Addictions
A conversation with Premier Smith’s outgoing chief of staff, architect of Alberta’s recovery-focused drug policies
Marshall Smith, Alberta’s Chief of Staff, sits in his office at the Alberta Legislature in Edmonton
Marshall Smith, on what he has learned as an addict and policy leader and what’s next for him
Alberta Premier Danielle Smith’s chief of staff, Marshall Smith, is leaving his post at the end of October.
Since taking office in 2022, he has been instrumental in shaping Alberta’s drug policies and developing the Alberta Model — a recovery-focused addiction treatment policy that has gained international recognition for enhancing access to mental health and addiction services.
Under his guidance, Alberta has prioritized building recovery communities over harm-reduction programs. Government data show a 53 per cent decrease in opioid-related overdose deaths in June 2024 from the prior year, which may suggest Smith’s initiatives are having an impact.
In a statement on social media, the Premier shared that Smith informed her of his decision to retire earlier this year, after dedicating 32 years to public service. His departure comes just ahead of the United Conservative Party’s leadership review on Nov. 2.
Smith met with reporter Alexandra Keeler on Sept. 10 to discuss his personal journey from addiction to recovery and how it has shaped Alberta’s drug policies. On Oct. 10, they spoke by phone to discuss his recent decision to step down and what lies ahead for him.
AK: What emotional and psychological impact did your addiction have on your sense of self?
MS: It makes you feel powerless. Addiction is an illness of isolation, despair, loneliness and powerlessness. One of the hallmarks of addiction is continuing to use a substance despite a complete lack of control over your using, and over the circumstances that you’re in.
AK: Do you think that sense of powerlessness impacts an individual’s ability to provide informed consent for involuntary treatment?
MS: I think that, over time, if addiction is left unchecked or untreated, or is allowed to progress to its very latter stages, you absolutely lose agency over your ability to make decisions.
I used to get the question a lot: ‘Is it a disease? Is it a choice?’ And I say it’s both. It’s actually a disease of choices, which is to say that it’s a disease or an illness that affects my brain’s ability to make good choices.
AK: Were you the driving force behind Alberta’s shift away from harm reduction towards a recovery-focused approach, or was there a broader change in attitudes within the community?
MS: Certainly I’m not solely responsible. I’m a member of a broad community of people in recovery who have been advocating for these policies for two decades. I think that I have a background [and] certain skills that have found me in positions like this, where I can be most effective helping my community advance these ideas and concepts and actually get them implemented into policy and action.
AK: Obviously your lived experience with addiction brings a valuable perspective to the table. But what data sources are the province using to inform its addiction and recovery policies?
MS: We have a very broad literature base that we use to inform a lot of our policy decisions … Alberta [also] has the most comprehensive data collection and data analytics system in North America, bar none.
A practical example of how that’s useful is … [if] the data shows us that a very high number of people who were in custody — whether that’s corrections or police custody — went on to fatally overdose in a period after their release, that tells us that we need to focus on correctional programs, and we need to focus on policing programs.
And we’ve done that. We have amazing new correctional treatment programs that are second to none. I don’t know of anybody in Canada that’s doing this — we’ve taken [jail units where inmates sleep and live] and turned them into treatment centres, and connected them with our new treatment centres outside of jails. We partnered with police, because police have probably the most amount of contact with people who are using substances, and we gave them the ability to help people get on to opioid-substitution medications.
We’re going to go even further. Minister [of Mental Health and Addiction Dan] Williams has just announced the creation of the Centre of Recovery Excellence (CoRE), which is a first of its kind in Canada. It’s a Crown corporation not beholden to pharmaceutical money, which is a big change for us, and we were very deliberate about that.
[CoRE] will give us the ability to pull in data from across systems in government and have that data analyzed … So we’re entering into a very exciting time in terms of data and analytics around this issue.
AK: Without CoRE fully operational yet, what made you confident the recovery-focused approach would succeed?
MS: I see hundreds of thousands of Canadians every day entering recovery and maintaining their recovery … What I see in the alternative is a lot of drug use, homelessness, despair, disease [and] crime.
We spend a lot of time talking about data and evidence and science, and all of those things are good and necessary … but it’s not the only component of the decision-making process. … The policies that we’re making and the pathways that we take also have to be informed by the values of the community that we serve. … For far too long in Canada, that hasn’t been a consideration.
I think that we are at a place in Canada where the country is saying to us it’s time to revisit the direction that we’ve been going. I think that they’re saying to us, as policymakers, that we gave this a chance. We had become convinced by experts and the media … to give [pro-drug, harm-reduction policies like safer supply] a try …
[A]fter 20 years of that, I think that Canadians are ready to throw in the towel and to say, ‘We’re done with this. We’ve given you enough time to prove out your thesis. It’s not worked, and now we’re looking for fresh ideas.’
