Addiction almost killed Marshall Smith. Now, he’s overhauling Alberta’s drug policy


One day in the early 2000s, police acting on a tip about some suspected drug dealers kicked in the door of a Vancouver hotel room. They found a well-known dealer inside, but they also found a fast-talking, rail-thin guy with a dimpled chin and boyish good looks. He was new on the scene. His name was Marshall.

Over the next few years, they got to know him well. Whenever they saw him, they would stop to talk. He was unusually well-spoken and, as they soon learned, he had a remarkable back story. They urged him to get help with his addiction.

Caught up in the turmoil of the streets, he always turned them down. Like many people hooked on street drugs, he spent his time hustling to get money for his next hit. He stayed up for days on end, wired on stimulants. He passed out in doorways. He ate food from trash cans.

Today that guy, now a silver-haired 53-year-old in a crisp dress shirt, holds one of the most powerful behind-the-scenes jobs in Canadian politics. Marshall Smith is chief of staff to Alberta Premier Danielle Smith, who has been wrangling with Ottawa over everything from pensions to clean-energy rules.

That alone would make his story worth telling. But his importance goes beyond his perch in a wood-panelled office of Alberta’s legislative building. Drawing on his experience living with addiction, then recovering from it, he is leading a campaign to upend the conventional wisdom on how to end Canada’s drug crisis.

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Marchers carry an empty coffin through Vancouver last Aug. 31 to mark International Overdose Awareness Day, as Canada continued to see high rates of opioid-related deaths.Darryl Dyck/The Canadian Press

That crisis has killed around 43,000 Canadians since 2016, about the same number as died fighting in the Second World War. The death rate escalated during the COVID-19 pandemic and has stayed high since.

About once every hour in Canada, someone succumbs to an overdose, in communities as rural as Bell Island, N.L., or as urban as Vancouver’s Downtown Eastside, where Mr. Smith once roamed.

The conventional wisdom, repeated over and over by advocates and health authorities, holds that the crisis is the result of a “poisoned drug supply.” Potent synthetic opioids such as fentanyl have taken over from heroin and cocaine as the dominant street drugs, permeating the drug market.

The solution is not to force people to stop using them or to put pressure on them to get treatment for their addiction. The solution is to make it less dangerous for them to use their drugs: the approach known as harm reduction. That means giving drug users supervised places in which to consume them, clean needles with which to inject them and even free, pharmacy-dispensed “safe supply” drugs to take.

Mr. Smith rejects that approach. Though harm reduction has its place, he says, the main problem is not the drugs, dangerous as they are. The problem is addiction. The solution is recovery.

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Alberta Premier Danielle Smith says her chief of staff has become ‘sort of the spiritual leader for all of us in the government.’Todd Korol/The Globe and Mail

First as an aide to a series of addictions ministers and now at the Premier’s right hand, he has been leading a top-to-bottom revamp of the province’s addiction-treatment programs. Under his tenure, Alberta has made treatment in publicly funded addiction centres free for anyone who wants it. It has given Albertans same-day access to addiction medicines through a toll-free number. It has spent tens of millions of dollars on raising the number of treatment beds.

To curb what it sees as the excesses of harm reduction, it has put strict new limits on the province’s supervised-consumption sites, which were being blamed for rising disorder in the surrounding communities. It has said a hard No to safe supply, too. There is nothing safe about it, Mr. Smith insists. In British Columbia, he says, the authorities have effectively become drug dealers, “handing out the very thing that they believe is poison” in the first place.

Alberta calls its new approach the Alberta Model and Mr. Smith is its chief architect. He says there is nothing quite like it anywhere. “The scale of change that we’re embarked on is unparalleled in the world,” he says. “This is where the most interesting drug-policy work on the planet is going on right now.”

His critics call that nonsense. They say there is no real evidence that Mr. Smith’s program will save lives. In fact, overdose deaths have soared in recent years.

