Safe Injection Sites - British Columbia



SAFE INJECTION FACILITIES: COMPELLING GOVERNMENT TO ACT

By Perry Bulwer, B.A., LL.B. 


December 2001

From 1999 to 2002 I was a law student at the University of British Columbia in Vancouver, Canada. I was also involved with various community-based advocacy groups supporting the rights of drug addicts and sex-trade workers. The following paper that appears after this intro and news updates, was written in December, 2001 for one of my law courses. It was a response to government inaction in the face of a publicly declared health crisis. It was subsequently published on the website of Pivot Legal, which at the time was a new legal advocacy organization serving Vancouver's most marginalized citizens. Pivot and its lawyers have since received several awards for outstanding community service. This paper, its companion piece on international law issues, as well as similar research were used by Pivot and other activists in the fight to force the government to act. In September 2003 North America's first legal supervised injection site, INSITE, began operating in Vancouver, Canada as a scientific pilot research project. The scientific evidence to date shows that such a facility saves lives by preventing overdose deaths and the spread of communicable diseases. However, the Conservative government under Stephen Harper has questioned the effectiveness of the service and has threatened to withdraw funding. In April 2008, the operaters of INSITE launched a constitutional case to test the federal government's power to close the facility. In May 2008, a letter leaked to the CBC revealed that doctors at the University of British Columbia's Department of Medicine last year unanimously urged Prime Minister Stephen Harper to keep INSITE open. On May 27, 2008 the B.C. Supreme Court struck down as unconstitutional sections of the Controlled Drugs and Substances Act. It gave Ottawa until June 30, 2009 to fix the law and bring it inline with the constitutional principle of fundamental justice. The court also granted INSITE an immediate exemption, allowing it to remain open. Ottawa must now update its laws to ensure provinces are free to provide health care services to addicts. Government opposition to effective harm reduction measures is nothing new, as this article explores. On October 8, 2008 Pivot filed a complaint with the federal auditor general alleging that the RCMP secretly commissioned research in hopes of discrediting INSITE. Consequently, the RCMP announced it would conduct an internal review regarding Pivot's allegations. This article, Vancouver's Radical Approach to Drugs, provides an updated overview of Vancouver's harm reduction approach to illicit drug use. And here is a transcript of a radio interview with Dr. Gabor Maté, a physician at INSITE, on the biological and socio-economic roots of addiction.

See related legal arguments in the following two articles on this blog:

The Constitutional Obligation of the City of Vancouver to Support Safe Injection Facilities
http://perry-bulwer.blogspot.com/p/safe-injection-sites-vancouver.html 


INTERNATIONAL LAW AND THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH CARE: Using Safe Injection Facilities to Control and Prevent Epidemics
http://perry-bulwer.blogspot.com/p/safe-injection-sites-international.html


FOR RELATED ONGOING MEDIA REPORTS ON THIS ISSUE SEE THE COMMENTS SECTION AFTER THE FOLLOWING ARTICLE


*********************************************************************************

SAFE INJECTION FACILITIES: COMPELLING GOVERNMENT TO ACT

By Perry Bulwer, B.A., LL.B. 

December 2001



ABSTRACT

The purpose of this paper is to explore the possibility of compelling the British Columbia provincial government, through legal action, to establish and fund Safe Injection Facilities (SIFs) as part of a program of health services for injection drug users (IDUs). Before examining the legal issues I will provide a brief background to the problem of infectious diseases and fatal drug overdoses. I will then consider the government policy response to the existing health crisis. Following that is a description of the function of SIFs and their effectiveness in other jurisdictions. I will then discuss the current legal framework and the impediments to establishing SIFs. Next, I consider whether there is a cause of action under human rights legislation. Finally, I turn to constitutional issues, namely sections 7 and 15 of the Canadian Charter of Rights and Freedoms. I conclude that there is evidence and the legal basis, under human rights legislation and the Constitution, to support an action against the government compelling it to establish SIFs.

BACKGROUND


In 1997, the National Task Force on HIV, AIDS and Injection Drug Use declared that “Canada is in the midst of a public health crisis concerning HIV, AIDS and injection drug use…. The number of new HIV infections among injection drug users is increasing rapidly, with Vancouver now having the highest reported rate in North America”.1 In that same year the Vancouver/Richmond Health Board declared a public health emergency in response to the emergence of an HIV/AIDS epidemic, as well as the high rate of fatal overdoses among IDUs, centred primarily, but not exclusively, in the Downtown Eastside.2


Recent estimates put the HIV prevalence rate among IDUs in Vancouver between 23 and 28 percent, and IDUs account for 38 percent of new HIV infections.3 Another serious communicable disease transmitted easily from one needle-sharing IDU to another is Hepatitis C. It is estimated that 85 percent of IDUs in Vancouver are infected with that disease.4 Tuberculosis, Hepatitis A & B, and syphilis also occur at epidemic rates among Vancouver IDUs. Tuberculosis, for example, had a 38 percent prevalence rate among Vancouver IDUs in 1998.5 Included in this epidemic of diseases among IDUs is an epidemic of fatal drug overdoses. From 1996 to 2000, there was an annual average of 312 overdose deaths in the Vancouver region.6

These various statistics are alarming, and even more so in light of the fact that the provincial government has apparently done little to stem this rising tide of disease and death. The problems associated with illicit drug use, while magnified, are not unique to Vancouver. However, in several European cities governments long ago proactively developed comprehensive harm reduction programs to deal with the public health issues associated with injection drug use. As part of a continuum of health care and associated services for drug addicts, SIFs were opened in several cities. Evidence indicates that these facilities are associated with an array of positive health and social outcomes, including reducing disease transmission and fatal overdoses. Considering the serious problem in Vancouver, the provincial government should establish and fund SIFs.


PROVINCIAL POLICY ON ADDICTION ISSUES


Under the previous provincial government, responsibility for addiction and other drug-related services fell to the Ministry for Children and Families. According to a 1998 review of alcohol and drug services in Vancouver by that Ministry there were major problems with existing service delivery, particularly in terms of accessibility, scope and the number of services available.7 That report stated:
The impact of the lack of adequate resources cannot be overstated. The simple fact is: there is not enough of anything, there are waiting lists for everything and we are chronically under-serving many. There is not only a need for more of the same, but new and innovative approaches need to be developed to attend to emerging trends and issues.8


The problem is especially acute for the most vulnerable populations such as IDUs who have difficulty accessing health care. A 1999 study suggested that “…access to drug and alcohol treatment, methadone maintenance and counseling services has been woefully inadequate in the downtown eastside and had diminished even further since 1995”.9

The new provincial government transferred responsibility for addiction services to the Ministry of Health Services, however, the range and level of services has not increased in response to the ongoing crisis. According to the previous Ministry’s“strategic purposes”, the priorities for addiction services include supporting “…education and harm reduction strategies to prevent the spread of HIV and other related infectious diseases”.10 Perusal of the current Ministry’s website indicates that of the addiction services carried over from the previous government, very few are based on harm reduction, but are instead abstinence-based programs.11 This means that not only is the range and level of addiction services “woefully inadequate”, but those most in need, and most likely to perpetuate the cycle of disease, will not access what services are available due to the requirement of abstinence. Apparently, the recommendation that “new and innovative approaches need to be developed” 12 has not been carried out.


A recent comparative study observed that in Europe during the 1990s, following the implementation of broad harm reduction prevention measures, including SIFs, there was a steady decrease in IDU-related harm. During that same period, the opposite trend occurred in Canada, including Vancouver. There was very limited harm reduction programming, consisting mostly of limited needle exchange and methadone programs, while IDU-related harm continued to increase at alarming rates.13 Perhaps, then, a brief look at the European experience will help determine the appropriateness of SIFs for dealing with the health crisis here.



THE EFFICACY OF SIFS IN OTHER JURISDICTIONS

There are presently over 40 SIFs operating in various European countries, including Germany, Switzerland and the Netherlands. Other countries planning or in the process of setting up SIFs include Spain and Australia.14 There are three primary goals of SIFs: to prevent the spread of drug-related disease by providing sanitary conditions and clean equipment for injection drug use; to prevent overdose deaths by providing supervision of drug injections by medically trained staff who can immediately intervene when problems occur; and the reintegration of drug users within mainstream society by providing a gateway through which injection drug users can access the health care system.15


Evidence suggests that those goals are being met in places where SIFs are operating. In Germany and Switzerland, large reductions in overdose deaths were reported in areas served by SIFs. As well, HIV/AIDS prevalence rates in drug users showed significant declines where SIFs were part of a comprehensive harm reduction strategy. Furthermore, various research data indicate that SIFs are an effective way of contacting the most marginalized drug users and connecting them to a wide array of health services they wouldn’t otherwise access.16 A comprehensive review of the literature reveals that SIFs are significantly reducing disease, hospitalization and death in those cities that have them. Moreover, they “have contributed to a stabilization of or improvement in general health and social functioning of clients” as a result of, among other things, the improved access to health services for addicts.17


I have presented here only a cursory view of the evidence as to the efficacy of SIFs. In any legal action brought against the government in an effort to compel it to establish SIFs, a great deal more evidence would be introduced on both sides of the issue. I am confident, however, based on the research, surveys and studies to date that there is evidence sufficient to establish that SIFs can effectively reduce death and disease transmission among IDUs. Therefore, the provincial government has at least a moral obligation to put people’s lives ahead of politics and establish SIFs. Whether or not it has a legal obligation remains to be seen, but first I will examine the current legal framework and the possible impediments to establishing SIFs.


OBSTACLES TO SIFS WITHIN THE EXISTING LEGAL FRAMEWORK

Under existing Canadian laws many of the activities associated with SIFs are illegal. The Controlled Drugs and Substances Act (CDSA) is the federal law that criminalizes certain conduct related to numerous prohibited substances listed in several schedules attached to the Act. Included in the list is heroin and cocaine, the two drugs most likely to be consumed in SIFs. While drug use by itself is not illegal, it is illegal to possess (s.4), traffic (s.5(1)), possess for the purpose of trafficking (s.5(2)), import and export (s.6), and produce a prohibited substance (s.7). Section 2(2)(b)(ii) of the CDSA specifies that


(b) a reference to a controlled substance includes a reference to

(ii) anything that contains or has on it a controlled substance and that is used or intended or designed for use

(A) in producing the substance, or

(B) in introducing the substance into a human body

Of concern to employees of SIFs would be the offences related to possession and trafficking. For the purposes of the CDSA, the definition of ‘possession’ is that found in section 4(3) of the Criminal Code:


(a) a person has anything in “possession” when he has it in his personal possession or knowingly

(i) has it in the actual possession or custody of another person, or

(ii) has it in any place, whether or not that place belongs to or is occupied by him, for the use or benefit of himself or of another person; and

(b) where one of two or more persons, with the knowledge and consent of the rest, has anything in his custody or possession, it shall be deemed to be in the custody and possession of each and all of them.

Subsection (a)(i) & (ii) describes what is referred to as ‘constructive’ possession and subsection (b) refers to ‘joint’ possession. Although it is extremely unlikely staff of SIFs would be guilty of personal possession, given the broad definition of possession it appears they could still be held criminally liable for possession of prohibited substances. However, a conviction for constructive or joint possession would depend on proof that the staff had a measure of control over the drugs. As long as clients of SIFs were responsible for obtaining, holding and administering their drugs without staff involvement then it is unlikely that staff would be found to have the necessary control. Although staff could also technically be charged with possession of certain drug paraphernalia such as syringes, this is extremely unlikely. Needle exchange programs across Canada are operating with impunity and there is no reason to believe SIFs would be any different in that regard.


Staff of SIFs might also be exposed to a charge of trafficking. Trafficking is defined in section 2(1) of the CDSA as selling, administering, giving, transferring, transporting, sending or delivering a prohibited substance. It also includes offering to do any of those things. Because staff would be providing equipment such as syringes they could be considered as administering the substance. However, as above, this would contradict the current enforcement standard regarding syringes. As long as strict guidelines are adhered to by staff, and they are merely observers, intervening only in emergencies, then trafficking charges should not arise.


In some situations staff of SIFs might also be open to charges of criminal negligence causing bodily harm or death. These offences are set out in sections 219-221 in the Criminal Code. In order to establish this offence the crown must prove the accused did or failed to do something they had a legal duty to do. It also must be shown that the accused showed “wanton or reckless disregard for the lives or safety of other persons”. However, case law suggests that for criminal negligence to apply the accused’s conduct must demonstrate a marked departure from the standard of behaviour expected of a reasonably prudent person in the circumstances.18 Standards of practice for SIFs are well established in all the European facilities. Though no SIF yet exists in Canada, standards of practice established in various health care services would be comparable to those required in a SIF. Some examples include needle exchange programs, the Street Nurse program in Vancouver, and hospital emergency rooms. Together, these various standards would define the standard of behaviour of a reasonably prudent person in the context of providing health services to IDUs.


A SIF or employee might also be vulnerable to civil action. If the facility allows the possession and use of illegal drugs and a patient suffers some harm, for example by overdosing, the facility might be liable for negligent care of the patient. The same would hold true if a patient harmed another patient using those drugs. However, to avoid both criminal and civil liability a facility or individual could claim the defence of necessity of treatment. The claim would be “…that allowing the use of illegal drugs was a necessity for the treatment of the patient and/or that, in the circumstances, it would be negligent to prohibit possession of a controlled substance by a patient, as this might interfere with essential medical treatment”.19 Supporting this defence is all the compelling evidence showing the benefits and reductions in harm associated with SIFs. Such evidence suggests that IDUs are at much greater risk of harm when injecting outside of SIFs as compared to inside them.


Furthermore, with regard to criminal liability, the Crown has the discretion whether or not to lay a charge. Current enforcement standards involving health care services operating in a “gray” area of the law, such as needle exchanges,20 suggest the same standard would apply to SIFs. Public funding of SIFs and the lack of moral blameworthiness on the part of staff working to reduce harm to IDUs are two other reasons why the Crown is unlikely to lay criminal charges. The exception might be in those rare situations where an employee caused harm by failing to meet the required standard of behaviour of the reasonable person in similar circumstances.

EXEMPTIONS AVAILABLE UNDER THE CDSA


Section 55(1)(a) of the CDSA permits the Governor in Council to make regulations respecting the circumstances in which controlled substances may be imported, exported, produced, packaged, sent, transported, delivered, sold provided, administered, possessed, obtained or otherwise dealt in. Section 55(1)(b) allows the identification of persons or classes of persons who may be authorized to conduct these activities. Section 56 of the CDSA allows the Minister of Health to
…exempt any person or class of persons or any controlled substance or precursor or any class thereof from the application of all or any of the provisions of this Act or the regulations if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest.

The Minister’s power to exempt is extremely broad. It is almost unfettered discretion to make such an exemption based merely on his or her opinion. Even if the Minister does not accept that SIFs constitute a medical purpose, SIFs could still be exempted as serving the public interest. These two provisions could be applied to SIFs, their staff and clients thereby protecting them from criminal charges.


HUMAN RIGHTS LEGISLATION: THE DUTY TO ACCOMMODATE

In considering whether there is a foundation for taking legal action against the provincial government for failing to establish SIFs, I start with a look at human rights legislation. The B.C. Human Rights Code21 provides that


8(1) A person must not, without a bona fide and reasonable justification

(a) deny to a person or class of persons any accommodation, service or facility customarily available to the public, or

(b) discriminate against a person or class of persons any accommodation, service or facility customarily available to the public

because of the race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex or sexual orientation of that person or class of persons.

The Canadian Human Rights Act,22 in section 3, also includes disability as a prohibited ground of discrimination. Section 25 of that Act defines ‘disability’ as including a “previous or existing dependence on alcohol or a drug”. Canadian courts have also, on several occasions, characterized drug dependency as a disability.23 For example, in R. v. Nguyen, Ryan J.A. quoted with approval a description of the “…sub-class of people who, by falling prey to heroin addiction, become effectively disabled from functioning as useful, self-supporting, productive members of society”.24


In saying that drug addicts, as disabled persons, are being discriminated against because SIFs are not available, the argument is that they are being denied reasonable access to quality health care services, something customarily available to the public. Due to the nature of their disability, drug addicts, as documented above, have difficulty accessing health care services. However, SIFs in other jurisdictions have proven highly effective in connecting drug addicts to essential health services that meet their particular needs and successfully reduce the rates of disease transmission and death by overdose. Does this mean, then, that the provincial government has a duty to accommodate the medical needs of IDUs by providing SIFs?


The B.C. Medicare Protection Act25 echoes the Canada Health Act26 by stating in the preamble an intention to “confirm and entrench universality, comprehensiveness, accessibility, portability and public administration as the guiding principles of the health care system”. Section 3 of that Act ensures “reasonable access…to quality medical care, health care and diagnostic services” to everyone in B.C., with no financial or other barriers. B.C.’s Health Act27 goes further and imposes a duty on the Minister of Health to do the following:


7(1)(a) take account of the interests of health and life among the people of B.C.,

(b) especially study the vital statistics of B.C.,

(c) endeavour to make an intelligent and profitable use of the collected records of death and sickness among the people,

(d) make sanitary investigations and inquiries about the cause of disease, and especially of an epidemic,

(e) inquire into the causes of varying rates of mortality and the effect of locality, employment and other circumstances on health,

(f) make suggestions as to the prevention and interception of contagious and infectious diseases the minister believes most effective and proper, and as will tend to prevent and limit as far as possible the rise and spread of disease…


There is a positive duty on the Minister beyond merely suggesting an opinion as to what the “most effective and proper” interventions are. The Minister is required to make studies, investigations and inquiries into the causes of epidemics such as are occurring in the Vancouver region. The Minister must also “endeavour [that is, make an earnest attempt] to make an intelligent and profitable use of” those investigations, inquiries and studies. The evidence to date overwhelmingly points to the fact that SIFs, especially as part of a comprehensive harm reduction program “will tend to prevent and limit as far as possible the rise and spread of disease”. There is strong support, therefore, for the proposition that the government must accommodate the special health needs of drug addicts, as disabled persons, not only to ensure their access to required health services, but also to prevent and control contagious diseases.


Accommodation means changing a rule or a practice, making adjustments or making alternative arrangements to remove the discriminatory effects on an individual or a group. SIFs would be an alternative arrangement allowing IDUs to access essential health services that, because of their disability, they have been unable to access. Of course, the government could defend against a claim of discrimination, but it would have to demonstrate that a complainant or a group of complainants could not be accommodated without undue hardship.


In a recent decision, British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U.,28 also known as Meiorin, the Supreme Court of Canada clarified the law regarding the duty to accommodate. The result of that decision was to make the distinction between direct discrimination and adverse effect discrimination irrelevant, and to make the duty to accommodate to the point of undue hardship a key element of any defence to a claim of discrimination. Shortly after the Meiorin decision the same court, in British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights),29 also known as Grismer, reaffirmed its new test in Meiorin and applied it to the provision of services. In the new three-part test…the defendant must prove that:

(1) it adopted the standard for a purpose or goal
that is rationally connected to the function
being performed;

(2) it adopted the standard in good faith, in the
belief that it is necessary for the
fulfillment of the purpose or goal; and

(3) the standard is reasonably necessary to
accomplish its purpose or goal in the sense
that the defendant cannot accommodate persons
with the characteristics of the claimant
without incurring undue hardship.30

In Grismer the Court held that the Superintendent of Motor Vehicles discriminated against Mr. Grismer by refusing licenses to all people with his particular optical disorder. The Superintendent was under a duty to accommodate Mr. Grismer by allowing him to be tested individually. Another example of accommodating disabled persons with regard to the provision of a service is in Chipperfield v. British Columbia (Ministry of Social Services).31 In that case the Ministry of Social Services had a duty to provide a transportation subsidy to persons receiving social assistance who have disabilities which prevent them from using public transit. The subsidy must be equivalent to the transportation subsidy provided to those who can use public transit.


There is a limit to the obligation to accommodate, that is, if it creates undue hardship on the service provider. This implies that some hardship is acceptable, but what constitutes undue hardship is a question of fact and will vary with the circumstances. There is no exhaustive list of factors, but in the context of SIFs two factors that a government resisting the establishment of SIFs might raise, other than the legal objections answered above, are safety and cost. However, it is difficult to imagine convincing arguments that SIFs would pose a safety risk to either employees or clients, or that the cost of funding SIFs would impose undue hardship on the government.


First of all, the very nature of SIFs is to promote safety, for both IDUs and the general public. The staff in SIFs would be at no greater risk than those in similar medical clinics and services. The evidence supports the contention that SIFs dramatically reduce harm. To oppose SIFs is, in essence, to prefer the current unsafe practices of injection drug use and all the serious, negative consequences that fall from that. Secondly, regarding costs, the government will actually save money in the long run by establishing SIFs. The Rand Institute in the U.S.A. has conducted numerous studies for several years on drug control policy. “A 1994 study commissioned by the U.S. office of National Drug Control Policy found that treatment is 10 times more cost effective than interdiction in reducing the use of cocaine in the United States. The same study found that every additional dollar invested in substance abuse treatment saves taxpayers $7.46 in societal costs and that additional domestic law enforcement efforts cost 15 times as much as treatment to achieve the same reduction in societal costs”.32 There is no reason to believe those figures would be substantially different in Canada. From a fiscal, as well as a public health policy point of view, it makes perfect sense for the B.C. government to fulfill its obligation to accommodate IDUs by establishing SIFs.

CONSTITUTIONAL ISSUES – SECTIONS 7 AND 15 OF THE CHARTER


A) SECTION 7


Any legal action taken to compel the government to establish SIFs should include constitutional arguments based on the right to security of the person and equality found in sections 7 and 15 respectively of the Canadian Charter of Rights and Freedoms. Section 7 provides that
Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.


It may be that the provincial government is depriving IDUs of their constitutional rights by not establishing health care facilities, such as SIFs, that provide medically necessary services vital to the security of their person. In arguing this position the challenge would not be to any statute, but to government inaction in the face of a legislated duty to act. It is unlikely a challenge to the laws themselves, that is, those laws that stand in the way of establishing SIFs, would be successful. For one thing, there are valid defences to those laws. There is also the exemption in section 56 of the CDSA, even though that exemption is rarely given. By not exempting SIFs from application of the law the government is effectively denying IDUs their right to security of the person in the form of necessary medical services.


There have been successful section 7 challenges to government decisions to deny services. In New Brunswick (Minister of Health & Community Services) v. G.J.,33 the Supreme Court of Canada found that the provincial government had deprived the appellant of her right to security of the person by denying her legal aid in a complex child custody case. Lamer C.J. for the majority said:
the subject matter of s.7 is the state’s conduct in the course of enforcing and securing compliance with the law, where the state’s conduct deprives an individual of his or her right to life, liberty or security of the person. I hasten to add, however, that s.7 is not limited solely to purely criminal or penal matters.34


In R. v. Morgentaler, Beetz J. stated:


“Security of the person” must include a right of access to medical treatment for a condition representing a danger to life or health without fear of criminal sanction.35

In Rodriguez v. British Columbia (A.G.), Sopinka J., speaking for the majority said


There is no question, then, that personal autonomy, at least with respect to the right to make choices concerning one’s own body, control over one’s physical and psychological integrity, and basic human dignity are encompassed within security of the person, at least to the extent of freedom from criminal prohibitions which interfere with these.36


In R. v. Parker, a case involving the use of a prohibited substance, marijuana, for medical purposes, Rosenburg J.A., relying on the decisions in Morgentaler and Rodriguez, concluded


that deprivation by means of a criminal sanction of access to medication reasonably required for the treatment of a medical condition that threatens life or health constitutes a deprivation of the security of the person…. Depriving a patient of medication in such circumstances, through a criminal sanction, also constitutes a serious interference with both physical and psychological integrity.37


The criminal sanctions that prevent the establishment of SIFs deprive IDUs, whose medical condition represents a danger to their life or health, access to appropriate medical services. The sanctions also interfere with their psychological integrity and basic human dignity by denying them a clean, safe environment staffed with medically trained personnel in which they can self-administer treatment for their illness of addiction.38 Therefore, IDUs are being deprived of their right to security of the person by not having available medical services, in the form of SIFs, that are reasonably required for their medical condition. However, the criminal sanctions standing in the way of SIFs can easily be avoided if the Minister of Health simply exempts them from application of the law as being “necessary for a medical purpose or…in the public interest” under section 56 of the CDSA. If the government chooses not to establish SIFs then its action, or lack thereof, can be said to deprive IDUs of their right to security of the person.


If a court finds that the section 7 right to security of the person is violated it is unlikely the government’s position can by saved by section 1 of the Charter. It is rare that a violation of the principles of fundamental justice will be upheld as a “reasonable limit prescribed by law as can be demonstrably justified in a free and democratic society”. The government could argue that its decision not to set-up SIFs was prescribed by law, that the objective of the policy was pressing and substantial (for example, budgetary concerns), that the decision was rationally connected to the objectives and that it constituted a minimal impairment of section 7. However, despite, these arguments, it is likely a court would find that the deleterious effects of the decision, namely denying necessary medical treatment to control epidemics of disease and overdoses, far out-weigh any salutary effects such as potential budgetary savings. While a section 7 challenge is certainly possible, an even stronger challenge with more likelihood of success is a section 15 argument that IDUs are denied their equality rights.


B) SECTION 15


Section 15(1) of the Charter provides that
Every individual is equal before and under the law the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.


Government failure to make reasonable accommodation for disabled persons amounts to discrimination against them. Sopinka J. for the Supreme Court of Canada, in Eaton v. County Board of Education, stated
…discrimination does not lie on the attribution of untrue characteristics to the disabled individual. … Rather, it is the failure to make reasonable accommodation, to fine-tune society so that its structures and assumptions do not result in the relegation and banishment of disabled persons from participation which results in discrimination against them.39

I have already established above that drug addiction amounts to a disability in Canadian law, so failure to accommodate IDUs special health care needs by providing SIFs is arguably discrimination.


In Law v. Canada (Minister of Employment and Immigration), Iacobucci J. articulated what was, in his view, the proper approach to analyzing a claim of discrimination under section 15:


First, does the impugned law (a) draw a formal distinction between the claimant and others on the basis of one or more personal characteristics, or (b) fail to take into account the claimant’s already disadvantaged position within Canadian society resulting in substantively different treatment between the claimant and others on the basis of one or more personal characteristics? If so, there is differential treatment for the purpose of s.15(1). Second, was the claimant subject to differential treatment on the basis of one or more of the enumerated or analogous grounds? And third, does the differential treatment discriminate in a substantive sense, bringing into play the purpose of s.15(1) of the Charter in remedying such ills as prejudice, stereotyping and historical disadvantage? The second and third inquiries are concerned with whether the differential treatment constitutes discrimination in the substantive sense intended by s.15(1).


The Supreme Court of Canada applied that approach in a subsequent case involving a claim of discrimination based on temporary disability.40 In Granovsky v. Canada (Minister of Employment and Immigration, Binnie J. stated:
The true focus of the s.15(1) disability analysis is not on the impairment as such, nor even any associated functional limitations, but is on the problematic response of the state to either or both of these circumstances. It is the state action that stigmatizes the impairment, or which attributes false or exaggerated importance to the functional limitations (if any), or which fails to take into account the “large remedial component” (Andrews v.Law Society of B.C. , [1989] 1 S.C.R. 143, at p.171) or “ameliorative purpose” of s.15(1) (Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at para 66; Law v. Canada, [1999] 1 S.C.R. 497, at para 72; Eldridge v. British Columbia (A.G.), [1997] 3 S.C.R. 624, at para 65) that creates the legally relevant human rights dimension to what might otherwise be a straightforward biomedical condition.41

Binnie J., at paragraph 80, reiterates the emphasis on the state’s response to the disability:
The “purposive” interpretation of s.15 puts the focus squarely on the third aspect of disabilities, namely on the state’s response to an individual’s physical or mental impairment. If the state’s response were, intentionally or through effects produced by oversight, to stigmatize the underlying physical or mental impairment, or to attribute functional limitations to the appellant that his underlying physical or mental impairment did not warrant, or to fail to recognize the added burdens which persons with temporary disabilities may encounter in achieving self-fulfillment, or otherwise to misuse the impairment or its consequences in a discriminatory fashion that engages the purpose of s.15, an infringement of equality rights would be established. (emphasis added)


In the case of SIFs the government, by “oversight”, has failed to adequately respond to the health crisis affecting IDUs. This lack of response further stigmatizes IDUs, who are already one of the most marginalized groups in society, and who are, in essence, criminalized as a result of their disease. This failure to respond to the crisis by establishing SIFs is also a failure “to recognize the added burdens” IDUs face in accessing the health care system. The failure to accommodate the health care needs of IDUs perpetuates the view that they are somehow less worthy of health care services than other Canadians. SIFs are one of the only approaches to the epidemics facing IDUs that have shown to effectively provide them access to the health care system. They are an alternative arrangement that would effectively accommodate the health care needs of IDUs as disabled persons.


Case law suggests that where discrimination based on an enumerated ground in s.15(1) is made out, government can be required to take positive action to remedy the problem. In Eaton, Sopinka J. stated that
…the purpose of s.15(1) of the Charter is not only to prevent discrimination by the attribution of stereotypical characteristics to individuals, but also to ameliorate the position of groups within Canadian society who have suffered disadvantage by exclusion from mainstream society as has been the case with disabled persons.42

In Eldridge v. British Columbia43 the Supreme Court of Canada held that the failure of provincial health authorities to provide funding for sign language interpreters for the deaf violated s.15(1). In that case the appellants sought and won equal access to health care services that are available to everyone. The government was required to provide interpreters for that purpose. A case involving IDUs would also claim the right to equal and effective access to health care services, but that purpose would be achieved through SIFs as opposed to interpreters.


Another helpful case is Auton (Guardian ad litem of) v. British Columbia (A.G.). Alan J. applied Eldridge and found that

[t]he petitioners are the victims of the government’s failure to accommodate them by failing to provide treatment to ameliorate their mental disability. That failure constitutes direct discrimination. Further, the petitioner’s disadvantaged position stems from the government’s failure to provide effective health treatment to them, not from the fact that their autistic condition is characterized, in part, by an inability to communicate effectively or at all.44

The petitioner’s in that case forced the government to provide funding for effective early treatment of autistic children. This decision goes further than Eldridge in the sense that the government was forced to fund an entirely different system of treatment as opposed to merely providing access to an existing system.


Accommodating IDUs by establishing SIFs would go a long way to ameliorating the dreadful conditions they face. SIFs would drastically reduce the prevalence and transmission rates of communicable diseases among IDUs. They would also greatly reduce the unconscionably high fatal overdose rates. SIFs would not only save lives and improve the physical health of IDUs, but they would also contribute to their mental health and social well-being by connecting them to an array of social services.


