Calgary doctor on consumption site review panel says he's sorry it fuelled fears around sites' future

Dr. Robert Tanguay says he's speaking out about the supervised consumption services review released last week, a review he participated in, because of anger, fear and misinformation he sees swirling around social media.

He says those reactions take away from the point of this report — to highlight concerns so these sites can be improved to serve everyone better.

"We can't be an ostrich and stick our head in the sand and think no, nothing's happening, and we can't run around saying, oh, this has got to be shut down, this is terrible — because neither of those are true," said Dr. Robert Tanguay.

Tanguay said unfortunately these sites have become a polarizing subject in the communities where they are located in Alberta and he said this report seems to have contributed to that divide.

"There's a lot of fear everywhere … and I'm really sorry that this report added to that," said Tanguay.

• 'A system of chaos': Supervised Consumption Services Review Committee releases findings

He said he's been the target of online criticism from people who are calling the report biased and flawed and who believe the committee's goal was to shut down the sites.

But he said no one on the committee wants to see the sites shut down. Nor was that written anywhere in the report.

He hopes to ease some fears and clarify some of the flaws in the report and in the sites themselves — because he said the sites need to evolve in response to the needs of the users and the surrounding neighbourhoods.

Report wasn't meant to be peer-reviewed, doctor says

Tanguay said there is a belief that this was an evidence-based, peer reviewed study — rather than a government report. 

And he said he got grief about it on Twitter. 

He said he's been attacked about the methodology. 

He said the committee used a mixed methodology research approach, which includes both surveys and interviews, knowing the data would be skewed.

But he said given the committee only had a few months, the members knew it would be the only way to get ample information in a short amount of time. 

"All we have to do when we look at this is say, OK, there was some smoke there, maybe there's some fire at some spots, now what," he said.

And he said the committee's findings — that there's some social disorder around some of the sites — matched with the findings in a  2018-2019 University of Lethbridge study funded by the city.

He said there were some things he wishes weren't included in the report, such as the reference to a magazine article that allegedly dropped the ranking of a neighbourhoods liveability due to the presence of a SCS.

"Overall, perceptions of the neighbourhood, known as the Beltline, have shown a steep decline recently. According to Avenue Calgary Magazine, liveability in 'the Beltline was ranked number one in 2018 and number two in 2017. This year it ranked 32nd,'" the review stated.

But after the review was released the editor of the magazine clarified the SCS had nothing to do with the drop in ranking.

• Review incorrectly implied consumption site caused neighbourhood ranking to drop, magazine says

"It just shouldn't have been in there because it doesn't matter what Avenue magazine has to say," said Tanguay.

Tanguay said he also doesn't agree with including drug and alcohol related deaths in the report, because he said these sites are not meant to provide services to those who consume alcohol.

But he said he wasn't the only one deciding what to include in the report.

"You have a committee sitting around a table deciding what goes and what doesn't go and at the end of the day you have to pick your battles," said Tanguay.

Insufficient data

Tanguay said the committee tried to collect data from each of the sites to reflect the work being done and their benefits, such as how many people were getting referred for treatment, but he said most of the sites weren't collecting information in a meaningful way.

"There's so much unknowns, we don't know who's using it, we don't know what happens after they use it, we don't know how many people use it every day … which was really frustrating especially when we want to show, like look, there's some positives here "

Tanguay said the site at the Royal Alex was the only one that had what he considered to be adequate system for collecting information. And he thinks it could serve as a model for community sites. 

When I listened to the press conference for the report it seemed to me like an accusation.- Dr. Rebecca Haines-Saah

Tanguay said the panel also conducted interviews with staff including the medical lead who helped set up these sites across Alberta, and some of the operators, but Tanguay said some operators — even the medical lead — weren't able to answer some of the questions such as, "What is the algorithm for an overdose?" or "When do you decide to use injectable naloxone?"

"Nobody seemed to know and so of course that creates skepticism from the panel," said Tanguay.

Tanguay said he's not blaming anyone — or pointing fingers — just raising awareness of the need for standardized data collection at all the sites and better training of staff.

He also said there should be doctors on site. 

"If somebody said I think I'm ready for help, bang, like here's your suboxone or methadone or I'm going to bring you right up to iAOT (injectible opioid agonist treatment) it should be right there.

"These aren't designed to treat."

'A hint of an accusation'

Dr. Rebecca Haines-Saah, an assistant professor in community health sciences at the University of Calgary, said it's unfortunate this report was presented with so much negative information and it didn't include the benefits of the sites, for balance.

She said it even seemed as though there was a hint of an accusation that the sites were inflating numbers.

"When I listened to the press conference for the report it seemed to me like an accusation, there's a hint of an accusation, like there's something nefarious going on in these sites," said Haines-Saah.

Haines-Saah agrees health services research can always be improved upon. But in this review she said it wasn't clear whether the panel didn't see what they wanted to see, or if protocols were not being followed.

"If we need to put in new and enhanced evaluation metrics by all means but I don't think that that's a flaw of the sites," said Haines-Saah.

I wish there was less spin on this.- Dr. Robert Tanguay

Haines-Saah it should have been presented differently — as a call for more science — rather than "a system of chaos," which Associate Minister of Health Jason Luan referred to during his press conference.

Tanguay, too, wishes the results of the report had been presented differently. 

"I wish there was less spin on this, I wish that when it was presented, it was presented as, 'OK here's what we found and now we have to figure out what to do' and I think that would have helped," said Tanguay.

Haines-Saah also said as for the qualifications of staff, supervised consumption sites have traditionally been staffed by community responders (former drug users trained as peer support workers), harm reduction nurses, or public health nurses — not addiction specialists.

Hope through healing

Tanguay said he strongly believes that supervised consumption sites play an important role in harm reduction but argues they need to be expanded to include mental health services and addiction services — and be better connected to community and residential treatment programs.

And he said staff need to be trained in recovery-oriented addiction management.

He also said the benefits of these sites need to be better studied. He said the problem is in the way the sites were initially set up to collect and evaluate metrics. He said that needs to be redesigned.

"What would be really nice is if we could do an assessment of, really showing, that SCSs do reduce mortality, do reduce morbidity, do reduce infection," said Tanguay.

Finally, he said the strong divide needs to be recognized and resolved.

He said he was encouraged at one town hall meeting in Calgary when a community resident went from being angry to understanding the usefulness of these sites, albeit with some improvements, and a user suggesting people with addiction need to be more responsible and do a better job of picking up their needles and garbage.

"It was really nice to see healing, to see a community coming together who walked into that room ready to fight and both agreed, hey, there's there's a piece on each side that's probably right and that's the reality."

And despite being the brunt of a lot of attacks since the report was released he said he's still happy to have taken part in the review because it's given him a chance to advocate for the province's most vulnerable populations.