Addictions expert Mark Haden: 'It's not a fentanyl crisis — it's a policy crisis'

As someone who’s lost loved ones to drugs, I often ask myself: What could’ve been done to prevent their deaths? What could our family and friends have done differently? I know I’m not the only one around asking these questions — there were 780 overdose deaths in British Columbia in the first half of 2017. That’s about four deaths per day. That’s a lot of families asking a lot of what ifs.

Looking at the issue of addiction more broadly, what can we as a society do to prevent these deaths? I asked Mark Haden, an adjunct professor at UBC’s School of Population and Public Health, for his take. Haden researches drug policy and advocates for a public-health approach to the regulation of currently illegal drugs. He also spent nearly three decades as an addictions counsellor, and is planning to start a psychedelic research centre in Vancouver.

I sat down with Haden at a coffee shop across the street from Oppenheimer Park in Vancouver’s Downtown Eastside, and picked his brain about drug policy, mental health and the healing potential of psychedelics.

Q&A with Mark Haden

Trevor Jang: There has been so much media coverage of the opioid overdose crisis. But what do you think is still missing from this conversation?

Mark Haden: The problem is prohibition. The fact that we criminalize drugs and marginalize drug users is why people are dying. It’s not a fentanyl crisis — it’s a policy crisis. And so all the media should be reflecting that.

The more they talk about the fentanyl crisis, the worse it gets. The more they talk about the prohibition crisis, the better it gets. The more they allow drug users to have a voice and they don’t pull them into this process of ongoing marginalization, the better the situation will get.

For the past decade, you’ve advocated for a regulated market for currently illegal drugs. Let’s get into the specifics of that. What would this market look like? How would it function?

All drugs would be different. The model for opiates that I recommend is rank all opiates on a scale of harmfulness. So basically, make weak, non-lethal opiates available for adults to purchase. As they become more concentrated and more potentially harmful, exert more controls over them. And if you want to use intravenous, high-concentrated opiates, you use it in a supervised setting. If you want less harmful, less concentrated products, you can take them home and use them at your leisure.

You’ve previously said that drug-policy reform is a movement based on evidence, as opposed to politics and fear. What’s the evidence that tells us giving addicts access to drugs, legally, would better society as a whole?

The process of drug prohibition is a failed social policy. There is a huge amount of research that has happened on drug prohibition around the world, and it has never worked anywhere. The evidence is absolutely consistent, so why would we spend money on a process that we know does not work? So, let’s try something different; let’s actually use a human-rights model where people are allowed to access the substances they choose.

When any country anywhere on the planet moves towards a human rights-based model away from a criminalization model, they always demonstrate benefits. There’s Portugal. There’s the Netherlands. There’s Uruguay. In fact, there’s even evidence in Canada. The benefits of a supervised injection site are clear and profound.

On the flip side of that question, Prime Minister Justin Trudeau says his government isn’t considering legalizing any drugs other than weed, even though many top health officials in B.C. and elsewhere are calling for it. What do you think the federal government is concerned about?

They’re scared of showing leadership. By leadership, I mean doing something the polls tell them is not supported by over 50 per cent of the population. Cannabis legalization is supported by over 50 per cent of the population, and heroin and other drug legalization is supported by less than 50 per cent of the population. So, what they’re scared of is leadership — being in a leadership role. They probably know it’s right. They know they need to do it. They understand the logic, and they are politicians who want to get re-elected.

British Columbia has a new government, as well as a brand new ministry dedicated solely to mental health and addictions. Given that drug policy is a federal issue, do you expect to see any real progress towards slowing down or solving the overdose crisis under the B.C. NDP?

Well, the funding for psychedelic research is coming provincially, thank you very much. So, there is an openness now at all levels of government to reconsider drug policy issues. Certainly, Justin Trudeau's legalization of cannabis signals an openness. Certainly, the bureaucrats that we’re talking to are more positive and constructive than the bureaucrats under former prime minister Stephen Harper. Harper was a difficult regime to negotiate drug-policy reform in, and certainly, a difficult regime to negotiate psychedelic research in. But he is gone and we have a new feeling in Ottawa. Things are a lot easier for us.

So, let’s get into your current day to day. You’re trying to open a psychedelic research centre. What do you think that would accomplish in the long term?

The healing potential of psychedelics is unparalleled. Addiction treatment is relatively ineffective. I worked for 30 years with addiction services and nobody ever walked into our office, had a profound experience, then walked out saying, “Thank you I’m healed.” Never happened. So the best we can do is manage the problem, help people become a little more connected to other people, give people some new ideas. But in terms of actually healing addictions, it’s actually very rare.

So, we need all the tools that we can get. And if there’s something out there that looks like it’s really helpful, it would be incredibly unwise and not following the evidence if we didn’t pursue it.

Tell me why a psychedelic experience has the potential to heal addiction, or get at the root issue. What is it about psychedelics that can put a person in a state of healing?

There are a variety of things that psychedelics offer therapists who are trying to treat people with addictions. One is the portal effect. The portal effect is the experience that you get after graduating high school and climbing Mount Everest. It’s the: “Wow, that was huge. I don’t believe what I’ve just accomplished.” People who have a psychedelic experience feel that they’ve had a transitionary experience, and that’s really helpful in the process of change.

