North America Recovers is a movement of individuals and organizations seeking to restore peace to North America by ending drug deaths, open drug scenes, untreated severe mental illness, and homelessness. We are open to all who want to advocate with us. We are nonpartisan and want policymakers to work together to enact our agenda. We convened for the first time in Seattle in January 2023. We are parents of children killed by fentanyl, recovering addicts, parents of homeless addicts, policy experts, and concerned citizens.

We are entirely self-funded by the members of the Coalition. We will accept donations but only from individuals who have no financial interest in the future of mental health care and homeless treatment.

The addiction and mental illness crisis has spread to cities across North America, manifesting as street homelessness, disorder, crime, despair and death.

We believe drug deaths of all kinds are the number one problem facing the United States and Canada. In 2021, over 107,000 Americans died from drug poisoning or overdoses - 14,000 more than in the previous year. CDC data is not complete for 2022, but there are no signs that the deaths are slowing. 

Nationwide, around one third of the homeless have severe mental illness, and the severely mentally ill are ten times more likely to be in a jail or prison than receiving treatment from a state mental hospital. RAND Corporation, the Treatment Advocacy Center, and several other recent studies recommend about 40-60 psychiatric beds per 100,000. In 2017, California, among the states with the highest homeless population, had only 17 beds per 100,000, leaving thousands to languish on the streets. This unjust and immoral situation contributes to the chaos and sorrow Americans see in their families, their communities, and on their sidewalks.

We believe the best way to fix these problems is to work together to advocate as a nonpartisan coalition. The diversity of political orientations, geographic locations, and areas of expertise in our coalition makes us greater than the sum of our parts.

We are explicitly nonpartisan. We have come from all political parties and ideologies to develop an agenda that is practical and effective. We have looked to the best solutions from around the U.S. and the world. We are anti-ideology. We want to do what works. And we are open-minded, and will consider changing our mind on important issues. We aim to be like Mothers Against Drug Driving (MADD) in advocating policies but not endorsing political candidates. That said, we will praise policymakers who show leadership and do the right thing. But we are choosing not to endorse candidates at this time.

The drug crisis is America’s biggest issue because so many are dying through overdoses and poisonings. Over 107,000 people died from overdose and poisoning in 2021, up from 93,000 in 2021, 70,000 in 2019 and 17,000 in 2000. That’s unacceptable. In 2020, nearly 9,000 Californians died from drug overdoses and poisonings — more than twice as many as died in vehicle accidents.

We are very interested in expanding our work to including families of victims of homicide related to the drug crisis. Most of our agenda would also reduce violence associated with open drug scenes, including murder, rape, robbery, and arson.

Fentanyl is more fatal and more addictive than any other drug available. It is fifty times more powerful than heroin and up to one hundred times more powerful than morphine. It is a drug so potent that a saleable amount can be sent through the mail without detection. That also means its fatality rate is immense. In 2020, the Drug Enforcement Agency published its Drug Threat Assessment, which reported that half the drug deaths in the country and in California were attributable to fentanyl. Its potency also makes it perfect for counterfeiting opioids pills because it can be easily disguised and sold for mark-up. But that also means that dealers end up poisoning and killing some of their buyers who think they’re taking something different and less harmful. 

Absolutely not. The drug war focused on incarceration rather than rehabilitation and peace. We oppose mass incarceration, overly long jail sentences for drug use, and arresting people who are using drugs peacefully in their own homes. But without mandatory treatment for drug users who break the law (apart from their use of illicit drugs), the alternative to incarceration is the growth of open drug scenes.

Supervised consumption sites exist in countries that have solved their drug crises, such as the Netherland and Portugal, but only as a small, highly regulated part of a care system where the goal, and the expectation for each user, is recovery.

In North America, supervised consumption sites are being implemented in a vacuum. They are disproportionately located in lower-income neighborhoods. Because they are not properly regulated or integrated into a recovery-oriented care system, they attract more drug activity to the communities where they are located. This is unfair to the drug users, who are given few, if any, resources to find treatment and recover, and to lower-income neighborhoods.

No, that’s a myth. It’s true that Portugal expanded drug treatment, but people are still arrested and fined for possession of heroin, meth, and other hard drugs. And drug users are typically sent to a regionally administered “Commissions for the Dissuasion of Drug Addiction,” composed of a social worker, lawyer, and doctor who encourage, push and coerce drug treatment.

