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