His harshest detractors say Mr. Smith is just a glib salesman who lacks the credentials to lead such a sweeping program of change. Mr. Smith fires right back, saying the flak comes mostly from a small “lunatic list” of radical activists and members of the “public-health intelligentsia.”

The scrapping between Mr. Smith and his foes is part of a fierce national argument over how to address the drug crisis. Though Mr. Smith is barely known to the public, and says he prefers it that way, he has emerged as one of the most influential voices in that argument.

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Safe-supply drugs, like this box of cocaine given out on the Downtown Eastside in 2021, have faced a backlash in recent years amid concerns over public drug use.Darryl Dyck/The Canadian Press

Lately, the momentum has been all his way. Public concern over open drug use, homeless encampments and other signs of public disorder has changed the political climate, making Alberta’s approach more palatable.

British Columbia’s NDP government just backtracked on its experiment with decriminalizing small-scale drug possession. The federal government denied Toronto’s request to launch its own experiment with decriminalization. Ontario Premier Doug Ford asked Ottawa to stop approving sites that give out safe-supply drugs. He argued, as Mr. Smith does, that people on the program often sell their drugs, which can end up in the hands of young people.

If the harm-reduction model was a revolution in the way Canada viewed drug use, Mr. Smith is leading a counter-revolution. At the annual Recovery Capital conference in Calgary last month, he got loud applause when he vowed that he and his team would keep working flat out to build the Alberta Model. “I’m a nightmare to work for – I can be bitchy and sucky and, you know, angry,” he told one session, but “come hell or high water – which is a saying we have in Alberta – we will get this done.”

Keith Humphreys, a professor in the School of Medicine at California’s Stanford University who shares Mr. Smith’s doubts about harm reduction, says he is “one of the most gifted public-policy entrepreneurs I have ever worked with.” The Premier, Ms. Smith, says he is “sort of the spiritual leader for all of us in the government.”

Another influential admirer is Pierre Poilievre, the federal Opposition Leader, who could become prime minister next year. In 2022, he put out a much-discussed video called Everything Feels Broken. It shows him touring the rougher parts of downtown Vancouver while praising the Alberta Model and condemning “woke Liberal and NDP governments” for letting “taxpayer-funded drugs flood our streets.”

Acting as his guide but never identified is a figure with a black windbreaker and a shock of silver hair, a guy who knew those streets as a homeless man in the depths of addiction: Marshall Smith.

Mr. Smith was born in Toronto but grew up in Los Angeles. His father, Mark Smith, was a sound engineer who worked in music and film.

Mr. Smith says he had an average middle-class upbringing in his family’s modest L.A. bungalow. But in high school he discovered alcohol. He favoured rye and Cokes and often ended up outdrinking his pals. “When we drank and they stopped, I didn’t,” as he puts it.

After his parents split up, he finished his high school in the States and then moved to Victoria, where his mother lived. He worked as a prison guard after graduation, moved into administration then jumped to the provincial government, developing a reputation as a skilled project organizer. He worked on Vancouver’s successful Olympic bid and joined a B.C. delegation to Prague, where he chatted with Henry Kissinger.

“Cruising the corridors of power with an easy confidence that belied his 28 years, he’d whisper advice to cabinet ministers one minute, spin a scrum of reporters the next, then crack up fellow Liberal insiders with an always-ready joke,” Michael Smyth wrote in the Vancouver Province a few years later.

All the while, he was drinking. His job called for moving from reception to reception and dinner to dinner, with after-work drinks thrown in. One night in a club, someone offered him cocaine. “It was fantastic,” he recalls.

The next step was methamphetamine. Mr. Smith was staying in a hotel in Vancouver and found he was out of coke. He went out on the street to see whether he could find some. A guy named Dave offered him meth instead.

And that, he says, “was the end of my cocaine problem.” It was all meth, all the time. Until then, he had managed to keep his job and his life more or less together. When he graduated to methamphetamine, a powerful stimulant, it all unravelled. As he often puts it when telling his story, “it was at that point that I hung up my suit and tie and kind of vanished into the streets.”