So Alberta is here leading that conversation of fresh and different ideas, and we’re happy to have that role.
The remainder of this interview took place on Oct. 10.
AK: Premier Smith announced your retirement at the end of October. What prompted your decision to step down?
MS: My time in Alberta has been a lengthy and intense role of system transformation over two premiers and standing up government twice.
While there’s still a lot of work to be done here, we have a tremendous team in Alberta that is leading that work under Minister Williams. I just felt that it’s time for me to step out of the role and continue to serve in other capacities.
AK: Looking ahead, what aspects of the Alberta Model will you carry with you into your future endeavours?
MS: I would say all aspects of the model need to be expanded across Canada, for jurisdictions that are interested.
Where I can be of the most assistance to other governments is talking to them about how to effectively organize themselves to be successful in this area. I think that governments across the country are struggling to figure out how to do that.
AK: What new opportunities do you hope to pursue that you haven’t been able to explore during your time in this role? Will your focus continue to be in addiction and drug policy?
MS: The majority of my focus will be on addiction and drug policy, but I have other areas of interest.
I’m passionate about the work that we’re doing with Indigenous people … I’m also very passionate about emerging technology and how we’re going to use that to uncover some of the answers that we’re looking for on these models.
I’m looking forward to having a little bit more freedom and focus.
This interview has been edited and condensed for clarity.
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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News release from Alberta RCMP
Virtual Opioid Dependency Program serves vulnerable population in Red Deer
Since April 2024, your Alberta RCMP’s Community Safety and Well-being Branch (CSWB) has been piloting the Virtual Opioid Dependency Program (VODP) program in Red Deer to assist those facing opioid dependency with initial-stage intervention services. VODP is a collaboration with the Government of Alberta, Recovery Alberta, and the Alberta RCMP, and was created to help address opioid addiction across the province.
Red Deer’s VODP consists of two teams, each consisting of a police officer and a paramedic. These teams cover the communities of Red Deer, Innisfail, Blackfalds and Sylvan Lake. The goal of the program is to have frontline points of contact that can assist opioid users by getting them access to treatment, counselling, and life-saving medication.
The Alberta RCMP’s role in VODP:
- Conducting outreach in the community, on foot, by vehicle, and even UTV, and interacting with vulnerable persons and talking with them about treatment options and making VODP referrals.
- Attending calls for service in which opioid use may be a factor, such as drug poisonings, open drug use in public, social diversion calls, etc.
- Administering medication such as Suboxone and Sublocade to opioid users who are arrested and lodged in RCMP cells and voluntarily wish to participate in VODP; these medications help with withdrawal symptoms and are the primary method for treating opioid addiction. Individuals may be provided ongoing treatment while in police custody or incarceration.
- Collaborating with agencies in the treatment and addiction space to work together on client care. Red Deer’s VODP chairs a quarterly Vulnerable Populations Working Group meeting consisting of a number of local stakeholders who come together to address both client and community needs.
While accountability for criminal actions is necessary, the Alberta RCMP recognizes that opioid addiction is part of larger social and health issues that require long-term supports. Often people facing addictions are among offenders who land in a cycle of criminality. As first responders, our officers are frequently in contact with these individuals. We are ideally placed to help connect those individuals with the VODP. The Alberta RCMP helps those individuals who wish to participate in the VODP by ensuring that they have access to necessary resources and receive the medical care they need, even while they are in police custody.
Since its start, the Red Deer program has made nearly 2,500 referrals and touchpoints with individuals, discussing VODP participation and treatment options. Some successes of the program include:
- In October 2024, Red Deer VODP assessed a 35-year-old male who was arrested and in police custody. The individual was put in contact with medical care and was prescribed and administered Suboxone. The team members did not have any contact with the male again until April 2025 when the individual visited the detachment to thank the team for treating him with care and dignity while in cells, and for getting him access to treatment. The individual stated he had been sober since, saying the treatment saved his life.
- In May 2025, the VODP team worked with a 14-year-old female who was arrested on warrants and lodged in RCMP cells. She had run away from home and was located downtown using opioids. The team spoke to the girl about treatment, was referred to VODP, and was administered Sublocade to treat her addiction. During follow-up, the team received positive feedback from both the family and the attending care providers.
The VODP provides same-day medication starts, opioid treatment transition services, and ongoing opioid dependency care to people anywhere in Alberta who are living with opioid addiction. Visit vodp.ca to learn more.
“This collaboration between Alberta’s Government, Recovery Alberta and the RCMP is a powerful example of how partnerships between health and public safety can change lives. The Virtual Opioid Dependency Program can be the first step in a person’s journey to recovery,” says Alberta’s Minister of Mental Health and Addiction Rick Wilson. “By connecting people to treatment when and where they need it most, we are helping build more paths to recovery and to a healthier Alberta.”