As for a section 1 analysis if it is found that a failure to accommodate IDUs with SIFs is an infringement of their section 15 right, it appears from Eldridge that such an analysis may not be necessary. In that case La Forest J. did not go through the steps of the Oakes45 test. Instead, he found that the decision not to fund medical interpretation services for the deaf did not constitute a minimum impairment of their section 15(1) right. Having decided that, it wasn’t necessary to go through the elements of the Oakes test. At paragraph 94 he stated:
…I am of the view that the failure to fund sign language interpretation is not a "minimal impairment" of the s. 15(1) rights of deaf persons to equal benefit of the law without discrimination on the basis of their physical disability. The evidence clearly demonstrates that, as a class, deaf persons receive medical services that are inferior to those received by the hearing population. Given the central place of good health in the quality of life of all persons in our society, the provision of substandard medical services to the deaf necessarily diminishes the overall quality of their lives. The government has simply not demonstrated that this unpropitious state of affairs must be tolerated in order to achieve the objective of limiting health care expenditures. Stated differently, the government has not made a "reasonable accommodation" of the appellants' disability. In the language of this Courts' human rights jurisprudence, it has not accommodated the appellants' needs to the point of "undue hardship”….

If a court finds that by not establishing SIFs the government is failing to reasonably accommodate disabled persons under s.15(1) then such discrimination could not meet the minimal impairment test and thus could not be saved by section 1.

CONCLUSION


There is no doubt that a health crisis of epidemic proportions has existed for several years among injection drug users in the Vancouver region. The provincial government has not taken effective measures to control the spread of disease or reduce the death rate associated with injection drug use. Evidence demonstrates that SIFs are effective at doing both. The government is discriminating against IDUs by not providing them with effective access to essential health care in the form of SIFs.


The litigative strategy most likely to succeed in compelling the government to establish SIFs would proceed on two fronts: under human rights legislation and by constitutional challenge under sections 7 and 15 of the Canadian Charter of Rights and Freedoms. Under human rights legislation the basic argument is that the government has a duty to accommodate IDUs as disabled persons by establishing SIFs and thereby removing the discriminatory effect of lack of access to necessary medical services. A section 7 challenge will argue that IDUs are deprived of their right to security of the person by not having access to necessary medical services in the form of SIFs. The section 15 argument is essentially the same as the human rights argument. The government failure to make reasonable accommodations for IDUs, as disabled persons, amounts to discrimination and is a violation of their Charter rights. The evidence and arguments set forth in this paper demonstrate that there is a strong case for compelling the government to establish and fund SIFs.

ENDNOTES:

1 Canadian National Task Force on HIV, AIDS and Injection Drug Use, “HIV/AIDS and Injection Drug Use: A National Action Plan (1997)”, at 3-4, online: www.cfdp.ca/hivaids.html.

2 Penny Parry, “Something to Eat, A Place to Sleep and Someone Who Gives a Damn”, HIV/AIDS and Injection Drug Use in the DTES, Final project report to the DTES Community, Minister of Health and V/RHB, 1997.

3 Supra note 1, at 5; Fischer, B., Rehn, J., Blitz-Miller, T., (2000), “Injection Drug Use and Preventive Measures: A Comparison of Canadian and Western European Jurisdictions Over Time”, Canadian Medical Association Journal, 162(12), 1709-1713.

4 Canada Communicable Disease Report, “Hepatitis C – Prevention and Control: A Public Health Consensus”, Vol. 2552 (Supplement, June 1999; online: www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/99vol25/25s2/index.html.

5 Thomas Kerr, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver: Harm Reduction Action Society, 2000) at 3 [citing the Vancouver Injection Drug Users Study (VIDUS), 1998 report]

6 Selected Vital Statistics and Health Status Indicators, 1996-2000: Drug induced deaths by age and gender. Victoria: British Columbia Vital Statistics Agency.

7 Supra note 5, at 23.

8 Ministry for Children and Families. (1998) Report on the Status of the Implementation of the Recommendations of: The Review of Alcohol and Drug Services in Vancouver.

9 Martin Schechter, et al, “Do Needle Exchange Programmes Increase the Spread of HIV Among Injection Drug Users?: An investigation of the Vancouver Outbreak”. AIDS, 1999, 13:F45-F51, at F50.

10 Ministry for Children and Families. Addiction Services: Our Mission and Mandate. (Victoria: Ministry of Children and Families, September 2000) at 1.

11 www.healthservices.gov.bc.ca/addictions/programsandservices.html. Last revised September 20, 2001.

12 Supra note 8.

13 Supra note 3, Fischer et al.

14 Kate Nolan et al., “Drug Consumption Facilities in Europe and the Establishment of Supervised Injecting Centres in Australia”, (2000) 19 Drug and Alcohol Review, 337 at 338-340.

15 For a description of SIF models see Kerr, supra note 5, at 29-30 and Appendix 1.

16 Kerr, supra note 5, at 32-35; Lindesmith Centre, Research Summary: Safe Injection Rooms, (1999) online: www.lindesmith.org/cites_sources/brief17.html ; Lindemsith Centre, Research Brief: Safer Injection Rooms, (1999) online: www.lindesmith.org/cites_sources/cites.html.

17 Supra note 14, at 340-341.

18 R. v. Anderson (1990), 53 CCC (3d) 481 (SCC); R. v. Waite (1989), 69 CR (3d) 323 (SCC); R. v. Tutton (1989), 69 CR (3d) 289 (SCC); R. v. Barron (1985), 23 CCC (3d) 544 (Ont. CA); R. v. Nelson (1990), 54 CCC (3d) 285 (Ont. CA); R. v. Gingrich (1991), 65 CCC (3d) 188 (Ont. CA); R. v. Ubhi (1994), 27 CR (4th) 332 (BCCA).

19 Ralph Jurgens & Richard Elliot, eds., Injection Drug Use and HIV/AIDS: Legal and Ethical Issues (Montreal: Canadian HIV/AIDS Legal Network, 1999).

20 The B.C. Compassion Club Society and its 1700 members are also technically violating the law, but the Vancouver Police Department and the Crown have exercised their discretion by not arresting members or laying charges.

21 Human Rights Code, R.S.B.C. 1996, C.210 proclaimed in force 1997.

22 Canadian Human Rights Act, R.S.C. 1985, C. H-6.

23 Entrop v. Imperial Oil Ltd., [2000] O.J. 2689 (Ont. CA), 50 O.R. (3d) 18, at para 89; Toronto Dominion Bank v. Human Rights Commission (1998), 163 D.D.R. (4th) 193 (FCA) at paras 1,15,16 of majority decision.

24 R. v. Nguyen (1995), 56 B.C.A.C. 290, at para 13, citing Oliver J. in R. v. Ping Li (unreported, November 19, 1993) Vancouver Registry No. CC930521.

25 Medicare Protection Act, R.S.B.C. 1996 c.286.

26 Canada Health Act, R.S.C. 1985, c. C-6.

27 Health Act, R.S.B.C. 1996 C.179.

28 British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U. (1999), 35 C.H.R.R. D/257.

29 British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights) (1999), 36 C.H.R.R. D/129.

30 Ibid. at D/136, para 20.

31 Chipperfield v. British Columbia (Ministry of Social Services) (No.3) (1998), 33 C.H.R.R. D/340 (B.C.H.R.T.).

32 The Lindesmith Centre-Drug Policy Foundation, online: www.soros.org/lindesmith/news/DailyNews/06_29_01RAND2.html, cited December 10, 2001.

33 New Brunswick (Minister of Health & Community Services) v. G.J., [1999] 3 S.C.R. 46.

34 Ibid. at para 65.

35 R. v. Morgentaler,[1988] 1 S.C.R. 30, at para 90.

36 Rodriguez v. British Columbia (A.G.), [1993] 3 S.C.R. 519, at 587-88.

37 R. v. Parker, [2000] O.J. No. 2787 (Ont. CA), at para 97.

38 It could be argued that feeding an addiction is not the same as treating it. Nevertheless, it is a form of treatment since addicts become violently ill if they do not receive the drug, and the only way to receive the drug is to administer it themselves. Obviously, one goal of a SIF is to ultimately wean an addict from his dependency, but whether or not that goal is achieved the SIF still provides a medically necessary service.

39 Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at para 67.

40 Whether drug addiction is characterized as a temporary or immutable disability the same analysis would apply.

41 Granovsky v. Canada (Minister of Employment and Immigration), [2000] 1 S.C.R. 703, at para 26.

42 Supra note 51, at para 66.

43 Eldridge v. British Columbia, [1997] 3 S.C.R. 624.

44 Auton (Guardian ad litem of) v. British Columbia (A.G.) (2000), 78 B.C.L.R. (3d) 55 (Auton #2).

45 R. v. Oakes, [1986] 1 S.C.R. 103.


BIBLIOGRAPHY

LEGISLATION

Canada Health Act, R.S.C. 1985, c. C-6.

Canadian Charter of Rights and Freedoms, Constitution Act, 1982.

Canadian Human Rights Act, R.S.C. 1985, C. H-6.

Controlled Drugs and Substances Act, R.S.C. 1996, c.19.

Criminal Code, R.S.C. 1985, c.46.

Health Act, R.S.B.C. 1996, c.179.

Human Rights Code, R.S.B.C. 1996, C.210.

Medicare Protection Act, R.S.B.C. 1996, c.286.

JURISPRUDENCE

Auton (Guardian ad litem of) v. British Columbia (A.G.) (2000), 78 B.C.L.R. (3d) 55 (Auton #2).

British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U. (1999), 35 C.H.R.R. D/257.

British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights) (1999), 36 C.H.R.R. D/129.

Chipperfield v. British Columbia (Ministry of Social Services) (No.3) (1998), 33 C.H.R.R. D/340 (B.C.H.R.T.).

Eaton v. County Board of Education, [1997] 1 S.C.R. 241.

Eldridge v. British Columbia, [1997] 3 S.C.R. 624.

Entrop v. Imperial Oil Ltd., [2000] O.J. 2689 (Ont. CA), 50 O.R. (3d) 18.

Granovsky v. Canada (Minister of Employment and Immigration), [2000] 1 S.C.R. 703.

New Brunswick (Minister of Health & Community Services) v. G.J., [1999] 3 S.C.R. 46.

Rodriguez v. British Columbia (A.G.), [1993] 3 S.C.R. 519.

R. v. Anderson (1990), 53 CCC (3d) 481 (SCC).

R. v. Barron (1985), 23 CCC (3d) 544 (Ont. CA).

R. v. Gingrich (1991), 65 CCC (3d) 188 (Ont. CA).

R. v. Morgentaler,[1988] 1 S.C.R. 30.

R. v. Nelson (1990), 54 CCC (3d) 285 (Ont. CA).

R. v. Oakes, [1986] 1 S.C.R. 103.

R. v. Parker, [2000] O.J. No. 2787 (Ont. CA).

R. v. Tutton (1989), 69 CR (3d) 289 (SCC).

R. v. Ubhi (1994), 27 CR (4th) 332 (BCCA).

R. v. Waite (1989), 69 CR (3d) 323 (SCC).

R. v. Nguyen (1995), 56 B.C.A.C. 290, at para 13, citing Oliver J. in R. v. Ping Li (unreported, November 19, 1993) Vancouver Registry No. CC930521.

Toronto Dominion Bank v. Human Rights Commission (1998), 163 D.D.R. (4th) 193 (FCA).


SECONDARY MATERIAL: ARTICLES, MONOGRAPHS, REPORTS

Canada Communicable Disease Report, “Hepatitis C – Prevention and Control: A Public Health Consensus”, Vol. 2552 (Supplement, June 1999; online: www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/99vol25/25s2/index.html.

Canadian National Task Force on HIV, AIDS and Injection Drug Use, “HIV/AIDS and Injection Drug Use: A National Action Plan (1997)”, at 3-4, online: www.cfdp.ca/hivaids.html.

Fischer, B., Rehn, J., Blitz-Miller, T., (2000), “Injection Drug Use and Preventive Measures: A Comparison of Canadian and Western European Jurisdictions Over Time”, Canadian Medical Association Journal, 162(12), 1709-1713.

Jurgens, R. & Elliot, R. eds., Injection Drug Use and HIV/AIDS: Legal and Ethical Issues (Montreal: Canadian HIV/AIDS Legal Network, 1999).

Kate Nolan et al., “Drug Consumption Facilities in Europe and the Establishment of Supervised Injecting Centres in Australia”, (2000) 19 Drug and Alcohol Review, 337.

Kerr, Thomas, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver: Harm Reduction Action Society, 2000)

Lindesmith Centre, Research Summary: Safe Injection Rooms, (1999) online: www.lindesmith.org/cites_sources/brief17.html

Lindemsith Centre, Research Brief: Safer Injection Rooms, (1999) online: www.lindesmith.org/cites_sources/cites.html.

Lindesmith Centre-Drug Policy Foundation, online: www.soros.org/lindesmith/news/DailyNews/06_29_01RAND2.html, cited December 10, 2001.

Martin Schechter, et al, “Do Needle Exchange Programmes Increase the Spread of HIV Among Injection Drug Users?: An investigation of the Vancouver Outbreak”. AIDS, 1999, 13:F45-F51.

Ministry for Children and Families. (1998) Report on the Status of the Implementation of the Recommendations of: The Review of Alcohol and Drug Services in Vancouver.

Ministry for Children and Families. Addiction Services: Our Mission and Mandate. (Victoria: Ministry of Children and Families, September 2000) at 1.
www.healthservices.gov.bc.ca/addictions/programsandservices.html. Last revised September 20, 2001.

Parry, Penny “Something to Eat, A Place to Sleep and Someone Who Gives a Damn”, HIV/AIDS and Injection Drug Use in the DTES, Final project report to the DTES Community, Minister of Health and V/RHB, 1997.

Selected Vital Statistics and Health Status Indicators, 1996-2000: Drug induced deaths by age and gender. Victoria: British Columbia Vital Statistics Agency.


196 comments:

  1. UPDATE OCTOBER 19, 2009:

    http://www.cbc.ca/m/touch/technology/story/1.841419

    CBC News reports on a new study that suggests that crack cocaine users are at increased risk of being infected with HIV and that safe smoking rooms could reduce that risk. Read the study at:

    Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs
    http://www.cmaj.ca/content/181/9/585.full

    For a commentary on the study, which was published in the Canadian Medical Association Journal, see:

    The changing landscape of crack cocaine use and HIV infection
    http://www.cmaj.ca/content/181/9/571.full

    ReplyDelete
  2. UPDATE JANUARY 15, 2010:

    CBC NEWS - B.C. court affirms injection site's right to exist

    The B.C. Court of Appeal has dismissed an attempt by the federal government to shut down Vancouver's supervised injection site on the city's troubled Downtown Eastside.

    The federal government appealed a previous B.C. Supreme Court ruling in favour of Insite, and on Friday morning in Vancouver, the B.C. Appeal Court confirmed the injection site's constitutional right to exist.

    Read more at:

    http://www.cbc.ca/canada/british-columbia/story/2010/01/15/bc-court-ruling-safe-injection-site-vancouver.html

    ReplyDelete
  3. UPDATE FEBRUARY 9, 2010

    CBC News - Ottawa to appeal injection site ruling

    The federal government is asking the Supreme Court of Canada for leave to appeal a lower court ruling that sanctioned Vancouver's supervised drug injection site.

    The case has raised important questions about the division of powers among federal and provincial governments that need answers, said Justice Minister Rob Nicholson on Parliament Hill Tuesday.

    Read more at:

    http://www.cbc.ca/canada/british-columbia/story/2010/02/09/bc-supreme-court-appeal-supervised-injection-site.html

    ReplyDelete
  4. UPDATE JUNE 7, 2010

    A new study published in the Lancet medical journal on May 29, 2010 has come to the following conclusion:

    "Treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts."

    A pdf of the study is available at:

    http://press.thelancet.com/riott.pdf Two news reports on the study are here and here.

    ReplyDelete
  5. UPDATE JUNE 24, 2010

    CBC News - Supreme Court to hear injection site appeal

    Canada's top court has announced it will hear the federal government's appeal in relation to Vancouver's supervised drug-injection site.

    http://www.cbc.ca/canada/british-columbia/story/2010/06/24/bc-supervised-injection-site-appeal.html

    UPDATE AUGUST 30, 2010

    CBC News - CMA Journal article backs drug injection site

    An article in the Canadian Medical Association Journal slams the federal government for its efforts to shut down Insite in downtown Vancouver, Canada's only safe injection site for drug addicts.

    A co-author of the paper has told CBC News he believes the federal government should stand aside, allow the centre to operate, and abandon an appeal to the Supreme Court

    "We've concluded after reviewing the evidence that Insite is doing what it's supposed to be doing, and furthermore that we're very concerned that the federal government has misled on the science," said Dr. Michael Rachlis, a professor of health policy at the University of Toronto.

    Read more at: http://www.cbc.ca/canada/british-columbia/story/2010/08/30/con-insite-cmaj.html

    ReplyDelete
  6. UPDATE APRIL 17, 2011

    CBC News - Vancouver injection clinic cuts overdose deaths: journal

    Overdose deaths in Vancouver's troubled Downtown Eastside have dropped by more than a third since the creation of Insite, the neighbourhood's supervised injection clinic, according to a study in the British medical journal The Lancet.
    see summary at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext

    The Lancet commentary accompanying the new study notes the issue is "politically fraught," adding supervised injection facilities "should be expanded to other affected sites in Canada, based on the life-saving impacts identified in Vancouver."
    read more at: http://www.cbc.ca/news/canada/british-columbia/story/2011/04/17/insite-lancet-study.html

    UPDATE MAY 10, 2011

    The Tyee - Band of mayors petition feds on fate of Insite

    Vancouver mayor Gregor Robertson and five of his predecessors called on the federal government today to reconsider its opposition to the Insite safe injection facility.

    Eleven other groups that filed for intervener status will also make arguments tomorrow. The BC Nurses Union is among them. The union issued a press release Monday declaring its support.

    "It is simply disgraceful that the federal government continues to try and outlaw this legitimate healthcare service and in the process attempt to make criminals out of nurses who are saving lives and providing quality care to this vulnerable population," said union vice president Janice Buchanan.

    Other intervening parties that support Insite include the BC Civil Liberties Association, the Canadian Medical Association and the Dr. Peter AIDS Foundation

    UPDATE JULY 31, 2011

    CBC News - Free crack pipes to be handed out in Vancouver

    Health officials in Vancouver say they will launch a pilot project later this year to distribute clean, unused crack pipes to drug users. ... It's part of the city's harm-reduction strategy that seeks to reduce the transmission of disease while ensuring health-care and social workers are able to interact with hard-to-reach drug addicts. ... The calls for free crack pipes comes as advocates in Vancouver also push for a safe-inhalation site, where crack users could smoke the drug in the presence of health-care workers, who would respond to overdoses. Any decision on such a site will likely have to wait until the Supreme Court of Canada rules on the future of the city's safe-injection site, known as Insite. http://www.cbc.ca/news/canada/story/2011/07/31/bc-crackpipes.html

    CBC News - UPDATE September 30, 2011

    Vancouver's Insite drug injection clinic will stay open.
    Top court rules on clinic's exemption from federal drug laws.


    Vancouver's controversial Insite clinic can stay open, the Supreme Court said Friday in a landmark ruling. In a unanimous decision, the court ruled that not allowing the clinic to operate under an exemption from drug laws would be a violation of the Charter of Rights and Freedoms.

    The court ordered the federal minister of health to grant an immediate exemption to allow Insite to operate.

    "Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation," the ruling said, written by Chief Justice Beverley McLachlin.
    http://www.cbc.ca/news/canada/british-columbia/story/2011/09/29/bc-insite-supreme-court-ruling-advancer.html

    READ THE FULL DECISION AT:

    Canada (Attorney General) v. PHS Community Services Society, 2011 SCC 44

    http://www.canlii.org/en/ca/scc/doc/2011/2011scc44/2011scc44.html

    ReplyDelete
  7. June 24, 2013

    War on Drugs failing to limit drug use in Vancouver

    http://www.cfenet.ubc.ca/news/releases/war-drugs-failing-limit-drug-use-vancouver

    A comprehensive report on the drug situation in Vancouver shows health-focused policies have been more effective than federal law enforcement measures at reducing illicit drug use and improving public health and safety.

    Researchers at the Urban Health Research Initiative (UHRI) at the BC Centre for Excellence in HIV/AIDS compiled 15 years of data in response to the ongoing public and individual health-related harms resulting from illicit drug use, including HIV and hepatitis C transmission.

    “Drug trends in Vancouver are shifting, with fewer people injecting drugs and more people ceasing their use, a result of the innovative harm reduction and addiction treatment programs implemented,” said Dr. Thomas Kerr, report co-author and UHRI co-director. “It’s important policymakers at all levels of government take note of this evidence and focus efforts on approaches proven to be more effective. Continuing to invest in failed policies like the war on drugs does little to reduce health and social harms.”

    The Drug Situation in Vancouver report includes detailed information on drug use trends, drug availability, HIV rates, and behaviors among some of the city’s most vulnerable people who use illicit drugs. The analysis found:

    Fewer people using injection drugs
    Significant decrease in syringe sharing and related HIV and hepatitis C transmissions
    Increase in drug cessation and access to addiction treatment
    Unchanged ease of access to and affordability of illicit drugs

    Among people who use drugs in Vancouver, methadone maintenance treatment increased from 11.7 per cent in 1996 to 54.5 per cent in 2008, remaining stable since. In addition, reports of difficulty accessing addiction treatment dropped from 19.9 per cent in 1996 to as low as 3.2 per cent in 2006, and has remained below 1996 levels. There was a corresponding upward trend of injection drug use cessation during a similar period, with a rate of just 0.4 per cent in 1996 compared to 46.6 per cent in 2011. Conversely, researchers found between 2000 and 2011 illicit drugs remained easily accessible and prices were stable.

    “The availability of drugs in Vancouver is troubling, however, consistent with international trends highlighting the overall success of market factors in making drugs freely and easily available,” said Dr. Evan Wood, report co-author and Canada Research Chair in Inner City Medicine at UBC. “While there have been public health benefits of the harm reduction strategies, the best strategy is to expand evidence-based addiction treatments to reduce demand for drugs and reduce the size of the drug market.”

    continued below

    ReplyDelete
  8. While there has been an overall decline in illicit drug use since 2007, there has been an increase in the use of some drugs. Among street-involved youth, for instance, there is a high rate of crystal methamphetamine use, with rates of injection having doubled since 2010.

    “Needle exchanges and the supervised injection facility have proven to save lives, but drug use trends are changing and policies and programs should reflect these changes,” said Lorna Bird, a drug user and member of the Western Aboriginal Harm Reduction Society. “We need more harm reduction interventions, like safer crack smoking kits, supervised consumption facilities for people who smoke illicit drugs, and programs focused on at-risk youth.”

    Among the key ongoing factors contributing to high-risk behaviours associated with illicit drug use is the prevalence of unstable housing among people who use drugs, which continues to be between 50 and 70 per cent. Unstable housing includes homelessness, shelters, and Single Room Occupancy hotels.

    “Homelessness and unstable housing amplify harms experienced by drug users,” said Dave Hamm, board member of the Vancouver Area Network of Drug Users (VANDU). “Quality affordable housing is critical to reducing the harms associated with using currently illicit drugs and connecting drug users to supports and programs that will help them live healthy, productive lives.”

    Drug Situation in Vancouver report:
    http://www.cfenet.ubc.ca/sites/default/files/uploads/news/releases/war_on_drugs_failing_to_limit_drug_use.pdf

    ReplyDelete
  9. UPDATE: SEPTEMBER 30, 2013

    Today marks the two-year anniversary of the decision by the Supreme Court of Canada in support of Insite, Vancouver’s supervised injection service, to continue to save lives and promote public health. The Canadian Drug Policy Coalition, in conjunction with PIVOT Legal Society and the Canadian HIV/AIDS Legal Network, sent a letter to federal Health Minister Rona Ambrose expressing deep misgivings about attempts by Ambrose’s government to hold back the implementation of new safer consumption services in Canada. You can view a copy of the letter here:

    http://drugpolicy.ca/930-Campaign/9%2030%20letter.pdf

    ReplyDelete
  10. Drug users sue Abbotsford over anti harm reduction bylaw

    CBC News May 21, 2013

    http://www.cbc.ca/news/canada/british-columbia/story/2013/05/20/bc-abbotsford-harm-reduction-lawsuit.html

    Advocates for needle exchanges are suing the City of Abbotsford, saying the city's bylaw which bans harm reduction centres violates basic human rights.

    The city, located in the Fraser Valley east of Vancouver, has a 2005 zoning bylaw that prevents methadone treatment clinics, needle exchanges and supervised injection sites from setting up.

    "It's become difficult for people to have clean needles," said Scott Bernstein, a lawyer with Pivot Legal Society, who is launching a lawsuit and a human rights complaint on behalf of three illicit drug users.

    "People who use drugs are actually entitled to the same level of health care as everybody else."

    The Fraser Health Authority asked the city to lift the ban in 2010, but the motion failed to pass. A public consultation was held earlier this year, but no decision has been announced.

    Berstein says he hopes the lawsuit will prompt action for some 500 injection drug users in Abbotsford, whose lives are at risk because the bylaw has prevented clean needle distribution and other live-saving public health programs in the city.

    Abbotsford Mayor Bruce Banman declined to comment.

    **************************************************
    Abbotsford reconsiders ban on harm reduction facilities

    CBC News January 22, 2013

    http://www.cbc.ca/news/canada/british-columbia/story/2013/01/22/bc-harm-reduction-abbotsford.html

    The City of Abbotsford is holding a public consultation tonight as it reconsiders its eight-year old ban on harm reduction centres, including medical marijuana dispensaries and needle exchanges.

    The city, which is located in the Fraser Valley east of Vancouver, has a zoning bylaw that prevents methadone treatment clinics, needle exchanges and supervised injection sites from setting up.

    Mayor Bruce Banman says the ban on pot dispensaries is unlikely to be changed, but he can see the benefit of allowing other harm reduction facilities.

    "I've said publicly all we have to do is reduce one case of AIDS and a couple cases of hepatitis C and this program pays for itself."

    Banman adds that the real harm reduction has to happen at the detox level, and that's the Fraser Health Authority's responsibility.

    The forum takes place tonight at 7 p.m. PT at the Matsqui Centennial Auditorium.

    The city considered lifting the ban in 2010 but the motion failed to pass. see: http://www.cbc.ca/news/canada/british-columbia/story/2010/06/10/bc-abbotsford-needle-exchange-ban.html

    ReplyDelete
  11. Vancouvers Harm Reduction Approach Is Working

    A 15-year study shows that fewer people use and inject drugs since the city adopted a public health approach and opened a safe injection site.

    By McCarton Ackerman, The Fix June 25, 2013

    A newly published 15-year study indicates that Vancouver's progressive efforts in harm reduction have effectively reduced illegal drug use and improved public safety.

    see: Urban Health Research Initiative
    http://www.cfenet.ubc.ca/sites/default/files/uploads/news/releases/war_on_drugs_failing_to_limit_drug_use.pdf

    The report by the BC Centre for Excellence in HIV/AIDS examined drug use from 1996-2011 in the city's impoverished Downtown Eastside, once known as "Ground Zero" for HIV and overdoses. The city then adopted a harm reduction approach that included opening Insite, Canada's first legal supervised injection site, in 2003. Dr. Thomas Kerr, co-author of the report and co-director of the center's Urban Health Research Initiative, says fewer people in the area are using drugs—and out of those who still do, fewer are injecting. Almost 40% of users reported sharing needles in 1996; that number dropped to 1.7% in 2011. The percentage of users who accessed methadone treatment jumped from 12% to 54% during that time period. The study also found fewer new HIV and Hepatitis C infections related to sharing needles. "A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa—in this community," says Kerr. "At the same time, the community was being leveled by an overdose epidemic."

    However, Canada's Conservative government still opposes Vancouver's programs. It introduced the Respect for Communities Act earlier this month, which will require applicants to consult with community, provincial and municipal authorities and law enforcement officials before setting up new supervised injection facilities. "We have a federal government that ignores science in favour of ideology, and people are sick and dying as a result," says Kerr. "When we're dealing with matters such as life and death, I think we're obligated to base our decisions on the best available scientific evidence. I think it's unethical to do otherwise." Canada's Supreme Court decided in 2011 that Insite could continue to operate, but the new federal legislation will make it much harder for similar sites to open. There are no legal safe injection sites in the US.

    http://www.thefix.com/content/vancouvers-harm-reduction-approach-shows-success91831

    ReplyDelete
  12. War on Drugs failing to limit drug use in Vancouver

    New report finds declines in drug use associated with harm reduction services, not law enforcement efforts.

    British Columbia Centre for Excellence in HIV/AIDS June 24, 2013

    Vancouver, B.C. (June 24, 2013)A comprehensive report on the drug situation in Vancouver shows health-focused policies have been more effective than federal law enforcement measures at reducing illicit drug use and improving public health and safety.

    Researchers at the Urban Health Research Initiative (UHRI) at the BC Centre for Excellence in HIV/AIDS compiled 15 years of data in response to the ongoing public and individual health-related harms resulting from illicit drug use, including HIV and hepatitis C transmission.

    “Drug trends in Vancouver are shifting, with fewer people injecting drugs and more people ceasing their use, a result of the innovative harm reduction and addiction treatment programs implemented,” said Dr. Thomas Kerr, report co-author and UHRI co-director. “It’s important policymakers at all levels of government take note of this evidence and focus efforts on approaches proven to be more effective. Continuing to invest in failed policies like the war on drugs does little to reduce health and social harms.”

    The Drug Situation in Vancouver report includes detailed information on drug use trends, drug availability, HIV rates, and behaviors among some of the city’s most vulnerable people who use illicit drugs. The analysis found:

    --Fewer people using injection drugs

    --Significant decrease in syringe sharing and related HIV and hepatitis C transmissions

    --Increase in drug cessation and access to addiction treatment

    --Unchanged ease of access to and affordability of illicit drugs

    Among people who use drugs in Vancouver, methadone maintenance treatment increased from 11.7 per cent in 1996 to 54.5 per cent in 2008, remaining stable since. In addition, reports of difficulty accessing addiction treatment dropped from 19.9 per cent in 1996 to as low as 3.2 per cent in 2006, and has remained below 1996 levels.

    continued in next comment...

    ReplyDelete
  13. There was a corresponding upward trend of injection drug use cessation during a similar period, with a rate of just 0.4 per cent in 1996 compared to 46.6 per cent in 2011. Conversely, researchers found between 2000 and 2011 illicit drugs remained easily accessible and prices were stable.