His descent made headlines. B.C. Political Aide Caught in Drug Raid on Canada Day, said the Vancouver Sun in 2004. The next year he made the news yet again when two men beat him up with a crowbar. He still has a scar from where the crowbar pierced his foot.

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On Vancouver’s Downtown Eastside, Mr. Smith continued to use meth as he hustled for money to get by. He would sometimes sleep on the street, or in a self-storage container under the Granville Bridge.Darryl Dyck/The Globe and Mail

He lost his job, his friends and his home. He found his way to the Downtown Eastside, then, as now, the most notorious haven for drug use in Canada. His weight plummeted, a common effect of using meth, which suppresses appetite.

For the next four years, he lived the life of a street hustler, with all the perils that came with it. He had his nose broken in a fight. He had a can of bear spray emptied into his face. He developed beat-up “street feet” from walking and standing all day.

Sometimes he scrounged up enough money for a hotel room. Other times he slept on a street corner. For a while, he had enough cash to rent a shipping container at a self-storage place under the Granville Bridge and crashed inside. He ran an extension cord to a nearby socket to power a heater and a light.

He did a couple of stints in jail. There, he encountered some of the guards he used to work with, along with some of the inmates he used to guard. One of them broke his jaw.

Only the persistence of the Vancouver cops who were watching over him allowed him to get out alive, he says. One of them said: Keep this up and you are going to die. Mr. Smith accepted his help and went to a small, publicly funded addiction-treatment centre in Maple Ridge, just outside Vancouver.

It worked. He not only got sober, but moved into the treatment business himself. Over the next decade, he held jobs at a number of programs around British Columbia, gaining a reputation as a charismatic and energetic advocate for recovery.

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Former B.C. MLA Lorne Mayencourt hired Mr. Smith to work at an addiction-treatment centre in Prince George.Chad Hipolito/The Globe and Mail

Lorne Mayencourt, a former member of the B.C. Legislature, hired him to work at the Baldy Hughes centre in Prince George. He says the guys there respected Mr. Smith because he had lived the life himself, knew all the tricks and “couldn’t be snowed.”

According to a report last summer in The Tyee, a Vancouver-based online news magazine, a consultants’ report on the centre found it fell short of several licensing requirements while Mr. Smith was in charge. Staff were not well trained in storing and administering medications. They were not doing proper assessments of clients, collecting their health data or preparing them for discharge once their treatment was done.

Mr. Smith left in 2011. Mr. Mayencourt dismisses the critical report, saying management of Baldy Hughes was “very, very professional.” Mr. Smith himself says Baldy Hughes used a new model of treatment, based on a famous Italian program, so judging it by the standards of more conventional treatment was unfair.

From early on, Mr. Smith’s emphasis on recovery put him at odds with the prevailing school of thought in British Columbia on how to deal with the drug crisis. In 2003, Vancouver became the first North American city with a supervised-consumption site when Insite opened its doors in the Downtown Eastside.

Authorities have since handed out millions of clean needles, along with countless tourniquets, crack pipes and doses of naloxone, a drug that reverses overdoses. With so many people dying, many argued, the emphasis should be on measures just to keep them alive, not get them sober – a much more complex, expensive and uncertain enterprise.

Mr. Smith strongly disagreed. By calling addiction a chronic condition and accepting that some people would always use drugs, he now says, it was treating them like patients with an incurable cancer, in essence telling them: “We’re really sorry, but we’re just going to have to keep you comfortable while you die.”

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Former premier Jason Kenney recruited Mr. Smith for an overhaul of drug treatment in Alberta.Dave Chidley/The Canadian Press

On the other side of the Rockies, Jason Kenney took notice. The United Conservative Party premier reached out to Mr. Smith. Would he come to Alberta to help revamp the province’s treatment system?