Another factor in what psychedelics offer is an increase in permeability between the conscious and unconscious mind. So, we have access to material in our unconscious mind that we don’t normally have access to. Our unconscious mind is that stuff that we don’t normally think about. We have buried tape loops, memories and behavioral patterns that we can’t normally access. So, psychedelic drugs allow us to access parts of ourselves that we can’t normally.

A third thing that psychedelics offer is a sense of connection. And the connection is to others, to family, to community, to friends and certainly in the context of a therapist, it’s a connection to a therapist. The alliance between the therapist and the subject is the greatest predictor of change.

And there are some psychedelics that actually seem to go directly to the addiction issue in ways that we don’t understand. For instance, it takes away heroin withdrawals.

Are you saying if I dropped acid, I could cure my depression?

No. What I’m saying is psychedelics as an adjunct to psychotherapy can be very helpful. Don’t do this at home, kids. It needs to be in the context of therapy.

Good disclaimer. So with the research centre, how far along are you?

We’re just starting. We don’t have any studies yet. We’re making proposals. We’re going to work hopefully with the MDMA study for PTSD. We want to look at psilocybin (magic mushrooms) for addictions, psilocybin for gambling addiction — that’s never been done — 3-MMC for couples counselling. These are just ideas that we’re having. That’s the wonderful thing about starting something new is you can just throw ideas in the pot.

We’re generating ideas and asking for approvals. Barriers are always the same: It’s always funding. The federal government has told us we’ll get our approvals, so it’s all about money. The more money we get, the faster we can do this.

I’ve read that at least 60 per cent of people struggling with addiction also have a mental illness; they often go hand in hand. But families impacted by these issues have told me that they aren’t treated concurrently in our system. What’s wrong with the way we treat mental illness in Canada?

Well, you’re right. Addictions and mental illness should be treated together for people who have both. My father was a psychiatrist, and he saw the transition from patients being strapped to their beds, to the development of psychiatric medications that allowed people to leave hospitals. It was huge. And now, psychiatric medications are fabulous, but they can also be overused. Sometimes, what people need is compassionate care and friends, and supportive family and community. Instead they’re medicated. So, do we overuse medications? Sometimes.

Psychiatric care is a difficult process to be involved with. Can we improve it? Yes, we can. But it takes a lot of work and focus and energy.

What about access to mental-health and addiction services for low-income people? I pay $130 an hour for a psychologist, but not everyone can afford that and get the help they need. What can be done about it?

The longer we see addictions as primarily a criminal justice problem, the less available treatment is going to be. If we actually want to make treatment available, we need to stop criminalizing drugs. And then we need to take the money out of criminal justice, and put it into health. Then it’ll change. Right now, all addictions services and all mental-health services have waiting lists — all of them. The only answer is to shift how the money flows.

Based on your experience as an addictions counsellor, what do you think is the root cause of addiction, and how does one overcome it?

Some people say the root cause of addiction is trauma. And certainly, in this community — in the Downtown Eastside community — trauma is very common. So, one large root cause is trauma, and trauma is actually healable, but that’s not the only cause. I certainly have had clients that didn’t have any trauma history at all. They just got into the wrong situation at the wrong place and took the wrong drug, loved it, and that was the end of that.

So, there’s many other drivers to addiction, not just trauma. But they’re all things that are workable. Disconnection is a primary driver. Disconnection from family, friends, community and a sense of meaning and purpose to life is a huge driver to addiction. The more people have a sense of meaning and purpose in their lives and a goal, the less addicted they’ll be. And the more they’re connected to family, friends and community, the less addicted they’ll be.

You also counselled parents whose children are struggling with substance use. What advice do you give these parents?

Stay connected. Often, the main issue the parents struggle with by the time they come to me is it’s been so difficult for such a huge chunk of time, that they’re giving up. They feel completely frustrated and angry. So, helping them to stay engaged and connected to the person, and not necessarily the outcome, is my primary goal.

The reason I’m writing about this is because I lost my father to a mixed cocaine and heroin overdose as a child. This happened in 1998 at the height of Vancouver’s last crisis with drugs, during its crack cocaine epidemic, so I see fentanyl as a continuation of the same issue. What can you say about Vancouver’s history with drug crises? Why is it still happening?

Well, there’s no one answer to that question. But certainly, we have a spirited discussion that happens in Vancouver that doesn’t happen in any other city I’ve ever lived in, which is a more progressive, positive, thoughtful approach. We’ve had at least three mayors talk openly about the need for drug-policy reform and to end criminalization of drugs, so we’ve had leadership in the city speaking about the need for significant changes. In fact, it was the city that started the supervised injection site; the health authority stepped in after the city required them to.

At the end of the day, it really is a federal decision. The criminalization of drugs lies with the feds. We can provide a variety of health services, but still, the money is getting sucked off into enforcement based on federal decisions. So, we need to change many levels of government to make this actual change happen.

If there’s one thing you can tell people to change their views around addicts and addiction, what would you tell them?

There’s no such thing as a good drug. There’s no such thing as a bad drug. There’s no such thing as a good person. There’s no such thing as a bad person. People are just people. We all have good sides and dark sides. Drugs are just drugs. How people interact with drugs, the context and use of drugs will either determine a benefit or a harm. So, the whole model we have of bad people using bad drugs is completely ridiculous.

This interview has been edited for clarity and length.