What does failure look like? What does success look like? What are we trying to do? What do we want to avoid? What unintended or undesirable consequences are we prepared to tolerate in pursuit of success? What are we not prepared to tolerate?
These are pretty basic questions. The specific context of the questions today is Ontario’s policy on safe-consumption sites for harmful drugs. Last week, the government announced new regulations for the sites, and these regulations will have the effect of shutting down some of the ones already operating. The government has plans to open a series of Homelessness and Addiction Recovery Treatment hubs, or HART hubs, which will (in theory) get people back on a path toward stable, healthy living.
In a recent column here at TVO Today, John Michael McGrath covered the challenges the HART hubs are going to face, and I completely agree with his conclusions. If you’re too pressed for time to read his column, the short version goes something like this: even if we assume that the Ford government will fully execute its plans for the HART hubs — and that will take time —the fully realized plan won’t be operating at the scale necessary to tackle the problem at it exists today. And the problem has been trending worse for a while.
I’ll say no more and let John’s column stand. But what I will add is a simple confession: I don’t really know what we’re trying to accomplish on this front. I think we got ourselves stuck at the tactical level — we have safe-injection sites to prevent overdose deaths. Okay! But… is that the plan? Or is that in service of some broader strategic goal?
The purpose of the injection sites as sold to the public: drug addiction is a hideously complicated problem, and it takes a lot of time to address, so we need to keep the people alive long enough to buy time to do the other things that might eventually help that person break free of their addiction. Is that still the plan? If it is, it’s not working. The measurable harms of the opioid crisis are getting worse.
Ontario’s public-health databases show this: through to 2021, the last year for which full information has been published, the line charting the human carnage of drug addiction (the overdose deaths) isn’t quite going vertically straight up, but it also ain’t trending down. The best that could be said of the numbers — and you can tinker with the settings to look at the figures in monthly, quarterly, and annual increments and draw some slightly different conclusions each time — is that we might be seeing some stabilization of overdose deaths, but at a level vastly higher than we had before Ontario began rolling out the consumption sites.
I am well aware that the counterpoint is going to be that, without the sites, things would be even worse. Okay! That’s plausible. But, again, let’s talk success and failure. Is it the official policy of this province that the literal best we can do is slow down this disaster? Have we given up on reducing it or even one day stopping it? Is that actually our policy? If so, can someone say so? If it’s not, do we have a plan to do better or nah?
The answer matters, because quality of life has deteriorated and crime has risen in the vicinity of these sites. As I asked at the outset, though, what is the level of deterioration, if any, that is officially considered acceptable in pursuit of our policy goals? Do we have goals? Do we have red lines for negative consequences? If we could quantify that the negative consequence was a part of achieving a net-positive outcome, we could then maybe tell the locals that their sacrifice was a lousy but worthwhile tradeoff in the grand scheme of things. But we don’t have any official goal we can use to make that claim, and what numbers we have suggest that we are, in fact, failing in even the most general sense. We are asking people to sacrifice their communities and sometimes their safety so that society, overall, can achieve a worse result.
In my last column here, I proposed a radical idea: maybe instead of just throwing more ministries and ministers at complex problems, like homelessness, we should demand better from the ministries and ministers we already have in terms of addressing the various root causes of the problem. On drugs and addiction, I think the same would hold true, but there’s a missing piece of the puzzle here. It’s hard to hold someone accountable when there’s no clear metric to define either success or failure.
And I am more than cynical enough to believe that this is very much by design. If there’s no clear goal, can you ever be accused of failure? If there’s no metric that has been laid out as a measure of success, you never have to worry about missing it and can instead talk about your efforts to reach it, the inputs directed toward the problem — things like task forces, dollars spent, facilities opened, and all the rest. For the officials in charge, it doesn’t matter if overdose deaths are up and crime is up if no one has established any sense of how many deaths is too many or how much crime is too much.
So for now, I would really like someone to just tell me what we’re trying to do here — in clear terms and with reference to data that we can collect and trust. I want to know what failure would look like, what success would look like, what level of community sacrifice is acceptable, and how much would be too much to ask. I want to know who’ll be in charge of implementing the policies we want to use to bring about our goals and, on the flipside, who’ll be responsible if we fail to achieve our goals.
This is all necessary to have accountability in a functioning democracy, even when the issue is complex and hard. In fact, especially when it’s so.
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