The Logical Next Step in Drug Policy

the 22nd of june

2019 is a day that i’ll never forget

my day started off as normal i woke up

had a shower

brushed my teeth and jumped on my bike

ready for my day of work

i set off through kitsilano one of

vancouver’s many lovely residential

neighborhoods

i made my way down to the seawall and up

and over into vancouver’s downtown

financial district

here i was surrounded by beautiful glass

high-rise buildings

luxury sports cars and designer stores

and then i arrived in gastown

in gastown i passed by a range of

artisan and luxury art galleries

funky underground bars and boutique

restaurants and then i arrived at

carroll street

carroll street marks the edge between

gas town and the downtown eastside

often referred to as canada’s poorest

area code

which for the past decade has been the

epicenter of canada’s

overdose crisis so this particular

morning

i turned onto carroll street and i

immediately noticed a man

lying in the doorway to an apartment

building on the corner of the block

the doorway was well lit and from my

vantage point of about 20 meters away i

can immediately tell that something

wasn’t right

the man was laying flat on his back with

his head looking straight up into the

sky

he was wearing blue jeans and a white

vest and had a few shopping bags on the

ground next to him

from my vantage point of about 20 meters

away

as i approached i saw four or five

people walk directly past him

two stepping over his legs as they did

so

so i biked over i jumped off my bike and

i knelt down next to him the man’s

breathing was incredibly shallow

breathing once every 10 to 12 seconds

and his face was pale white

with his lips being blue verging on

purple

so i started shaking him desperately

trying to wake him up and it was at that

point that i noticed

two syringes lying on the ground tucked

into the doorway behind him

so i got out my phone i dialed 9-1-1 and

i put on speaker and left it beside me

i then got out my naloxone kit naloxone

is an incredibly powerful drug which

when injected

can immediately reverse opioid overdoses

so i took out the three vials that i had

on me and i began injecting him

after about 90 seconds still nothing had

changed about his condition

and so dispatch told me to start doing

chest compressions and giving him

breaths

so i started doing that and thankfully

within

about a minute he started to regain

color in his face and his breathing

started to become more regular

he still hadn’t regained consciousness

but within three to four minutes

an ambulance was on the scene and they

took over ultimately saving his life

the scene i’ve just described was my

first time responding to an overdose by

myself in vancouver

today in vancouver an average of five

people die

because of overdose and province-wide

since the beginning of the covert

pandemic

overdose deaths have taken more lives

than car crashes

homicides suicides and covert 19 deaths

combined on april 14

2016 in response to an unprecedented

rise in overdoses

bc’s provincial health officer declared

a public health emergency

since then since 2016 over 14 and a half

thousand canadians

have died because of fatal overdoses

these spiken overdoses have been due to

the introduction

of a new and extremely potent opioid

called fentanyl

fentanyl is up to 50 times stronger than

morphine

and due to its low cost of production

dealers are cutting it

into virtually all street drugs today in

vancouver

and nationwide both those who are using

drugs recreationally

and those who who are going through

addictions are playing russian roulette

with their lives

every single time they use so

what is being done in canada to stop

this

well in response to these alarming

numbers both provincial

and federal governments have implemented

harm reduction interventions

into communities most heavily impacted

by overdose

in relation to drug use harm reduction

describes the policies

programs and practices that aim to

minimize the negative effects

of drug use be that health social or

legal

this progressive policy stance

recognizes that many people

are unable to stop using drugs and

regardless of this fact

deserve to be kept alive harm reduction

neither promotes

nor denounces drug use but solely looks

to support people

and help with the problems associated

with it

in vancouver the first kind of major

form

of harm reduction was seen through

needle exchange programs

in the 80s and 90s this original

intervention curbed vancouver’s hiv

epidemic

where again the downtown eastside

displayed some of the highest rates of

infection

of anywhere in the western world being

deployed at an extremely low cost

and by eliminating the need for

injection drug use to share needles

public health agencies were able to

significantly reduce

the number of infections within the

community

in 2003 canada took its next step in

implementing progressive forms of harm

reduction

in a landmark case the bc provincial

government challenged the federal

government

allowing for the opening of insight

canada’s first

legal supervised consumption sites

supervised consumption sites are centers

where people can bring in drugs and news

under the supervision

of health care professionals and peers

this supervision significantly reduces

the risks associated with injection drug

use

including the spread of blood-borne

diseases as well as potential injuries

from unsafe and unsanitary using

environments

instead of this drug users was provided

with this

undoubtedly however the strength of

supervised consumption sites

lie in their ability to save lives

with healthcare professionals there to

monitor people using drugs they can

immediately respond

to overdoses and reverse the fatal

symptoms before it gets anywhere near

how serious it would be outside of the

facility

worldwide there are over 100 sites in

operation

in 60 cities and 11 countries and not

one death has ever occurred

