Overdose

by Benjamin Perrin

  But although we shouldn’t put all our faith in the Portugal model as a panacea for Canada’s opioid crisis, the general approach it advocates is promising. Many of the people I interviewed, including some police officers, strongly support its general approach, which combines decriminalizing simple possession of illicit drugs with expanding access to treatment. Those are key building blocks of a compassionate, evidence-based drug policy.

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  ——

  Now, at the end of my investigation into the opioid crisis, I’m convinced that we must decriminalize simple possession of illicit drugs and radically change how our criminal justice system and our laws deal with people with opioid use disorder.

  It’s time to stop punishing those with substance use disorders and instead treat them with compassion. It’s time to stop fuelling the stigma that’s endangering people’s lives and instead help them deal with their pain and trauma. It’s time to stop deploying criminal law in ways that run counter to the best medical evidence about opioid use disorder and how to treat it. It’s time to stop the endless cycle of criminalization that helps no one and that comes at a massive cost to those who use illicit drugs and to our society as a whole. It’s time to stop locking up vast numbers of people with substance use and mental health issues and instead help them get the treatment and support they need. It’s time to end the failed experiment of prohibition and the war on drugs.

  But getting to this point was a real journey for me. It required an open mind and an open heart. And I hope that sharing my own transformation will help others see the opioid crisis through different eyes.

  I’m not alone in experiencing such a shift in outlook. Linda Lupini, executive vice president of the BC Provincial Health Services Authority and BC Emergency Health Services, told me of another example: “We had the head of the paramedic service in Ottawa come and visit us, and he said, ‘How are you dealing with this? It’s starting to show up in Ontario.’ We went and took him on a tour. When we started talking about decriminalization and safe injection sites and overdose prevention sites, he said, ‘You guys are really out there. People coming in, injecting. What are you guys talking about?’ Anyway, he spent a week here. At the end of the week he came for a debrief and he said, ‘I’m a hundred percent supportive of everything you guys do. My mind has been completely turned.’ ”

  But so far, the powers that be haven’t been willing to take the controversial step of declaring the war on drugs to be a failure and decriminalizing people who use drugs in order to help save their lives. The federal Liberals and the Conservatives have both balked at the suggestion. As a senior BC provincial official (who requested anonymity) told me, “I’ve sat in two meetings with the prime minister, and I mean the highest level, with [the now former] Minister of Justice and Attorney General Jody Wilson-Raybould and eight other people—small meetings in Vancouver, two of them…. We begged for money and we begged for decriminalization, and we got $10 million sent to the [BC] government after the first meeting. And we were told, directly from the prime minister, it’s not happening—decriminalization.”

  “He said that right to you?” I asked.

  “Right to our face. ‘It’s not happening,’ he said. ‘You have no idea what I’ve been through across this country trying to deal with the marijuana and cannabis issue. I can tell you straight out, it’s not happening.’ Then he came back and said, ‘You know, I gave you the $10 million.’ And we’re like, ‘Okay—that’s going to help us save more people over the next year, but that’s not going to fix this permanently. We need to talk again about decriminalization.’ ”

  This description of a closed-door March 2017 meeting with Prime Minister Justin Trudeau was independently confirmed by Leslie McBain with Moms Stop the Harm, who was also in attendance. “At the end of the meeting we were all asking for decriminalization,” she said. “Ending the war on drugs. There were police officers in there, there were front-line emergency response teams, there were doctors, there were social workers, there were people with lived experience, myself. We all had the same message.

  “ ‘Well, I hear you and I understand, and I’m sympathetic,’ ” McBain quoted Trudeau as saying. “ ‘But do you know how much trouble I’m having legalizing pot?’

  “We all sat there in stunned silence,” she continued. “That was his stance then and that seems to be his stance today. He’s almost ignoring it, it seems. It was a nothing response.”

  These accounts reflect a prime minister who’d faced political challenges with legalizing cannabis and so wouldn’t consider decriminalizing hard drugs. In other words, the position he took was entirely political—based neither on evidence during a public health emergency nor on the advice of the experts he met with. I wrote to Trudeau asking for his own account of the meeting, and never received a reply.

  Lives being lost in this ongoing crisis are the equivalent of a fully-loaded large passenger aircraft crashing and killing everyone aboard every 5 to 6 weeks in Canada. Yet it didn’t even merit a mention during the 2019 federal election leaders’ debate or make it onto the CBC’s list of election issues.

  “If that doesn’t break the shell and get into the psyche of the government, what will?” asked McBain. “We’re getting small funding here, small funding there. And it’s good, we need it, but the big things that need to be done are not being done. We haven’t declared a national state of health emergency, and we haven’t seen anyone in the upper echelons of government talk about the fact that we need to take these courageous moves to stop the deaths.”

  –14–

  HOW CAN WE SOLVE THIS CRISIS?