    “The availability of drugs in Vancouver is troubling, however, consistent with international trends highlighting the overall success of market factors in making drugs freely and easily available,” said Dr. Evan Wood, report co-author and Canada Research Chair in Inner City Medicine at UBC. “While there have been public health benefits of the harm reduction strategies, the best strategy is to expand evidence-based addiction treatments to reduce demand for drugs and reduce the size of the drug market.”

    While there has been an overall decline in illicit drug use since 2007, there has been an increase in the use of some drugs. Among street-involved youth, for instance, there is a high rate of crystal methamphetamine use, with rates of injection having doubled since 2010.

    “Needle exchanges and the supervised injection facility have proven to save lives, but drug use trends are changing and policies and programs should reflect these changes,” said Lorna Bird, a drug user and member of the Western Aboriginal Harm Reduction Society. “We need more harm reduction interventions, like safer crack smoking kits, supervised consumption facilities for people who smoke illicit drugs, and programs focused on at-risk youth.”

    Among the key ongoing factors contributing to high-risk behaviours associated with illicit drug use is the prevalence of unstable housing among people who use drugs, which continues to be between 50 and 70 per cent. Unstable housing includes homelessness, shelters, and Single Room Occupancy hotels.

    “Homelessness and unstable housing amplify harms experienced by drug users,” said Dave Hamm, board member of the Vancouver Area Network of Drug Users (VANDU). “Quality affordable housing is critical to reducing the harms associated with using currently illicit drugs and connecting drug users to supports and programs that will help them live healthy, productive lives.”

    The 56-page Drug Situation in Vancouver report was released at Carnegie Community Centre in Vancouver and is available online at:

    http://www.cfenet.ubc.ca/sites/default/files/uploads/news/releases/war_on_drugs_failing_to_limit_drug_use.pdf

    ReplyDelete
  14. Best evidence says supervised injection sites are ‘best care’

    by THOMAS MAN, The Globe and Mail July 05, 2013

    Supervised injection sites are places where people can safely inject drugs under medical supervision. Understandably, there are many questions and concerns regarding the existence and creation of more such sites in Canada. As a taxpayer, health-system user and family physician, I share many of these concerns. But first, I’d like you to meet John.

    Every three months, John walks into my office and refills his medications. He is a middle-class working citizen with three children. He has high blood pressure and high cholesterol, is 15 pounds overweight and was recently diagnosed with prediabetes. At each visit, we discuss the need for 30 minutes of daily exercise and better eating habits.

    John and I both realize that his health, finances, family, quality of life and mortality are all at stake. But changing behaviour can be difficult. There are numerous hurdles to overcome, including current and past circumstances, genetics and his individual choice, all of which contribute to his state of health.

    As John tackles these hurdles, I write his prescriptions and work with him to find ways to reduce the risks. After all, they will affect his life, his family and, probably, other Canadians. The national cost of heart disease and stroke is upward of $20-billion a year.

    So how does his situation relate to injection drug use? Much like John’s lifestyle, injection drug use has been repeatedly shown to be a product of current and past circumstances, genetics and individual choice. Injection drug use affects the individual, families and other Canadians.

    I’m concerned about the harms associated with users injecting in public spaces, stray needles, crime rates, health complications, health-care spending and the morality of funding supervised drug use. But I’m also relieved by what I have learned.

    The majority of studies published in medical journals have shown that government-established supervised injection sites and needle exchanges do not increase drug use or drug users. They do not increase drug-related criminal activity, according to Vancouver Police Department statistics. Rather, multiple studies have shown that there is less injection drug use in public spaces, fewer stray needles and a corresponding increase in the number of needles discarded in neighbourhood safe disposal boxes.

    In regards to health concerns, supervised injection sites have been associated with safer injection practices. By accessing the appropriate addiction, social, and preventative health services through these sites, there is less need for delayed, complicated and significantly more expensive medical treatments. While the yearly operating cost of Canada’s first supervised injection site is about $3-million, the prevention of the spread of HIV alone is estimated to save Canadians more than $5-million a year in health-care costs.

    Finally, is it moral to fund a site for the supervision of drug use? Each of us will have to find his or her own answer. Speaking for myself, I refuse to pick and choose which patients deserve compassionate care and which deserve righteous judgment.

    At the end of the day, I will advocate for supervised injection sites the same way that I advocate for John and all my patients’ health: using the best available evidence to provide the best available care, regardless of my biases toward each patient’s current or past experiences, genetics or decisions.

    It’s our health. They’re our taxes. Let’s take care of them together.

    Dr. Thomas Man is a family physician in Toronto.

    http://www.theglobeandmail.com/commentary/best-evidence-says-best-care/article13001078/

    ReplyDelete
  15. Abbotsford drug bylaw goes to human rights tribunal

    City passed bylaw in 2005 to block access to supervised injection sites

    CBC News July 18, 2013

    The City of Abbotsford will have to answer to the B.C. Human Rights Tribunal after allegations its anti-harm reduction bylaw discriminates against drug users.

    Abbotsford amended its zoning in 2005 to block access to facilities such as sterile needle exchanges and supervised injection sites.

    Barry Shantz with the B.C.-Yukon Association of Drug War Survivors, the group behind the human rights complaint, says the city acted outside its jurisdiction and violated the Charter rights of drug users.

    “Drug users are consistently facing stigma and discrimination in Abbotsford,” he said.

    “The tribunal’s acceptance of our complaint and Drug War Survivors as representatives for the marginalized and vulnerable is a good first step in giving us some dignity back.”

    Shantz argues drug addiction should be treated as a medical issue, not a criminal one.

    “This is a confidence-builder,” he said.

    “All of the scientific evidence supports harm reduction. The most studied medical facility on the planet is InSite [Vancouver’s supervised injection site]. Double thumbs up from any research and study that ever happens here. So we are cranking up the heat.”

    The Fraser Health Authority has a harm reduction plan for Abbotsford, but has been unwilling to implement it while the city's bylaw stands.

    The B.C. Human Rights Tribunal is expected to hear the complaint early next year.

    http://www.cbc.ca/news/canada/british-columbia/story/2013/07/18/bc-abbotsford-harm-reduction.html

    ReplyDelete
  16. Insite helped me battle drug addiction and win

    by Guy Felicella, Vancouver Observer August 4th, 2013

    I have used drugs since 1991, and started injecting them in 1997.

    I used in back alleys, all day and every day. I became consumed by heroin and truly believed that there was no hope for me.

    Heroin was my friend. It never judged me; it was always warm and made me feel like I could do anything. The Downtown Eastside is a tough place for anyone, but it is one place where everyone who doesn’t fit in is accepted, and I fit right in.

    I’m one of the lucky ones who escaped without catching HIV even after using in the dirtiest of places, but when you’re addicted, you don’t care about health. Most people would use others needles, share hits of drugs but I always thought it wasn’t worth it so I used my own stuff, never sharing.

    In the late 1990s to early 2000s, things became so bad in the DTES that overdoses and HIV were spreading at a rapid pace. There were handfuls of people handing out clean needles, but most people would just share and it began to look pretty terrible for all addicts downtown.

    In 2003 Insite came into the picture and I was one of the first people to sign up. They preached of a safe environment and a place where you can use in safety. In 2009, 484 overdoses occurred there with no fatalities.

    I learned so much from the staff there. I finally felt like someone cared, and you could really feel the love. In a place where it seemed impossible to get clean, people now had the choice to change their lives.

    If you ever wanted help, it was right upstairs. I have been a part of the recovery program at Onsite on more than one occasion, and every time I started using again, they never judged me. They would always say: “Next time, you’ll do it.”

    In fact, Insite saved my life on three occasions, twice in one day. I did a lethal dose of heroin and was dead for six minutes and 53 seconds. The nurse Sara brought me back and I remember waking up and crying, telling her I didn’t want to use anymore.

    So back upstairs to Onsite treatment I went. What people often don’t understand is how hard recovery can be, and I left once again. The staff at Onsite still supported me; they never gave up on me even when I gave up on myself.

    In December 2012, I became suicidal and lost my desire to live. A nurse at Insite named Cookie took the time out of her day to calm me down and it was her kind words that inspired me to give it another try.

    So the journey began again and I stopped using on March 18, 2013. I’m currently in a treatment center and this is the most work I have ever done on myself.

    It is because of God and Insite/Onsite that I am where I am today. If they didn’t exist in my life, I wouldn’t be here, and neither would many others.

    The people who work there care so much about human life, from the front desk all the way down to the chill room. They give hope to people who live and struggle with addiction.

    They care if you use, they care if you want to get clean, they care about you, period.

    They give you options and choices and it is up to you, but at least the choice is there. Before Insite and Onsite, there was no choice but to use or die. Society puts so much emphasis on the fact that drug users are bad, but we are human beings.

    Doesn’t everyone deserve the right to get clean or to use in a safe environment with the support of kind staff who will break their backs to help you? You see, compassion is the answer. Never give up on someone because you never know when your kind gesture might inspire them to get clean.

    I know it worked for me, and it can work for countless others. I think Onsite is the best thing that has ever happened to Vancouver and I would go to any length to support them. They inspired me to get my life back.

    http://www.vancouverobserver.com/life/insite-helps-people-battle-drug-addiction-and-win

    ReplyDelete
  17. Vancouvers Insite celebrates 10 years as threat of Conservatives Bill C-65 looms

    BY LIBBY DAVIES, MP (NDP) SEPTEMBER 20, 2013

    It's ironic, and typical, that as Insite celebrates its 10th anniversary of successful operation in Vancouver's Downtown Eastside, the Conservative government in Ottawa is still railing against Safe Injection Sites and no doubt has Bill C-65 ready to go when Parliament returns October 16.

    Bill C-65, An Act to amend the Controlled Drugs and Substances Act, was the last bill to be introduced before parliament recessed in June. It's a nasty bill, couched in anti-harm reduction rhetoric, full of misconceptions, and designed to shut down any attempt to open a safe injection site in Canada.

    The bill is a shining example of Conservative ideology trumping evidence-based health and science.

    But try as hard as they can -- Insite just won't go away and nor will public support for it. After numerous court rulings, including the Supreme Court of Canada, enormous public scrutiny, more than 24 peer reviewed scientific studies, Insite will continue no matter what legislation the Conservative government throws at it.

    September 2003 marks the opening of Insite, but the struggle to get there began many years before that.

    The original application to Health Canada was subject to a run of hurdles that would have challenged an Olympic athlete. The then Liberal government was wary and skeptical of approving the original Section 56 exemption under the Controlled Drug and Substances Act that was needed for Insite to operate. Mounting public pressure, particularly from Vancouver, forced the government into giving the exemption and Insite launched its critically needed services.

    Insite opened as part of a public health plan after a 12-fold increase in overdose deaths in Vancouver between 1987 and 1993. At the time, the Vancouver area was also seeing drastic increases in communicable diseases amongst injection drug users, including Hepatitis A, B, and C and HIV/AIDS.

    What has been remarkable about Insite is its ability to overcome political challenges and retain strong community support.

    I remember vividly, participating in a community action named "1000 Crosses" in Oppenheimer Park. The crosses represented the people who had died needlessly from drug overdoses. I vowed to take the message for action to Ottawa, as a newly elected Member of Parliament.

    continued below

    ReplyDelete
  18. I recall how opposed the local business community was at first when Insite was first raised as a needed health intervention and to save the lives of injection drug users. I remember meeting with Allan Rock, then Minister of Health in in Ottawa in 1997, and later, with Bud Osborn, who came to a second meeting to convince the Minister that Insite could turn the tide of preventable drug overdoses. Bud presented Allan Rock with a book of his powerful poetry that spoke the truth about the situation in the Downtown Eastside. Poetry that became a rallying call for action, and this excerpt from Bud's poem stays with me:

    "...but with these thousand crosses
    planted in oppenheimer park today
    who really see them
    feel sorrow
    feel loss
    feel rage
    our hearts shed bitter tears
    these thousand crosses are symbols
    of the social apartheid in our culture
    the segregation of those who deserve to live and those who are abandoned to die these thousand crosses represent the deaths of drug addicts these thousand crosses silently announce a social curse on the lives of the poorest of the poor in the downtown eastside....".

    Even in opposition the Conservatives wouldn't consider a shred of mounting evidence that Insite was part of the solution, not the problem. Prior to the 2006 election we invited Stephen Harper to visit the facility on East Hastings Street, to see for himself what important work was underway. Of course he refused.

    Conservatives don't like reality to confuse their "truth."

    Insite had to fight tooth and nail to get its permits to operate extended, while in Ottawa in 2007 the Conservative government eliminated "Harm Reduction" from Canada's Drug Strategy. But still Insite continued to garner positive international reviews and continued to save lives.

    Ten years marks a sustained commitment by the Vancouver Network of Drug Users (VANDU), and the Portland Hotel Society and many others who never shied away from the belief that drug users have human rights, dignity and a right to access health care.

    For my part, I'm proud to have been part of this struggle for INSITE and what it stands for. I remain determined to defeat not only Bill C-65, but also the architects of the absurd stance that public policy can ignore scientific evidence.

    Libby Davies is the Member of Parliament for Vancouver East.

    http://rabble.ca/news/2013/09/vancouvers-insite-celebrates-10-years-threat-conservatives-bill-c-65-looms

    ReplyDelete
  19. Fentanyl overdoses Why a safe injection site is an election issue

    Overdose deaths cast light on Insite's decade-long battle with Conservatives

    By Jason Proctor, CBC News August 11, 2015

    From his vantage point on the sidewalk next to Vancouver's supervised injection site, Jace Korpan watched a suspected fentanyl crisis unfold on Sunday.

    Korpan, a regular presence in the Downtown Eastside, says he is not a drug user but is familiar with the Insite facility.

    There was a lineup outside the door, and as word of overdoses on the street spread, workers ran back and forth to administer an antidote. The price of failure: death.

    "Because of them, people are here still," said Korpan. "That's the honest truth. That's the bottom line."

    An election issue?

    You won't get much of an argument on that point from the addicts, business people and residents nearby.

    Nor from the province, medical authorities or the Vancouver police, who put out a warning about a deadly batch of pink heroin, potentially tainted with fentanyl, in the hours after 16 people overdosed last weekend.

    But more than a decade after opening its doors and getting support all the way to the Supreme Court of Canada, North America's first legal supervised injection site is still fighting Ottawa for survival.

    Advocates say that battle may add a political edge to the current fentanyl crisis.

    "I would be happy if this was an election issue," said Dr. Patricia Daly, chief medical health officer with Vancouver Coastal Health.

    Most of the recent headlines around fentanyl have come from the shocking deaths of recreational users: a popular Burnaby teen; and the young North Vancouver parents of a two-year-old, now orphaned.

    But there's another side to the problem; fentanyl has also cut a swath through the Lower Mainland's sizable population of habitual and injection drug users, where the synthetic opioid is passed off as OxyContin or cut into heroin.

    "The value of a place like Insite — and we've seen this through a number of studies — is that overdoses do occur there, but there's immediate medical resources available, so that there have been no deaths from overdoses," said Daly.

    "Even people who have had suspected fentanyl overdoses."

    In fact, it was following a rash of fentanyl-related overdoses at Insite last October that police began an investigation, which they claim led them to a major distributor of the drug.

    continued below

    ReplyDelete
  20. Respect for communities

    Insite opened in 2003, partly in response to an earlier heroin crisis that saw as many as 200 people dying annually in the Downtown Eastside by the mid-1990s.

    But the Conservative government has opposed the facility from the start, arguing communities should focus on prevention and enforcement, as opposed to helping addicts essentially poison themselves.

    The fight ultimately wound up at the Supreme Court of Canada, whichfound Insite "saves lives" and ruled unanimously that the facility should be allowed to operate under an exemption from drug laws.

    In response to the ruling, the Conservatives introduced Bill C-2, the Respect for Communities Act, which passed into law this June.

    At the time, Health Minister Rona Ambrose said the legislation established "rigorous criteria" for the type of exemption a supervised drug injection site would need to operate.

    "This law requires that the voices of law enforcement and parents be heard before drug injection sites can be considered to open in local neighbourhoods," she said.

    But advocates claim the rules instead set a bar no facility will be able to clear. Pivot Legal Services Society lawyer Adrienne Smith argued against Bill C-2 in front of a parliamentary committee.

    "With this law in force, even if there were a Liberal or NDP health minister who wanted to grant an exemption, the wording of the legislation makes it nearly impossible," Smith said.

    "So this Conservative government on its way out the door has effectively barred access to supervised injection services that could save lives across the country in the midst of a fentanyl crisis."

    At present, Insite has to apply for its exemption every year.

    No 'magic treatment'

    Obviously, the government doesn't see things that way.

    Daly said she doesn't want to see young people taking drugs either, and she'd also like to help addicts stop using.

    "I'm in agreement with the government on that," she said.

    "But where we disagree on that is we both have those goals, but how do we get there? I don't have a vaccine that can prevent addiction, and I don't have a magic treatment for addiction."

    As with everything in Vancouver's drug wars, there appears to be a gulf between ideology and on-the-ground reality; politics fill the gap.

    On the sidewalk near Insite, a dozy man sitting near Korpan speaks up: "I challenge you to find me some real heroin right now."

    As Korpan nods, the man says the street is flooded with synthetic drugs. A lot of it is fentanyl.

    That's reality. So is addiction. And regardless of the risk, desperate people are going to inject.

    Which means overdoses are going to happen.

    http://www.cbc.ca/news/canada/british-columbia/fentanyl-overdoses-why-a-safe-injection-site-is-an-election-issue-1.3186016

    ReplyDelete
  21. With Drug Policy in Election Spotlight, Insite Earns International Praise

    http://thetyee.ca/Video/2015/08/26/War-On-Drugs/

    https://youtu.be/WzEBOYei1so


    With the election heating up, drugs and addiction are becoming a divisive issue in federal party platforms. The Liberals and NDP promise to legalize or decriminalize marijuana while the Conservatives continue to promise tougher legislation.

    Canadian drug policies are once again earning international attention: British journalist Johann Hari spent four years studying Insite and other international treatment programs for his book Chasing the Scream: The First and Last Days of the War on Drugs. He recently sat down with TVO's The Agenda to talk about his findings.

    Addiction, he says, is neither caused by drugs nor the people who use them, but rather by unstable and unsupportive environments. When people feel isolated and disconnected from society, that is when addiction happens.

    He points to projects like Insite in Vancouver's Downtown Eastside, Portugal's decision to decriminalize all drugs, and Switzerland's prescription heroin program as successes in reintegrating addicts into society and reducing their reliance on chemicals.

    ReplyDelete
  22. Safe Injection Facilities

    Out of Harm's Way


    By Keri Blakinger, The Fix October 7, 2015

    No one has ever died shooting heroin in an injection center anywhere around the world. So, why are they still illegal in the US?

    Damien Trimingham was a bright kid. He was well-liked and a successful athlete. He came from a good family. He did not seem destined for a life of addiction— and indeed he wasn’t.

    At just 22, Damien died of a heroin overdose.

    The police did not notify his worried family for three days.

    That was in February of 1997, and now almost two decades later, his father Tony, a psychotherapist, has become a leading voice in harm reduction.

    On Sept. 30, he recounted his son’s story to a crowd of more than 200 at “Out of Harm’s Way,” a panel discussion in Manhattan.

    “It was, of course, a shock even though we knew that death was a possibility with heroin use,” he said. At the time of his death, Damien was trying to stay clean. His father said, “That’s one of the ironies of heroin use, that the people who die are often the ones trying to give it up.”

    He continued, “I was to find out later that no one has ever died in an injection center anywhere around the world, even though there are many overdoses.”

    That’s when Tony latched onto the idea of safe injection facilities (SIFs). Although they aren’t legal in the United States (yet), there are around 100 SIFs operating around the world, in places like Canada, Spain, Germany, Holland, and Norway.

    The idea is that SIFs provide a safer environment for injection drug users. Staff are available to teach safe injection practices and clean syringes are free for the taking. Crucially, there’s also naloxone available to treat overdoses immediately, without any fatalities.

    Predictably, SIFs tend to face some initial resistance, but in Australia, Tony was instrumental in turning the tide of public opinion.

    The year that Damien died, the Australian government proposed a heroin prescription program, but ultimately the prime minister vetoed it. But the time seemed ripe for harm reduction and so Tony took action. He wrote a letter to the local paper, describing his son’s death and explaining how unnecessary it was. The paper published his piece on the front page, and it sparked debate.

    After four years of lobbying and advocating, Tony said, “We got our injection facility, thank goodness.” He added, “It was a hard road because there were opponents.”

    Overall, though, he said it’s often apathy and not opposition that is the toughest obstacle. “Most of the general public don’t really care,” he said. “They’re not pro, they’re not against. It doesn’t affect them.”

    Like Australia, Germany has safe injection sites, and another of the panelists—former Frankfurt drug czar Werner Schneider—documented the history of his city’s harm reduction efforts. Frankfurt began exploring harm reduction in earnest in the 1990s in response to a significant uptick in heroin use. That exploratory work quickly led to the creation of a safe injection facility.

    Schneider said, “The most important result of this program was a tremendous reduction of drug-use related death cases.” Simultaneously, the city witnessed a decrease in criminality and also a decrease in public concern about drug use as a major citywide problem.

    Like Frankfurt, Vancouver experienced a ballooning heroin problem in the '90s. Canadian Senator Larry Campbell—a former law enforcement officer who was also the mayor of Vancouver—told the crowd that as overdose deaths skyrocketed, so did HIV and incarceration rates.

    continued below

    ReplyDelete
  23. After a decade as a cop and two as a coroner, Campbell got tired of watching the bodies pile up, and so in 2002 he ran for mayor.

    “I ran on the platform that I would open a supervised injection site in Vancouver,” he said.

    He did that, but keeping open North America’s only safe injection facility, Insite for Community Safety, was a struggle. Although the federal government initially offered the program a three-year legal exemption, once that initial approval expired, Insite had to sue to keep its doors open.

    Campbell said that SIFs are a crucial part of the shift from punishing addicts to treating addiction as a medical problem.

    “Addiction is a medical disease. Addiction is not a criminal offense. No one starts out life saying, ‘You know what, I think I’ll be an addict,’” he said.

    “You can address this as a humanitarian gesture, a humanitarian idea, that we’re all people … but I recognize that there are those who don’t move from a humanitarian end but from an economic end.” That works, too, though, because Campbell explained that safe injection facilities can save on welfare, police and prison costs.

    “So whether you believe in humanitarianism or economy,” he concluded, “this is an idea that works. It’s good, and it’s time.”

    Liz Evans, a nurse who works with Insite, concurred. She said that Insite is estimated to have saved $14 million in 10 years. “Over 2 million injections have taken place and not one has resulted in death,” she said.

    Over time, the community has come to accept the program. Evans said that the last poll taken showed that 76% of Vancouver residents supported the safe injection site.

    By bringing users off the streets, it has created a better environment with less public injection around the facility but also, she said, the presence of a safe injection facility seems to encourage people to get help. “If you’ve just come to Insite once, you’re 33% more likely to come to detox or treatment,” she said.

    Evans pleaded for “peace” in the War on Drugs and said, “The controversy today should not be around where … a safe injection facility makes sense. The controversy today should be over how we have allowed the status quo to persist for such a long time.”

    She added, “In Vancouver, drug users will tell you that Insite is a symbol of care. This is a humane space where we are able to reverse a pattern of exclusion.”

    The panelists—and moderator Amy Goodman of Democracy Now!—drew an enthusiastic crowd, and the evening was punctuated regularly by bursts of applause. (One comment that drew particularly raucous support was a question Tony posed to the crowd: “Who in here supports safe injection facilities?”)

    Although many audience members came from in and around New York City, some traveled much farther, with four- and five-hour drives from Binghamton and points north.

    One of those longer commuters was John Barry, the executive director of an upstate New York syringe exchange called the Southern Tier Aids Program (STAP).

    “We need one of these,” he said.

    He acknowledged that growing political will and legal support for SIFs could be difficult, but he didn’t see it as impossible: “I think the dominoes have to fall in the right order.”

    https://www.thefix.com/safe-injection-facilities-out-harms-way

    ReplyDelete
  24. Opening five safe injection sites makes financial sense for Ontario: study

    The Canadian Press December 1st, 2015

    VANCOUVER — Opening five safe-injection sites in Ontario makes financial sense, says a medical researcher who based his study on a Vancouver clinic where drug users shoot up under supervision.

    Dr. Ahmed Bayoumi of St. Michael's Hospital in Toronto said establishing facilities such as Insite in that city and in Ottawa would save money and reduce the incidence of diseases such as HIV and hepatitis C.

    "Three facilities for Toronto and two for Ottawa represent a good investment compared to other things that we ordinarily invest in in health care," he said in an interview Monday.

    Insite is North America's only supervised-injection site, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses.

    The site provided a baseline for estimating the approximate cost of operating a safe-injection site as well its effectiveness at improving users' health, Bayoumi said.

    Victoria and other cities across Canada have considered establishing similar facilities.

    Montreal announced its intention to open a safe-injection site after a 2011 Supreme Court of Canada decision ruled against the former Conservative government's attempts to shut down Insite for violating federal drug laws.

    Unlike in Vancouver's Downtown Eastside, Bayoumi said multiple facilities would be more appropriate in Ontario, where populations of drug users are more spread out.

    He said the study's economic estimates are conservative because they're based on Insite being a freestanding clinic, compared to an approach that would incorporate safe-injection facilities into existing health centres.

    While the study focused on needs in Toronto and Ottawa, Bayoumi said other Ontario cities could also benefit from such facilities.

    "The next step is mostly a political decision rather than a research decision, as in, 'Is there an interest and a will to actually establish some facilities?'"

    Ontario's health minister said a national strategy to deal with intravenous drug users, rather than a piecemeal approach, would be most beneficial.

    "I think that more than anything, this is an opportunity to bring together all jurisdictions and look at this in a uniform way," Eric Hoskins said.

    "We, up until recently, had a federal government that made it clear they didn't support such sites. We now have a government that understands the science and is willing and prepared and wants to make decisions based on evidence."

    The minister said any request for a safe-injection site would have to come from municipal governments.

    Insite opened in 2003 as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths in the Downtown Eastside.

    The facility provides clean needles to addicts to stop the spread of infectious diseases before they inject drugs at one of 12 booths.

    Studies in major medical journals have hailed the success of Insite, suggesting it has helped reduce overdose deaths, infectious diseases and crime in the 10-block area that draws addicts.

    The former federal government was criticized for wanting Insite to be shut down over concerns it promotes drug use, but lost a series of legal battles that kept the clinic open.

    Geordon Omand, The Canadian Press

    http://www.vancouverobserver.com/news/opening-five-safe-injection-sites-makes-financial-sense-ontario-study

    ReplyDelete
  25. Vancouver drug overdose death toll rises to 4 within last 24 hours

    Drug overdose death toll rises as police update numbers with a 4th death Wednesday afternoon

    CBC News December 23, 2015

    The death toll from a rash of overdoses within the last 24 hours has risen to four, Vancouver police said Wednesday just hours after issuing a public warning.

    Police had initially reported three deaths but Wednesday afternoon were called to the scene of another overdose — this time, a man in his 50s.

    Police say there have also been 17 non-fatal overdoses in the city — most of them on the Downtown Eastside.

    Their warning comes in the wake of recent concerns over stolen fentanyl patches and counterfeit percocets.

    "Various drugs from the scenes of the overdose deaths have been seized and forwarded to Health Canada for analysis, but investigators expect to find fentanyl in many of those samples," said a statement from Const. Brian Montague.

    Fentanyl is a synthetic narcotic that is 50 to 100 times more toxic than other opioids, the statement said.

    Among the three dead, a 24-year-old man in Downtown Vancouver, a 35-year-old man in East Vancouver and a woman believed to be in her mid-20s on the city's Downtown Eastside.

    Police say the public warning applies to both "seasoned" and recreational drug users.

    http://www.cbc.ca/news/canada/british-columbia/vancouver-drug-overdose-death-toll-rises-to-4-within-last-24-hours-1.3378832

    ReplyDelete
  26. Greater Victoria sees 8 suspected drug overdose deaths in a week

    Morphine, heroin, fentanyl and methamphetamine found in one confirmed overdose case

    The Canadian Press December 27, 2015

    The B.C. Coroners Service says drugs are likely the cause of eight deaths in Greater Victoria over the past week.

    "That's quite a bit higher than we would expect in a one week period," said coroner Barb McLintock.

    She says five men and three women have died of suspected overdoses in several communities, including Saanich, Langford and Sooke, between December 20 and 26.

    The only confirmed overdose is a man who died in a downtown Victoria parkade last Saturday, and was found to have a mixed cocktail of drugs in his system, including morphine, heroin, fentanyl and methamphetamine.

    The coroner is still waiting on toxicology reports for the other seven deaths.

    "It would appear most of them, if not all, of these unfortunate people who died were regular experienced drug users," said McLintock.

    Other agencies such as police have also reported seeing a number of overdoses where people survived.

    http://www.cbc.ca/news/canada/british-columbia/victoria-drug-overdoses-1.3381589

    ReplyDelete
  27. Victoria overdose deaths renew call for supervised injection site

    'It's time that we start actually providing comprehensive harm reduction,' says social worker

    CBC News December 28, 2015

    A recent spate of deaths likely caused by drug overdoses in Victoria have advocates calling for a supervised injection site and better health care for drug users in the city.

    "We supply people with safe, clean supplies and nowhere to use them. And then we wonder why people die," said Bruce Wallace, assistant professor at the University of Victoria's School of Social Work.

    "It's time that we start actually providing comprehensive harm reduction and we start addressing why we're stigmatizing and criminalizing people."

    Fentanyl warnings

    The BC Coroners Service said drugs are likely the cause of eight deaths in Greater Victoria over the past week.

    Health officials in Victoria and Vancouver have been warning drug users about fentanyl, a highly potent and dangerous opioid increasingly being mixed with illegal narcotics across the country.

    The coroner is still waiting on toxicology reports in seven of the deaths, but in one case, a drug overdose has been confirmed.

    The man, who died in a downtown Victoria parkade last Saturday, was found to have a mixed cocktail of drugs, including fentanyl, in his system.

    Frequent drug users at risk

    Of the 30 overdoses in the past few weeks in the Greater Victoria Area, five of them have been tied to a homeless camp near the city's courthouse, say officials.

    Residents of the camp say a man who lived there, Brad Paul, was found dead in his tent and have erected a small memorial in his name.

    But, they say, they're concerned about more than just those who live at the camp.

    "So many have died outside of just this camp, and they just get forgotten," said camp resident Sean Manley.