Cities need to use carrots and sticks, services and law enforcement. A major study found that five European cities (Amsterdam, Frankfurt, Lisbon, Vienna, and Zurich) ended open drug scenes through the combination of social services and law enforcement. The same worked in the U.S. In North Carolina, police broke up drug dealing with community outreach workers. They offered the dealers jobs and help with restarting their lives as an alternative to arrest and incarceration.

Yes, but it will be harder, the drugs will more expensive, and the drug dealing will be less disruptive. Ending the open drug scenes will eliminate an attractive nuisance for addicts and those trying to recover.

Many progressive nations like the Netherlands use medically-assisted mandatory drug treatment where opioid addicts get a prescription to Suboxone or methadone and an assertive case worker to help them employment, re-affiliate with families and friends, and recover from addiction. We should expand the use of Suboxone, under a doctor’s supervision, to help addicts quit fentanyl and heroin.

One leading expert is Keith Humphreys, a Stanford University addiction specialist and advisor to President Joe Biden. “What’s happened in these places [San Francisco, Seattle, and Portland] is just the removing of all pressure,” he said. “The thinking was, ‘Oh, people will just show up automatically and go into treatment.’ But that doesn’t happen very often in addiction. Usually there’s pressure.”

Open air drug scenes are places like the Tenderloin neighborhood of San Francisco where people of all ages and races inject and smoke meth, cocaine, heroin, and fentanyl on the sidewalk. Large homeless encampments, prostitution, and violence are common features of open air drug scenes.

Open air drug scenes increase crime first and foremost by entrenching an illegal drug economy in a concentrated area. With the drugs come assault, theft, prostitution, homelessness, and general public disorder. All of these braid together to create a rising tide of lawlessness and despair. 

Mandatory drug treatment is treatment offered to drug users who’ve broken the law as an alternative to prison or jail. Specialized “drug courts” handle cases of those who are addicted, and their offering of mandatory drug treatment has been shown to reduce recidivism. 

Mandatory treatment works nearly as well as voluntary treatment. One study found that people sentenced through drug courts were two-thirds less likely to be re-arrested than individuals prosecuted through the normal criminal justice system. Another group of researchers estimated that every dollar spent on drug courts saves approximately $4 in spending on incarceration and health care. Eighty percent of treatment providers say they support short jail stays to motivate treatment compliance. Some parents want their children to go to mandatory treatment once it is clear that they will not ever voluntarily do so.

We can provide the right treatment. Inpatient treatment works better than outpatient treatment, and we should expand inpatient treatment so that patients aren’t required to leave right when their cravings peak. For those addicted to opiates, medically assisted treatment is a proven method to stop addiction.

Nationally, around a third of the homeless have severe mental illness. In Los Angeles, two-thirds of the homeless have severe mental illness, addiction, or both. In San Francisco, half of the homeless have both severe mental illness and a drug addiction.

Current services for the mentally ill are woefully inadequate. This means people needing treatment and stabilization often must wait for several hours, sometimes an entire day, to get a bed, even when their needs are urgent. 

Someone who is severely mentally ill is nearly 10 times more likely to be behind bars than in a state mental hospital. The Los Angeles County Jail has more mental health beds than any hospital in the country. Many of the severely mentally ill do not know or understand that they have a mental illness, making treatment nearly impossible without mandates. Voluntary care should be pursued before mandatory care, but sometimes the mentally ill need mandated care. Many of the severely mentally ill who are homeless cycle between jail and short hospital stays, never getting well.

Voluntary care should be attempted before mandatory care. But sometimes mandatory care is what patients need to prevent them from harming themselves or others, or ending up in prison, which is what happens today. There are more mentally ill in the Los Angeles County Jail today than any other psychiatric institution in the country.

There are two main ways to require long-term psychiatric care in California: conservatorship and assisted outpatient treatment. In the past, such things could be abused. But under conservatorship, which is called guardianship in other states, a judge appoints a relative or other qualified person to make financial, legal, and other key decisions on behalf of a person deemed “gravely disabled” by a physician. This is the most serious of decisions and cannot be made lightly. This is the measure of last resort overseen by the courts.

Under assisted outpatient treatment (AOT), courts can require mentally ill people to follow treatment plans, like taking medication, to prevent violence, addiction, and crime. Those who do not comply with their treatment plans can be held for up to seventy-two hours to determine if they meet the standard for involuntary hospitalization. 

Evidence suggests that AOT is highly effective. Nine out of ten AOT programs studied in California significantly reduced criminal justice involvement. Six out of seven programs reduced homelessness. AOT in other states has been shown to reduce homelessness by up to 74 percent and arrests of the mentally ill by up to 83 percent.

