The Same Money, The Same Question

Where I was

I remember feeling cold and lethargic. I had been in provincial bullpens before, but I was really feeling shitty.

My mind cycled back to previous years — 2011, 2012, 2013, 2018, 2019. Now 2023. I was looking for reassurance I was going to be okay. I told myself this is probably going to get a bit worse, meaning my withdrawals, but I'll be recovering and super grateful and happy in a month.

I had a nagging worry it could physically get much worse though. Twice that year I had severe seizures. Once in Grand River, where my girlfriend called 911 and I was arrested and refused treatment. The charges were dropped, but there was damage — mentally, spiritually, emotionally.

I had another seizure a few months prior in Carleton Place. On a flat roof, of all places. I was able to recognize the signs and made sure I walked to the middle of the roof by the drain and went on my knees. I woke up with paramedics behind me and in front of me, on top of me — we were descending down a ladder. I just came to.

Both times I refused medical treatment. I just didn't think they could do anything. It was drug induced, and I had to pay the piper. You always pay to play. The debt doesn't go away. There is no seven-year statute on removing drugs from your body like there is with bankruptcy.

As I moved through the criminal justice jail court machine, and through my detox, my capacity deteriorated. I didn't really know what was happening then. I just knew I was losing reference to reality and I had a hard time discerning what was real and what was something I was making up in my head.

I remember the TV playing after lockdown and how I kept struggling with hearing the TV and the "dream" state I was in. When I would see health care, I didn't know how to articulate what was going on. There was an immense amount of shame. My main goal was to not look stupid. I'm not sure why social etiquette was high on my list of all things, but I was embarrassed.

I don't know exactly what happened. I do know I woke up days later in the Ottawa General, handcuffed and shackled to a gurney. I had wet my pants and just remember feeling confused. I thought maybe I was in treatment, but I was unsure why they wouldn't uncuff me. There was no discussion to tell me what was going on.

Eventually they deemed me well enough to be back in the jail. I still didn't know until we were at the jail. In some weird way I still thought I was going to treatment.

What I think works

People in this debate split into two camps. Coercion versus choice. My experience doesn't fit cleanly into either.

There's a big part of me that agrees with the CIA legislation being discussed. I've read a lot of people's opinions — lawyers, doctors, nurses, people in politics. I haven't read about much lived experience.

The drug scene has changed. What I believed even in 2019 is significantly different after I experienced the destruction of my capacity in 2023. I was always a tough-love kind of guy. It just works. Some people learn the hard way. But it's important to note that what works and what I believed worked are two different things. I also know what worked for me may not work for you.

I do think there are commonalities regardless. How one should be treated — with dignity and respect, even if their capacity is temporarily not there.

I don't think the jail was prepared for what I was going through. There's a lack of education because these new drugs are attacking multiple systems at the same time, and there are fewer resources. Historically we didn't need to change much — the drug supply was relatively stable. Coke to crack. Stronger heroin. Same families of drugs. Now we have the internet, social media, peptides, research chemicals, analogs, unregulated variations of everything. It's just prevalent.

I think the line "recovery only works when chosen" is mostly true. But there's nuance to it. How one feels when they have some support, and isn't in a perpetual state of withdrawal and conflict with themselves and the world — there I was more inclined to participate pro-socially and regain hope in being able to contribute to society and feel good about myself.

If there was a CIA act, I believe I would have qualified. And I would have felt relief, mixed with anger. You're never going to love being detained, especially the first time.

I don't think it's going to do all the lifting itself though. We'd still only have a non-demand person who's been away from pro-social support and living for a while — likely a long while. There's going to need to be transitional houses or centres with support. A high degree of intervention still.

I love the ICPM program (Integrated Correctional Program Model) I learned in federal prison. I love parole. I love the CRF (Community Residential Facility) system. I believe if we used some sort of outpatient, toned-down version of it — the nuts and bolts, not the revocation, just the access to support — we could really get people to a level of executive functioning maybe not previously thought possible.

When people get that hope again, it's like winning the Super Bowl. People are starved for hope at this point. I'm all for motivating people. Letting them have another shot at changing their life.