    Many in the tent city carry an emergency kit that contains Naloxone, an opioid blocker that can quickly reverse the effects of an overdose.

    It's a kit that some advocates say can play a big part in helping to prevent overdose deaths.

    "These things save lives, everyone should have the training and a Naloxone kit on them," said safe injection site advocate Darrin Murphy.

    The kits have only been available to the general public for the past year.

    http://www.cbc.ca/news/canada/british-columbia/victoria-drug-overdoses-1.3382665

    ReplyDelete
  28. Safe injection sites have potential to save lives says Jane Philpott

    Federal health minister says the more people know about them, the greater their support

    By Susan Lunn, Peter Zimonjic, CBC News March 14, 2016

    Toronto's medical officer of health is calling on Canada's largest city to move one step closer to opening three safe drug-injection sites.

    In the report, Dr. David McKeown calls for three sites to be located at The Works Needle Exchange Program, the Queen West Community Health Centre and the South Riverdale Community Health Centre.

    Federal Health Minister Jane Philpott told the CBC last week that supervised injection sites are among a number of strategies the government has put forward to cope with drug abuse and overdose deaths.

    "From a public health point of view it makes a tremendous amount of sense," she said. "Sites like Insite in Vancouver and others like them have the possibility to save countless lives."

    There are only two in the country right now, and both are in Vancouver. Insite has existed for years. The other just received approval from Health Canada.

    Overdoses on the rise

    In 2013, there were 206 overdose related deaths in Toronto, a problem that has been on a steady rise for years. In the last decade alone, the number of reported overdose deaths in the city has risen by 41 per cent.

    Toronto Coun. Joe Cressy, chair of the city's drug strategy panel, says the increase in overdoses has been accompanied by rises in the number of drug-related diseases such as HIV and hepatitis C.

    Drug use has caused a number of other issues across the city that safe injection sites may be able to address, Cressy said.

    "We're hearing frequently from our residents that they have an issue of needles being found in the local coffee shop bathrooms, in the local park, in the local school yard," Cressy said.

    Contentious issue

    Next week McKeown will recommend Toronto hold public consultations about potentially opening the three supervised drug injection sites.

    continued below

    ReplyDelete
  29. The issue is a contentious one. The union representing Toronto police officers has already come out against the idea.

    Toronto Mayor John Tory admits getting unanimous consensus isn't easy.

    "These are difficult issues," he said. "They have some emotional aspects to them, they have some substantive aspects to them, some on which even reasonable people can disagree."

    There is interest in safe drug injection programs in other cities as well, including Ottawa, Victoria and Montreal. The federal government has to approve their plans, but the new Liberal government is much more open to the concept than its predecessor.

    The previous Conservative government fought to close Insite all the way to the Supreme Court of Canada, losing that battle in 2011. Its subsequent legislation laid out several conditions that had to be met before a site could open.

    The former health minister, now the interim Conservative leader, Rona Ambrose, says she'll be watching to make sure those rules are respected.

    "I would expect that the government would follow the law and make sure that there is wide support in the neighbourhood, and that this is something the people in the neighbourhood support and that there [are] public consultations," she said.

    Philpott says for now she will try to work within the Conservative's legislation, pointing out it requires consultation, not consensus.

    "One-hundred per cent consensus in many situations is difficult to achieve," Philpott said. "Having said that we are always in favour of consultation … and I think it's the kind of thing that the more people understand about what it actually offers the more people are in favour of it."

    Philpott said that officials at the Public Health Agency of Canada who "hadn't had the opportunity to visit" Insite in the past are going there to study it.

    If Toronto city council gives the green light to hold public consultations it will still take until the fall at the earliest before the city could formally apply to the government to open three drug-injection sites in the city.

    http://www.cbc.ca/news/politics/save-injection-sites-toronto-1.3491134

    ReplyDelete
  30. Seattle considers supervised injection site says King County sheriff

    'I've got to wrap my mind around a place where you go to shoot up and you're not going to get arrested'

    By Wanyee Li, CBC News March 15, 2016

    The sheriff in Seattle is looking to Vancouver for answers as the American city considers opening a supervised injection site.

    It would be a first in the United States.

    Canada has two legal supervised injection sites, both of which are in Vancouver. Advocates for supervised injection sites, who were instrumental in setting up Insite in Vancouver's Downtown Eastside, are heading to Seattle this month to share ideas.

    King County's sheriff says he is cautiously open to the idea.

    "I've got to wrap my mind around a place where you go to shoot up and you're not going to get arrested. And it's maybe promoted with tax dollars," said John Urquhart, sheriff of King County.

    "It's going to be a tough sell."

    He says law enforcement in the region has not accepted the idea.

    "One thing that I found about police chiefs and sheriffs is they cry and moan and say what we're doing isn't working … and then they turn around and advocate for the status quo," he said.

    "And I'm not willing to do that."

    City officials are also considering setting up a supervised injection site in Victoria and Toronto, where the police union has already voiced its opposition.

    Heroin addiction an 'epidemic'

    Urquhart calls heroin addiction an "epidemic" in the United States and says desperate times have pushed him to consider radical solutions.

    "The reason it's on our radar is because it's not just in back alleys anymore. It's not just junkies like we used to say," he said.

    Urquhart worked as a narcotics detective for 25 years before becoming sheriff.

    "I arrested people and I took them to jail … and guess what? It didn't make a difference. The war on drugs hasn't worked."

    Urquhart says in an ideal world, he would like to see more treatment centres in Washington — enough so that all addicts would have access to one.

    "But society, especially in this country, is not able to provide that."

    Since politicians are not willing to take that step, according to Urquhart, he is looking forward to hearing from Vancouver officials on how supervised injection sites could make for a temporary solution.

    "That's the issue — how do we keep these people alive?"

    With files from CBC Radio's The Early Edition

    To listen to the full interview, click the link labelled: Seattle considers supervised injection site.

    http://www.cbc.ca/news/canada/british-columbia/seattle-considers-supervised-injection-site-says-king-county-sheriff-1.3492748

    ReplyDelete
  31. Canadian official causes stir with progressive speech at UN narcotics conference

    by Tom Blackwell | National Post March 16, 2016

    The Liberal government used its first foray into the global anti-narcotics arena this week to signal a clear shift away from the war-on-drugs philosophy, promising more safe-injection sites, promoting “harm reduction” and touting its plan to legalize marijuana.

    The speech by Hilary Geller, an assistant deputy minister of health, caused a stir at the generally staid Commission on Narcotic Drugs conference in Vienna, observers said.

    The audience of government and non-governmental organization officials from around the world “erupted in applause” mid-way through the address and gave a prolonged ovation at the end, said Jason Nickerson, an Ottawa-based researcher who is attending the meeting.

    The talk not only contrasted with the Harper government’s international stance on drugs, but stood out from the cautious pronouncements most other nations made, said the Bruyère Research Institute scientist, who favours more liberal policies.

    “There are some countries here that are coming out and saying important, progressive things,” he said. “But it’s certainly not as explicit as what Canada is saying.”

    A Conservative opposition critic had a different reaction, sounding the alarm about Geller’s prediction of more government-sanctioned injection sites – where opioid users can use illicit intravenous drugs under a nurse’s supervision.

    While the Supreme Court of Canada ruled such sites legal, the Conservatives passed legislation requiring extensive public consultations and other measures before they could be set up, said Rob Nicholson, the party’s justice critic.

    “Drugs that are used at these injection sites, mostly heroin, are dangerous and addictive and they kill Canadians,” said the former justice minister. “I disagree with the idea they are safe. There’s nothing safe about taking heroin.”

    Nicholson also stressed that the Conservatives invested hundreds of millions of dollars in drug-abuse treatment and prevention.

    Still, the Harper government was generally tough on the issue, implementing mandatory-minimum jail sentences for some trafficking offences and beefing up police narcotics enforcement.

    continued below

    ReplyDelete
  32. On the world stage it opposed having international conventions embrace harm reduction, programs that focus on preventing the side effects of illegal drug use — like HIV infection — rather than prosecution.

    That put the Conservative government in league with some of the world’s most authoritarian states, said Richard Elliott, head of the Canadian HIV/AIDS Legal Network.

    Under Harper, Canada also failed to condemn the death penalty for drug offences, enforced regularly by nations like Iran and Indonesia, he said.

    Geller stressed this week her government opposes capital punishment “in all cases.”

    Her stance generally marked a “180-degree” shift, said Donald MacPherson, executive director of the Canadian Drug Policy Coalition.

    “It was very moving for the Canadians in the room, people who have been working on this issue for 10 years in a context where Canada has been more aligned with China and Russia and Pakistan.”

    The Vienna conference is a precursor to the UN General Assembly’s special session on drugs this year, which will consider a possible overhaul of international narcotics treaties and their law and order approach.

    Geller said Canada remains committed to combating illicit drug activities, but believes a comprehensive public-health approach is needed, including prevention and treatment.

    Harm reduction is “critical,” she said, referring to needle-exchange programs and safe injection sites, as in Vancouver and as requested by advocates in Toronto, Ottawa and Montreal.

    “With one long-standing supervised injection site already operating in Canada, we have recently approved a second, and anticipate that there will be others in future,” said Geller.

    She also defended the government’s plan to “legalize, strictly regulate and restrict access to” marijuana. The current approach is not working, with high rates of pot use among young people, thousands of Canadians earning criminal records for non-violent offences and organized crime reaping huge profits, said Geller.

    A day earlier, another UN body had chided Canada for its cannabis intentions, which it said violated the international Convention on Narcotic Drugs.

    Read the Notes for Hilary Geller's Address at:

    http://news.nationalpost.com/news/canada/canadian-politics/liberal-sparks-eruption-of-applause-with-progressive-speech-at-un-narcotics-conference

    ReplyDelete
  33. Vancouvers safe injection site the first in North America opened 13 years ago. What’s changed?

    BY DOUGLAS QUAN, NATIONAL POST MARCH 20, 2016

    VANCOUVER — On a recent afternoon, a woman sat on the sidewalk, steps from this city’s supervised drug-injection facility, Insite, pant leg rolled up, needle in hand. A young man walked by and casually offered a reporter a ball of speed. A short time later, three police cars swooped in to arrest a hoodied man for allegedly wielding a hammer in a nearby alley during a suspected drug-induced frenzy.

    Thirteen years after this facility, North America’s first, opened in the Downtown Eastside with an emphasis on harm reduction over treatment — a model now being contemplated in several Canadian cities — one might be tempted to wonder: what’s changed?

    A lot, insist Insite staff, academics, and area residents, who point to a reduction in overdose deaths and the spread of disease in the neighbourhood.

    “Go back to the 30-plus peer-reviewed journals and look at what the evidence seems to be suggesting,” said Andrew Day, operations director at Vancouver Coastal Health, which runs the facility.

    “If we weren’t here, it would be even worse.”

    Still, skepticism persists.

    Toronto’s medical officer of health, Dr. David McKeown, recently called for three supervised-injection sites in the city amid growing overdose rates.

    In response, federal Conservative health critic Dr. Kellie Leitch warned that “drugs like heroin are dangerous and addictive which is why we believe that every effort should be made to help people get off drugs.”

    The Toronto Police Association’s president is worried such facilities will attract crime and loitering and swallow up police resources. The city would be better off directing money at treatment, Mike McCormack said.

    “Insite is not a model we want to see replicated.”

    Nestled in the shadow of the dilapidated Balmoral Hotel, Insite sees 600 to 900 visitors daily. Clients register using whatever name they want and tell staff what drug they’ve brought with them — typically heroin, cocaine or meth.

    They pick up whatever supplies they need from a counter — syringe, cooker, alcoholic swab, tourniquet — and are assigned to one of 13 mirrored, and constantly disinfected, booths in plain view of nurses and support staff.

    Nurses won’t perform injections for clients but may offer guidance on certain techniques to reduce risks, Day said.

    Afterwards, clients can grab a coffee or juice in the “chill lounge” before leaving.

    Clients are never pressured to use the detox facility upstairs or enrol in addiction treatment. Most of them are entrenched in their drug use and have extensive histories of trauma and abuse, Day said. It takes time to build relationships with them.

    “Some people are really marginalized and they’re not going to go to a walk-in clinic … (or) a regular family physician. For some people, this is that starting point.”

    The Liberal government has clearly been won over. Health Canada last week granted Insite a four-year exemption from federal drug laws. (Under the Conservatives, it had to apply annually for the exemption).

    Talk to frontline staff and they’ll tell you the harm-reduction model is making a difference, said Jennifer Vishloff, a registered clinical counsellor. She was given unprecedented access to Insite nurses for her Simon Fraser University master’s thesis, which was published last year.

    Vishloff said she was struck by their compassion, resilience and ability to win the trust of clients.

    “They were working hard to show there are no disposable people,” she said. “That’s what motivates them day to day.”

    Further, nurses recognize the need to give clients freedom to make their own choices, she said.

    “Allowing people to be independent … and make their own decisions about their health, goes a long way in people actually wanting to seek out help.”

    continued below

    ReplyDelete
  34. Nurses shared with Vishloff how rewarding it was to teach clients even small things, like how to inject properly and independently.

    But they were also candid about the challenges, including the unpredictable behaviour of some clients.

    One time, a client was face down and had a bent needle in his mouth, Vishloff was told. His arm was still tied with a tourniquet.

    A nurse grabbed his shoulder and called for help. But another nurse yelled, “Don’t touch him!” Apparently this was normal behaviour for the client and touching him could make him violent.

    Nurses also shared the ethical dilemmas they face, like whether or not to turn away someone who is a recreational user. One time, a drunk party reveller who had never injected before walked in.

    “I didn’t feel comfortable signing them up because they definitely weren’t entrenched,” a nurse told Vishloff. “Yet at the same time they were intoxicated which increases their overdose risk. … I made the call to let them use the site, and there wasn’t a consensus on the team.”

    One nurse described to Vishloff how she had to suppress the urge to tell young women to “run out of there!”

    “It’s just hard to reserve judgment because having worked for many years and knowing what I know, you’re just like … Ooh, don’t do it! Like, ahhhh! But in reality what I have to kind of remember is that it’s safer for the girls to know how to inject themselves than it is for them to be injected by their boyfriends or pimps.”

    Nurses also spoke of the helplessness they felt when clients came in looking worse than their last visit. “You just see people waste away sometimes,” one nurse said.

    The work of Insite staff has, without question, paid off, said Thomas Kerr, director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.

    “The evidence is pretty clear. There’s no real serious academic debate.”

    Kerr co-authored a 2011 study that showed overdose deaths in the immediate area fell 35 per cent during the first two years of operation.

    In a 2007 study, Kerr and his colleagues surveyed more than 1,000 Insite clients. A majority reported being less rushed when injecting, were injecting less frequently outdoors, and were more careful about syringe disposal.

    Criminologists at SFU estimated in a 2010 study that Insite, on average, prevented 35 new cases of HIV and almost three deaths per year, saving more than $6 million annually.

    “You’re not risking dying; it’s a lot safer,” said Cody Zutz, 32, a drug user who has lived in the neighbourhood for 15 years. “In the back of your mind, you know if (you’re) going to overdose, those people are there to save your life.”

    So why do people still shoot up in the alleys? Usually because they don’t want to line up to get in, he said, admitting moments later: “If you’d been here 20 minutes ago, I shot up (crystal meth) outside because I didn’t have the patience.”

    However, if he was going to inject heroin that he was “unsure” about, he’d go in “just to be safe.”

    Street-level drug use in the neighbourhood is less visible and there have been fewer overdose deaths and medical calls since Insite was introduced, said a Vancouver police spokesman.

    “It has taken people out of alcoves, alleys, stairwells,” Sgt. Randy Fincham said. The facility can also alert drug users to new dangers, such as the recent spike in fentanyl-related deaths.

    Fincham added that the disproportionately large number of officers in the Downtown Eastside is not because of Insite.

    “These officers were there before Insite. We have not had an increase in officers as a result of its introduction.”

    Buy-in from officers does not appear to be universal, however. One officer responding to the man wielding the hammer just let out a chuckle when asked for his views on Insite.

    “You don’t want to know our opinion.”

    http://www.theprovince.com/news/vancouver+safe+injection+site+first+north+america+opened/11797581/story.html

    ReplyDelete
  35. Treating addiction with hydromorphone saves lives and money, experts say

    'I'm not getting stoned, I'm not getting that kind of effect from it,' addict says of hydromorphone

    By Greg Rasmussen, CBC News April 06, 2016

    http://www.cbc.ca/news/canada/british-columbia/heroin-hydromorphone-addiction-1.3524118

    A longtime heroin addict named Max winds a band of blue rubber around his bicep.

    "So my veins will stick up," he explains before quickly sliding the needle beneath his skin and injecting a powerful drug called hydromorphone.

    This isn't happening in a back alley. Instead, Max is inside a brightly lit room where injection drug users are taking part in a clinical trial where they are given their drugs and needles.

    The facility is called the Crosstown Clinic in Vancouver's downtown eastside.

    The trial is the first of its kind in the world and one addiction expert is urging jurisdictions across the country to quickly follow suit.

    Max, who didn't want his last name used, injects at one of several stations set up for drug users. A box of tissues and other supplies sit on a stainless steel counter gleaming under crisp, bright lights. Watchful medical staff dispense the needles, check identification and watch for medical problems.

    "I get the itchies really bad for about 30 or 60 seconds. My face will totally change colour," he says, describing the immediate impact of the drug flowing through his veins.

    True to his word, Max then slips a back scratcher under his shirt as the itching hits right on schedule.

    But it's a minor price to pay compared to the very real pain of heroin addiction.

    Powerful tool

    A new study says the drug used by Max, hydromorphone, is a powerful tool that could helps thousands of other Canadians battling opioid addiction.

    Max is part of a subset of drug users that don't respond to methadone, the drug most widely used to treat addicts.

    Researchers say about ten per cent of addicts don't find relief from methadone, so they often keep using street drugs.

    This new study involving 202 participants shows hydromorphone does work, and Max says it's changed his life.

    When he was selected for the drug trial, things were looking grim.

    "I was homeless, I was committing crimes to get my fix." He also didn't think he had long to live.

    Since being enrolled in the trial, he has put on weight, works out every day and says he can function more or less normally after injecting hydromorphone.

    "I'm not getting stoned, I'm not getting that kind of effect from it."

    He says heroin addiction is incredibly powerful and that he fell into using it after getting addicted to prescription painkillers following a car accident.

    "Your body starts to crave it to the point where almost nothing will stop you from getting it. There's a real dire need to get that into your system, and your body is screaming for it from every angle."

    continued below

    ReplyDelete
  36. Preventing deaths

    Dr. Scott MacDonald is the lead physician at the Crosstown Clinic. He says hydromorphone substitution prevents overdose deaths from street opiates, including fentanyl and heroin.

    "In December, over 60 people in British Columbia died from fentanyl overdoses," MacDonald said. "Not one of the patients receiving care at our clinic on injectable opioid treatment died. The number was zero. I think that's relevant."

    He says it's especially important now that overdose deaths are spiking to record numbers across Canada.

    A report last year by the Ottawa-based Canadian Centre on Substance Abuse said, in some jurisdictions, deaths jumped by more than 20 times previous levels. An exact national number is difficult to determine, but about 300 died in British Columbia alone in 2014, a large increase from the previous year.

    In addition to the hydromorphone trial, the Crosstown clinic has also been the only site allowed under a special permit to dispense a drug very similar to street heroin.

    This recent trial was to find out if hydromorphone was just as effective.

    MacDonald says the advantage is that hydromorphone is already licensed in Canada. That means other jurisdictions wouldn't need special permission from Ottawa to open up clinics and supply the drug to addicts.

    Addiction not a 'second class' illness

    Addiction researcher Dr. Eugenia Oviedo-Joekes says this trial is the first of its kind in the world and she is urging an expansion of clinics modeled on Vancouver's Crosstown.

    "We are trying to provide alternative treatments for people that are continuing to inject in the street, and we are not serving them well with the few options we have," Eugenia Oviedo-Joekes says.

    She says addiction should not be treated as a "second class" illness because of the social stigma attached to it.

    She says access to drugs such as hydromorphone or even the medical equivalent of heroin are now proven to be the best form of treatment. And she said supplying the medication to patients in a controlled setting does not encourage people to use drugs.

    "I really hope the government is willing to listen to the evidence. I really hope some people stop playing to the fear of what it means. This treatment is for those we are leaving behind, the poorest, the most vulnerable."

    Researchers also point to other benefits from the trial, showing participants were much less likely to get involved in crime because they no longer had to scramble to pay for heroin. They also spent less time in emergency wards and were not as costly to the criminal justice system.

    http://www.cbc.ca/news/canada/british-columbia/heroin-hydromorphone-addiction-1.3524118

    ReplyDelete
  37. Increase in overdose deaths prompts B.C. to declare public health emergency

    Province had 474 drug-related deaths in 2015, a 30 per cent rise over previous year

    CBC News April 14, 2016

    A public health emergency has been declared in British Columbia over a "significant" increase in drug-related overdoses and deaths.

    The announcement was made Thursday morning by Provincial Health Officer Dr. Perry Kendall. It is the first time he has exercised his emergency powers.

    Kendall said that overdose deaths have climbed steadily since 2010, reaching 474 in 2015, a 30 per cent increase over the 365 overdose fatalities in 2014.

    The medical emergency status triggers new powers that will allow officials to collect real-time information on reported overdoses. That data will help pinpoint new spikes quickly, allowing medical service staff to warn and protect those at risk.

    This year in B.C. there were 76 drug-related deaths in January alone, the largest number of deaths in a single month since at least 2007.

    If that pattern continues this year, it could mean as many as 600 to 800 fatal overdoses in 2016.

    As the rate of overdoses has grown, so has the proportion of illicit drug-related deaths due in part — or entirely — to fentanyl, which was involved in five per cent of deaths in 2012 and approximately 31 per cent in 2015.

    Kendall said he will be conferring with a range of medical personnel in the coming weeks to work out the best way to collect and disseminate this information.

    http://www.cbc.ca/news/canada/british-columbia/bc-public-health-emergency-overdose-drugs-1.3535910

    ReplyDelete
  38. BC declares public health emergency as overdoses surge again

    by SUNNY DHILLON AND KAREN HOWLETT — The Globe and Mail April 14, 2016

    British Columbia has declared a public health emergency after another surge in drug-related overdoses and deaths, making it the first province in the country to take such a step as others, including Ontario and Alberta, work to combat the effects of fentanyl.

    “This is, frankly, a crisis,” provincial health officer Perry Kendall said.

    Dr. Kendall’s decision comes after B.C. recently suffered its highest monthly total of overdose deaths in nearly a decade.

    “We in Canada have been watching with dismay as the number of overdose deaths associated with opioid drugs, in fact all illicit drugs, increases,” Dr. Kendall said, adding that despite the efforts of B.C. officials, the number of deaths has continued to climb.

    A recent Globe and Mail investigation found that online suppliers have exploited gaps at the border to get illicit fentanyl into Canada, devising ways to conceal the drug and skirt inspection rules. Fentanyl was developed as a prescription painkiller, but gained popularity as a street drug after OxyContin was removed from the market in 2012.

    B.C. had 76 illicit drug overdose deaths in January, the highest total in a single month since at least 2007. At its current rate, the province could have 600 to 800 overdose deaths this year, Dr. Kendall said in a news conference on Thursday. B.C. had 474 such deaths last year, a significant increase from 211 in 2010.

    The number of B.C. illicit drug overdose deaths linked to fentanyl, an opioid up to 100 times more potent than morphine, has also surged, from 5 per cent in 2012 to about 31 per cent last year. Of the 201 overdose deaths in B.C. so far this year, 64 were associated with fentanyl.

    Declaring a public health emergency – the first time B.C. has ever done so – allows officials to collect real-time data on all overdoses, Dr. Kendall said. Overdose information is currently released only when a person dies.

    Dr. Kendall, who was joined at the news conference by B.C. Health Minister Terry Lake, said compiling real-time data was a key recommendation in a recent report by the B.C. Drug Overdose and Alert Partnership, which is led by the B.C. Centre for Disease Control.

    “We have determined that in order to assist us in providing an enhanced response, a key need is for more information and more detailed information on the who, the where, the when of these tragic incidents,” he said.

    Dr. Kendall said knowing more about overdoses more quickly will allow health officials to provide a better response. He stressed the medical information will be treated confidentially.

    The emergency declaration did not immediately spur other provinces that have been hit hard by fentanyl to follow suit.

    A spokesperson for Ontario Health Minister Eric Hoskins referred questions to the province’s chief medical officer of health, who could not be reached for comment on Thursday evening.

    continued below

    ReplyDelete
  39. Health care workers in Ontario said the province should treat the increase in overdose deaths with the same urgency as B.C. is doing. Several communities have sounded the alarm in recent weeks about a spike in overdoses from street drugs that appear to have been laced with fentanyl.

    “If this isn’t a public health emergency, then Ontario needs to redefine what constitutes an emergency,” said Michael Parkinson, community engagement co-ordinator with the Waterloo Region Crime Prevention Council, which has issued local alerts about the prevalence of illicit fentanyl.

    The most recent information on fatal opioid overdoses in Ontario is from 2014, when 173 people died of fentanyl overdoses, accounting for one in four opioid fatalities.

    “I think there’s enough of a rise in fentanyl that we should be seriously looking at whether this meets the definition of a public health emergency,” said Kieran Michael Moore, associate medical officer of health for KFL&A Public Health, an agency representing Kingston and neighbouring communities.

    A spokesperson for Alberta’s minister of health said the province sought legal advice last fall to determine whether a public health emergency should be declared. The spokesperson said the government decided a declaration was not necessary to move forward with attempts to combat fentanyl and other opioids.

    A statement attributed to Alberta Health Minister Sarah Hoffman said her government has taken steps to address the illicit use of fentanyl, including more than doubling the province’s supply of take-home naloxone kits.

    Hakique Virani, an assistant clinical professor in public health and addiction at the University of Alberta’s Faculty of Medicine, has called fentanyl the No. 1 public health concern in the province. He said B.C.’s announcement was welcome, although he would like to have seen such action sooner.

    Dr. Virani said it was unclear if other provinces will be encouraged to do the same.

    “Why now is it more of an emergency after B.C. has called one than it was last month, when we were still losing somebody every single day ... to opiate overdose? It would be a difficult thing, I think, for a minister or a chief medical officer of health to explain, ‘Well, now it’s an emergency because B.C. said it was.’

    “It’s been an emergency for years.”

    B.C. health officials will work together over the next few weeks to sort out the logistics of collecting the data. Dr. Kendall said a conference will also be held in early June to look at other programs and policies to reduce overdose deaths.

    Mr. Lake, who said B.C. leads the country on harm reduction strategies, added the crisis has taken a toll on families.

    “To lose a loved one to an overdose is indeed a tragedy,” the minister said. “These are our sons, our daughters, our mothers, fathers, brothers, sisters, and friends. We have to do everything we can to stop this toll.”

    http://www.theglobeandmail.com/news/british-columbia/overdoses-prompt-bc-to-declare-public-health-emergency/article29631552/

    ReplyDelete
  40. Fentanyl overdoses rise emergency reporting takes effect

    by Tom Fletcher - BC Local News May 12, 2016

    Drug overdose cases continue at high levels as an emergency order to report them immediately takes effect for hospitals, paramedics, police and firefighters across B.C.

    Health Minister Terry Lake said Thursday there were 56 overdose cases reported in April, and the province has seen an average of 60 a month since January. Half of those cases are related to fentanyl, a potent synthetic opioid increasingly showing up in street drugs.

    "People don't know they're taking it, and it's 100 times more powerful than other opioids," Lake said. "They think they're taking oxycontin or something like that, and it's fentanyl, and there are tragic consequences."

    Provincial Health Officer Dr. Perry Kendall sent out B.C.'s first-ever public health emergency order this week to emergency wards and first responders. Real-time reports of clusters of overdoses are to allow local public warnings and deployment of naloxone, an antidote for opioid overdoses.

    Lake said the real-time information has been shown to work.

    "In Kamloops a couple of weeks ago, we were lucky enough to be able to collect data from the emergency department, and we had about seven treated overdoses in 24 hours," he said. "We were able to get that word out quickly, and in that case I think we were able to avoid deaths."

    Fentanyl has been traced to illicit drug labs in China. Considered 100 times more potent than heroin and other opioids, its strength makes it easy to smuggle and to reach dangerous levels when mixed with other drugs.

    http://www.albernivalleynews.com/news/379264241.html

    ReplyDelete
  41. Overdose deaths up from 40 a month in 2015 to 64 a month this year

    Public health emergency was declared last month

    By Liam Britten, CBC News May 12, 2016

    Drug overdose deaths have reached an average of 64 per month, up from 40 per month last year despite a public health emergency called last month.

    Provincial health officer Dr. Perry Kendall also says the percentage of overdoses involving fentanyl has jumped to 49 per cent from less than a third in 2015.

    Kendall says better info is going to be needed to get a handle on the overdose crisis, and on Thursday morning, orders for information gathering went out to ERs and ambulances across the province.

    "With the mapping we're getting from B.C. Ambulance, we can get to location. We can get to time of day where they're responding to overdoses, and that will tell us exactly where we should target our resources," he told On The Coast guest host Gloria Macarenko.

    Kendall says the declaration of a public health emergency has seen some positive results, including more awareness, more Naloxone being given to drug-using patients when they are discharged from hospitals and discussions at the municipal level to request supervised injection sites from Health Canada.

    The data also shows overdose deaths have jumped 327 percent since 2008, and Kendall says long-term solutions might require more than medical action.

    "The logical answer, if we didn't have moral qualms or political qualms or ethical qualms, would be to offer people a safer alternative," he said.

    "But that means a prescription alternative and that is completely contrary to most of our drug policies … so that is a political or policy challenge."

    Kendall says he's hopeful about the wider availability of Suboxone in B.C., an opioid replacement drug safer than methadone, and he's hopeful it will become even more widely available in the future.

    With files from CBC Radio One's On The Coast

    To hear the full story, click the audio labelled: Despite declaration of health emergency, opioid overdose deaths growing at:

    http://www.cbc.ca/news/canada/british-columbia/opioid-overdose-deaths-emergency-1.3580212

    ReplyDelete
  42. Proposed regulations would allow doctors to prescribe heroin to addicts

    Move reverses 2013 Harper decision banning BC doctors from prescribing to addicts

    The Canadian Press May 13, 2016

    Health Canada is planning to change regulations to allow doctors to prescribe heroin to some opioid addicts who do not respond to treatments such as methadone.

    The move reverses a 2013 decision under the Harper government, which banned a group of British Columbia doctors from prescribing the drug to a small group of addicts.