AOT prevents the mass lock-up of patients in mental hospitals. AOT realizes the promise of community-based treatment by allowing the mentally ill to live outside of institutions. This lighter mandate is proven to work, which is cause for celebration.

Our cities are facing a humanitarian crisis of addiction and mental illness that manifests as street homelessness, disorder, crime, despair and death.

The federal government has prioritized two ideas in its attempt to solve the problem, Housing First and harm reduction, to the exclusion of recovery-oriented care. After ten years of these policies, the problem has only gotten worse. Also, federal funding for local programs is tied to housing first and harm reduction philosophies. This approach by the federal government has made it difficult for state and local governments to try other strategies.

The Housing First model is an approach to the homelessness crisis that sees housing and poverty as the primary drivers of homelessness. Housing First advocates believe that building more affordable housing would fully solve the homelessness crisis. They often see housing as a human right and essential to human dignity. They believe that permanent housing should be offered to the homeless without preconditions. They hold that other solutions to the homeless issue—like temporary shelters, housing with preconditions, and mandatory drug and psychiatric treatment—misdiagnose the problem and should not be implemented. 

Proponents of Housing First are right to encourage the building of permanent supportive housing, but their philosophy goes too far. By excluding shelter and transitional housing, Housing First causes many homeless people to live unsheltered, where they are more likely to be victims of violence or suffer from addiction. Unsheltered homelessness also encourages the creation of open drug scenes. And, many homeless people do want access to basic shelter. There are frequently long lines outside of shelters and some homeless people have to be turned away.

Housing First doesn’t recognize the root of the homeless problem: drug addiction and severe mental illness. People are usually on the streets because they are addicted to drugs or struggle with untreated severe mental illness. Policies that ignore these factors have significant downsides. Housing First has been shown to not improve the health outcomes of those it houses, because it gives housing without preconditions. Contingent housing, which requires its recipients to follow certain rules, like abstinence or accepting medical treatment, has been shown to improve health outcomes and self-sufficiency.

Contingency-based housing is housing offered to the homeless with conditions, usually requiring that they address their underlying substance abuse or mental illness through abstinence, therapy, or medication. It has been shown to effectively house people as well as make them healthier and self-sufficient. In contrast, Housing First has been shown to have either no effect or a negative effect on its clients’ health and well-being. 

According to HUD, an unsheltered homeless person resides in a place not meant for human habitation, such as a car, park, sidewalk, or abandoned building. A sheltered homeless person resides in an emergency shelter, or transitional housing, or supportive housing.

The philosophy of harm reduction originally developed to prevent the spread of AIDS through the use of condoms and needle exchanges. The basic idea is that we cannot prevent everyone from engaging in risky behavior, so we need to find ways to reduce associated harms for those at one end of the drug use spectrum. Harm reduction practitioners provide valuable services and genuinely help drug users live safer lives.

Harm reduction practitioners provide valuable services and genuinely help drug users live safer lives. Our coalition supports harm reduction measures such as the use of fentanyl test strips and Narcan, within a recovery-oriented context.

But today, the harm reduction movement has become extreme–it has grown to include the provision of supplies like pipes and foil for smoking crack and methamphetamine. Radical harm reduction advocates claim that so-called “safe supply” is the only way to stop overdoses, and argue for the legalization of all drugs, including heroin and methamphetamine. They avoid providing resources for recovery, as they view promoting recovery as a form of harmful stigmatization.

Harm reductionists also advocate for supervised consumption sites where drug users can take drugs under the watch of medical professionals equipped to reduce overdoses.

What the most radical harm reductionists promote is essentially palliative care for a curable disease.

Our coalition supports certain harm reduction measures, such as fentanyl test strips and Narcan to reverse overdoses, within a recovery-oriented context. But today’s extreme harm reduction policies enable and subsidize addiction rather than recovery. They also aim to reduce all harms to the drug user, while ignoring harms to their families, communities and society at large. Real harm reduction would never translate to harm promotion—it should be a means to the end of recovery.

Current policies often measure outcomes in terms of clients served, housing units built, or overdoses reversed. This means that service providers can claim success even as homelessness, addiction and untreated mental illness increase.

Instead, we propose that outcomes be measured in terms that make sense: reductions in street homelessness, drug use initiation, and overdose deaths. On an individual level, treatment success can be measured in terms of family and community reaffiliation, economic self-sufficiency, and long-term remission of symptoms.