  Troy Balderson apologized for running late. A water leak had sprung that morning at one of the shelters run by Lookout Housing and Health Society in Vancouver’s Downtown Eastside, which also runs the Powell Street Getaway supervised consumption site. Balderson is the charitable organization’s downtown projects manager. He had a lot on his plate, but the leak wasn’t a problem that fazed him. Not long before it was six people overdosing in a single night in one of their buildings. That put the other trials of his job in perspective.

  “We understand that everybody comes from a past, and we’re not here to put barriers between them and our services,” said Balderson. We were sitting in his small office, filled with boxes of supplies, near the shelter’s busy entrance. The Powell Street Getaway also provides meals, medication administration, emergency clothing, social activities, and employment and internship programs as well as substance use and mental health programs. “We meet them where they’re at.”

  “What do you think needs to be done to really address this crisis?” I asked.

  “If we get enough people to understand that it’s not just a bunch of druggies shooting drugs,” he explained. “That it’s people suffering from many, many stages of trauma, from many, many walks of life.

  “They’re invisible. If we take the time to speak with those folks, that’s all it takes. It’s a simple hello. A simple ‘I’m going to take five minutes out of my day. I’m going to spend it with you and you’re going to be heard.’ That in itself is probably a bigger gift than anybody knows. Just taking that time.”

  Balderson’s words stayed with me as I stepped back from months of speaking with people on the front lines of the opioid crisis. It was now crystal clear to me: our response to this epidemic must begin with care and compassion for those who, for many reasons, have come to self-medicate the physical, psychological, and emotional pain and trauma in their lives using illicit opioids. That means no longer essentially criminalizing opioid use disorder but instead ensuring that people have safe places to use substances of known contents and potency. It means developing connections with them as a prelude to offering rapid access to evidence-based treatment options if and when they want to stop using.

  As we’ve seen, Canada’s century-long experiment with drug prohibition and tough-on-crime drug policies has
been a miserable failure. The opioid crisis has exposed the war on drugs as a fundamentally flawed response to the risks associated with illegal drugs. And it’s not just Canada that’s following this wrongheaded and punitive approach to dealing with drug users.

  I couldn’t believe how far I’d come over the last 100 days: the things I’d seen and heard about, the people I’d met along the way. My mind had changed and my heart had expanded. A few years ago you couldn’t have paid me to wear a T-shirt that declared “End the War on Drugs”; now I wanted to order a caseload and distribute them myself. My investigation into the opioid crisis that started in my hometown of Vancouver had opened my eyes to a totally different reality. In retrospect, my previous views about illegal drugs were based on ignorance and ideology—a dangerous combination. Critically, they weren’t evidence-based—informed by medical or criminology research, let alone the actual experiences of people who use drugs.

  And a remarkable thing happened as I began sharing my findings with people: they started opening up, too. When I talked about decriminalization to a friend of mine, an emergency room physician, it turned out that he was totally supportive of it. An old friend from university revealed that his girlfriend was addicted to heroin and that he was grateful for the research I was doing. My investigation has given me a better understanding of some of the challenges that people who use drugs are facing, although I’ll never fully appreciate what their day-to-day challenges are like.

  I’ve come to see that there’s a clear moral wrong in this whole issue: the injustice of unmercifully judging and punishing people who are using drugs in an attempt to get relief from the pain in their lives. As I’ve studied, thought about, and prayed about this issue all along the way, that’s a truth I’ve come to understand not only at an intellectual but also at a spiritual level. It’s been a real transformation. I was dead wrong about drug policy. Our response to substance use must be one of care, compassion, and understanding for those who are using. We’re in no place to judge and condemn them. Rather, we’re called to love them. And establishing that loving connection can help bring hope for a better future—something crucial for addiction recovery that can’t be obtained through a prescription.

  I went back to the list of questions I’d written up at the beginning of my investigation. Reading them again, it was clear that many were based on myths and stereotypes that I’d now thoroughly debunked based on my research.

  The promise of prohibition was a lie—a quixotic, aspirational policy that’s not only unrealistic but dangerous. I’d have a much harder time purchasing unpasteurized milk in Vancouver than I would purchasing illicit drugs. Why? Because milk sales are regulated and subject to rigorous health and safety standards, whereas illicit drugs have zero oversight. Instead of stopping drugs, as it promised, prohibition has left the drug market as a “free-for-all” to be run completely by organized crime—they make their illicit products without any standards and are almost never held accountable when people die as a result.

  Show me the peer-reviewed research that says prohibition works. You couldn’t design a worse approach to substance use disorder if you tried. What an insane system we’ve come to accept “for the good of society.” Prohibition isn’t good for society; it’s been a disaster. The first step in coming up with a new approach is admitting it, and ending our collective denial and apathy.