    In 2014, a B.C. judge granted an injunction exempting the doctors and patients from the ban.

    Health Canada now plans to allow access to heroin in special cases, according to a regulatory amendment published in the Canada Gazette.

    Interested parties have 30 days to comment on the proposal.

    Under the change, heroin would be covered under what the department calls its special access program, or SAP.

    http://www.cbc.ca/news/politics/prescribe-heroin-health-canada-1.3582193

    ReplyDelete
  43. While we're at it why not legalize all drugs?

    by Michael Enright, CBC Radio May 15, 2016

    In 1994, the American writer Dan Baum interviewed John Ehrlichman, henchman to Richard Nixon and Watergate co-conspirator, about the opening volleys of the US War on Drugs in the 1970s.

    Erlichman quite openly explained that the war on drugs was directed at two groups, which Nixon felt were his mortal enemies; young people and blacks.

    Then, in a moment of extraordinary candor Ehrlichman said this: "By getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities, arrest their leaders, raid their homes and vilify them night after night on the evening news."

    Baum's gripping story in the April edition of Harper's Magazine underlines how the war on drugs was three things; a lie, a put up job and a complete failure.

    Canada has never had a declared war on drugs, although we have always chosen interdiction and heavy law enforcement over common sense.

    The Trudeau government is moving, carefully and cautiously, to decriminalize marijuana. And this week, a former prime minister, Jean Chretien, said such a change was long overdue.

    Actually a review of all our drug laws is long overdue. And if the stars and planets are properly aligned, Canada will, in the not too distant future, legalize all drugs, not just marijuana.

    That's right, all of them — heroin, methamphetamines, cocaine, crack and powder and everything else in the illegal pharmacopeia.

    Legalization would have, I submit, immediate and lasting benefits.

    In the first place, it would tear a huge hole in the network of drug dealers here and abroad. Take away the demand, the supply dries up. Reduce the supply, no more drug dealers.

    On top of which, because illegal drug users often resort to crime to pay for their habit, decriminalization would bring down those crime rates.

    We might learn a thing or two from Portugal. Throughout the 1980s and 1990s, Portugal had the highest rate in the European Union of HIV among injecting drug users. Then in June 2001, Portugal passed a series of laws decriminalizing all drugs within its border — everything.

    Rather than an epidemic of drug tourism, as everybody feared, drug usage actually went down. For example, Portugal has the lowest rate of marijuana usage in the EU, about 10 per cent of people over the age of 18. By contrast, in the United States with some of the toughest drug laws in the world, the figure is 40 per cent. Experts now say that Portugal now manages and controls its drug problem better than any other country in the West.

    It should be clear by now that prohibition doesn't work. It didn't work for alcohol in the Twenties and it doesn't work for drugs nearly a century later. Think of the billions now spent on enforcement, interdiction, court time, police resources, and imprisonment. Now think of that amount of money being spent on treatment and education.

    This will only happen, though, when governments come to the understanding that drug use is a medical, not a criminal problem.

    http://www.cbc.ca/radio/thesundayedition/legalize-all-drugs-hard-truths-about-climate-change-moms-with-sons-in-jail-john-banville-s-blue-guitar-1.3566782/while-we-re-at-it-why-not-legalize-all-drugs-michael-s-essay-1.3570518

    ReplyDelete
  44. Light Years Ahead of the US on Drug Reform, Canada Will Allow Prescription Heroin

    It was first in North America with safe injection sites and heroin maintenance studies. Canada plows ahead

    By Phillip Smith / AlterNet May 15, 2016

    Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable.

    "A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

    The move is yet another reversal of hardline Conservative drug policies by the Liberal government headed by Prime Minister Justin Trudeau, which was elected last fall. The Trudeau government has pivoted sharply away from Conservative positions in favor of mandatory minimum drug sentences and against marijuana legalization, and now is moving to undo Conservative efforts to block the limited use of prescription heron.

    Canadian scientists had laid the groundwork for prescription with the North American Opiate Medication Initiative (NAOMI), which first tested "heroin-assisted maintenance" in Vancouver a dozen years ago, and which was followed by the Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) between 2005 and 2008. SALOME examined whether giving hard-core heroin users heroin was more effective than giving them methadone.

    SALOME showed that the users in the study were more likely to stay in treatment, reduce other illegal drug use, engage in fewer other illegal activities and have better physical and mental health outcomes if given heroin than if given methadone. But when that study ended in 2008, researchers were faced with the ethical dilemma of cutting off the patients whose lives were being improved by prescription heroin.

    The doctors began applying for, and receiving, permission under the Special Access Program, and Health Canada approved those applications in 2013. But that infuriated the Conservatives, and then-Health Minister Rona Ambrose introduced new regulations to bar doctors from prescribing "dangerous drugs" such as heroin, cocaine, and LSD.

    Former SALOME participants launched a constitutional challenge to the ban and in 2014 won a temporary injunction giving them the right to continue to receive prescription heroin while the case was being decided. Now, with Health Canada's move, the federal government will no longer attempt to block prescription heroin.

    That was good news for the Pivot Legal Society, which argued the case for continuing the prescriptions, and for Providence Health Care, in whose Crosstown Clinic in Vancouver's Downtown Lower East Side the heroin was administered.

    "Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use," the two groups said in a joint statement.

    Canada is leading the way on cutting edge responses to heroin addiction in North America. In addition to the groundbreaking NAOMI and SALOME studies, which cannot be replicated in the US under current law and regulations, Canada has also had safe injection sites operating in Vancouver for more than a decade. We still don’t have any of those in the US.

    http://www.alternet.org/drugs/canada-will-allow-prescription-heroin

    ReplyDelete
  45. Solving Canadas opioid epidemic must include tackling what got us into the predicament in the first place

    By Alan Cassels, an expert advisor with EvidenceNetwork.ca and the author of the just-published, The Cochrane Collaboration: Medicine’s Best Kept Secret.

    A version of this commentary appeared in the Toronto Star, the Huffington Post and Vancouver Province

    By all accounts we are in the midst of a deadly drug epidemic so severe and widespread few people in North America will remain untouched by it. In case you think I’m exaggerating, right now we have probably the highest rates of narcotic abuse and deaths in modern history.

    Critics have begun pointing the finger at the medical system and its prescribers – well-meaning doctors and specialists who’ve been giving too many patients excessively powerful opioid medications to deal with modest pain. But we can dig deeper and look at the relationship between medical education and pharmaceutical company influence as a significant contributing factor.

    Typically the suggestion of an epidemic is hyperbolic, but it doesn’t seem so in this case. Last week, Dr. Perry Kendall, the provincial Health Officer in British Columbia said that BC has a bona fide “public health emergency” on its hands, mostly due to the alarming number of overdose deaths linked to prescription opioids.

    Opioids include prescription narcotics like Oxycontin, hydromorph Contin and fentanyl (which some say is 100 times stronger than morphine). Dr. Kendall said that there were more than 200 opioid-related overdoses so far this year in BC, and if those numbers continue, there’ll be 800 by the end of the year.

    What’s happening in BC is just a small microcosm of what is happening across Canada, where we have some of the highest rates of prescription opioid consumption in the world. From 2006 to 2011, use of opioids in Canada rose by 32 percent and that rise has continued unabated, despite efforts to slow it down.

    The United States is also in full-on damage control mode, trying to stem the incredible numbers of deaths due to opioids. In 2012, there were 259 million prescriptions written for opioids — enough to give every American adult their own bottle of pills. Since 2000, the overdose death rate in the U.S. has risen by 200 percent and there were nearly 19,000 opioid-related overdose deaths in 2014. Two weeks ago, I sat in a room while Dr. Vivek Murthy, the new Surgeon General of the United States, told the assembled crowd that he was driven to make the opioid epidemic a top priority in his administration due to the devastation he’s seen in communities all across the country.

    continued below

    ReplyDelete
  46. He told us the US experiences an overdose death every 24 minutes and the life expectancy of white, male, middle class Americans is dropping.

    The problems, as well as potential solutions, are incredibly complicated but I agree with Dr. Murthy when he says that curbing society’s exposure to opioids — particularly those that come from a prescription pad in a doctor’s office — is absolutely vital. As he said: “Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription.”

    It’s important to recognize that liberal prescribing of opioids is a very recent problem and, since the mid-1990s, can be linked to the message-crafting activities of the pharmaceutical industry which helped shape both patient perceptions of pain and influence how doctors thought about the safety of these drugs. Doctors were increasingly encouraged — sometimes through industry-funded educational activities or by using textbooks on pain management paid for by the makers of opioids — to prescribe the drugs for a much wider population of patients experiencing pain.

    If revising the messaging around opioids was a business-oriented strategy of the opioid makers, we cannot place the blame solely upon them. Some of that blame has to do with the co-dependent relationship between physician education and the drug industry, which funds a substantial portion of physician education in Canada.

    Is this epidemic not dire enough to finally build the absolute firewall we need between physicians education and the pharmaceutical industry?

    We need unbiased, safety-oriented messages around the appropriate use of opioids and knowledge of their wicked addiction potential. We also need to remind ourselves, both patients and prescribers, that any incredibly powerful and effective drug can also be incredibly dangerous and destructive.

    The focus to tackle the addiction problem has to be serious, multifaceted source control. We need greater access to addiction treatment facilities, and methods to rescue people from the depths of addiction, certainly. But we also need to curb society’s underlying dependence upon drug company money for doctor training.

    http://umanitoba.ca/outreach/evidencenetwork/archives/28763

    ReplyDelete
  47. Are You in Pain and Getting the Help You Need? The Opiate Addiction Dilemma That Obama Truly Grasps

    And if our other politicians don't follow Obama's lead, they're unlikely to make strides in solving America's addiction problem.

    By Stanton Peele / AlterNet May 20, 2016

    Throughout the 20th, and now the 21st, centuries, public health officials and politicians have announced new drug scares. These scares have usually—but not always—involved opiates, also known as narcotics, but they’ve also in recent decades included cocaine and its derivative, crack, methamphetamines, Ecstasy, and other substances.

    Today, the villain is prescription painkillers, as deaths associated with them reach new heights. And, so, once again, politicians and public health officials want to make it harder for people to receive legitimate prescriptions for painkillers.

    Does this sound familiar? As painkillers proliferated in American society throughout the 1990s and 2000s restrictions were placed on the prescription and purchase of painkillers, making it both harder to obtain drugs such as oxycodone (OxyContin) and fentanyl, while also making these drugs more expensive relative to illegal narcotics. Guess what happened next? Many painkiller users turned to ... heroin.

    And, so, we got a phenomenon not previously observed. Whereas health professionals (like CNN’s Sanjay Gupta) tended to see one form of narcotics as replacing the other, we managed to create the unprecedented situation in the U.S. of having simultaneous epidemics of both heroin and painkiller deaths—and, while we were at it, adding in a record number of tranquilizer-related deaths.

    Not a good result. And, yet, here we go again.

    We can go back a hundred years to see how our policy was formed, to 1914 and the passage of the Harrison Act, technically a taxation bill, but one that had the effect of making narcotics (and cocaine) illegal. The result? Whereas heroin users had been supplied the drug by individual physicians or at hospital clinics, previously ordinary citizens habituated to heroin were now thrown onto the streets to seek their drug supplies, becoming the “addicts” who created the drug underworld Americans came to fear and loathe.

    Along with this shift, heroin use became lodged in inner cities, creating drug ghettos, whereas earlier opiate use was more likely to be found among middle-class and white Americans. Much is now being made that the narcotic addiction tide has been partially reversed to include more white, and perhaps somewhat more middle-class, users. But heroin addiction is still heavily concentrated in inner cities, like Baltimore, while painkillers are rampant in impoverished white enclaves, like Appalachian West Virginia.

    This is the United States on drugs, the United States of heroin/narcotic addiction, which Yale psychiatrist David Musto termed “The American Disease.”

    Flash-forward to the present. The opioid death epidemic “unexpectedly dominated” the bipartisan governors’ conference this year, with the governors passing a resolution to make it harder for people to obtain and use prescription painkillers. Finally, something both Republicans and Democrats agree on!

    Only one notable political figure, not up for re-election, opposed the governors’ consensus:

    “If we go to doctors right now and say ‘Don’t over-prescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” President Obama said during his meeting with the governors. “In some cases, addiction is already there.”

    What the hell?!

    This statement is prescient and nostalgic at the same time. Prior to the Harrison Act, those addicted to narcotics were supplied their drug by medical providers.

    continued below

    ReplyDelete
  48. Currently prescribing heroin or providing sites where heroin can be safely administered under medical supervision, is the leading edge of drug policy reform in Britain, Denmark, the Netherlands, Switzerland, Germany, and—in North America—Vancouver.

    Why not in the United States? Because “heroin is bad, and injecting heroin is bad, so how could supervised heroin injection be a good thing?” This question was asked rhetorically by Ithaca’s Democratic Mayor, Svante Myrick (age 29). Rhetorically, because Mayor Myrick was actually proposing a plan for establishing a site where people could legally shoot heroin.

    But the plan is a nonstarter, because probably every other politician in America who mouthed the words Myrick did would actually mean them. Keep in mind, however: Virtually no deaths have ever occurred at supervised heroin injection sites or in places where heroin is provided by prescription.

    Which brings up a strange anomaly. While heroin deaths have reached a peak, heroin purity has declined since the 1990s. And as painkiller deaths slowly rose in the 2000s, the use of painkillers did not rise. And while somewhat more people are using tranquilizers, deaths associated with their use have quadrupled. In other words, the problem isn’t in the drugs, but in how we use them.

    Heroin use, in itself, is not toxic. People have taken opiates safely for centuries. The ratio of strength for a fatal injection of heroin relative to a typical street dose is 50-1, or more. Drug users die, in over 90 percent of cases, from combining depressant drugs, including different narcotics (which may have caused Prince’s death) or tranquilizers or alcohol or other drugs. Amy Winehouse drank alcohol while using tranquilizers. Philip Seymour Hoffman died from taking heroin mixed with benzodiazepines, amphetamine, and cocaine.

    At the same time that they assure drug purity, drug-administering sites (where drugs are tested) and drug-providing sites offer ready access to treatment for those who want to remit or reduce their drug use. No such assisted remission is available to street users—although many do ultimately outgrow narcotic addiction—“mature out”—on their own.

    So, in rejecting injection sites, or prescribed heroin, our concern obviously isn’t to reduce drug fatalities or to support people in quitting drugs. It’s a way for us to repeat, as we have been for a hundred years, the mantra that “drugs are bad.”

    Let’s return to Obama’s remarkably prescient statement. He recognizes that people have reasons, whether physical or mental (as though we can separate the two), for using painkillers—including perhaps their having become addicted to them. The president’s keen insight is that the greater damage occurs when people are denied a reliable supplier and are forced to ferret drugs out for themselves, on the street or from multiple medical sources.

    Or else the users are forced to deal with pain and emotional problems without them. What gives us the right to force this choice on them?

    Assisting people safely to take drugs, on the other hand, represents the policy of harm reduction. This isn’t American drug policy—harm reduction is backed by neither drug czar Michael Botticelli nor the director of the National Institute on Drug Abuse, Nora Volkow.

    Yet, President Obama enunciated this harm reduction perspective in his response to the governors’ seat-of-the-pants action plan for prescription painkillers. We’re going to miss a person able to form such a calm, rational, empathic perspective on drugs—one that neither Donald Trump nor Hillary Clinton is capable of. (Is it too late for Svante Myrick to run for president?)

    Stanton Peele is the author, with Ilse Thompson, of "Recover! Stop Thinking Like an Addict and Reclaim Your Life with the PERFECT Program." He is the developer of the Life Process Program.

    http://www.alternet.org/drugs/obama-only-reasonable-voice-drug-policy-government

    ReplyDelete
  49. Little — if any — heroin left in Vancouver, all fentanyl: drug advocates

    Dangerous opioids cheaper and easier to smuggle

    By Geordon Omand, The Canadian Press May 22, 2016

    For Hugh Lampkin, fentanyl's surge to all but replace heroin on the Vancouver drug scene calls to mind a curious image: a rainbow.

    "Traditionally, heroin comes in about four different colours," said the longtime drug advocate, describing a bland palette of beiges, browns and blacks.

    "Well now you're seeing multiple colours, like colours of the rainbow: green and pink and orange and white. ... Right away, when you see these colours that's a pretty good indicator that it's fentanyl that you're doing."

    As government data tracks a spike of fentanyl across Canada, people who use illicit drugs in Vancouver's Downtown Eastside say there is virtually no heroin left on the street after it has been pushed out by the cheaper and more potent fentanyl.

    Martin Steward of the Western Aboriginal Harm Reduction Society said fentanyl's takeover is evident by how easily people are overdosing on small amounts of what is being sold as heroin, and simply by people's physical response to the drug.

    Fentanyl posing as heroin

    "I know people who use heroin and they'll inject what they normally do. And the next time they'll do exactly the same thing of what they think is heroin and they're out. Like, they're going under from it," Steward said in an interview, referring to an overdose.

    "They're using the same thing, the same product, but getting a different result. That's a forerunner for me to see that it's not heroin."

    There have been 256 fatal overdoses from illicit drugs in the first four months of this year, already more than half the 480 that occurred for all of 2015. Fentanyl's connection to those deaths has been surging at a staggering rate.

    The B.C. Coroners Service reported last week that the presence of fentanyl in cases of illicit drug overdose deaths rose from a third in 2015 to nearly 50 per cent so far this year.

    Speaking anecdotally, Lampkin said he doesn't believe anyone in Vancouver has used real heroin in more than a year and that many users don't appear to be aware of it.

    He's observed overdose victims needing three full vials of the overdose-reversing drug naloxone to recover, he said.

    'Growing trend'

    "I think it's not so much as they're moving to it as a case of not having any choice," said Lampkin, who sits on the board for the Vancouver Area Network of Drug Users.

    "The people who are controlling the supply, they're passing off what should be heroin as fentanyl because of the close proximity of the high."

    continued below

    ReplyDelete
  50. Vancouver police report heroin-related drug seizures and criminal charges in the city have remained relatively stable over the past five years, but Lampkin said drugs are only tested when charges are laid or usually in the event of a fatal overdose.

    Sgt. Darin Sheppard, who heads up a British Columbia RCMP division that investigates organized drug crime, said that while heroin is still present in the province, fentanyl is increasingly taking over the market.

    "It's a growing trend," he said, pegging 2014 as the first year fentanyl was noticed in a significant way.

    Mark Haden, a public health professor at the University of British Columbia, draws a parallel to alcohol prohibition, which he said led to stronger, more concentrated booze that was often toxic.

    Dangerous opioids: low cost, easy to smuggle

    "Dealers will always want small packages. That's the natural process of drug prohibition," he said, dismissing the war-on-drugs policy approach taken by governments as shortsighted and ineffective.

    There are multiple explanations offered for the rise of the dangerous opioid, centring on its low production cost and the simplicity of smuggling it across the border in its compact, concentrated form.

    Jane Buxton with the Centre for Disease Control said money plays a key role in fentanyl's upward trend line.

    "Whoever is importing or selling drugs, they're doing it presumably for a profit and therefore if there's a substance that is easy to access and cheap, and can be sold for a great profit, that's what's going to be focused on," she said.

    The manufacturer of the prescription opioid OxyContin designed a tamper-resistant version of the prescription drug that becomes inert when meddled with, making it impossible to grind and snort, for example.

    The effectiveness in disabling OxyContin as a drug source has in turn contributed to a spike in black market opioids, Buxton said.

    More data needed

    Still, it's difficult to know exactly what is happening on the ground without effective and timely data collection, she added.

    Michael Parkinson of the Waterloo Region Crime Prevention Council in Kitchener, Ont., lamented that no province, territory or the federal government gathers real-time data on opioid overdose fatalities.

    That is seriously hampering their ability to craft fast and effective responses to drug crises, he added.

    "(With) other causes of accidental death, for example influenza, we know how many people died or were hospitalized last week," said Parkinson.

    Alberta and B.C. now have more up-to-date numbers on fentanyl overdose deaths, he said, but other opioids aren't included.

    "It's an international mystery. It really is. It's scandalous," Parkinson said, pointing out that there have been 4,984 deaths in Ontario due to opioids over a 13-year period.

    "We get three people dropping off from anaphylaxis and it's all hands on deck," he added. "That hasn't happened with opioid overdoses."

    http://www.cbc.ca/news/canada/british-columbia/little-if-any-heroin-left-in-vancouver-all-fentanyl-drug-advocates-1.3596202

    ReplyDelete
  51. Remembering Bria - Victoria woman dies from fentanyl overdose

    Health officials to meet in Vancouver next week to assess response to overdose crisis that has gripped B.C.

    By Megan Thomas, CBC News June 02, 2016

    After trying to help his daughter break free from a drug addiction for more than a decade, Fernand Magnin says he had to prepare for the possibility he would one day lose her.

    But it didn't make it any easier.

    His daughter, Bria Magnin-Forster, 30, died from a fentanyl overdose in early May.

    She was using alone in a bathroom at a shelter in Vancouver at the time, the Victoria father says.

    "In the end, it was the police at the door at 5 a.m. telling you that she had died from an overdose the night before."

    More than 250 people in B.C. died from drug overdoses in the first four months of the year. The death toll is nearly double what was reported during the same time period last year.

    In April, shortly before Bria died, B.C. took the unprecedented step of declaring a public health emergency over the rise in drug overdoses.

    Bria's family chose to share in her obituary notice that her death was caused by a fentanyl overdose to help raise awareness about the human toll of the crisis.

    "We felt that there are too many families that are being impacted by overdoses," Magnin says.

    "We see very few obituaries, if any, where people talk about the fact that the person died from a drug addiction."

    Few warning signs

    Magnin says there were few warning signs that his bright, creative child would fall into a life of addiction.

    She did well in school. She was a talented musician and excelled at writing.

    "We never had any particular incident or troubles during her childhood," he said.

    But in her teenaged years, Bria dealt with an eating disorder. Issues with anxiety followed, her father says.

    By 2005, the family realized she was using drugs. It was crystal meth at first, Magnin believes.

    "From then on it was really a kind of ongoing struggle for many, many years."

    continued below

    ReplyDelete
  52. There was hope after Bria hit a new low in 2010 and was hospitalized for several months.

    Following treatment, Magnin says she was placed in a Victoria group home where she found the right support and managed to stay clean.

    But he says the space was soon needed for someone else and Bria moved to her own apartment.

    "It was a critical moment. She was not ready to be on her own," he said. "To be left on your own to pull your life back together; it just wasn't enough for her."

    When things fell apart again, Bria returned to the streets. That was followed by a stay in jail.

    Upon her release in January, Magnin says there was a spot in a treatment program in the Lower Mainland.

    But there was no legal requirement that kept her there, he says. The family later found out she left the three month program after three days.

    On May 2, she was found dead from an overdose. Bria Magnin-Forster was 30 years old.

    No easy answers

    On June 9, addiction experts, drug users, health officials and police will meet in Vancouver to examine the response to B.C.'s overdose crisis and determine next steps.

    As Magnin grieves the loss of his daughter, he is also reflecting on what some of those steps should be.

    He supports making supervised drug consumption services widely available as an immediate safety measure but hopes solutions will address more than just preventing overdose deaths.

    Magnin is calling for stronger mental health services and better communication with families of addicts as they navigate the system.

    He says he was often in the dark about his daughter's treatment because of confidentiality requirements.

    He would also like to see more of a focus on addressing illicit drug use as a mental health issue rather than as a crime and less emphasis on providing those services in the community, rather than structured facilities.

    "It's not locking up everybody. It's providing enough support that they will be able to function and move in the right direction," Magnin said.

    "It is a very tricky path to follow, but we just know that what has been done up until now has not worked."

    http://www.cbc.ca/news/canada/british-columbia/remembering-bria-victoria-woman-dies-from-fentanyl-overdose-1.3612754

    ReplyDelete
  53. Fentanyl overdose epidemic spurs call for safe injection sites across BC

    Group advocating supervised consumption facilities

    By Deborah Wilson, CBC News June 01, 2016

    A Victoria-based advocacy group is calling for health officials to move beyond monitoring overdoses and start reducing them by expanding access to supervised drug use services.

    To make its point, on Wednesday morning the group, called Yes2SCS (Yes to Supervised Consumption Services), planted 600 white crosses on the Harris Green, next to a busy commuter route into Victoria's downtown.

    The crosses were erected, according to Yes2SCS spokesman Mark Willson, "to represent the amount of folks we believe could be lost in the coming year, according to the provincial health officer."

    Willson said a letter was also sent Wednesday to B.C. Health Minister Terry Lake and regional health authorities, urging the immediate creation of supervised injection sites in communities across the province.

    Currently, Vancouver's Insite and the Dr. Peter Centre are the only supervised injection sites approved in Canada.

    The chair of Victoria's Society of Living Illicit Drug Users, Katie Lacroix, said there is "a lot of fear" among users in Victoria about overdoses — which caused as many deaths in the first four months of 2016 as in all of 2015.

    "People may be overdosing but not dying; they're having lack of oxygen to the brain," Lacroix said in an interview with On The Island's Gregor Craigie. "There are long term physical and psychological effects of that."

    Safe place needed

    "People are trying to use together and spreading that message, but with the increase in fentanyl, people just never know what's going to happen when they're using," she said.
    "People need to have a safe place they can use so they're not scared and using behind dumpsters."

    British Columbia's provincial health officer says he supports expansion of safe injection services under the public health emergency he declared in April.

    Dr. Perry Kendall said heath authorities and local governments including Victoria and Nanaimo are developing plans to put a supervised consumption room into an existing health care facility.

    However, he said, getting formal federal approval for such a facility is extremely difficult without the repeal of the Respect for Communities Act (Bill C-2) enacted by the federal Conservative government in 2015.

    Anti-overdose drug recommended for shelters

    As an alternative, Dr. Kendall said, "if you have enough naloxone kits in a shelter or subsidized housing where you knew you had an issue with overdoses, you could be providing, as it were, a very low barrier supervised consumption site."

    "If you're injecting with somebody who does have a naloxone kit, then they are in some respects just monitoring your health and if they need to they can deliver the naloxone," Kendall said. "So that's a strategy that we're pursuing as well."

    With files from On The Island and Megan Thomas.

    To hear the interviews with Mark Willson of Yes to Supervised Consumption Services (Yes2SCS) and Katie Lacroix of the Society of Living Illicit Drug Users (SOLID), click the link below and the audio labelled: Group plants 600 crosses to push for overdose prevention measures

    To hear the interviews with Dr. Perry Kendall, British Columbia's Provincial Health Officer, click the link below and the audio labelled: Province's top doctor says emergency measures could include safe injection sites

    http://www.cbc.ca/news/canada/british-columbia/fentanyl-overdose-epidemic-spurs-call-for-safe-injection-sites-across-b-c-1.3611321

    ReplyDelete
  54. Drug users call for more supervised injection sites during fentanyl crisis

    Advocacy groups say supervised injection sites needed to reduce explosion in opiod overdose deaths

    By Liam Britten, CBC News June 08, 2016

    Despite the declaration of a public health emergency in B.C., opioid overdose deaths are not going down and and advocacy groups for current and former drug users want action.

    Laura Shaver, president of the B.C. Association of People On Methadone, says the best solution to the problem is more supervised injection sites and she wants to know what's taking so long.

    "We don't need any more data. We don't need any more research," she told On The Coast host Stephen Quinn

    "What we need is ... [to] give some healthcare funding to open some more sites, so we can save lives."

    Shaver and others, including the Vancouver Area Network of Drug Users (VANDU), marched on Vancouver's Downtown Eastside Wednesday to demand action.

    They called on the federal government to permit more special exemptions to the Controlled Drugs and Substances Act to allow an increase in the number of supervised injection sites.

    Shaver fears there could be up to 800 overdose deaths in 2016 after the 474 in 2015 and says supervised injection services are a proven model that could reverse that trend.

    Health authorities also call for more services

    Shaver is not alone in calling for more supervised injection services in B.C.

    Health authorities on the Lower Mainland, Vancouver Island and the Interior have either called for more services in their jurisdictions or expressed interest in such services.

    However, Provincial Health Officer Dr. Perry Kendall said last week that getting formal federal approval for such facilities is extremely difficult without the repeal of the Respect for Communities Act enacted by the federal government in 2015.

    As an alternative, Kendall said, "if you have enough naloxone kits in a shelter or subsidized housing where you knew you had an issue with overdoses, you could be providing, as it were, a very low barrier supervised consumption site."

    "If you're injecting with somebody who does have a naloxone kit, then they are in some respects just monitoring your health and if they need to they can deliver the naloxone," Kendall said. "So that's a strategy that we're pursuing as well."

    With files from CBC Radio One's On The Coast

    To hear the full story, click the link below and the audio labelled: Fearing even more OD deaths, methadone users call for more supervised injection sites

    http://www.cbc.ca/news/canada/british-columbia/methadone-supervised-injection-sites-1.3623377

    ReplyDelete
  55. 5 new supervised injections sites coming to fight Vancouvers fentanyl overdose crisis

    Health officials say location of new supervised injection sites won't be released before they are approved

    By Mike Laanela, CBC News June 10, 2016

    Five new supervised injection sites could be opening somewhere in the Vancouver area, but health officials will not release the locations until they are approved by Health Canada.

    Health Minister Terry Lake says the province wants to open the new sites — similar to the Insite facility in Vancouver's Downtown Eastside — to stop the soaring number of overdose deaths.

    But according to Vancouver Coastal Health spokeswoman Anna-Marie D'Angelo none of the new sites would be stand-alone sites like Insite.

    Instead, all would be located inside existing facilities that already provide services for drug users.

    There are already two supervised injection sites operated by Vancouver Coastal Health. One is Insite. The other is a smaller location at the Dr. Peters Centre at St. Paul's Hospital. That one is only open to clients of the centre, which serves people with HIV/AIDS.

    Both have Health Canada permits, which are required in order to legally allow doctors and nurses to monitor users at a supervised drug site, she said.

    Overdose rates spiking

    Along with the five new sites planned by Vancouver Coastal Health, health authorities across the province are looking at similar options, according to the health minister.

    Lake says he wants the federal government to reconsider laws that restrict these types of facilities so that health authorities can create more of these services. Under existing laws all the proposed sites still require Health Canada approval.

    "We have seen the evidence. We know that we can reduce overdose deaths. We can reduce other related harms, reduce hospitalizations and connect people to services once they're ready to accept that help," said Lake.

    Yesterday a report released by British Columbia's chief coroner said illicit drug overdoses have become the leading cause of unnatural death in the province, outpacing fatalities from vehicle crashes.