One of the first things Mr. Smith did when he arrived in 2019 was to pick up the phone and try to find out how many treatment beds the province had. No one could tell him. He hit the road with a friend, driving to every treatment centre he could find and asking how much space they had. He would record the answer with a clicker, the kind that nightclub bouncers use.

He found that, because of high costs and bureaucratic hurdles, many of the available beds were going empty. After investigating further, he came to the conclusion that Alberta’s treatment system was a ragged patchwork of disconnected parts. It wasn’t that the system was broken. There was no system.

So he set out to build one. After four years of work, it is beginning to come together.

The UCP government says it has built or funded more than 725 beds since taking office in 2019, freeing up more than 10,000 additional spaces, an increase of 55 per cent. Spending on mental health and addictions has roughly tripled since 2019. The ministry in charge has gone from being a small division in the health ministry to the seventh largest department in the provincial government.

There is more to come. In April, the government announced that it was setting up a whole new agency, Recovery Alberta, to deliver addiction and mental health services. A second agency, the Canadian Centre of Recovery Excellence, will pull together research on addictions and treatment.

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This past March, Mr. Smith led a tour around Edmonton and Red Deer to see the results of his addiction-care policies, including the Recovery Navigation Centre in Edmonton,.Megan Albu/The Globe and Mail

One frigid Alberta day this winter, Mr. Smith took me on a tour of the system he has helped to build. Though he can be chippy and boastful, Mr. Smith is also engaging and formidably articulate. When he is speaking with someone, he looks them straight in the eye, addresses them by name and often leans in to tap their forearm as if to say, “and get this!”

Driving his white SUV, often taking his hands off the wheel to make a gesture, he kept up a steady stream of the fluent talk for which he is known. He talks so much in his job that his favourite vacations are at a quiet Mexican resort where no one expects him to say anything. His other, less placid recreation is going to the arena to cheer on the Edmonton Oilers. He keeps his hockey sweater in his trunk.

Our first stop was a new “navigation centre” in Edmonton. The idea is to give people suffering from homelessness and addictions an easy off-ramp from the streets. The centre can help them find a shelter bed, apply for social assistance, replace lost identification documents and get on addiction medicines, which can be delivered right to the centre through the province’s Virtual Opioid Dependency Program.

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The Red Deer Remand Centre has a therapeutic living unit, whose entrance is plastered with inspirational messages about clean living.Megan Albu /The Globe and Mail

The second stop was at a jail in Red Deer. Jails tend to be revolving doors for people with addictions. They break the law to get drugs, do some time, get out and do it all over again.

To break that cycle, authorities have set up a recovery centre right in the jail. Those who clear the application process get off the usual collection of locked cells and onto a separate floor. They have their own private rooms, better beds and clothing, an exercise area and even pizza-and-karaoke nights.

The price of admission is taking part in a heavy schedule of group meetings and therapy intended to prepare them for their eventual release. Sitting in a circle with a dozen others, a 35-year-old named George (last names are off limits here) said he had been sober for eight months and 11 days, his longest period of abstention since he was 13.

The others gave him a round of applause. Mr. Smith joined in. “It is so amazing to watch when the light comes on in these guys,” he said later.

The final stop on his tour was at a “therapeutic community,” also in Red Deer. Pioneered at a place called San Patrignano near Rimini, Italy, therapeutic communities offer a long-term program of job-training, mentoring and communal living designed to help clients not just overcome their addictions but learn to live healthy and productive lives again.

Red Deer’s is one of at least 11 that Alberta hopes to build around the province. It opened last May, and it’s Mr. Smith’s pride and joy. He said he himself sketched out the design for the 75-bed facility. He even chose the carpets.

He showed off its amenities: a games room with foosball, table tennis and big-screen TV; a well-equipped cafeteria that serves vegan and gluten-free meals to those who want them; the big meeting hall where residents gathered earlier to congratulate a man who was graduating after a nine-month stay, hoping to be reunited with his eight-year-old twin sons.

