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Addictions

A conversation with Premier Smith’s outgoing chief of staff, architect of Alberta’s recovery-focused drug policies

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11 minute read

Marshall Smith, Alberta’s Chief of Staff, sits in his office at the Alberta Legislature in Edmonton

By Alexandra Keeler

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.

Subscribe to Break The Needle. Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.

Addictions

Calls for Public Inquiry Into BC Health Ministry Opioid Dealing Corruption

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Sam Cooper

The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.

A confidential investigation by British Columbia’s Ministry of Health, Financial Operations and Audit Branch has uncovered explosive allegations of fraud, abuse, and organized crime infiltration within PharmaCare’s prescribed opioid alternatives program. Internal audit findings, obtained by The Bureau, suggest that millions of taxpayer dollars are being diverted into illicit drug trafficking networks rather than serving harm reduction efforts.

The leaked documents include photographs from vehicle searches that show collections of fentanyl patches and Dilaudid (hydromorphone) apparently packaged for resale after being stolen from the taxpayer-funded “safer supply” program. This program expanded dramatically following a federal law change implemented by Prime Minister Justin Trudeau’s government in 2020, which broadened circumstances in which pharmacy staff could dispense opioids, according to the document’s evidence.

“Prior to March 17, 2020, only pharmacists in BC were permitted to deliver [addiction therapy treatment] drugs,” the audit says.

B.C.’s safer supply program was launched in March 2020 as a response to the opioid overdose crisis, declared in 2016. It allows people with opioid-use disorder to receive prescribed drugs to be used on-site or taken away for later use.

The Special Investigations Unit and PharmaCare Audit Intelligence team identified a disturbing link between doctors, pharmacists, assisted living residences, and organized crime, where prescription opioids meant to replace illicit drugs are instead being diverted, sold, and trafficked at scale.

“A significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients,” the document states.

It suggests that financial incentives have created a business model for organized crime, asserting that “prescribed alternatives (safe supply opioids) are trafficked provincially, nationally, and internationally,” and that “proceeds of fraud” are being used to pay incentives to doctors, pharmacists, and intermediaries.

BC Conservative critic Elenore Sturko, a former RCMP officer, began raising concerns about the program two years ago after hearing anecdotes about prescribed opioids being trafficked. She asserts that the program is a failure in public policy and insists that Provincial Health Officer Dr. Bonnie Henry be dismissed for having “denied and downplayed” problems as they emerged. Sturko also argues that B.C. must change its drug policy in light of U.S. President Donald Trump’s stance linking the trafficking of fentanyl and other opioids to potential trade sanctions against Canada.

The document shows that PharmaCare’s dispensing fee loophole has incentivized pharmacies to maximize billings per patient, with some locations charging up to $11,000 per patient per year—compared to just $120 in normal cases.

Perhaps most alarming is the deep infiltration of B.C.’s safer supply program by criminal networks. The Ministry of Health report lists “Gang Members/Organized Crime” as key players in the prescription drug pipeline, which includes “Doctors, pharmacies, and assisted living residences.”

This revelation confirms long-standing fears that B.C.’s “safe supply” policy—originally designed to prevent deaths from contaminated street drugs—is instead sometimes supplying criminal organizations with pharmaceutical-grade opioids.

The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.

Beyond organized crime’s direct involvement, pharmacies themselves have exploited regulatory gaps to generate massive profits from PharmaCare’s policies:

  • Pharmacies offer kickbacks to doctors, housing staff, and medical professionals to steer patients toward specific locations.
  • Financial incentives fuel fraud, with multiple investigations identifying 60+ pharmacies offering incentives to clients.
  • Non-health professionals, including housing staff, are witnessing OAT (opioid agonist treatment) dosing, violating patient safety protocols.

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Addictions

Provinces are underspending on addiction and mental health care, new report says

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The Greta and Robert H. N. Ho Psychiatry and Education Centre, the HOpe Centre, a health care facility for mental illness and addiction in North Vancouver, B.C. (Dreamstime)

By Alexandra Keeler

The provinces are receiving billions in federal funds to address mental health and substance use. Why are so many spending so little?

The provinces are failing to allocate sufficient funding to addiction and mental health care services, a new report says.

The report, released Dec. 19 by the Canadian Alliance on Mental Illness and Mental Health, criticizes the provinces for a “long history of … demanding maximum cash for health care from the federal government with minimum accountability.”

