Overdose
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“It was a life of hell,” he said James Keller, “B.C. Health Provider and Patients File Lawsuit Over Prescription Heroin Access,” Vancouver Sun, November 13, 2013.
Love returned to illicit heroin Providence Health Care Society v. Canada (Attorney General), 2014 BCSC 936, para. 59.
A major study of the economic implications of these medications Nick Bansback et al., “Cost-Effectiveness of Hydromorphone for Severe Opioid Use Disorder: Findings from the SALOME Randomized Clinical Trial” (2018) 113 Addiction 1264–1273 at 1271.
“It is the application of a ‘bundle’ of interventions” Providence Health Care Society v. Canada (Attorney General), 2014 BCSC 936, para. 26.
It’s prescribed for opioid use disorder in the United Kingdom, Switzerland, Germany, Denmark, and the Netherlands BC Ministry of Health and BC Centre on Substance Use, Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder (2017) at 15, www.bccsu.ca/wp-content/uploads/2017/10/BC-iOAT-Guidelines-10.2017.pdf.
“The goal of this recommendation is to give addicted persons a ‘clean opioid’ ” Vancouver Police Department, The Opioid Crisis: The Need for Treatment on Demand: Review and Recommendations (May 2017) at 22, http://vancouver.ca/police/assets/pdf/reports-policies/opioid-crisis.pdf.
Chapter 12—How Can We Help People Stop Using?
British Medical Journal which found that “patients who ‘successfully’ completed inpatient detoxification” John Strang et al., “Loss of Tolerance and Overdose Mortality After Inpatient Opiate Detoxification: Follow Up Study” (2003) BMJ May 3; 326(7396): 959–960.
“this approach has been associated with elevated risk of HIV and hepatitis C transmission” BC Ministry of Health and BC Centre on Substance Use, A Guideline for the Clinical Management of Opioid Use Disorder (June 5, 2017) at 11, www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf.
In fact, relapse rates are 60% to 90% Julie Bruneau et al., “Management of Opioid Use Disorders: A National Clinical Practice Guideline,” CMAJ 2018 March 5; 190:E247-57 at E253-4.
2017 Vancouver Police Department report on the opioid crisis Vancouver Police Department, The Opioid Crisis: The Need for Treatment on Demand: Review and Recommendations (May 2017) at 25, http://vancouver.ca/police/assets/pdf/reports-policies/opioid-crisis.pdf.
New national guidelines for treating opioid use disorder were published in the Canadian Medical Association Journal in March 2018 Julie Bruneau et al., “Management of Opioid Use Disorders: A National Clinical Practice Guideline,” CMAJ (March 5, 2018), 190:E247–57; see also Centre for Addiction and Mental Health, “Opioid Agonist Therapy” (2016), www.camh.ca/-/media/files/oat-info-for-clients.pdf.
“there are increased odds of success when doses are reduced gradually” BC Ministry of Health and BC Centre on Substance Use, “A Guideline for the Clinical Management of Opioid Use Disorder” (June 5, 2017) at 30, www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf.
These first-line treatments just aren’t effective for approximately 10% of people with opioid use disorder Providence Health Care, “About SALOME,” www.providencehealthcare.org/salome/about-us.html.
more than half of those who start treatment with Suboxone or methadone discontinue it BC Ministry of Health and BC Centre on Substance Use, Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder (2017) at 14, www.bccsu.ca/wp-content/uploads/2017/10/BC-iOAT-Guidelines-10.2017.pdf.
new guidelines for opioid use disorder say that residential treatment and psychosocial treatment Julie Bruneau et al.,
“Management of Opioid Use Disorders: A National Clinical Practice Guideline,” CMAJ (March 5, 2018), 190:E247-57 at E253; BC Ministry of Health and BC Centre on Substance Use, A Guideline for the Clinical Management of Opioid Use Disorder (June 5, 2017) at 31, www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf.
Controversially, a significant majority of Canadians recently polled Angus Reid, “Opioids in Canada: One in Eight Have Family or Close Friends Who Faced Addiction,” January 11, 2018, http://angusreid.org/opioid-crisis.
