Creating Good Addiction Policy

Addiction is often a complex and chronic illness, especially with increasing severity.1–4 It affects people from all backgrounds, but particularly those vulnerable based on genetic risk and their social determinants of health.2 The latter are particularly important for addiction treatment outcomes and the potential for health inequities.5 The complex and chronic illness of addiction requires nuanced and comprehensive approaches that are individualized to meet the unique needs of each person with addiction longitudinally.1,4 There is no one-size-fits-all approach. Individual needs also evolve over time, depending on the person’s circumstances and their stage of change.4 Good policy identifies what specific problem it intends to address and considers the implications of that policy if it is put in place. Too often it seems, policy development in addiction, despite good intentions, is reactive, put in place ahead of a clear evidence base to support it, and tends not to look ahead to troubleshoot on how to prevent unintended consequences. Good policy requires broad agreement from people of differing points of view, experiences, and backgrounds. For addiction, this particularly requires involvement of those with lived and living experience.6 The consequences of our changing illicit drug supply, from overdose deaths to public disorder and homelessness, have spawned understandable emotional appeals to do something. Public, government, and treatment provider-based reactions have led to the pursuit of safer supply, decriminalization, increased enforcement, and involuntary treatment. The commonality between all of these highly disparate policies is that each proposes an “answer” to a complex, chronic problem by only focusing on one aspect of it. Inevitably, then, these approaches fail as there are no simple solutions. But we do have a very clear evidence base to work from to inform policy. A good policy for addiction should promote a comprehensive approach.4,7 It needs to be medically managed.2–4 There needs to be a goal of helping people with addiction to change their behaviour towards that which is progressively healthier for them.4 Reviewing and addressing the social determinants of health needs to be part of all treatment planning—from economic stability to education to health access to community environment and social context.8 Outreach services need to be established, functioning like assertive community treatment teams for addiction, that could even include a safer supply initially, for promoting engagement and retention. Access to care needs to be expanded on an outpatient and inpatient basis, spanning from harm reduction to recovery-based options.3,4 All treatment needs to be evidence-based and done by a trained workforce with standards of care in place.1,7 Comprehensive aftercare needs to be established.1,3,4 Continuity between care points needs to be in place.3 For those who are at imminent risk despite efforts to help, there may be a role for using the Mental Health Act for involuntary care as a last resort, as long as it is done in the least restrictive manner, with clear goals that address that person’s needs.4 All policy needs to be subject to rigorous and independent review that is modified based on outcomes. What is demoralizing is that none of these ideas are particularly new and has been repeatedly identified over the years. What has been lacking is a sustained and coordinated approach with adequate funding. The consequences of addiction are more than ever in the spotlight. We need to work together as a community for good policy that advocates for comprehensive evidence-based approaches.