  The threat of criminal sanctions doesn’t deter those with opioid use disorder from seeking out and using illicit drugs, but it compels them to use alone where they’re at greater risk of dying in the event of an overdose. And, for people who might be thinking of experimenting with street drugs, the distant prospect of criminal penalties for possession are nowhere near as discouraging as the ever-present risk of suffering a fatal overdose. The experience of Portugal in decriminalizing drugs is very promising, notably in reducing illicit drug overdose deaths and expanding treatment options. We need to fundamentally shift the starting point of our drug policy so that it’s understood to be not a criminal matter but rather a public health, medical, and social issue.

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  ——

  Prevention should also be part of the response to illicit drug use, but it needs to be done right. Lisa Lapointe, chief coroner with the BC Coroners Service, cites research finding that “interactive, skills-based approaches showed positive results, with targeted approaches being especially effective.”

  What hasn’t been found helpful is fear-mongering. “Evidence suggests that the reasons for drug use are complex and multifaceted, and programs focused on scaring people from using drugs are not effective in saving lives,” Lapointe writes. “Additionally, they tend to increase the stigma surrounding drug use and actually discourage people from seeking help—an obsolete approach that has led to the loss of countless lives.”

  This applies to young people as well. Lapointe cites the massive “Just Say No” and D.A.R.E. campaigns undertaken by the U.S. government to discourage youth from using illicit drugs—initiatives with a US$1 billion total price tag that were later found to have had “no positive effects on youth behaviour and may have, in fact, prompted some to actually experiment with using substances.”

  We live in a lovely family neighbourhood in East Vancouver, a few blocks from a busy street. There are lots of great restaurants and small grocery stores, but you’ll also occasionally see used syringes in the tall grass beside the sidewalk near the thoroughfare. So we had to educate our children about staying out of the grass there and about what syringes were—to not touch them since it’s not safe, and to let an adult know if they come across any. It was also an opportunity to talk about drug use. One thing I’d already learned about kids is that telling them not to do something is the fastest way to make them do that thing. Same as with us adults, probably.

  “Some people use drugs because they’re sad and want to feel better, then they can’t stop,” I said to my young kids. “But the drugs can hurt them and make things even worse.” Then I let them ask questions and answered them as best as I could.

  “Kids need to get age-appropriate information on drugs and addiction. Especially the middle school and high schoolers—they must have current, continually updated information on drug safety,” said Leslie McBain. “If we want to look a little more long-term than next month or next year, kids have to start to understand themselves, their own anxieties, their own fears. Things that would make them want to try a drug to feel better. And also the dangers of just experimenting.”

  Research has found that having higher self-esteem, supportive relationships with adults, and positive role models helps youth engage in less substance use. And as McBain says, giving them the facts about substance use in a sensitive, nonjudgmental manner is key. This includes the fact that fentanyl can be fatal if consumed, and how difficult it is to know whether it’s present in illegal drugs.

  Here are some other tips from the experts about how to talk to youth about substance use:

  • Educate yourself so you can answer questions. If you don’t know the answers, offer to look for them together.

  • Become informed. Learn about the substances commonly used by young people. Find out how the substances work, what their street names are, and the signs of being under the influence.

  • Be a good listener. Give your kids room to participate and ask questions. Respect their opinion.

  • Stick to the facts. Avoid preaching, scare tactics and exaggeration. Research shows these tactics do not work, and may actually lead to a loss of trust.

  • Look for natural opportunities to discuss substance use and decision-making, including stories in the news and social media.

  • Be open and respectful. Ask questions about what they’re hearing, seeing, or have learned. Then, listen. Talk about why people use substances and the potential consequences.

  • Focus on your heartfelt concerns for their safety and a deep regard for their wellness (
in contrast to right/wrong, good/bad, obey/punish). Emphasize your deep caring and commitment to understand in contrast to setting them straight.

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  ——

  In the face of the scale and complexity of the opioid crisis, it’s easy to think that we have little power to effect change. But when we see suffering and injustice, one of the most important things we can do is respond to it directly. Here are 10 concrete actions you can take today to help address the opioid crisis.

  1. Tell someone.

  Among the biggest impediments to a more compassionate, evidence-based drug policy is a lack of knowledge and the prevalence of stereotypes. Truth will always be a powerful force for those who are able to hear it and are willing to speak it. Share this book and what you’ve learned with a family member, friend, or colleague. Many of them probably have the same questions I did when I started on this journey. Some of them have probably been affected by the opioid crisis or know someone who has been.

  2. Show your support for a compassionate, evidence-based drug policy.

  One way to demonstrate this support is by sharing my Vancouver Declaration on Responding to the Opioid Crisis, which summarizes the main policy and legal recommendations in this book. It appears in the Appendix that follows, and can be found at www.overdosebook.ca.

  Some of these recommendations can have an immediate impact, whether in directly saving lives or in reducing the risks faced by people who use drugs. Others will take time to bear fruit. But the evidence is clear: they will benefit not only those who use drugs but also their family members, friends, and society as a whole. It’s taken over a century to get into this mess, and it will likely take a generation or more to make substantial progress in getting out of it. We have to start now.