U.S. National Institute of Drug Abuse estimates that every $1 spent on addiction treatment National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide, 3rd ed. (January 2018) at 14.
Chapter 13—Won’t Decriminalization Make Things Worse?
I never once saw Jim smile Jim is a pseudonym.
A stunning 70% of federal offenders are admitted to prison Fraser McVie, “Drugs in Federal Corrections—The Issues and Challenges” (undated), www.csc-scc.gc.ca/research/forum/e133/e133c-eng.shtml.
Sociologists believe that stigma flows from three main sources Robin Room, “Stigma, Social Inequality and Alcohol and Drug Use” (2005) 24 Drug and Alcohol Review 143–155 at 147, 149.
the Supreme Court of Canada has recognized that all criminal offences generate stigma R. v. Creighton, [1993] 3 S.C.R. 3, para. 21.
“You must not possess drug paraphernalia” BC Provincial Court, “Probation Pick List” (May 1, 2017) at 14.
The only reason they require Health Canada approval is the existence of the drug possession offence Canada (Attorney General) v. PHS Community Services Society, [2011] 3 SCR 134, 2011 SCC 44 at paras. 19, 20, and 109.
Property theft typically generates a 10 to 20% return Eric Stewart, “Fentanyl,” Vol. 79, No. 1—Just the Facts (Ottawa: RCMP, January 13, 2017), www.rcmp-grc.gc.ca/en/gazette/fentanyl?fent.
“For opioid dependent inmates released from a correctional facility” Michael Egilson, Verdict at Coroners Inquest: Jansen, Brandon Juhani, File no. 2016:1027:0004 (January 25, 2017) at 5.
Experts at the UNODC concluded that the “range of drugs and drug markets” United Nations Office on Drugs and Crime, Executive Summary: Conclusions and Policy Recommendations (Vienna: UN, 2018) at 1, www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_1_EXSUM.pdf.
It costs taxpayers $116,000 a year to keep someone in federal prison in Canada Correctional Service Canada, “CSC Statistics—Key Facts and Figures” (June 2017), www.csc-scc.gc.ca/publications/005007-3024-eng.shtml.
half of all federal inmates are imprisoned on drug-related charges E. Ann Carson, “Prisoners in 2016” (U.S. Department of Justice, Bureau of Justice Statistics: January 2018) at 1, www.bjs.gov/content/pub/pdf/p16.pdf.
fewer than one in six people with drug use disorders are receiving treatment Ibid.
Illicit drug manufacturing and drug trafficking remain crimes Caitlin Elizabeth Hughes & Alex Stevens, “What Can We Learn from the Portuguese Decriminalization of Illicit Drugs?” (2010) 50 British Journal of Criminology 999 at 1001–1002.
written by an American constitutional lawyer and published by the CATO Institute Glenn Greenwald, Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies (Washington, DC: CATO Institute, 2009).
Portugal “may offer a model for other nations” Caitlin Elizabeth Hughes & Alex Stevens, “What Can We Learn from the Portuguese Decriminalization of Illicit Drugs?” (2010) 50 British Journal of Criminology 999–1022 at 1018.
best available data from the National Statistics Institute in Portugal reveals a massive drop Caitlin Elizabeth Hughes & Alex Stevens, “A Resounding Success or a Disastrous Failure: Re-Examining the Interpretation of Evidence on the Portuguese Decriminalisation of Illicit Drugs.” (2012) 31 Drug and Alcohol Review 101–113 at 105–108.
“It may also be another indicator of falling levels of heroin use” Caitlin Elizabeth Hughes & Alex Stevens, The Effects of the Decriminalization of Drug Use in Portugal (Oxford, The Beckley Foundation, 2007) at 3 (citations omitted).
Overall, these mixed results are seen as a net benefit Caitlin Elizabeth Hughes & Alex Stevens, “A Resounding Success or a Disastrous Failure: Re-Examining the Interpretation of Evidence on the Portuguese Decrimina
lisation of Illicit Drugs.” (2012) 31 Drug and Alcohol Review 101–113 at 105.