    The report said there were 308 illicit drug overdose deaths from January through May of this year, compared with 176 deaths in the same period last year.

    Fentanyl was involved in 56 per cent of deaths in the first four months of this year compared with just five per cent of drug-related deaths in 2012.

    Chief Coroner Lisa Lapointe said that overdose deaths could amount to 750 people by the end of 2016 if the trend continues.

    In comparison, there were 300 fatalities from motor vehicle incidents in the province in 2015.

    The province's public health officer declared a state of emergency in April because of the rising number of drug-related deaths.

    Overdose kits distributed

    Meanwhile, to prevent more deaths from overdoses, the BC Centre for Disease Control has distributed 8,000 kits containing the opioid antidote naloxone.

    The kits are now available at over 100 establishments across the province and 1,200 kits have already been used to reverse overdoses, said Dr. Mark Tyndall, the centre's executive director.

    Health Canada removed the prescription status on naloxone in March to improve accessibility.

    "The option to get it out of pharmacies has also been very helpful and we need to make sure people are aware they can pick it up," said Tyndall.

    The kits have a larger dose of the antidote than what was previously prescribed for opioids in order to be effective on the more dangerous substance fentanyl, he said.

    But more services are needed, including rapid access to detox programs, to help people with addictions, he added.

    The health minister acknowledged there is a gap and said the government is investing in new services and centres for mental health and substance abuse.

    However, Lake said "you can't flip a switch" and it will take time for new services to have an effect.

    http://www.cbc.ca/news/canada/british-columbia/supervised-drug-site-fentanyl-1.3628411

    ReplyDelete
  56. Health Canada will reduce barriers to safe injection sites says Philpott

    Health minister says communities that want harm-reduction facilities should be able to get them

    By Peter Zimonjic, CBC News September 22, 2016

    Federal Health Minister Jane Philpott is asking her officials to make it easier for communities to approve and set up safe injection sites because of what she calls a public health emergency.

    "I've made it very clear to my department that there should be no unnecessary barriers for communities who want to open supervised consumption sites," Philpott said during question period in the House of Commons. "They are working with communities that are interested in this."

    "Clearly, it's important that this is done right."

    The minister made the comments in response to a question from Vancouver Kingsway MP Don Davies. He said Canada was on track for 2,000 overdose-related deaths this year and wanted to know what Philpott was doing to make safe-injection sites easier to set up.

    The Liberals have long supported the expansion of safe injection sites as a means of harm reduction for addicts, but have been slowed in approving new sites by legislation brought in under the Conservatives.

    The Respect for Communities Act, which came in in 2015, requires 26 criteria to be met before the federal government can begin considering a new safe consumption site.

    Critics of the law say that meeting all 26 criteria is onerous and takes so long that addicts literally die in back alleys because there is no supervised location where they can be treated when they overdose.

    Philpott has told officials to take into consideration the public health emergency that is occurring in many communities and directed staff to review all 26 criteria and remove or amend anything that poses an unnecessary barrier to getting a site up and running.

    After question period Davies told reporters he welcomed the government's decision as "excellent" and "long overdue," but urged the Liberals to move quickly.

    Davies said the opioid overdose crisis has been going on for months if not years, and every stakeholder in the country is unanimous that getting more supervised injection sites up now will save lives.

    "This is a national health crisis, and in that kind of situation I expect the government to move very quickly, and they haven't moved quickly enough," he said.

    On Thursday Philpott said that she was determined to see progress.

    "We're also looking at the legislation under the Controlled Drugs and Substances Act," she said. "And if it becomes clear to us that we need to make some further amendments to that act to ... ensure that there are no barriers, then we will certainly do that."

    Communities need a say: Tory critic

    Conservative health critic Colin Carrie accused the Liberals of hypocrisy, saying they are keen to get social licence from communities when building pipelines, but are happy to circumvent the consultation process when it comes to safe injection sites.

    "The Respect for Communities Act gives police, residents and municipal leaders a say when it comes to opening an injection site in their community," he said.

    "Instead of making it easier for drug addicts to consume drugs, the Liberal government should support treatment and recovery programs to get addicts off drugs, and enact heavy mandatory minimum sentences to crack down on drug traffickers."

    http://www.cbc.ca/news/politics/philpott-safe-injection-fentanyl-1.3774678

    ReplyDelete
  57. BC clinics free heroin enables addicts to have a meaningful life again co-ordinator says

    Goal is to give addicts just enough heroin to take away their desire to seek out street drugs

    By Nick Purdon, Leonardo Palleja, CBC News September 28, 2016

    If you met Lisa James, chances are you'd never guess she injects herself with heroin twice a day.

    She's a devoted mom to her daughter Tia, 24, who has a rare neurological disorder that causes tumours to grow on her spine and brain.

    She comforts Tia when she's overcome with nausea. She's by her side when she visits doctors.

    "My relationship with my daughter is better than it's ever been," says James, 48.

    But James says it wasn't so long ago, her days were spent doing absolutely anything to score heroin.

    She used to steal hundreds of dollars' worth of meat from grocery stores and sell it on the streets.

    She even stole from Tia.

    "I took $500 out of her account and because of the lovely girl that she is, she never wanted to make me feel bad," James says. "If someone had told me I would do something so despicable — I never would have believed it."

    She says that all changed when she was accepted to the Providence Crosstown Clinic in Vancouver's Downtown Eastside, where she's buzzed in every morning at 9 a.m.

    She sits down in a sterile room and injects a syringe full of free heroin into her arm.

    "Nobody knows I am an addict," James says. "I share with some people and they are always shocked. 'You're an addict? Really? A heroin addict?' They would just never know. And that's a nice feeling."

    Crosstown has been operating for seven years and is the only harm-reduction treatment centre in North America where addicts get actual heroin.

    The program is for longtime addicts who've been unable to get off opioids using other treatments, including methadone.

    Each participant goes through a titration process, supervised by a physician, to determine their tolerance level. The idea is to give addicts just enough heroin to take away their desire to acquire street drugs.

    The clinic is at capacity and serves 130 addicts. Research co-ordinator Kurt Lock estimates there are at least 500 opioid addicts in the Downtown Eastside alone who could benefit from the program.

    He says addicts approach him every day to see if they can get into the clinic.

    "I see desperation," Lock says. "When they come and see me, this is their last straw."

    continued below

    ReplyDelete
  58. Decades of addiction

    James got high for the first time when she was 12.

    "My grandma, who was actually an opiate addict and probably wasn't aware of that, gave me some Tylenol with codeine in it just to help because I had a terrible headache," James says.

    "I just remember the warmth coming over me. I loved it and I wanted more."

    After that, James started stealing pills from pharmacies and friends' houses.

    "I crushed them up and snorted them, trying to get that feeling again."

    In her 20s, she tried heroin.

    "I was in heaven, absolute heaven."

    Then one night, heaven turned to hell.

    She and two friends overdosed.

    "I couldn't see for about 20 minutes or so," she says.

    Her friend Otis died in the middle of the night.

    "It was horrific. I still think about him."

    The reality is death is never very far away if you're an opioid addict.

    Statistics from B.C.'s coroner service reveal there were 433 overdose deaths across the province in the first seven months of 2016.

    Fentanyl, an extremely powerful opioid, was detected in 238 of those cases.

    Controversial harm reduction

    Conservative Health Minister Rona Ambrose tried to shut down Crosstown in 2013. Her government argued the clinic enables addicts and that the goal should be to get heroin out of the hands of drug users.

    It took an order from B.C.'s Supreme Court to keep the clinic open.

    Lock agrees that Crosstown enables addicts.

    "We are enabling them," he says, "but we are not enabling them to continue doing evil in that simplistic sense. We are enabling them to have a meaningful life again."

    Lock says the clinic's goal is to stabilize the lives of addicts rather than push them to quit.

    He says the negative health effects of heroin addiction have nothing to do with the drug itself, but rather what it takes for a user to feed the habit.

    He says most addicts forego food, sleep and medical attention in their search for drugs.

    "A lot of people, they think that there's something intrinsic within the heroin that's harming people and that's just not the case," Lock says.

    "We've been brought up to think of heroin as the killer drug, but heroin itself, if you take it in proper conditions, and you are eating food, and you are getting sleep, there's no reason you couldn't get to live to 100 years old on the drug."

    These days, James and Tia spend as much time together as they can. They make dinner and go to movies.

    "We appreciate the little things together," James says.

    Usually when people talk about the "little things," it's because they're trying to savour life. And that's exactly what mother and daughter are doing.

    Tia has had several surgeries, but her prognosis is still uncertain.

    "She has an army of doctors," James says, "and basically I try to be there for her."

    James gets her second shot of heroin in the mid-afternoon.

    She insists the treatment has brought stability to her life and without it she wouldn't be able to look for a job. "I did my shot an hour ago," James says. "Do I look high? I am just normal."

    It costs British Columbia taxpayers $27,000 for the clinic to supply a year's worth of heroin to a single addict.

    The societal benefits are harder to calculate, but James insists, for her, they are crystal clear.

    "We all need our moms," she says. "I am able to be her mom."

    http://www.cbc.ca/news/canada/crosstown-clinic-heroin-addiction-1.3779768

    ReplyDelete
  59. Seattle Could Become the Home of the First Safe Injection Sites in the US

    A broad-based heroin and opioids task force has recommended them. The mayor, the county executive, and the county sheriff are on board.

    By Phillip Smith / AlterNet September 21, 2016

    Seattle and surrounding King County are on a path to establish the country's first supervised drug consumption sites as part of a broader campaign to address heroin and prescription opioid misuse. A 99-page report released last week by the Heroin and Prescription Opiate Addiction Task Force calls for setting up at least two of the sites, one in the city and one in the suburbs, as part of a pilot project.

    The facilities, modeled on the Canadian government-funded InSite supervised injection site in Vancouver, just 140 miles to the north, would be places where users could legally inject their drugs while under medical supervision and be put in contact with treatment and other social services. There have been no fatal overdoses in the 13-year history of InSite.

    Although such facilities, which also operate in various European countries and Australia, have been proven to reduce overdose deaths and drug use-related disease, improve local quality of life, and improve the lives of drug users, they remain controversial, with foes accusing them of "enabling" drug use. Thus, the report refers to them not as "safe injection sites," or even "supervised consumption sites," but as the anodyne "Community Health Engagement Locations" (CHELs).

    "If it’s a strategy that saves lives then regardless of the political discomfort, I think it is something we have to move forward," said County Executive Dow Constantine, discussing the plan at a news conference last week.

    The safe sites will address the region's high levels of opioid and heroin use, or what the task force called "the region’s growing and increasingly lethal heroin and opioid epidemic." As the task force noted, the number of fatal overdoses in the county has tripled in recent years, with the rate of death rising from roughly one a week (49) in 2009 to one very other day (156) in 2014. The current wave of opioid use appears centered on young people, with the number of people under 30 seeking treatment doubling between 2006 and 2014, and now, more young people are entering detox for heroin than for alcohol.

    continued below

    ReplyDelete
  60. Overdose deaths actually dropped last year to 132, thanks to Good Samaritan laws that shield people who aid overdose victims from prosecution and to the wider use of the opioid overdose reversal drug naloxone. But that's still 132 King County residents who needn't have died. Task force members said the CHELs would help reduce that number even further.

    "The heroin epidemic has had a profound effect not just on our region, but across our country as a whole," said Seattle Mayor Ed Murray. "It is critical that we not only move forward with meaningful solutions that support prevention and treatment, but that we remove the stigma surrounding addiction that often creates barriers to those seeking help.

    Not only are key local elected officials on board, so is King County Sheriff John Urquhart. He said the safe site plan was workable.

    "As long as there was strong, very strong, emphasis on education, services, and recovery, I would say that yes, the benefits outweigh the drawbacks," he said. "We will never make any headway in the war on drugs until we turn the war into a health issue."

    The region may willing to embrace this ground-breaking harm reduction measure, but it is going to require some sort of federal dispensation to get around the Controlled Substances Act and the DEA. How that is going to happen remains to be seen, but Seattle is ready.

    The task force wasn't just about CHELs. In fact, the safe sites are just a small, if key, component of a broad-based, far-ranging strategy to attack the problem. The task force report's recommendations come in three categories:

    Primary Prevention

    --Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
    --Promote safe storage and disposal of medications.
    --Work with schools and health-care providers to improve the screening practices and better identify opioid use.

    Treatment Expansion and Enhancement

    --Make buprenorphine more accessible for people who have opiate-use disorders.
    --Develop treatment on demand for all types of substance-use disorders.
    --Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.

    Health and Harm Reduction

    --Continue to distribute more naloxone kits and making training available to homeless service providers, emergency responders and law enforcement officers.
    --Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.

    Will Seattle and King County be able to actual implement the CHELs? Will the federal government act as obstacle or facilitator? That remains to be seen, but harm reductionists, policy-makers, and drug users in cities such as Portland, San Francisco, and New York will be watching closely. There have been murmurs about getting such sites up and running there, too.

    http://www.alternet.org/drugs/seattle-could-become-home-first-safe-injection-sites-us

    ReplyDelete
  61. Seattle task force wants to use Insite as model for first supervised injection site in US

    Washington having overdose crisis; task force says it's time for supervised injection site

    By Liam Britten, CBC News October 05, 2016

    A task force wants the Seattle area to become home to the first supervised injection site in the United States and experts are looking to Vancouver as a model.

    Last year, 229 people died from drug overdoses in King County, which includes Seattle, home to about two million people.

    "It's super alarming," Brad Finegood, co-chair of the Heroin and Prescription Task Force, told On The Coast host Stephen Quinn.

    "We've seen the trend steadily go up over time. Any time you have a situation where you have a public health epidemic like we do, people dying of drug overdoses, it's something we need to take hold of and take action on quickly."

    Finegood says authorities have seen fentanyl on Seattle's streets but aren't affected by it to the same extent as Vancouver, yet, "but we know it's on its way."

    He says InSite is a "foundational" example for supervised injection sites, because there have been no deaths there. He says it breaks the grip of isolation and connects people with other services.

    "It's beyond amazing," he said.

    'That's somebody's sibling; that's somebody's parent'

    Finegood says reaction to the call for supervised injection services has been mixed.

    "It's never easy to recommend something where people have some deep moral beliefs," he said. "But we've also seen a ton of public support."

    For Finegood, seeking a supervised injection site has a personal dimension. His brother died of an overdose 12 years ago on New Year's Day.

    "Knowing today or tomorrow, somebody's going to die of a drug overdose in our community, that's somebody's brother, that's somebody's sibling, that's somebody's parent," he said.

    "We need to be able take action as fast as possible and do what we need to do in order to keep people from dying and give people a chance to recover."

    In addition to calling for the injection sites, the task force has expanded availability of the anti-overdose drug naloxone in the area and is also calling for more addiction treatment services.

    http://www.cbc.ca/news/canada/british-columbia/seattle-injection-site-1.3793307

    ReplyDelete
  62. PopUp supervised injection tent in Downtown Eastside sees steady stream of users

    People were overdosing all around us, say organizers

    By Belle Puri, CBC News October 12, 2016

    Janet Charlie's 26-year-old son Tyler died of a fentanyl overdose in August so she knows the need for facilities like a pop-up supervised injection tent opened by a pair of community activists in a Vancouver Downtown Eastside alley.

    "I think it would have saved him," said Charlie.

    "He'd have somebody watching him, somebody who knows narcan training."

    Narcan is the brand name for naloxone, an opioid used to reverse the effects of a drug overdose.

    It's available at the tent which is a place for overdose-prevention, harm reduction and outreach.

    Big need

    Organizers Sarah Blyth and Ann Livingston estimate volunteers at the tent have had to use narcan at least 24 times to save a life since the facility opened on Sept. 20.

    "We're not going to stand by and watch people die in the alley and that's what we would be doing if we didn't do anything," said Blyth, who is a former Vancouver park commissioner.

    The tent has a few clean tables, chairs and supplies for intravenous drug users.

    Between 10 a.m. and 9 p.m., it averages 110 injections a day.

    "We're getting the stuff from Vancouver Coastal Health and from the B.C. Centre for Disease Control," said Livingston.

    "And we're saving all the ambulance calls, the emergency room visits."

    GoFundMe campaign

    It costs approximately $100 a day to operate the tent. All of the money comes from donations.

    A GoFundMe campaign called Overdose Prevention in the Downtown Eastside has been started to raise $3,000 to keep the facility open for at least another month.

    "We need lots more cleaning supplies. We could use some funding for brooms to clean up the alley," said Blyth.

    "Before we were in the alley, there were needles on the ground. Now, we make sure that they're gone."

    Great idea

    A DTES resident who would only give his name as John says he's been clean from drugs for awhile but thinks the pop-up site is a great idea if it prevents fatal overdoses.

    "I've lost friends this way. It's not something I want to see again," said John.

    Vancouver Coastal Health runs Insite on the DTES.

    But drug users say lineups and waits at that supervised drug injection site are too long.

    VCH also plans to open two new sites in early 2017.

    "I wish they had this in August back then. My son would be still here," said Janet Charlie.

    "He was only 26 years old."

    Charlie is a regular volunteer at a coffee stand that helps fund the supervised injection tent.

    http://www.cbc.ca/news/canada/british-columbia/pop-up-supervised-injection-tent-in-downtown-eastside-sees-steady-stream-of-users-1.3802469

    ReplyDelete
  63. Bill to make it easier to create supervised drug-consumption sites becomes law

    Jane Philpott says the country is facing an opioid crisis of 'unprecedented proportions'

    By Kristy Kirkup, The Canadian Press May 18, 2017

    Canada is dealing with an opioid crisis of "unprecedented proportions", Health Minister Jane Philpott said Thursday as she spoke in defence of a new law that removes 26 strict requirements for new supervised injection sites.

    Under the former law, new sites had to provide medical and scientific evidence of benefit and letters of support from provincial health ministers, local police and regional health officials — criteria established by the previous Conservative government that advocates argued created far too many barriers for harm-reduction facilities.

    The government said Thursday the new law streamlines the application process to align it with five factors set out by the Supreme Court of Canada, adding that evidence of a site's intended public health benefit will be required for applications.

    One letter of support from a provincial or territorial minister will still be required and if the federal government refuses a site application, it will be required to make the rationale public.

    "The evidence on supervised consumption sites is absolutely clear," Philpott said outside the House of Commons.

    "In communities where they have been well-established and maintained, including of course Insite in Vancouver, . . . it has been shown to, of course, save lives and reduce infections but it has shown to have no negative impacts on crime rates in the community."

    The new law also includes measures to restrict the import of pill presses and encapsulators — two machines commonly used in the production of illicit drugs, Public Safety Minister Ralph Goodale said.

    It also lifts a restriction that prevented border guards from inspecting packages under 30 grams in weight even if they had reason to believe the packages held illegal drugs, he added.

    "Bear in mind that a 30-gram package can include enough opioids to kill . . . 15,000 people," Goodale said. "That is a reasonable measure to put in the law to allow (the Canada Border Services Agency) to have the authority, if they have reasonable grounds to suspect an offence, they will have the authority to inspect the package."

    Health officials and political leaders have been sounding the alarm about a dramatic spike in opioid deaths across Canada — the focus of a national summit in Ottawa last fall that pulled together experts from across the country.

    http://www.cbc.ca/news/politics/injection-consumption-site-passed-1.4122528

    ReplyDelete
  64. Debate over drug consumption sites might be coming to end

    An increase in sites has not been matched by an increase in complaints

    By Aaron Wherry, CBC News November 05, 2017

    In the space of two years, the number of supervised consumption sites approved to operate in Canada has gone from one to 22, plus three interim sites.

    In November 2015, when Justin Trudeau's new Liberal government was sworn in, there was only Vancouver's Insite.

    Health Canada has now granted approval to two dozen new sites in 11 cities. There are permanent or mobile facilities approved for Victoria, Surrey, Kelowna, Kamloops, Vancouver, Calgary, Edmonton, Lethbridge, Toronto, Ottawa and Montreal. Another five applications are pending.

    That simple count alone might suggest that the debate over supervised consumption sites, or at least the most pitched and divisive version of that debate, is rapidly receding into the past.

    There also appears to be a difference of tone in the partisan discussion.

    Measuring political opposition

    Interviewed by CBC News in British Columbia earlier this year, Conservative Leader Andrew Scheer ranged from being somewhat critical to unenthusiastic about such facilities. And while his comments this week to the Globe and Mail fall short of a full endorsement for such facilities, there does seem to be something like openness.

    "My message to people in British Columbia and Vancouver is a sincere desire to find policy that works, balancing the legitimate and proper concerns of families and individuals who have real concerns about [supervised consumption] in their community with the need to save lives, the recognition that addicts are in a type of place where they will do what they can to get their hands on narcotics and take them," Scheer said.

    Liberals still jumped on Scheer's other comments about dealing with drug addiction — he suggested prosecution for drug use can move people towards rehabilitation — and Conservatives responded by alleging the Liberals are somehow planning to decriminalize all narcotics.

    But perhaps there is some measure of progress here anyway.

    Compare Scheer in 2017 with Tony Clement's declaration in 2008, when he was the ruling Conservative Party's health minister, that Vancouver's Insite was an "abomination."

    A Supreme Court ruling kept Insite operating. But when the Conservative government tabled legislation to establish new tests and requirements for establishing a similar site, the Tories sent a note to supporters entitled, "Keep heroin out of our backyards."

    "Do you want a supervised drug consumption site in your community?" wrote Jenni Byrne, the party's campaign manager. "I don't want one anywhere near my home."

    In the midst of the 2015 election campaign, a Conservative note warned supporters that a Liberal or NDP government would "actually expand these injection houses to neighbourhoods like yours, all across Canada."

    Back in December 2016, Scheer was warning supporters of his leadership campaign that the Liberal government "wants to impose heroin injection facilities on neighbourhoods."

    That emphasis on public consultation is still there, outright opposition may still exist in the Conservative ranks and the party might yet return to its previous tone, but Scheer's comments this week lacked a certain stridency.

    And that lack of objection may extend beyond the Conservative Party.

    continued below

    ReplyDelete
  65. Opioid crisis changes context

    "Whereas it took many, many years of advocacy and civil disobedience to establish a supervised injecting site in Vancouver, it's become a lot less politicized, a lot less controversial and I think there are no really sane actors who are sitting around questioning whether there is a role for these initiatives anymore," says Dr. Thomas Kerr, a researcher at the University of British Columbia who has studied Insite, noting that temporary facilities have been allowed to set up in Toronto and Ottawa.

    The deadly opioid epidemic and the emergence of fentanyl have no doubt changed the context. At least 2,458 deaths in 2016 have been linked to opioid-related overdoses. And, unfortunately, it sometimes takes a widespread crisis to make change.

    As such, it is possible a re-elected Conservative government would have also ended up expanding the number of supervised drug consumption sites. But the Liberal government, while rewriting Conservative legislation around such sites, has at least not hesitated.

    The rapid increase in approvals may, in fact, result in Canada being a world leader in the use of supervised sites. According to a count from earlier this year, the Netherlands had 30 of the world's 92 consumption sites, followed by Germany with 24.

    In her previous role as health minister, Liberal Jane Philpott reversed a ban on the medical use of pharmaceutical grade heroin to treat some people with addictions (Conservatives loudly touted that ban in 2013, but were quiet when Philpott reversed it).. Another drug, hydromorphone, is being used in Ottawa.

    Kerr says new approaches are being tested as the number of sites increases, including checking drugs for unknown contaminants.

    Not a panacea

    It is tempting to wonder whether such a significant expansion of sites, which exist to save lives, reduce the spread of disease, improve public safety and encourage treatment, could invite a backlash: if improvements aren't apparent, or surrounding neighbourhoods somehow seem to suffer.

    But both Philpott and Kerr point to a different risk: that communities will think a consumption site is a solution in and of itself.

    "What I might be concerned about is that I worry that people will get the message somehow that this is a panacea or a silver bullet, that it's going to somehow magically address the really complex circumstances that we're facing as a country in terms of the rising rates of overdose deaths," Philpott said in an interview earlier this year. "This is one of a really broad range of tools that fall into the classic four pillar response to drug policy."

    (Those pillars being harm reduction, prevention, treatment and enforcement.)

    What about decriminalization?

    In terms of what else can be done, Kerr is among those who believe a different system of regulation and decriminalization is best for those dealing with addictions to drugs like heroin.

    "It's really, really hard to engage people in care when society treats them like a criminal and when they have to endure all the stigma, including in health-care settings, that arises from criminalization," Kerr says.

    The Liberal government has repeatedly ruled out decriminalization of hard drugs.

    If the Canadian experience is any lesson, it might be deeply controversial and loudly opposed until, all of a sudden, it isn't.

    http://www.cbc.ca/news/politics/consumption-sites-heroin-opioid-analysis-wherry-1.4280612

    ReplyDelete
  66. Change your stance on overdose prevention sites, health groups urge Ford

    120 organizations, including Canadian Medical Association, signed open letter to Ontario premier

    CBC News August 30, 2018

    More than 100 health groups plan to send an open letter to Premier Doug Ford on Thursday, urging him to reconsider his Progressive Conservative government's position on overdose prevention sites.

    The letter — signed by 120 organizations including the Canadian AIDS Society and the Canadian Medical Association — urged Ford "to heed the recommendations of experts in public health, front-line clinicians, harm reduction staff, and people with lived experience of drug use."

    The letter also addressed Health Minister Christine Elliott.

    "Rather than impeding access to life-saving health services, we urge you to work with community organizations and other health services providers to ensure greater, equitable access to supervised consumption sites and overdose prevention sites for the people of Ontario."

    Since coming into power, Ford's conservative government has put several approved sites on pause — including one in Toronto — while the government studies the issue.

    "Minister Elliott is undertaking an evidence-based review, listening to experts, community leaders, community members and individuals who have lived through addiction to ensure that any continuation of drug injection sites introduce people into rehabilitation and ensure those struggling with addiction get the help they need," a spokesperson for Elliott said in a statement to CBC Toronto.

    "All of these voices will inform the review and recommendation. In the interim, the ministry has indicated that no new sites should open to the public. We expect this review to conclude in short order and will be making a recommendation on how to proceed."

    The organizations claim in the letter that the delays and closures of the sites could mean "more preventable overdose deaths and new infections of HIV, Hepatitis C and other illnesses."

    "We are not going to stand by while our government undermines access to these life-saving health interventions," said Nicholas Caivano, a policy analyst with the Canadian HIV AIDS Legal Network, the group that spearheaded the letter.

    Premier Ford has long been against the idea of the sites, expressing his opinion against them during his election campaign.

    "I have talked to numerous people that family members have had addictions and they are telling me they don't want an area that they can do more drugs," he said. "What they need is rehabilitation programs."

    The letter agrees that more rehabilitation programs are needed, but maintains that supervised injection sites and overdose prevention sites are needed too.

    It further states that "Canada is experiencing a large-scale opioid overdose crisis" and it is one of the "worst drug safety crisis in Canadian history."

    In Toronto alone, 300 people died of opioid overdoses in 2017, which is a 60 per cent increase from 2016.

    https://www.cbc.ca/news/canada/toronto/change-your-stance-on-overdose-prevention-sites-health-groups-urge-ford-1.4804099

    ReplyDelete
  67. Rod Rosenstein's Cheap and Dangerous Shot at Vancouver’s Insite

    Deputy U.S. attorney general argues for same old failed tactics in dealing with opioid crisis.

    By Crawford Kilian, TheTyee.ca August 31, 2018

    Canadians, like Americans, know Rod J. Rosenstein, the deputy attorney general of the United States, only because he appointed Robert Mueller as special counsel to investigate possible Russian meddling in the 2016 election. That makes him something of a hero, one who often comes under attack from Donald Trump.

    On Monday, Rosenstein went from hero to zero just by publishing an op-ed in The New York Times. “Fight Drug Abuse, Don’t Subsidize It,” he urged — and especially don’t fight it by establishing safe injection sites.

    Rosenstein may be a great lawyer, but as a public health expert he’s just another charlatan. The great 19th-century German doctor and politician Rudolf Virchow famously observed that “Medicine is a social science, and politics is nothing else but medicine on a large scale.” Or, in Rosenstein’s case, malpractice on a national scale.

    Rosenstein notes that drug overdoses are now killing over 60,000 Americans a year (and doesn’t mention that’s almost twice as many as die by gunshot). He laments that “remarkably, law enforcement efforts actually declined while deaths were on the rise… The Trump administration is working to reverse those trends. Prosecutions of drug traffickers are on the rise, and the surge in overdose deaths is slowing.”

    He gives no source for “slowing.” The most recent information from the U.S. Centers for Disease Control is from 2016, when the CDC reported that overdoses killed 63,632 Americans — two-thirds of them involving opioids. And that was a 21.5-per-cent increase from 2015.

    Injection sites ‘dangerous’?

    Rosenstein is alarmed that “some cities and counties are considering sponsoring centers where drug users can abuse dangerous illegal drugs with government help. Advocates euphemistically call them ‘safe injection sites,’ but they are very dangerous and would only make the opioid crisis worse.”

    He goes on to describe how these sites’ “staff members help people abuse drugs by providing needles and stand ready to resuscitate addicts who overdose.” Clean needles! Resuscitated overdose cases! The horror!

    After a litany of American cities considering such sites, Rosenstein says “they’re illegal,” and threatens the cities “should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.” He frets about the obvious — drugs may be laced with fentanyl or carfentanil — and warns that “a bystander or emergency medical worker who comes in contact with such drugs can be gravely harmed.” Perhaps so, but bystanders and first responders are more likely to come in contact with such substances in some dark alley than in a safe injection site.

    continued below

    ReplyDelete
  68. And it’s precisely Insite that Rosenstein attacks. He cites just one source, a scandalized city councillor in Redmond, Washington, who visited the Downtown East Side last year and said “It was the most depraved scene I’ve witnessed in person.” He derided “Seattle’s far left politicians” for wanting safe injection sites there.

    Rosenstein certainly didn’t check with Vancouver Coastal Health, which helps run Insite and reported last year:

    “From Jan. 1 to Nov. 30, 2017, there were 119,395 visits to the supervised injection room at Insite. Among those, 1.2 per cent visits resulted in an overdose. 10,534 visits used the injection room in November 2017, that was 4.1 per cent decrease over the average number of visits in the previous three months (10,980) visits, and nine per cent decrease over the number of visits in November 2016 (11,544 visits). 94 visits resulted in an overdose in November 2017, a 19 per cent decline over the average overdoses during the previous three months (117 overdoses), and 61 per cent decrease over the number of overdoses in November 2016 (239 overdoses).”