The alliance is a coalition of 18 prominent health organizations dedicated to improving Canada’s mental health care. Its members include the Canadian Medical Association, the Canadian Psychiatric Association and the Canadian Mental Health Association.

On average, the provinces have allocated just 16 per cent of $25 billion in federal health-care funding toward mental health and addiction services, the report says.

“Given the crisis of timely access to care for those with mental health and substance use health problems, why are so many provinces and territories investing so little new federal dollars to improve and expand access to mental health and substance use health care services?” the report asks.

However, some provinces dispute the report’s criticisms.

“The funding received from the federal government is only a small part of Alberta’s total $1.7 billion allocation towards mental health, addiction and recovery-related services,” an Alberta Ministry of Mental Health and Addiction spokesperson told Canadian Affairs in an emailed statement.

“[This] is a nation leading level of investment response.”

‘Take the money and run?’

In 2023, Ottawa and the provinces committed to spend $25 billion over 10 years investing in four priority areas. These areas are mental health and substance use, family health services, health workers and backlogs, and a modernized health system.

The alliance’s report, which looks at provincial investments in years 2023 through 2026, says mental health and substance use are being given short shrift.

B.C., Manitoba and P.E.I. have allocated zero per cent of the federal funds to mental health and substance use, the report says. Three other provinces allocated 10 per cent or less.

By contrast, Alberta allocated 25 per cent, Ontario, 24 per cent, and Nova Scotia, 19 per cent, the report says.

The underspending by some provinces occurs against a backdrop of mental health care already receiving inadequate investment.

“[P]ublicly available data tells us that Canada’s mental health investments account for roughly 5% of their health budgets, which is significantly below the recommended 12% by the Royal Society of Canada,” the report says.

However, several provinces told Canadian Affairs they took issue with the report’s findings.

“Neither the Department of Health and Wellness nor Health PEI received requests to provide information to inform the [alliance’s] report,” Morgan Martin, a spokesperson for P.E.I.’s Department of Health and Wellness, told Canadian Affairs.

Martin pointed to P.E.I.’s investments in opioid replacement therapy, a mobile mental health crisis unit and school health services as some examples of the province’s commitment to providing mental health and addiction care.

But Matthew MacFarlane, Green Party MLA for P.E.I.’s Borden-Kinkora riding, says these investments have been inadequate.

“P.E.I. has seen little to no investments into acute mental health or substance use services,” he said. He criticized a lack of new detox beds, unmet promises of a new mental health hospital and long wait times.

The alliance’s report says New Brunswick has allocated just 3.2 per cent of federal funds to mental health and addiction services.

However, a New Brunswick Department of Health spokesperson Tara Chislett said the province’s allocation of $15.4 million annually from the federal funds does not reflect the additional $200 million of provincial funding that New Brunswick has committed to mental health and substance use.

In response to requests for comment, a spokesperson for the alliance said the federal funding is important, but “does not nearly move the yardsticks fast enough in terms of expanding the capacity of provincial health systems to meet the growing demand for mental health and substance use health care services.”

 

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‘Blaming and shaming’

The discrepancies between the report’s findings and the provinces’ claims highlight a need for standardized metrics around mental health and addiction spending.

The report calls on federal and provincial governments to develop national performance indicators for mental health and substance use services.

“At the end-of-the day you cannot manage what you do not measure,” the report reads.

It advises governments to communicate their performance to Canadians via a national dashboard.

“Dashboards are being used with increasing frequency in the health system and other sectors to summarize complex information and would be one way to effectively tell a story … to the public,” the report says.

It also urges Ottawa to introduce legislation — what it dubs the Mental Health and Substance Use Health Care For All Parity Act — to ensure equal treatment for mental and physical health within Canada’s health-care system.

This call for mental and physical health parity echoes the perspective of other health-care professionals. In a recent Canadian Affairs opinion editorial, a panel of mental health physicians argued Canada’s failure to prioritize mental health care affects millions of Canadians, leading to lower medication reimbursement rates and longer wait times.

The alliance says its call for more aggressive and transparent spending on mental health and addictions care is not intended to criticize or cast blame.

“This is not about blaming and shaming, but rather, this is about accelerating the sharing of lessons learned and the impact of innovative programs,” the report says.


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.

Our content is always free.

Subscribe to get BTN’s latest news and analysis, or donate to our journalism fund.

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