It’s a phased program that sees residents move up as they improve, eventually earning a private room with separate bathroom and often becoming mentors to newcomers. Mr. Smith stresses that, contrary to what his critics say, he does not insist that strict abstinence is the only path to recovery. Drugs and alcohol aren’t allowed, but residents can smoke on an outdoor deck and take addiction medicines like methadone or suboxone if they need to.

To help them get better, the centre offers standard treatment methods like cognitive behavioural therapy and dialectical behavioural therapy. Medical staff are on hand to help them with health problems and case workers to help them arrange court dates and posttreatment housing. Everyone is expected to contribute to the community, doing chores such as working in the kitchen.

The Red Deer Recovery Community offers a spiritual room for smudging, a gym and movie theatre. As they go through the program, residents graduate to private rooms with separate bathrooms.

Megan Albu/The Globe and Mail

It’s a far cry from the 30-day or 60-day programs that are common in many provinces. Residents often drop out of such programs, or finish them and fall into addiction again. Some go into treatment time after time and still don’t get better.

Mr. Smith contends that the problem isn’t that drug treatment usually doesn’t work, as some of his critics claim. It’s that a lot of treatment just isn’t very good. If someone has been living in a tent under a bridge and using fentanyl for years, a few weeks of treatment isn’t going to cut it.

The focus of the Alberta Model is to get people with addictions quickly and smoothly into high-level treatment, to keep them there as long as they need and ease their transition back to normal life.

If they are not in a condition to do that, Mr. Smith says, the government should sometimes step in, even if that means giving them care against their will. Alberta is working on a “compassionate intervention” law that would create “facilities and legal processes to save the lives of those who are a danger to themselves or others.”

At least four of the multimillion-dollar therapeutic communities are being built in First Nations, which have an overdose fatality rate seven times that of the general population. Mr. Smith has cultivated close ties with several chiefs who are sympathetic to his recovery message and skeptical about harm reduction.

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Alberta hopes initiatives like the ones at Red Deer’s therapeutic community will keep people out of hospital emergency rooms – or morgues – but it’s too early to see evidence that its methods are working.Megan Albu/The Globe and Mail

Even some of his critics concede he has brought new resources and attention to the drug problem. But will it all make any real difference?

Governments across Canada are shovelling money into addiction treatment, community policing, street-nurse programs, supportive housing and other strategies. People keep dying. No one has a silver bullet.

Alberta admits it can’t really say whether its recovery model is working, at least not yet. Asked whether it has any figures on recovery rates in its treatment centres, a spokesman, Hunter Baril, said that “we are still working to build a fulsome data set that informs on the outcomes of treatment and recovery.”

Neither can it say whether waiting times for treatment have improved with all its new spending. Mr. Baril says “we are currently working to establish a program that better defines what wait times look like.” Treatment centres, he explains, have not been required to report on their success rates. Alberta is trying to change that.

And yet the government has no hesitation boasting that its efforts are causing death rates to drop. Mr. Smith told the Hotel Pacifico podcast in January that though both B.C. and Alberta were still seeing high numbers of overdose deaths, “ours are on the decline quite, quite significantly. … That’s not happening in British Columbia.”

That claim was false. Both provinces had their worst years for overdose fatalities in 2023. Data just released by Alberta show that 2,051 people died from overdoses, the first time the annual toll has topped 2,000. That is nearly two-and-a-half times as many as in 2017.

Mr. Smith blames the increase partly on a spike in overdoses in Edmonton last summer from an influx of carfentanil, a cousin of fentanyl that is 100 times as strong. He says critics are exploiting the death figures to discredit the Alberta Model: “They favour a different model, and so it’s in their interest to criticize ours.” That’s premature, he says. Alberta is still rolling out its new system.

The critics say that, despite his background, Mr. Smith simply doesn’t understand the problem he is trying to solve. “It’s obvious to me that he hasn’t done much reading, he hasn’t talked to people who are affected by addiction and he hasn’t talked to the experts,” says Esther Tailfeathers, a well-known addictions doctor on the Blood Tribe reserve in Southern Alberta and a champion of harm reduction.