    Sure, the DTES is a grim place, and all of B.C. suffers a growing number of overdose deaths. The B.C. Coroners Service recently reported 134 suspected drug overdose deaths in July, a 25-per-cent increase over June. We are now running an average of 125.4 overdose deaths a month in 2018, up from 120.8 last year, 82.8 in 2016, and 30.7 in 2014.

    But there were no deaths at supervised consumption or drug overdose prevention sites.

    Rosenstein claims that “injection sites destroy the surrounding community. When drug users flock to a site, drug dealers follow, bringing with them violence and despair, posing a danger to neighbours and law-abiding visitors.” He ignores the fact that dealers and injection sites tend to congregate where the users are. If anything, Insite and similar sites are a sign of health in their communities, not a symptom of malaise.

    With casual citation that would earn him a rebuke from any judge, Rosenstein mentions “some estimates” that only 10 percent of safe injection site users get treatment. But zero percent of fatal overdose cases get treatment, and we would have far more deaths than we do without Insite. If nothing else, drug users can walk away from Insite having bought a little more time to get a grip on their lives.

    As an intelligent and highly educated lawyer, Rosenstein must know how “swift and aggressive action” has abjectly failed to stop the opioid catastrophe, just as it failed against cocaine and heroin and psychedelics and marijuana. Yet here he is, wading into a public health crisis even deadlier than gun violence, prescribing yet more of the same swift and aggressive action.

    Especially given his sycophantic reference to “the Trump administration,” Rosenstein’s op-ed looks more like a move to please his boss than a sincere effort to address a health disaster. Perhaps he has good reason to fear Trump will fire him and then get rid of Mueller, and thinks some swift and aggressive claptrap in The New York Times will buy him some time — just like an Insite user.

    https://thetyee.ca/Opinion/2018/08/31/Rosenstein-Cheap-Shot-At-Insite/

    ReplyDelete
  69. Vancouver police seize cannabis intended for opioid substitution in Downtown Eastside

    by Charlie Smith, The Georgia Straight September 14th, 2018

    Tears were shed this morning at the DTES Market at 62 East Hastings Street when cops arrived to take away some weed.

    That's because this cannabis was being supplied on a nonprofit basis to low-income people in pain.

    According to Overdose Prevention Society executive director Sarah Blyth, the cannabis is a substitute for those who don't want to use opioids that may be laced with deadly fentanyl.

    "We supply cannabis replacement to people in the Downtown Eastside that are trying to get off other drugs like fentanyl and heroin," Blyth told the Straight by phone. "We would love to have an opiate replacement program at our site but we can’t."

    Blyth called the police raid "totally disgusting", noting that this cannabis is being used by people with long-term injuries. Users include seniors in pain and those who can only get around with the help of wheelchairs, but that was not a concern for police.

    "People were crying when they left, including myself, because it's really the only thing that we have for folks in the Downtown Eastside," Blyth said. "People are living in alleys. How can we expect them not to have anything? Some people can't just go from opiates to nothing—like, it's impossible!"

    Vancouver police have not responded to the Straight's emailed request for an interview.

    In its most recent annual report, the Overdose Prevention Society recorded 175,284 visits and dealt with 417 overdoses onsite. Naloxone was administered on 397 occasions, there were 153 calls to 9-1-1, and no deaths.

    As a result of its peer interventions, the organization has won awards from Vancouver Fire and Rescue Services, B.C. Civil Liberties Association, and B.C. Centre for Substance Abuse, as well as a 2018 Mayor's Achievement Award.

    The Overdose Prevention Society isn't the only organization that's looking at the positive effects of cannabis as a substitute for harder drugs.

    In July, the New York State Department of Health began allowing registered medical practitioners to "certify patients to use medical marijuana as a replacement for opioids, provided that the precise underlying condition for which an opioid would otherwise be prescribed is stated on the patient's certification".

    A Journal of the American Medical Association–published study revealed a correlation between states with more liberal cannabis laws and a decrease in opioid prescriptions from 2010 to 2015.

    Even B.C.'s former health minister, Terry Lake, has suggested that cannabis might help treat opioid addiction.

    Last year, the Straight quoted a specialist in complex pain and cannabinoid medicine, Dr. Caroline MacCallum, who spoke of the positive effects of cannabis for people in pain—and how it could help reduce opioid use.

    "I’m able to taper patients off of these drugs and get them less constipated, less confused, and feeling better," MacCallum said at the time.

    Update
    At 1:55 p.m., VPD spokesperson Const. Jason Doucette emailed the following statement in response to the Straight's interview request:

    "Just after 10 a.m. today, VPD officers were in the market at 62 East Hastings Street and located a table with a plastic display of mainly cannabis products, marked for sale. Our officers attempted to identify the owner of the products but no one took ownership, including a woman seated near the table.

    "The product was seized and tagged at the VPD property office for destruction."

    https://www.straight.com/cannabis/1136796/video-vancouver-police-seize-cannabis-intended-opioid-substitution-downtown

    ReplyDelete
  70. Sensible BC

    Dana Larsen: Director of Sensible BC and the Vancouver Dispensary Society

    Vancouver police have seized cannabis intended for opiate addicts and I'm not happy.

    I'm a director of the Vancouver Dispensary Society. We donate cannabis to a couple of groups that provide it to opiate users as a safer form of pain control and to help alleviate withdrawal symptoms. So far we've seen remarkably positive results.

    Sarah Blyth runs an Overdose Prevention Site, and also runs a city-sponsored street market next door. In the market she had a booth where cannabis was available to opiate users for low cost, or free for those who couldn't pay. Called the "High Hopes Foundation" they provide cannabis as a substitute for opiates, and are also part of a research project to determine the benefits of cannabis for opiate users.

    Sarah has been running the High Hopes Foundation there for over a year. Vancouver police told the media in August 2017 that they had no problems with cannabis being provided to opiate users there: "Our main priority is reducing overdoses—not shutting down programs that seem to be working."

    Of the 100 people they've been tracking through the High Hopes Foundation, 25 have quit opiates by substituting with cannabis and kratom. Another 50 have substantially reduced opiate use.

    POLICE CHANGE POLICY, SEIZE CANNABIS, THREATEN ARRESTS, FORCE HIGH HOPES OUT

    On Friday, VPD officers showed up and seized the cannabis from the High Hopes Foundation. This was a sudden and unannounced change in policy.

    On Saturday, they came back and seized cannabis again.

    Now the police have pressured the city-appointed manager of the street market to kick out the High Hopes Foundation.

    HEALTH OFFICIALS CRITICIZE POLICE ACTIONS

    The BC Centre on Substance Use immediately came out against the VPD action. https://twitter.com/BCCSU/status/1040689320032526336

    Dr. Mark Tyndall, BC's Deputy Provincial Health Officer, said the police action was "punitive, compounds trauma and suffering, and contributes nothing to community safety." https://twitter.com/DrMtyndall/status/1040698189827829761

    UBC researcher and infectious disease epidemiologist Dr. Milloy said seizing the cannabis "is like arresting people who are handing out life jackets on a sinking ship." https://www.ctvnews.ca/health/vancouver-police-seize-cannabis-meant-for-opioid-addicts-advocate-says-1.4095761

    HOW YOU CAN HELP

    Please call these two numbers to express your support for Sarah Blyth's work and to ask for police to stop seizing cannabis intended for opiate substitution.

    * Vancouver Police Board: 604-717-3170

    Tell them that their original policy of putting overdose prevention first was the right one, and that seizing cannabis intended for opiate substitution is wrong.

    * Vancouver Mayor's Office: 604-873-7621

    Tell him that the police board must instruct police to stop seizing cannabis intended for opiate substitution, and that the city needs to put overdose prevention first.

    Also please click here for a form letter you can send to City Council.

    Please make your voice heard! Call those two numbers and send the form letter. We need your help!

    Thank you for your support!
    Cannabis is not the problem. Cannabis is the solution!

    DANA LARSEN
    Director of Sensible BC and the Vancouver Dispensary Society

    ReplyDelete
  71. B.C. children's watchdog calls for youth-specific supervised consumption sites

    by Eva Uguen-Csenge, CBC News November 15, 2018

    In a report that reveals 24 youth died of overdoses in 2017, B.C.'s child and youth advocate says young people in the province need more harm reduction services, including supervised consumption sites.

    The representative for children and youth, Dr. Jennifer Charlesworth, made the recommendation in a 54-page report card focused on youth aged 13 to 18 living through the ongoing opioid crisis.

    The report says some may not agree with the idea of young people using drugs at a safe consumption site funded by taxpayers, but Charlesworth says the goal is preventing overdoses and deaths.

    "Adult [supervised substance-use] sites are not youth sites. They are not places that [young people] feel safe and supported."

    Drug use to 'numb' pain
    The report, titled Time to Listen, gathered information from 100 young people across the province in focus groups and reviewed critical injury reports.

    The surveyed youths' experiences with substance use varied with almost 90 per cent drinking alcohol or using marijuana or nicotine. Approximately half reported using cocaine, ecstasy or prescription pills and a third used fentanyl and other drugs.

    Charlesworth says all of them reported using substances to "numb" emotional pain.

    The representative adds that while many people believe youth should be in drug-free environments, often youth are not ready for treatment.

    "When we've only been able to offer abstinence-only programs, we actually effectively drive those young people underground," she said.

    The report's recommendations also calls for more youth involvement in the province's Mental Health and Addictions Strategy, an accessible information source about youth substance use services and for training to help foster parents communicate with youth about substance use.

    It is published ahead of a Ministry of Mental Health and Addictions strategy expected to be released next spring.

    Mental Health and Addictions Minister Judy Darcy says the strategy will be focused on prevention and early intervention with children and youth.

    "We're looking at improving the whole range of services for children and youth at risk of substance use and at risk of overdose, and we'll be looking very closely at [the representative's] recommendations in that context," said Darcy.

    She did not say whether the province would consider youth-specific consumption sites but pointed to the existing set of guidelines for youth accessing supervised consumption sites.

    According to those guidelines, only youth showing "obvious signs of substance use with injectable drugs" are able to access the sites.

    https://www.cbc.ca/news/canada/british-columbia/child-youth-representative-overdose-supervised-consumption-site-1.4908162

    ReplyDelete
  72. Overdose task force recommends city establish clean drug supply site

    Staff will be asked to find sites where drug users can access safer opioids — such as hydromorphone

    CBC News · Dec 18, 2018

    Vancouver Mayor Kennedy Stewart has unveiled the recommendations of an emergency task force aimed at reducing opioid deaths in the city, including providing illegal drug users with a clean supply.

    B.C. has often been described as "ground zero" for the overdose epidemic. In 2017, more than 1,400 people died of an illicit drug overdose in the province. It's estimated that one person dies of an overdose in Vancouver every day and four across B.C.

    Stewart said that despite best efforts, Vancouver's overdose crisis is likely to claim as many lives in 2018 as it did in 2017.

    The report outlines 23 recommendations the city can take over the next 18 months.

    "There has been a strong call for a clean drug supply to avoid overdose deaths from a contaminated drug supply," said the report.

    "It is recommended that the city prioritize and identify space for a suitable location for a storefront service space, either in or adjacent to the Downtown Eastside, where the B.C. Centre Disease Control can launch its pilot enrolment project."

    Stewart confirmed staff will be asked to find sites where drug users can access a clean drug supply — such as hydromorphone — to prevent overdoses.

    "Unless we take action now, our friends, family and neighbours will continue to die," he said at a news conference.

    "We cannot ignore the fact that our drug supply is poisoned and that is the main cause of overdose deaths. Unless we take action on supply, there will be no end in sight."

    Hydromorphone is already available as part of an approved project involving Providence Health Care's Crosstown Clinic. Officials with the B.C. Centre for Disease Control recently suggested making the opioid available in vending machines.

    Sarah Blyth of the Overdose Prevention Society, who was a member of the task force, said she's thankful the city has made this a priority.

    "It seems like there's a really good understanding that safe supply is going to really help folks get what they needs as opposed to having to use what's killing them on the street," she said.

    The report, containing dozens of other recommendations, calls for a $500,000 one time commitment from the City of Vancouver, $2.7 million from the province and $770,000 from the federal government.

    It also calls for investment in Indigenous health services and for Downtown Eastside single-resident occupancy (SRO) hotels to work with response organizers.

    The report goes before city council for approval on Thursday.

    https://www.cbc.ca/news/canada/british-columbia/overdose-task-force-recommends-city-establish-clean-drug-supply-site-1.4951485

    ReplyDelete
  73. Safe supply program will distribute free opioids to entrenched users

    50 opioid users in Vancouver's Downtown Eastside will regularly get pills to crush up and inject

    Rafferty Baker · CBC News · January 04, 2019

    Carissa Sutherland's history with drugs is a lot like many others in Vancouver's Downtown Eastside.

    The 29-year-old started about 10 years ago with morphine and hydromorphone pills marketed under the brand name Dilaudid or "Dilly" as it's known on the street.

    "I kind of just progressed more and more, and then I couldn't get Dillies very much — or they were more expensive than heroin, so that I ended up just doing heroin," said Sutherland, who soon added methamphetamine to the mix.

    For her, an especially low point came when she overdosed, alone, in a Wendy's bathroom about two years ago. Luckily, someone found her, and her life was saved.

    Now, a "safe supply" program for people in Sutherland's situation is launching in the neighbourhood.

    Operated by the Portland Hotel Society (PHS) out of its Molson Overdose Prevention Site (OPS), the pilot program will distribute free Dilaudid pills for 50 patients.

    The hydromorphone pills, which are manufactured to be taken orally, will be crushed up and rendered as an injectable drug, just like heroin. It's the first time in Canada that opioids will be prescribed in this way and an idea that came directly from the street.

    According to Coco Culbertson, who is overseeing the program for PHS, the dosage will be prescribed by a physician, and participants will be able to get up to five doses per day, to be injected under the supervision of PHS staff and volunteers.

    Culbertson said the pills, which are worth about 36 cents when bought legally, cost drug users $20 - $30 on the street. According to Sutherland, a user on the street can make up to four or five pick ups per day to support a habit, sometimes buying multiple pills each time.

    "We're really looking for our "hard target" folks that are experiencing repeated overdose and that are subject to a toxic drug supply on the street," said Culbertson, who added that there's already a list of about 75 people for the program, which starts on Tuesday.

    "We are hoping that this program, in its simplicity, allows us to scale up as needed, and that a program like this can be easily replicated in other areas in other regions," she said.

    continued below

    ReplyDelete

  74. Crosstown Clinic
    Just a couple blocks away at the Crosstown Clinic, there's another injectable opioid treatment program that's been operating for several years.

    There, under the management of Dr. Scott MacDonald, about 130 patients are administered up to three daily, scheduled doses of either prescription heroin or hydromorphone.

    "This is safe. It's effective. It's cost effective. It reduces mortality, reduces crime — both violent crime and property crime — and it reduces the burden on taxpayers," said MacDonald, who believes the facility's pharmacy could distribute injectable doses for as many as 800 people across the region.

    When asked what he thinks of PHS's new approach to prescribing opioids to neighbourhood drug users, with a little less structure than Crosstown's system, MacDonald said that it's a worthwhile scientific study to undertake, and he's looking forward to seeing the results.

    Both programs include access to a wide variety of other social and health services.

    'Safe supply'
    Sutherland's life has taken a dramatic turn for the better since her overdose. She's still a regular drug user, but for the past year and a half, she's been injecting under supervision at Molson OPS.

    She quickly started volunteering there and now Sutherland's on the payroll as a peer support worker. She's taken part in reversing dozens of potentially fatal overdoses. She's also found housing through PHS.

    But despite the more stable life, the drugs have still put her in risky situations. Sutherland is hoping that will disappear if she's accepted in the new 'safe supply' program.

    "I'm hoping that once I get on the Dilly program, I won't have to do that — I won't have to go boost from stores — or steal from stores or sell things to get money to get drugs," she said.

    For her, she says, safe supply doesn't just mean drugs that won't contain unknown amounts of deadly fentanyl, it also means a drug supply that leads to a much safer lifestyle.

    https://www.cbc.ca/news/canada/british-columbia/phs-injectable-dilaudid-program-launching-1.4965641

    ReplyDelete
  75. Project that kept more addicted patients in treatment expands across B.C.

    Expansion involves same strategy used to drive down HIV, AIDS rates

    The Canadian Press January 17, 2019

    An 18-month pilot project is being expanded across British Columbia after more than double the number of drug-addicted people stayed in treatment.

    The initiative, led by the BC Centre for Excellence in HIV/AIDS and Vancouver Coastal Health, uses the same strategy that helped drive down the province's HIV and AIDS rates.

    Dr. Rolando Barrios, the centre's senior medical director, says it involves tracking patients who don't show up for appointments and uses a team of doctors, nurses and social workers to follow them through treatment to help with their needs, such as housing and employment.

    The pilot at 17 clinics in Vancouver involved 1,100 patients and showed seven out of 10 of them stayed in treatment after three months, up from three people, as part of a program that prescribes substitute opioids to curb drug cravings and ward off withdrawal symptoms.

    Barrios says retaining people who are addicted to opioids like heroin and fentanyl in treatment is the biggest hurdle in the overdose crisis that has claimed thousands of lives.

    He says the expansion of the pilot involves simple steps such as reminding patients when their medication is about to expire and having pharmacies connect with health-care teams when people don't pick up their medications.

    https://www.cbc.ca/news/canada/british-columbia/project-that-kept-more-addicted-patients-in-treatment-expands-across-bc-1.4982725

    ReplyDelete
  76. New podcast made by drug users aims to change how you think about addiction

    CBC Radio January 30, 2019

    AMT: Hello I'm Anna Maria Tremonti and you're listening to The Current.

    AMT: We hear a lot of talk about Canada's opioid crisis. How often do we hear what it sounds like up close personal, like you just heard. That's audio from a new podcast launching from Vancouver today. It's called Crack Down and it takes on drug policy from a perspective most of us don't often hear. It is told by the drug users themselves. The show's editorial board puts it this way - and I'm quoting: "We know policy better than policymakers, law better than lawmakers, dosages better than pharmacists". That's the quote Garth Mullins is the show's host and creator. He is also a drug user and an activist. And he's with me from our Vancouver studio. Hi.

    GARTH MULLINS: Hi Anna Maria.

    AMT: What happened to Doyle, the person we just heard overdosing in that clip?

    GARTH MULLINS: Well, luckily for him, he was at an overdose prevention site. So there were people right on hand and you heard them in the clip responding immediately. They know what to watch for, what's an overdose looks like and had an intervene with no oxygen to bring it back. So Doyle walked out of there just a few minutes later.

    AMT: What's it like being surrounded by so many people, people you know, people you care about who are overdosing on drugs?

    GARTH MULLINS: It's incredibly sad and incredibly frustrating all at the same time. So you know I tried to count up the amount of people that I'd lost to overdose and I got to about 50. And I did have to stop because you know it's very hard to remember each person that you've known, and some quite well, some you know since I was a kid almost, and realize that maybe half of the people that you came up with are gone now. This is my second overdose crisis. We had one here in Vancouver in the 90s. And it's never really stopped.

    AMT: 50 people who overdosed.

    GARTH MULLINS: That's right. Yes.

    AMT: And sometimes it's not even clear what really happened, eh?

    GARTH MULLINS: Yes in some cases, yes for sure, for sure you don't. And in some cases you or someone you know it's right there when it happens or close enough, but you know we didn't always have Naloxone available to us. So there have been times when people weren't able to respond.

    AMT: I was just going to ask you. It's relatively new that it can be reversed, like you just described.

    GARTH MULLINS: Well I said it was sad it was also frustrating. Part of the frustration is that Naloxone was first patented in 1961. And we've been trying to get a hold of it, for ourselves, for a generation. And more recently and last couple years now we have - like drug users people in the community - now have it, but we sure fought for it for a long time. And we even obtained - wouldn't say illegally - but outside of official sanction for a time. We had to try and make do with that.

    AMT: Have you reversed an overdose yourself?

    GARTH MULLINS: I have. But compared to I think of Laura shaver who she sits on our board and she's maybe, I asked her just yesterday, and she said or maybe 60 or 70. She's lost count.

    AMT: And what have you learned from those experiences?

    GARTH MULLINS: You learn your you're thankful for the skill. You wish more people had the skill. I sort of think Naloxone could be in every medicine cabinet in the country, every first aid kit. You also realise that this intervention is-- we do it in the last few heartbeats of someone's life potentially. You know and the real interventions need to be way upstream. Like when you break old another or ampule of Narcan or Naloxone there, drawled up, that snap is kind of demission of so many things have already failed.

    continued below

    ReplyDelete
  77. AMT: And how would you take it up further, sooner?

    GARTH MULLINS: Well the thing that's really killing people is contaminated drug supply. So people need a safe drug supply. You know we have pharmacies all over the country that have a safe non-lethal version of what's killing people right now. But it simply rules and policies that are prohibiting access to that.

    AMT: Well we're going to talk more about that in a second. I want to get back to the experiences of reversing overdoses, of losing so many people. Why did you want to take those experiences and turn them into a podcast?

    GARTH MULLINS: I guess because we sort of see the representations of drug users in the media. We're either sort of a scapegoated as destructive people who've made bad choices, or kind of pitied. We felt like those two modes don't really accurately reflect what we can bring. And the idea of drug user activism which may sound novel, but is actually somewhat old, doesn't really appear very often. And so when you think about the things that we've been talking about: safe injection sites, or overdose prevention sites, or Naloxone, or even clean needle distribution, all of those things were fought for and won by drug user activists. All of them were done outside of the law before they were officially sanctioned and funded. And that's really how history moves. That's how progress happens. Is that kind of civil disobedience and the kind of human rights struggle?

    AMT: So what's missing from the coverage in the headlines now about the opioid crisis in Canada?

    GARTH MULLINS: I think a really more fulsome view of who drug users are. So you know you'll see on every article there'll be a picture of a street maybe with an abandoned syringe in the gutter or something. And that gives the impression that drug users are inner-city Neighborhood gritty phenomenon when drug use is everywhere. You know in your church, in your community center, in your workplace, in your family. There's drug users all across the country in communities big and small. And so you may as well show a picture of someone mowing the lawn in a leafy suburb because that's just as accurate as the gritty inner-city kind of picture.

    AMT: And we don't hear from those drug users.

    GARTH MULLINS: Well that's right. I mean drug use is highly stigmatized. It's illegal. We are illegal. So of course - and I don't begrudge this - people keep quiet about it. Because you know you can get fired. You can get evicted. You can have all kinds of bad things happen to you. You know your family can cut you off. You can be alienated from contact with friends. There can be a lot of different kind of outcomes for somebody who comes up and says: 'Yeah I'm a drug user'. So the coverage tends to be in people who have no choice but to use it in places that are public. So that creates a stereotype of where drug use is in the country.

    AMT: So if we heard from then listen to the range of people who are drug users, what would we hear that we don’t hear now?

    GARTH MULLINS: I think you'll hear that the overdose crisis as a result of bad drug policy more than bad drugs. I think you'd hear of people who have a lot of experience with jail and policing and homelessness - you know with the 60s scoop and residential schools - but you'd also hear from people who have testified at the Supreme Court, testified to a parliamentary committees. We've met and lobbied prime ministers and international dignitaries. You'd hear of people who were really reclaiming some self-determination in their lives and the lives of the community. You'd hear from people also who were on the front lines and always have been saving lives and saving each other.

    AMT: Now you're coming from a place of experience. So can we talk about you?

    GARTH MULLINS: Oh yes for sure.

    continued below

    ReplyDelete
  78. AMT: Okay so when did you start using drugs?

    GARTH MULLINS: I guess when as a teenager that was heroin, injection heroin. I used it all the way through the last overdose crisis. So I am particularly lucky to still be here. And then for the last many years I've been on methadone.

    AMT: And when it started, why did it start?

    GARTH MULLINS: Well I guess several years ago I was diagnosed with PTSD. So it's got to do with trauma. You know it's hard to say, but I'm like so many people there is probably factors within me. There's probably environmental and systemic factors around me and it can be a lethal cocktail. For me anyway I was pretty alienated. I didn't like myself. I sort of felt a divide in myself, or at war with myself. And all that alienation was just like a roar in my ears, howling all the time. And then you drive on and you're like that background howl just disappears. And suddenly there's a switch to turn off a terrible feeling that you didn't even know it was possible to control. And of course that off, which is very temporary and it comes back pretty quick. But it's like I feel normal you know. I thought this must be what everybody else feels like all the time. This must be the world of well-adjusted citizens that I am surrounded by.

    AMT: And so you want it again.

    GARTH MULLINS: Yes for sure.

    AMT: What lengths would you go do to get that feeling?

    GARTH MULLINS: Ah well I mean pretty extreme lengths. When you're using through an overdose crisis, you're willing to take your life in your hands. And it's not a conscious decision, you know. It's just that when basically your past has trauma in it and your future is potentially dope sickness - withdrawal symptoms from not having opioids - you're kind of bounced on your eternal knife edge at the present. And those kind of threats like you know, maybe I could die, they become an abstraction.

    AMT: And so you were in your late teens. How would you pay for it?

    GARTH MULLINS: Yeah. I mean like I worked a lot of jobs. I did some more dodgy things at different times to pay for it. It's sort of the daily grind that really gets to you. And there was one time when I was sick, when I was in withdrawal, and I sold the boots off my feet at a pawn shop. And I didn't have time, in the urgency of my dope sickness, to go home and get sneakers or any alternative. So I was walking down the street, in November, in the rain, in socks. You know that wears on you. That has a cumulative effect, all of those kind of little interactions.

    AMT: And when you got to that point - you know you said that you didn't like yourself and then when you when you started taking heroin you saw yourself differently, you felt okay - When you have to do that, when you have to sell the boots off your feet and walk away in your socks, what did you think of yourself? Did you scare yourself?

    GARTH MULLINS: What a sad situation this is, you know. And so it can be a self-reinforcing cycle. You know you do something that kind of makes you dislike yourself more. And so it will increase your interest in turning off that dislike.

    AMT: I'm going to play another clip from your podcasts trailer. This is a member of your show's editorial board. This as Simona Marsh.

    SOUNDCLIP

    You know we are not going to quit doing the drugs. Like that's not even an option. If for all these straight people that think that's an option, well, go read your book again because in my book it doesn't say anywhere where I am quitting doing drugs. The thing is you can read all the books, until you lived it, you don't know it.

    AMT: I think a lot of people were here that clip and think, if she doesn't want to stop how do we help her? How should we help her? Why should we help her?

    continued below

    ReplyDelete
  79. GARTH MULLINS: We should ask Simona. I mean that's really the key, is you start with what the person thinks is success and what the person thinks is help. But I think Simona who speaks for a lot of people who are - and myself. You know. I did heroine on for a long time and you reach a certain point where you realise I probably won't quit tomorrow. Because you start off with this illusion, oh I'm going to kick tomorrow. Tomorrow I'll do it. Tomorrow will be the day. And after a few years of that not happening, you kind of have to be a little honest with yourself and realize maybe this won't happen tomorrow. So maybe the goal is actually to use less. Are use safer or to arrange your life in a more sustainable way. But the presumption that the goal is always abstinence, is always zero drugs and all they need is a few days are locked in a room to be sick and dry out. That's kind of a Nancy Reagan philosophy that has proved to be really harmful.

    AMT: You use methadone now, am I right?

    GARTH MULLINS: Uh hmm.

    AMT: Will you ever be at a place where you can stop do you think?

    GARTH MULLINS: I don’t know. Methadone has done right by me and I haven't used heroin for a long time. But method on it is an opioid. It's like a nicotine patch. It's trying to give you the same protection against the cravings, protection against that withdrawal symptom with a kind of a safer format.

    AMT: Does it work for you?

    GARTH MULLINS: Yes it does, it does work for me. So if I'm on Methadone for the rest of my life then fair enough.

    AMT: And that's on prescription essentially right?

    GARTH MULLINS: That's right. Yes.

    AMT: Do you consider yourself an addict, or do you consider yourself recovered, or is that an inappropriate question?

    GARTH MULLINS: I don't know. I mean I consider myself I guess a radio documentarian and an activist and a bunch of things. But, yes, I am a methadone patient or methadone user. I don’t know the sort of dichotomy of recovery it's a little funny, because you know we celebrate these people who are clean. And I have been at times, I think. But it implies that everybody else is dirty. And it sort of it breaks it down so that there's no room for a comment like Simona's. There's no room for a recognition that there is something less than abstinence, or something that's not a full complete cessation of using that's still less harmful and more helpful to people.

    AMT: Well at the same time people who are clean, to use the language, celebrate themselves for that too, though, did they not?

    GARTH MULLINS: Sure and so they should. It's I think it's starting with where the person is. You know that it's a complex situation. Maybe letting the individual define a little bit what is success can be helpful, because a lot of people have had no self-determination in their life. So giving a little bit in reducing the harms to it I think is really helpful.

    AMT: Can everybody is methadone? Is it a choice? Was that a choice for you?

    GARTH MULLINS: Well when I got on methadone it wasn't easy. There's a lot of barriers. You go to a clinic. They're mostly private. You often pay extra fees. They urine screen you all the time. You have to go to a pharmacy. Most methadone patients have to go every day to pick up the methadone. It's a very highly regimented system. So it creates barriers. It's not easy for everybody. You know people who are working and start early in the morning it can be hard for them. And I think that methadone itself doesn't work for everybody either. You know when I got a Methadone 15 years ago, the drugs were not as strong as they are now. They keep getting stronger. So you might need something stronger than methadone to reach to be capable substitute for the fat not contaminated drugs that people are doing now.

    continued below

    ReplyDelete
  80. AMT: Harm reduction policies are slowly gaining traction with lawmakers over the past couple of decades. What's your sense of how the public acceptance of those policies have shifted?

    GARTH MULLINS: Have they gained traction with lawmakers?

    AMT: Some.

    GARTH MULLINS: Huh. I mean certainly I hear from various levels of government that that, yes, harm reduction is part of the public policy and you know safe injection sites like inside are permitted now because of the Supreme Court. So if we literally - I mean law interpreters like the judges, then maybe. But I mean the federal government fought for 10 years to close insight. And the overdose prevention sites that have popped up across the country were started illegally first, eventually recognized. And then Doug Ford came to power in Ontario and capped them. And that's just one example of harm reduction, another, having needle distribution. That took Vancouver having the highest rates of HIV transmission in the industrialized world, and activism,, for people to realize out here, okay, maybe we need to allow some illegal distribution. So I see these things as incremental as fought for every time and not really yet one, not necessarily secured.

    AMT: I've got another clip I want to play for you. This is again from your podcast. This is Dave Murray.

    SOUNDCLIP

    We used to put pictures on the wall, like VANDU, of the people that we lost and try to keep up with it nowadays.

    AMT: VANDU. What is VANDU?