By 2005, 65% of people were referred for cannabis, 15% for heroin Caitlin Elizabeth Hughes & Alex Stevens, The Effects of the Decriminalization of Drug Use in Portugal (Oxford, The Beckley Foundation, 2007) at 3.
the equivalent of a fully-loaded large passenger aircraft crashing and killing everyone aboard Adam Miller, “Why the Opioid Crisis Isn’t a Bigger Federal Election Issue”, CBC, October 5, 2019, https://www.cbc.ca/news/health/opioid-crisis-election-1.5309759.
Chapter 14—How Can We Solve This Crisis?
prohibition has left the drug market as a “free-for-all” I have to give credit to Pivot Legal Society for making this point in my interview with them.
Lisa Lapointe, chief coroner with the BC Coroners Service Lisa Lapointe, “Scare Tactics Less Effective in Overdose Crisis,” December 2, 2017, https://news.gov.bc.ca/factsheets/scare-tactics-less-effective-in-overdose-crisis.
Research has found that having higher self-esteem BC Government, “Talking to Youth,” www2.gov.bc.ca/gov/content/overdose/talking-to-youth.
tips from the experts about how to talk to youth about substance use Ibid. Copyright © Province of British Columbia. All rights reserved. Reproduced with permission of the Province of British Columbia.
It is important that help (9-1-1) is called immediately in the event of an overdose BC Provincial Health Services, BC Centre for Disease Control and TowardtheHeart.com, Fentanyl-Induced Muscle Rigidity (July 24, 2017) at 2.
“Human beings have long looked to faith for strength and support” Alexandre Laudet et al., “The Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction Among Individuals in Recovery from Alcohol and Drug Problems” (2006) Alcohol Treat Quarterly 24(1-2): 33–73.
“substance users often come into recovery feeling abandoned by God” Ibid.
“In retrospect, I can see that God has been with me all the time” Ibid.
A study of 14 countries (including Canada) by the World Health Organization Robin Room, “Stigma, Social Inequality and Alcohol and Drug Use” (2005) 24 Drug and Alcohol Review 143–155 at 145.
ACKNOWLEDGMENTS
Launching this project without any research team or funding was exciting, but daunting. We’re in the midst of an international public health emergency, so I didn’t want to waste any time. I’m very grateful for the support that quickly came in when I needed it from an individual donor, the Macdonald Laurier Institute for Public Policy, and the University of British Columbia, Peter A. Allard School of Law. My student research assistants, Emilly Porter, Matthew Scott, and Emily Chung, each made distinct contributions to this book, and I appreciate their hard work and passion for this topic. Haley Hrymak also provided valuable suggestions on the manuscript. I want to thank Lisa Godfrey for her timely, accurate, and diligent work transcribing all my research interviews. The City of Vancouver Archives, Vancouver Coastal Health Research Institute, Providence Healthcare, Fraser Health, and Island Health also need to be acknowledged for facilitating access to documentation and their experts.
I’m so happy to be publishing another book with the great team at Penguin Random House. I especially appreciated Diane Turbide’s quick, enthusiastic response when I first pitched the project. Her great advice to me hadn’t changed: make the issue real for people, don’t just write a policy report. It was a pleasure working with Justin Stoller and Helen Smith on revising the manuscript. I really appreciated their ideas, challenges, and encouragement.
My biggest word of thanks is reserved for my wife, Claudia. One minute she’s my editorial assistant and policy strategist, and the next my best friend and comforter. When I got on a writing streak, which could last for days at a time, she cleared the schedule and took care of all of life’s important details so that I could get down on paper what was in my head.
Finally, I’d like to thank all the people I interviewed and got to know for this book. You are heroes, working in incredibly difficult circumstances, during a crisis you never asked for. Your dedication, professionalism, and championing of new ideas have saved lives. I hope that by sharing your stories and expertise many people will come to see, as I have, that what’s needed most is understanding, care, and compassion.