“Part of the Alberta RCMP’s CSWB mandate is the enhancement of public safety through community partnerships,” says Supt. Holly Glassford, Detachment Commander of Red Deer RCMP. “Through VODP, we are committed to building upon community partnerships with social and health agencies, so that we can increase accessibility to supports in our city and reduce crime in Red Deer. Together we are creating a stronger, safer Alberta.”
By Alexandra Keeler
Across Canada, mobile health models are increasingly being used to offer care to rural and underserved communities
Saskatchewan has launched a small fleet of mobile wellness buses to improve access to primary health care, mental health and addiction services in the province.
The first bus began operating in Regina on Feb. 12. Another followed in Prince Albert on March 21. Saskatoon’s bus was unveiled publicly on April 9. All three are former coach buses that have been retrofitted to provide health care to communities facing barriers to access.
“Mobile health units are proven to improve outcomes for people facing barriers to healthcare,” Kayla DeMong, the executive director of addiction treatment centre Prairie Harm Reduction, told Canadian Affairs in an email.
“We fully support this innovative approach and are excited to work alongside the health bus teams to ensure the people we support receive the care they need, when and where they need it.”
Wellness buses
Like all provinces, Saskatchewan has been grappling with the opioid crisis.
In 2023, an estimated 457 individuals died from overdoses in the province. In 2024, that number fell to 346. But the province continues to struggle with fatal and non-fatal overdoses.
In late February, Saskatoon firefighters responded to more than 25 overdoses in a single 24-hour period. Just over a week later, they responded to 37 overdoses within another 24-hour window.
Saskatchewan’s wellness buses are part of the province’s plan to address these problems. In April 2025, the province announced $2.4 million to purchase and retrofit three coach buses, plus $1.5 million in annual operating funds.
The buses operate on fixed schedules at designated locations around each city. Each bus is staffed with a nurse practitioner, nurse and assessor coordinator who offer services such as overdose reversal kits, addiction medicine and mental health referrals.
“By bringing services directly to where people are, the health buses foster safer, more welcoming spaces and help build trusting relationships between community members and care providers,” said DeMong, executive director of Prairie Harm Reduction.
Saskatoon-based Prairie Harm Reduction is one of the local organizations that partners with the buses to provide additional support services. Prairie Harm Reduction provides a range of family, youth and community supports, and also houses the province’s only fixed supervised consumption site.
The mobile model
Saskatchewan is not the only province using wellness buses. Across Canada, mobile health models are increasingly being used to expand access to care in rural and underserved communities.
In Kingston, Ont., the Street Health Centre operates a retrofitted RV called PORCH (Portable Outreach Care Hub) that serves individuals struggling with homelessness and addiction.
“Our outreach services are extremely popular with our clients and community partners,” Donna Glasspoole, manager at Street Health Centre, said in an emailed statement.
“PORCH hits the road two to three days/week and offers a variety of services, which are dependent on the health care providers and community partners aboard.”
Street Health Centre also has a shuttle service that picks up clients in shelters and brings them to medical clinics or addiction medicine clinics.
The PORCH vehicles are not supported by provincial funding, but instead rely on support from the United Way and other grants. Glasspoole says the centre’s permanent location — which does receive government funding — is more cost-effective to operate.
“The vehicles are expensive to operate and our RV is not great in winter months and requires indoor parking,” she said.
Politically palatable
Many mobile health models currently do not provide controversial services such as supervised drug consumption.
The Saskatchewan Health Authority told Canadian Affairs the province’s new wellness buses will not offer supervised consumption services or safer supply, where drug users are given prescribed opioids as an alternative to toxic street drugs.
“There are no plans to provide supervised consumption services from the wellness buses,” Saskatchewan Health Authority spokesperson Courtney Markewich told Canadian Affairs in a phone call.
This limited scope may make mobile services more politically palatable in provinces that have resisted harm reduction measures.
In Ontario, some harm reduction programs have shifted to mobile models following Premier Doug Ford’s decision to suspend supervised consumption services located within 200 metres of schools and daycares.
In April, Toronto Public Health ended operations at its Victoria Street fixed consumption site, replacing it with street outreach and mobile vans.
The Ontario government’s decision to close the sites is part of a broader pivot away from harm reduction. The province is investing $378 million to transition suspended sites into 19 new “HART Hubs” that offer primary care, mental health, addictions treatment and other supports.
Glasspoole says that what matters most is not whether services are provided at fixed or mobile locations, but how care is delivered.
Models that “reduce barriers to care, [are] non-judgemental, and [are staffed by] trauma-informed providers” are what lead more people toward treatment and recovery, she said in her email.
In Saskatchewan, DeMong hopes the province’s new wellness buses help address persistent service gaps and build trust with underserved communities.
“This initiative is a vital step toward filling long-standing gaps in the continuum of care by providing low-barrier, community-based access to health-care services,” she said.
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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