Every time, someone might not get it right. But sometimes we learn one thing, two things — and those things don't slip us up the next time. If there is a next time.

What I'm worried about

When I imagine CIA running — assessment centres, secured beds, community care plans for six months — what do I worry about?

I worry about the privatization of addiction even more so than it already is. I love capitalism. I think if you solve a problem you should get paid. Money is a powerful motivator, and we need incentives to tackle complex problems.

Having said that, I have to ask myself: when BayMark Health Group got involved purchasing CATC, did I receive better treatment?

For anyone reading this who wasn't in the methadone system in 2018: in March of that year, Texas-based BayMark Health Services — a portfolio company of the U.S. private equity firm Webster Capital — bought Canadian Addiction Treatment Centres. The deal included 72 opioid treatment clinics, 19 pharmacies, and one residential treatment centre. All in Ontario. It made BayMark the largest provider of opioid addiction treatment in North America. The Globe and Mail covered it at the time. Almost nobody else did.

Dr. Meldon Kahan, then medical director of the substance-use service at Women's College Hospital in Toronto, told The Globe what should have been the front-page question:

It should make OHIP really wonder about the fact that this chain of clinics is so profitable that an American company thought that there was an investment opportunity here. — Dr. Meldon Kahan, Women's College Hospital, 2018

The Ministry of Health's response at the time, per the same article: not our problem. They're private clinics. Physicians bill OHIP directly.

Nobody asked Dr. Kahan's question. The deal went through. And then I'm not sure. There were more clinics. More access. There were also EKGs every year. drug tests twice or once weekly. Doctor appointments. Medications I didn't ask for — Senokot for constipation, clonidine for sweats. Whether all of that was better treatment, or just more billable touchpoints, I genuinely can't tell you. From the rolls, it felt like both.

Eight years later, here's what we know. Across Canada, opioid deaths have risen from roughly 12 per day in 2018 to 18–20 per day in recent years. Ontario alone saw a 72 percent increase in overdose deaths between the first and last years of one major study covering 2018 to 2022. Youth opioid death rates in Ontario rose 369 percent between 2013 and 2021, and youth prescriptions for opioid use disorder medication hit their lowest point in 2024 — the prescribing went down while the dying went up. South of the border, private equity now owns roughly 7 percent of all U.S. substance use disorder facilities and nearly one-third of methadone clinics, and a bipartisan Senate investigation has been examining whether that ownership is restricting access to treatment.

That's the per-dollar test. We spent more. More people died. The treatment industry consolidated. Whatever question the 2018 BayMark deal raised about profitability and incentives, nobody in government answered it. So the question is still open. And now Saskatchewan — and Ontario, and Alberta before them — is building a second layer of treatment infrastructure on top of it. Involuntary, this time. Court-ordered. Secured.

If the government implements these policies and hands the reins to American private equity, I'm not sure we can expect anything much different than the privatization of prisons — and the failure to copy that model in Ontario (the super jails). Or the selling off of the biggest addiction treatment provider in the province in the middle of an opiate epidemic we are still paying for.

Saskatchewan has named the building — Saskatchewan Hospital North Battleford, a psychiatric facility. It has not named the operators of the assessment centres outside that hospital. It has not named the Commissioner. It has not written the regulations. The Canadian Bar Association's Alberta branch said the parallel Alberta Commission is "significantly empowered without oversight" and the act "lacks clearly defined checks and balances." Saskatchewan copied the framework. So the same critique applies until the regulations close the gap — and the regulations are being written this fall.

That window — between an act passing and the regulations going live — is exactly the window where the 2018 question gets answered, one way or the other. Either Saskatchewan writes regulations that learned something from CATC, or it doesn't, and we find out who shows up with a bid.

There just seem to be common themes. At least from my perspective. And my experience.

Where I land

If I could leave you with one thing, it's this: you only need to get it right once.

We can argue what recovery looks like. That's fine. We can't really argue about how vulnerable these people are. If you can't discern reality from your dreams, and you're adding powerful unregulated illegal substances to mask those symptoms, and then not sleeping or eating right — what do you think will happen?