last year in canada over five and a half

thousand people died from overdose

however the bc center for disease

control suggests

that this number would be doubled around

10 000 if consumption sites had not been

introduced

to me this is simply remarkable and

shows the value

that supervised consumption sites can

have within communities

to me this fact alone the fact that it

saves so many lives

should be the only thing that

legitimizes its implementation

now some of you might be wondering is

this moral

is this not simply enabling drug use

should we not be trying to get people

off of drugs well despite what many

critics think

the research shows that they do research

from vancouver

munich sydney copenhagen berlin

and paris all show the same thing when

someone has access to a supplies

consumption site

for as little as one year they show a 30

increased chance

of getting into recovery and accessing

detox

now this may come as a surprise

but what the research shows us is that

these sites are accessing our most

vulnerable and most marginalized

community members

those in our community who to date have

had little to no contact

with healthcare providers or mental

health services

these are members of our communities who

are used to being stigmatized

however in supervised consumption sites

they get treated with compassion

in a non-judgmental environment which

for many is the first time

this has happened you see non-judgmental

care

creates trust it creates trust in a

system

which for many has let them down a

system which for many

has let them slip through the cracks of

early intervention healthcare

and housing support and to be honest has

probably alienated them completely

from wanting to receive services

supervised consumption sites

break the cycle now

what the overdose crisis has taught us

is despite the effectiveness of

consumption sites

they have simply not been enough to

treat this issue entirely

what this overdose crisis has taught us

is that drug policy

is incredibly complex and this situation

is going to require

bold simultaneous progressive and

sometimes controversial solutions

now more than ever we need to implement

drug policies based on the evidence

so what is the evidence well

the answer and the clear next step in

drug policy

is that we need to be providing a safe

regulated

prescription-based supply of opioids for

those going through addiction

now this may sound controversial but the

thing is

we have done it before during alcohol

prohibition in the united states

rates of crime went up 20 percent and

rates of addiction rose by 40 percent

additionally yearly up to 10 000 people

died

from alcohol poisoning as a result of

moonshine and other unregulated alcohols

what did we do once we knew the dangers

of

alcohol consumption we regulated it and

we provided a safe alternative for the

consumer

now logically opioid regulation will

look much different to that

of alcohol but the thing is the logic is

behind it is exactly the same

just like any other approach to a mass

poisoning a public health approach that

is

you immediately cut out the poison by

providing a safe alternative

last year in canada like i said five and

a half thousand people died from opioid

poisoning

and in the us the fentanyl tainted drug

supply took the lives

of up to 70 000 people it’s clear

that we need to be cutting out fentanyl

and cutting out this poison

so what is the evidence around offering

a prescription-based

supply of safe opioids well

trial studies from portugal switzerland

the uk

and now canada have been remarkable

these studies have shown that for the

cohorts that have had access to a safe

supply

their lives quickly changed for the

better

see in practice prescription opioids get

dispensed

by doctors at regular times throughout

the day creating a structure and with

routine

set around their drug consumption people

going through opioid addiction

are able to spend more time on

productive activities such as

getting job training spending more times

with their friends and family

or seeking housing the most recent study

we have

is from a study in the uk in the

middlesbrough safe supply program

patients showed a 90 drop in common

activity

and raises of up to 396 percent

in perceived mental and physical health

these statistics represent the visible

benefits to both individuals

and communities as people’s drug intake

is removed from the chaos of the streets

which comes from a black market supply

when we factor in the toll on our health

care system

the tornado policing system and the

tornado criminal justice system

the canadian center for substance use

and addiction estimates

that the toll on our society every year

comes to around three and a half billion

dollars

implementing a safe supply would not

only save lives but it would

significantly cut into this number

in order for this to work we need to

ensure that governments are committed

to simultaneous investment in affordable

housing

and in addiction treatment centers but

the harsh reality is

that for our friends families and our

wider community members

going through opioid addiction they

cannot seek recovery

if they are not alive to do so we need

to remove the fear around drugs

and we need to remove the stigma around

those who use them

we need to listen to the experts who

have now been researching

for decades and in some places

implementing evidence-based policies

that work not only for individuals but

for the wider community

as well in the words of the great

mahatma gandhi

the true measure of any society can be

found in how it treats its most

vulnerable members

today that statement holds true people

are dying

unnecessarily we need to take action

and we need to show through both

financial investment and through policy

regardless of a person’s drug use we are

going to support them

we need to show that we care and

ensuring a safe supply

does exactly that thank you