandoning, policies that normalize addiction while sidelining treatment, recovery, and public safety.

The New Democrat premier of British Columbia, David Eby, stood before reporters last spring and called his government’s decision to permit public drug use in certain spaces a failure.

The policy was part of the broader “harm reduction” strategy meant to address overdose deaths. Instead, it had stirred public anger, increased street disorder and had helped neither users nor the communities that host them. “We do not accept street disorder that makes communities feel unsafe,” Eby said. The province scrapped the plan.

In Alberta, the Conservative government began shutting down safer-supply prescribing due to concerns about drug diversion and misuse. The belief that more opioids can resolve the opioid crisis is losing credibility.

Ontario Progressive Conservatives are moving away from harm reduction by shutting down supervised consumption sites near schools and limiting safer-supply prescribing. Federal funding for programs is decreasing, and the province is shifting its focus to treatment models, even though not all sites are yet closed.

Yet amid these non-partisan reversals, Manitoba’s government has announced its intention to open a supervised drug-use site in Winnipeg. Premier Wab Kinew said, “We have too many Manitobans dying from overdose.” True. But it does not follow that repeating failed approaches will yield different results.

Reversing these failed policies is not a rejection of compassion. It is a recognition that good intentions do not produce good outcomes. Vancouver and Toronto have hosted supervised drug-use sites for years. The death toll keeps rising. Drug deaths in British Columbia topped 2,500 in 2023, even with the most expansive harm reduction infrastructure in the country. A peer-reviewed study published this year found that hospitalizations from opioid poisoning rose after B.C.’s safer-supply policy was implemented. Emergency department visits increased by more than three cases per 100,000 population, with no corresponding drop in fatal overdoses.

And the problem persists day to day. Paramedics in B.C. responded to nearly 4,000 overdose calls in July 2024 alone. The monthly call volume has exceeded 3,000 almost every month this year. These are signs of crisis management without a path to recovery.

There are consequences beyond public health. These policies change the character of neighbourhoods. Businesses suffer. Residents feel unsafe. And most tragically, the person using drugs is offered little more than a cot, a nurse and a quiet signal to continue. Real help, like treatment, housing and purpose, remains out of reach.

Somewhere along the way, bureaucracies stopped asking what recovery looks like. They have settled for managing human decline. They call it compassion. But it is really surrender, wrapped in medical language.

Harm reduction had its time. It made sense when it first emerged, during the AIDS crisis, when dirty needles spread HIV. Back then, the goal was to stop a deadly virus. Today, that purpose has been lost.

When policy drifts into ideology, reality becomes an afterthought. Underneath today’s approach is the belief that drug use is inevitable, that people cannot change, that liberty means letting others fade away quietly. These ideas do not reflect science. They do not reflect hope. They reflect despair. They reflect a politics that prioritizes the appearance of compassion over effectiveness.

What Manitoba needs is treatment access that meets the scale of the problem. That means detox beds, recovery homes and long-term care focused on restoring lives. These may not generate the desired headlines, but they work. They are demanding. They are slow. And they offer respect to the person behind the addiction.

There are no shortcuts. No policy will undo decades of pain overnight. But a policy that keeps people stuck using is not mercy. It is maintenance with no way out.

A government that believes in its people should not copy failure.

Marco Navarro-Genie is vice-president of research at the Frontier Centre for Public Policy and co-author, with Barry Cooper, of Canada’s COVID: The Story of a Pandemic Moral Panic (2023).

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