She says recovery from addiction is not a linear process, a simple matter of doing the work and getting better. Those suffering from it often have relapses. Many are burdened with past trauma and mental illness. Most don’t have the advantages enjoyed by Mr. Smith, with his comfortable upbringing and job skills.

She thinks the government’s plan to put a 75-bed, $30-million therapeutic community on the reserve is like opening a Walmart there and expecting “that somebody’s going to go and buy what they need and pay and get out and they’re fine.”

Mr. Smith concedes that addiction can be stubborn and that recovery is a long-term, often life-long process. He still goes to meetings himself to talk and share stories with other recovering addicts. A long-time smoker known for slipping onto his office balcony at the legislature for a puff, he quit this winter and “it has been incredibly tough.”

He insists, though, that with good treatment, addiction can be beaten. Asked for evidence, he e-mails over an alphabetical list of 175 studies.

A report by the British Columbia Centre on Substance Use on therapeutic communities says that several reviews of communities around the world found that they had “similar or superior outcomes” to other treatment options, “with some studies reporting greater improvements in legal issues, employment status and psychological functioning.”

One study of San Patrignano said that 72 per cent of those who completed the program were still drug free after five years. The trouble, says respected Ontario addictions doctor Meldon Kahan, is that many people can’t hack the long-term commitment and so drop out. Running such communities is “enormously expensive,” too.

He applauds Alberta for spending the money anyway, but says recovery programs should be geared for everyone, whether or not they are ready for long-term treatment. Though Dr. Kahan is a skeptic about safe supply, he says any recovery program should be paired with reasonable, well-regulated harm-reduction measures designed to keep people alive even if they are not ready to attempt recovery.

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Harm reduction is still a part of daily street life in Alberta cities like Edmonton, where this used Naloxone kit lies discarded in the dirt.Amber Bracken/the Globe and Mail

Most experts agree. The answer to the overdose crisis, they say, lies in a mix of harm reduction and treatment, not one or the other. Most places do both. As well as using harm-reduction programs such as safe supply, B.C. is spending many millions expanding treatment programs. Alberta gives out needles and naloxone kits like any other province. It has seven supervised consumption sites.

In that sense, the feuding between Mr. Smith and his critics often seems futile, another example of today’s polarized politics.

Both camps are sincere and passionate. Both want to save lives. Harm-reduction advocates remind us that addiction is not a crime or a moral failing. Those who use drugs are more than just anonymous figures haunting our back alleys. They are real people with sons and daughters, mothers and fathers. Yet we often treat them as pariahs, threatening them with jail and failing to give them the necessities of life, like proper housing.

The recovery camp reminds us addiction does not need to be a life sentence. Millions of Canadians have managed to overcome it, whether by taking addiction medicines like methadone, going to programs that demand abstinence like alcoholics or narcotics anonymous or simply exercising their willpower and quitting cold turkey.

Sometimes they just need a push to get there. Mr. Smith says that the harm-reduction camp tends to patronize drug users, giving them everything and demanding nothing. By treating them as victims with the right to keep on using as long as they wish and face no consequences, it fails to take account of the human capacity to rebound from the most wretched circumstances.

Though he deplores the corrosive prejudice he calls “toxic stigma,” he says there should be at least some disapproval attached to using dangerous illegal drugs. Shunning and shaming smokers, he notes, helped slash the number of deaths from tobacco.

As he puts it, addiction is “an illness that tells you you don’t have a problem.” Looking back at his four years on the street, it is clear to him now that “I needed to get out of there. I needed to get the drugs away from me. I needed order and boundaries in my life.”

He still keeps in touch with the policeman who hounded him to get sober all those years ago. That young cop, now a senior officer, saw something in him. He told him he was better than what he had become. He told him he could change.

Now that Mr. Smith is in the position to make a difference, he says he wants to give others the same chance.

With a report from Alanna Smith

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