    GARTH MULLINS: Vancouver Area Network of Drug Users. This is basically a drug users union or kind of like an activist group that formed 20-22 years ago during the last overdose crisis. They are trying to fight for some of these reforms I was talking about.

    AMT: What do you think it's going to take to prevent more of those deaths?

    GARTH MULLINS: I fundamentally believe it will take decriminalization and a safe drug supply.

    AMT: And safe supply; explain how it works.

    GARTH MULLINS: All these contaminated drugs or a lot of them are opioids stimulants. These are all also things you can find in a pharmacy. And so it is possible to prescribe safe drugs to people. So Dave Murray, who we just heard from was part of a group of physicians that had the opportunity to be prescribed heroin, starting about eight years ago in a study, in a pilot project. And the results were incredibly successful. So for people who fail off of methadone, who didn't work well for them, maybe prescription heroin, you know clean pharmaceutical grade heroin - diacetylmorphine it's called - is the way. But unfortunately these studies never got rolled out to broader access. So it is still a small group of people like Dave from those studies that get that type of prescription heroin. It's not available to the people who are vulnerable to overdose and in this situation anywhere else. And it's the fact we haven't ruled that out. We haven't ruled out an idea left over from the last time we had this big problem. It kind of is amazing.

    AMT: We spoke about a new safe supply pilot in Vancouver and our program a few weeks ago. How hopeful are you that that project will show success?

    GARTH MULLINS: There's there's no question that it's an improvement. You know this is Dilaudid, injectable Dilaudid, and it's probably about two blocks from where the prescription heroin pilot is. It's 50 people. And I think it's an excellent start. I'm sure the studies are going to show that when people are able to access that they're able to reduce risks and harms in their life in other areas. Because every time you go to the clinic and you get some injectable Dilaudid that's pharmaceutical grade you don't have to go score off of the contaminated drug supply.

    AMT: You know it's not hard to imagine the amounts political pushback to governments supplying opioids to heroin users on a wide scale. What makes you think it is a viable option?

    continued below

    ReplyDelete
  81. GARTH MULLINS: Other countries have done it. Other places have done it before. It was a choice in I think 1908 to make opium illegal. And you know if you can make that choice you can make other choices. And I think also we elect politicians not to be cheerleaders but to be leaders. You elect them to try to be courageous and you know I guess that's kind of naive sounding, maybe it is, but that's what we should at least demand from them.

    AMT: And yet we have a system where a lot of people can get drugs for-- like a whole bunch of drugs for a whole bunch of illnesses you have to pay for.

    AMT: Well I mean this is where a carrot as an outlier as well. We need a national pharmacare program. There's no question about that. This is the unfinished work of Tommy Douglas. This is the unfinished work of public health care. But also opioids are cheap, really cheap, like those dilaudids we were talking about, used at their trial in Vancouver. They are something like 37 cents a pill. And if you don't treat something like this as a government, you'll pay for it in another area. So the cost of emergency room visits, the cost of policing, the cost of jails. All of these things that are incorrectly applied really to the overdose crisis. It costs way more. So it's incredibly efficient. If someone wants to be really crass and put dollar values on it, there's a massive savings to actually treating people properly.

    AMT: Do you worry at all of those people who listen to you and think: "He's doing okay. It's not a big deal to take this drug when you are younger. He's on Methadone now. He's an activist. He's got a podcast".

    GARTH MULLINS: Yes. I'm not sure that having a park cast is a big marker of success.

    AMT: It depends on who you talked to. But you know what I'm saying.

    GARTH MULLINS: I hope that it is.

    AMT: You know what I'm saying, your functioning and your still here.

    GARTH MULLINS: You know I'm not trying to be a role model for anybody. I think were also past the point of trying to scare people straight with spooky messages about drugs. I think people need honest communication.

    AMT: But you do want to scare them a bit, right? It's not really in the end an answer, is it, to start in on heroin in your late teens?

    GARTH MULLINS: You're going to hear people on this podcast that have uncomfortable messages. So you're going to hear people say things like 'heroin actually saved my life'. You know we talked to somebody who said you know they would have killed themselves but for the respite that they were able to get from opioids. So it's not always an easy answer. But I think the question that you're posing is what will scare people away from using drugs.

    AMT: No. I am asking could you attract people to using drugs?

    GARTH MULLINS: Yes. I think when you hear this part gas you’re not going to think this is a glorious path. The criminalization and marginalization of people is profound and deep. And I don't think anyone's going to say 'yes sign me up I want some extra helping of oppression and exploitation into my life'.

    continued below

    ReplyDelete
  82. AMT: So you held a listening party for people in your community to hear the pied. How did that go?

    GARTH MULLINS: Well it went great. We brought people together at the Vancouver Network of Drug Users, had about 35-40 people there. Played the pod [unintelligible]. You know I've never sat in a room full of people like just basically listening to the radio collectively before. And so I just I don’t know how that would go in any situation. And then here we are with a group of people who are like coming from all kinds of different walks of life, people who are great stimulant users, people who are abused users, methadone users, people who are drinkers. You bring all those people together in any situation and you know one might expect friction but we just had this kind of rapt attention. People really are interested in it. We had a great discussion afterwards.

    AMT: What did they say? What kinds of things did you hear?

    GARTH MULLINS: Somebody said to me: "Well do people really even listen to the radio?" And I said yes, good question.

    AMT: Oh yes.

    GARTH MULLINS: That's what I said. I hope that they do. I think they do. And you know somebody else said: "Well you got to make sure to keep it light sometimes, like keep it funny." And the guy's right who said that.

    AMT: I'm guessing there's a whole bunch of humanity in there.

    GARTH MULLINS: Definitely.

    AMT: In those conversations, right, as people start talking about their views of it and how it affects them and what they are thinking.

    GARTH MULLINS: You know when we as activists go to meet with government or some official, there's always this skepticism. There's always this disbelief. And I think drug users are very used to that, being sort of looked at a [unintelligible], not entirely believed. So we started trying to bring more research and science with us. And so we did in the podcast too. We have a science adviser and a partnership with the B.C. Centre on Substance Use. Part of the first episode that we played for folks was speaking to that guy and people really appreciate that.

    continued below

    ReplyDelete
  83. AMT: Who'd you want to listen to that podcast? Who do you want to hear Crackdown?

    GARTH MULLINS: Well you know we started with the community because we want to make sure we were representing people properly. But really we want anybody who's affected by the crisis to listen and that a lot of people. That's in the millions in this country, in the United States and in other places, tens of millions. And I know that's not really generally the numbers that's subscribed to a podcast. But we want it to be accessible to anybody who's connected, who's family member might be in there, or who are a drug user themselves. But you know I also really want Justin Trudeau to listen to it. I want Doug Ford do listen to it. I want the premier in my province, John Horgan, to listen to it. I think it's important that we start changing the conversation around this because it's not getting the results that we need yet.

    AMT: And as you point out, I mean opioid use and other drugs touches more people then we tend to realise, but I'm guessing you are someone to reach out to those people they need to hear them. We all need to hear the voices of people who might have a stereotypical view of and might learn something.

    GARTH MULLINS: Absolutely. You know part of this is how fortunate we are to be where we are because we have a drug user movement here. But people don’t have that collective opportunity in most places. Like most of my life and most of other drug users lives you're in isolation. You're doing this stuff primarily alone or with contact with a small group of people and you keep quiet about it. We want to be able to bring that to people and kind of break some of that isolation.

    AMT: Garth it's good to talk to you. Thank you for taking the time.

    GARTH MULLINS: Thanks very much Anna Maria.

    AMT: Garth Mullon's is the creator and host of Crackdown, apodcast that launches today and he joined us in our Vancouver studio. That's our program for today. Stay with Radio One for Q. Sarah McLachlan has been named host of the 2019 Juno Awards. She'll be with Tom Power today for a career spanning interview. We are going to leave you today with a little more from the podcast Crackdown with Garth Mullins. I'm Anna Maria Tremonti. Thanks for listening to The Current.

    SOUNDCLIP

    If it's Russian roulette why do we do it?

    [Music]

    Many reasons. Avoiding dope sickness is a big one. Now I've done some dodgy things to avoid that dope sickness. Like this one time I'd spent the rent. There's an eviction notice on the door of my apartment and I'm dope sick. Cold chemical sweat is dripping down my back. At a pawn shop, not far from here, I sell the boots off my feet. Wet November pavement seeping up through my socks was just the price of doing business that day. Drugs can [unintelligible] out, if just from mourning, the trauma of colonisation, or partner's violence, or the drudgery of work, or the terror of homelessness, or the brutality of racism. Drugs can dull the pain of injuries we got on the job. And also, drugs just feel good.

    [Seagulls’ sounds]

    https://www.cbc.ca/radio/thecurrent/the-current-for-january-30-2019-1.4998405/wednesday-january-30-2019-full-transcript-1.4999388

    ReplyDelete
  84. Supervised inhalation sites needed to cut overdose deaths in B.C., Victoria councilor says

    by Liam Britten, CBC News, February 07, 2019

    Victoria city council wants the province to expand access to supervised inhalation sites as a way to combat the ongoing overdose crisis.

    Coun. Sarah Potts put together a motion with three other councillors to urge the province to move forward on supervised inhalation sites where drug users can smoke illicit drugs — meth for instance, or opioids which may be contaminated with fentanyl — while being observed in case they overdose.

    The motion passed Thursday morning.

    "We most often think of overdoses ... attached to intravenous drug use, but right now this is the next frontier," Potts said.

    "We have the tools, we have the knowledge, we have the science and the social science backing to understand that this is what we need to do."

    She added that smoking is the most common way men and "younger and more vulnerable users" aged 15 to 29 consume drugs.

    It's also the second-most common mode of consumption among those who have died of a suspected overdose.

    It is estimated that an average of four people die every day in B.C. from suspected overdoses.

    On Thursday, B.C.'s chief coroner reported that fentanyl was implicated in 86 per cent overdose deaths in B.C.

    Potts said building a supervised inhalation site is expensive because, if indoors, they need to have powerful ventilation systems.

    A safe inhalation site was opened last year in Lethbridge, Alta, and an outdoor one has been run by Vancouver's Overdose Prevention Society on the Downtown Eastside since April 2017.

    Sarah Blyth runs the Vancouver site and says there is massive demand for the tent — it has had over 100,000 visitors since it opened.

    "People who smoke also overdose and when they overdose it's very quick," Blyth said. "You need to help people right away."

    She said it's better from a health perspective to keep drug smokers smoking and not progressing into injecting.

    "Once people are injecting, their level of tolerance to the drug ... goes up quite a bit. You don't really want to be encouraging that."

    The focus of the City of Victoria motion isn't calling for a site in Victoria in particular. It calls, instead, for more of them across the province.

    A spokesperson for B.C.'s Ministry of Mental Health and Addictions said the province is providing funding to the Overdose Prevention Society's work as a pilot program.

    "We are looking forward to the findings generated by that pilot," the spokesperson wrote in an email. "We know that inhaling toxic unregulated drugs presents a high risk for overdose including from non-opioid stimulant drugs."

    The City of Vancouver has also called on the province to expand supervised inhalation services.

    Potts' motion moves the issue forward to the Association of Vancouver Island and Coastal Communities. That body will vote on whether to send the recommendation to the Union of B.C. Municipalities for its 2019 general meeting agenda.

    https://www.cbc.ca/news/canada/british-columbia/opioid-overdose-death-inhalation-smoking-1.5008422

    ReplyDelete
  85. BC's top doctor calls for regulated opioid supply after almost 1,500 overdose deaths in 2018

    CBC News February 07, 2019

    There were 1,489 suspected illicit drug overdose deaths across British Columbia in 2018, and health officials say the province needs new approaches to the problem before the numbers will start declining.

    That number from the B.C. Coroners Service is up slightly from a year earlier, but the 2018 total is expected to grow as the coroner wraps up its investigations. Already, more people died from overdoses last year than from homicide, suicide and car crashes combined.

    Dr. Bonnie Henry, B.C.'s provincial health officer, said the numbers make it clear that drug users need a safe, regulated supply of opioids.

    "If we're going to turn the corner on this complex crisis, we need to find the ways to provide safer alternatives to the unregulated and highly toxic drug supply and to end the stigma associated with criminalization of people who use drugs," Henry said in a press release.

    "We need options to provide people at risk of overdose with low-barrier access to a regulated supply of opioids, and we need to connect people who use drugs with the supports they need rather than sending them to the criminal justice system."

    That sentiment was echoed by Dr. Evan Wood, the executive director of the B.C. Centre on Substance Use, who said, "We urgently need to end the harms caused by prohibition, while also implementing upstream responses that address the serious health and social consequences of untreated addiction."

    The people most affected by the overdose crisis continue to be middle-aged men, according to the coroner. Eighty per cent of suspected overdose victims last year were male, and 71 per cent were people between the ages of 30 and 59. The majority of victims — 86 per cent — died indoors.

    There were no deaths at supervised consumption sites or overdose prevention sites.

    "Families and communities across the province are losing friends, neighbours and loved ones to illicit overdoses at an alarming rate. The illicit drug supply is unpredictable and unmanageable, and fentanyl is now implicated in 86 per cent of overdose deaths," said Lisa Lapointe, B.C.'s chief coroner.

    "Innovative and evidence-based approaches are necessary if we want to effect meaningful change and stop the dying. We need to be prepared to do things differently to save lives."

    There were only 11 days last year that saw no overdose deaths in B.C. The highest numbers were in Vancouver, Surrey and Victoria, while Kelowna's figures actually dropped from 75 deaths in 2017 to 55 in 2018.

    Data from a federal task force on opioid deaths said nearly 4,000 Canadians died as a result of overdoses in 2017, a 34 per cent increase from the previous year.

    https://www.cbc.ca/news/canada/british-columbia/bonnie-henry-opioid-deaths-1.5009950

    ReplyDelete
  86. Free heroin? Unusual clinic offers 'chance at being human again'

    Low-dose drug program provides an alternative to potentially deadly street narcotics

    Nick Purdon & Leonardo Palleja · CBC News June 09, 2019

    When I first met Kieran Collins in Vancouver three years ago, he had a $100-a-day street heroin habit that he fed any way he could.

    "You're doing things that you don't really want to do — things that you weren't raised to do," said Collins, who was 36 at the time. "You know they are wrong, but you get accustomed to having to feed it."

    He's still hooked, but a lot has changed.

    Back then, Collins was haggard and desperate. He referred to his 20-year addiction to opioids as "a monster" as we sat in a park in Vancouver's Downtown Eastside, and he talked about what he thought would happen to him if things didn't change.

    "I will be dead in not long," Collins said. "I have overdosed a couple of dozen times ... one of these times I won't come out of it.

    "It's not the way I would like to go," he added. "Especially how that would make my family feel."

    Since I spoke with Collins in 2016, the opioid crisis gripping Canada has killed more than 10,000 people.

    In British Columbia alone there have been so many overdose deaths that average life expectancy is actually going down in the province.

    Collins has managed to stay alive through this crisis. He credits a unique, controversial clinic's approach to dealing with people who use drugs.

    Twice a day, Collins visits the Crosstown Clinic in Vancouver's Downtown Eastside. A nurse hands him a syringe of prescription-grade heroin.

    It's just enough of a dose so that he doesn't go into withdrawal.

    "It's not like this makes the problem just go away," Collins says, but it allows him to function.

    In total, 140 people are prescribed heroin at the clinic. For each of them, other treatments such as methadone haven't worked.

    The idea behind the program, which is publicly funded by the province, is that if users like Collins have a clean supply of heroin, they won't take street drugs like fentanyl — which was responsible for about 87 per cent of illicit-drug overdose deaths in B.C. last year.

    After his shot, Collins takes a seat in the waiting room with some of the other users. It's a precaution in case there are complications.

    Another patient sitting nearby, 58-year-old Kevin McGarragan, says the program has saved his life.

    "If I wasn't here I'd probably be in an urn or underground."

    Dr. Scott MacDonald, the lead physician at the clinic — the only one in the country that prescribes diacetylmorphine, the medical term for heroin — says the way to curb the crisis is to stop viewing opioid addiction as a criminal problem.

    "This is a treatment for a chronic relapsing illness, just like diabetes and high blood pressure," he says.

    "We need to get away from thinking this is a criminal problem — it is a medical problem and it is a chronic, manageable illness."

    When Collins is cleared to leave the clinic, he thanks the staff and heads off to meet his father who works across the city in a design studio.

    continued below

    ReplyDelete
  87. On the way I ask Collins how his life has changed since he began getting his heroin from the clinic.

    At first he's a bit defensive.

    "They're not medicating us to the point where we are like 'arghhhh,'" he says throwing his head back and rolling his eyes. "They just give us enough so that we are not a mess. So we can feel what it is to have a chance at being human again.

    "Before, it felt like I was almost just existing," Collins explains. "But now, some days I wake up and it's like whoa, I am lucky to be alive."

    Collins stayed in touch with his father throughout his 20-year addiction — but only since he started on the program has he reconnected with the rest of his family.

    "I'm an uncle now, my little sister has a kid," he says proudly. "I see him all the time."

    Kieran's father, Wayne Collins, likes to joke that his hair is white from worrying about his son.

    "I've nursed him through comas," he says. "I've nursed him through him having fallen out of a three-story window, wondering if he's going to come back to me."

    Father and son hug for a moment before Wayne gives Kieran directions about the work he wants him to do cleaning up the studio. He says the biggest change in his son since starting on the heroin program is that now when Kieran says he'll do something, he follows through.

    When Kieran was feeding his habit on the street, he'd disappear for months — sometimes longer. And there were many times when Wayne feared he'd lost his son forever.

    "I've had the phone call from the landlord that says, 'he's DOA, you gotta go down to the hospital and ID the body' — and he's back. He's just got a spirit that keeps coming through.

    "I believe in my heart that he is going to walk out of this," Wayne adds. "Some people go, 'Oh you are crazy — 20 years.' But that's part of knowing the whole person."

    Over the years Wayne says many people have told him the best way to deal with his son's addiction is through "tough love." But he insists Kieran has taught him about a different kind of love.

    "I think people who talk about tough love for addicts — it's the easy way out," Wayne says. "It's way harder to stay engaged and practice unconditional love, and show love for somebody who is lost."

    In the afternoon Kieran returns to the clinic to get his second shot of heroin.

    "People get addicted to drugs," he explains. "They don't do them because they want to do them, they have to do them — like a frigging slave."

    That's the reality for many people in Vancouver's Downtown Eastside.

    According to statistics obtained by the Georgia Straight newspaper, a two-block area along Vancouver's East Hastings Street had more than 3,000 overdose calls in just two years. That's seven per cent of the entire province's 911 calls for suspected drug overdoses.

    If anyone understands these statistics, it's the Crosstown Clinic's research coordinator, Kurt Lock. He has worked in the Downtown Eastside for 20 years.

    When I walk with him through the neighbourhood, it's clear that most people know who he is. Lock explains that when you're the guy who can get people free heroin, it increases your popularity.

    continued below

    ReplyDelete
  88. He says the 140 spots for patients at the Crosstown Clinic are "a drop in the bucket." To meet demand, he estimates they'd have to open five more clinics.

    But is it really a solution to expand a program that gives out free heroin and doesn't push people to quit — after all, isn't heroin a poison?

    Lock shakes his head. "If you have a clean, regulated supply, the drug itself it's not harmful for you," he says.

    "I won't say it is good for you, but someone could live to be 100 years old and use heroin every day if it's not tainted with any contaminants."

    Lock explains that many long-time opioid users look older than they really are because of what it takes to feed a street habit. Bad nutrition, homelessness and the contaminants found in street drugs are some of the things that hurt most long-time, chronic users.

    Lock also counters critics who say health programs should be focused on getting people to quit rather than giving them the drug.

    "The reason we provide heroin to people and we don't just expect them to quit is just that simply doesn't work," Lock says.

    "We tried that for the last many decades … Why don't we put people in treatment? Well, we have done that. Why don't we put people in jail? Well, we have done that too. But the problem still exists."

    Instead, Lock says the clinic focuses on quality of life.

    The idea is to attract users to the clinic by providing them with the drug, and then once they are in a health care setting, try to address the issues that led to their dependence on narcotics in the first place.

    Typically, the retention rate in opioid replacement programs that use methadone is around 30 per cent. In comparison, the Crosstown clinic's retention rate is more than 80 per cent.

    To supply a single user like Kieran Collins with heroin for a year costs around $27,000.

    Proponents of the Crosstown program argue that this is cheap, because if Collins was getting his drugs on the street then society would pay twice as much through things like social, policing and hospital costs.

    Toronto Public Health, for example, says "the social cost of one untreated person dependent on opioid drugs, which is attributed to crime victimization, law enforcement, productivity loss, and health care costs, is estimated at $45,000 a year."

    Beyond the financial costs, there's no escaping the fact that 11 Canadians die of opioid-related overdoses every day.

    Collins says he sometimes runs into the mother of a friend who died, and it's a reminder of the human toll of street drugs. "I was there when he overdosed and died. She always kind of stops me and she's obviously mad because she's lost her son — but I think she kind of blames me."

    Perhaps the most surprising thing Collins said during the two days I spent with him is that now his drugs are supplied to him, for the first time he's started to think of a life without them.

    "I would like to know what it's like to live without having a vice of putting narcotics in my body every day," he says.

    "I would like to know what it feels like, when I leave this world, to be in a clear mindset."

    https://www.cbc.ca/news/health/national-heroin-treatment-program-crosstown-clinic-1.5137551

    ReplyDelete
  89. Supplying Safe Drugs to Users in Downtown Eastside Gets Green Light

    The program and new shelters are among measures to combat COVID-19 spread in neighbourhood.

    by Christopher Cheung, The Tyee March 26, 2020
    https://thetyee.ca/News/2020/03/26/Safe-Drug-Supply-Downtown-Eastside/

    Some drug users in Vancouver’s Downtown Eastside will have access to a safe supply as part of the city’s response to the COVID-19 crisis.

    Vancouver Mayor Kennedy Stewart announced today that the federal government has given the go ahead for a program to supply users with safe drugs, rather than leaving them to buy from illicit dealers.

    The province is now working on the details of implementing the safe supply, which will be announced in the coming days.

    “We must tackle the poisoned drug epidemic, something that was already cost us more than 1,000 lives,” Stewart said during a news conference.

    Advocates have long argued that a regulated, controlled supply of drugs of guaranteed quality would reduce deaths. The coroner’s service estimates that drug overdoses — largely due to substances contaminated with fentanyl — caused 981 deaths last year.

    The COVID-19 crisis added urgency to the issue because of the risk the virus could be transmitted when people bought drugs on the street or used with others.

    Trey Helten, a manager with the Overdose Prevention Society, told The Tyee this week that the pandemic has also resulted in fewer ships coming into port, reducing the drug supply. The resulting higher prices have left those desperate for drugs talking about robberies, he added.

    Stewart said it’s estimated that 20 to 30 per cent of drug users in the Downtown Eastside neighbourhood are not connected with health-care providers or safe consumption sites. The safe supply plan is intended to focus on this group.

    “It’s in the public’s health interest to make safe supply a priority,” Karen Ward told The Tyee this week. Ward is a well-known neighbourhood advocate who was recently hired by the city as a full-time crisis response co-ordinator for the Downtown Eastside.

    “The last thing you want is 3,000 opioid addicts sick and angry, doing anything they can to get unsick,” she said.

    Provincial Health Officer Dr. Bonnie Henry argued for safe supply last year in response to the opioid crisis.

    Drug users need options other than “contaminated” street drugs to be able to enter “the treatment side of the spectrum,” she said.

    Stewart also said the the city will open emergency response centres in the Roundhouse and Coal Harbour community centres. The staffed spaces will provide shelter beds for people who have no alternative or are showing symptoms of the disease.

    The city is responding to growing concerns about the risks of COVID-19 transmission in the neighbourhood, where residents have long struggled with challenges around shelter, poverty, health and drug use.

    Many service providers and drop-in centres have closed because of the pandemic, cutting residents off from everything from support to showers to meals.

    The closures also increased the difficulty of getting information to residents about how to avoid getting the virus or infecting others.

    On March 19 the city declared a COVID-19 state of emergency.

    ReplyDelete
  90. BC records highest number of fatal overdoses in a single month with 170 deaths

    by Rhianna Schmunk · CBC News · June 11, 2020

    The BC Coroners Service said 170 people died of an illicit drug overdose in May, the highest total ever recorded for a single month in provincial history.

    It's also more people than have died from COVID-19 in B.C. all year.

    "It's frustrating to see the number of illicit drug deaths go up and to reach a new high ... It's sad to see this many people impacted, losing their lives," said Andy Watson, a spokesperson for the coroners service.

    The province said 167 people have died of COVID-19 since B.C.'s first case of the virus was confirmed six months ago. The annual total for overdoses in B.C. was 554 as of May 31.

    More than 82 per cent of overdose deaths in May involved fentanyl.

    Watson said post-mortem toxicology testing suggests there were a greater number of cases with "extreme" concentrations of the opioid in May compared with previous months.

    "The rate and the level of fentanyl concentration is the highest that we've seen it," Watson said Thursday.

    "We know ... that the drug supply right now is highly toxic ... For people who are using drugs, it's a dangerous time right now."

    A statement from the coroners service said 70 per cent of drug overdose deaths this year were men, with 85 per cent of fatalities happening inside a home.

    No deaths have been reported at supervised consumption or drug overdose prevention sites. The Fraser Health and Vancouver Coastal Health authorities had the highest number of deaths.

    The provincial government declared a public health emergency on April 14, 2016, as overdose deaths began to spike. Since then, more than 5,000 people have died.

    B.C. was starting to see a drop in deaths by the end of 2019, only to see a surge once the COVID-19 pandemic began.

    Measures to prevent the spread of the coronavirus created fears that the illegal drug supply would become even more toxic, with regular supply chains cut off. Limited access to supervised consumption sites, overdose prevention sites or drug-checking services also created a danger, Watson said.

    The province published guidelines for a safe supply of drugs for users in March in an effort to prevent more deaths.

    Provincial Health Officer Dr. Bonnie Henry, who has also been leading B.C.'s pandemic response, has called for the decriminalization of the possession of illegal drugs in the province for years. She has repeated her recommendation this year.

    The province said in 2019 it would not follow Henry's recommendation, as decriminalization fell under federal jurisdiction.

    https://www.cbc.ca/news/canada/british-columbia/overdose-deaths-bc-1.5607792

    Related Articles:

    "Hundreds of British Columbians are accessing province's 'safe supply' of drugs"
    https://www.cbc.ca/news/canada/british-columbia/safe-supply-bc-drug-overdose-covid-public-health-emergency-1.5594197

    "Getting cut off safe supply prescription was like a 'slap in the face,' says Vancouver woman"
    https://www.cbc.ca/news/indigenous/bc-safe-supply-prescription-cutoff-1.5588955

    ReplyDelete
  91. Police chiefs call on Ottawa to decriminalize possession of illicit drugs for personal use

    by Peter Zimonjic · CBC News · July 09, 2020

    As Canada continues to battle an opioid epidemic, the Canadian Association of Chiefs of Police is calling on federal lawmakers to decriminalize the possession of small amounts of illegal drugs for personal consumption.

    CACP's president, Chief Const. Adam Palmer, said it's time to rethink how police and governments approach the use and abuse of illegal drugs in order to save lives.

    "Arresting individuals for simple possession of illicit drugs has proven to be ineffective. It does not save lives," Palmer said. "The CACP recognizes substance use and addiction as a public health issue. Being addicted to a controlled substance is not a crime and should not be treated as such.

    "We recommend that Canada's enforcement-based approach for possession be replaced with a health-care approach that diverts people from the criminal justice system."

    CACP is a non-profit that represents about 1,300 police chiefs from federal, First Nations, provincial, regional, transportation and military police services across the country.

    Palmer said that, as an alternative to the criminal model, partnerships could be formed between social services, police, the health-care sector and governments to ensure drug users get access to the treatment they need.

    The focus of police efforts, he said, should be on cracking down on drug trafficking and the illegal production and importation of drugs — a task the police are better suited to address.

    Palmer said such a shift in policing would require changes at the federal level to the Controlled Drugs and Substances Act.

    In 2018, the CACP tasked a committee with exploring the impacts on public safety and policing of moving toward decriminalization.

    That report, delivered this month, concluded that substance abuse is a public health issue and that taking a public health approach to the problem would lead to lower rates of crime, overdoses and blood-borne diseases.

    Palmer was asked about the #defundthepolice movement on social media and whether police forces in Canada are willing to see their funding diverted toward social services or health care.

    He said that in Vancouver, where he serves as chief constable of the Vancouver Police Department, police are already looking the other way on cases of simple possession in order to focus resources on trafficking and production — so there may not be much money to divert.

    Palmer did say he was willing to discuss the notion of redirecting police funding to other initiatives if all affected parties are consulted.

    A statement from Minister of Health Patty Hajdu and Justice Minister David Lametti said they welcomed the "endorsement of a holistic approach" to dealing with the opioid crisis.

    "We appreciate efforts made by law enforcement officers to consider alternative options to criminal charges for simple possession of illicit drugs in appropriate cases, and recognize the importance of reducing barriers to treatment, as well as integrated partnerships between law enforcement and health and social services," the statement said.

    The ministers went on to say that the federal government would continue to work with substance abuse experts, first responders and law enforcement to further their own public health approach to dealing with the opioid epidemic.

    "Our government remains committed to advancing evidence-based responses to help reverse the trend of opioid overdose deaths and other substance-related harms in Canada."

    https://www.cbc.ca/news/politics/chiefs-police-decriminalize-posession-personal-use-1.5643687

    ReplyDelete
  92. Federal prosecutors told to avoid drug possession charges when possible in new directive

    by Catharine Tunney, August 19, 2020

    Federal lawyers are being asked to avoid prosecuting simple drug possession cases unless major public safety concerns are at play — a move that comes amid a push on the federal government to reconsider decriminalization.

    The directive, which was issued earlier this week, revises the Public Prosecution Service of Canada's (PPSC) approach to simple possession offences under the Controlled Drugs and Substances Act.

    Director of Public Prosecutions Kathleen Roussel is now asking her team of lawyers to focus on seeking charges only in "the most serious cases" and to otherwise ask for alternative measures, such as restorative justice and Indigenous approaches to divert simple possession cases away from the criminal justice system.

    "For example, where the possession relates to a substance use disorder, prosecution should generally be avoided where the offender is enrolled in a drug treatment court program or a course of treatment provided under the supervision of a health professional," said PPSC spokesperson Nathalie Houle in an email.

    "When deciding whether to initiate and conduct any prosecution, PPSC prosecutors must consider not only whether there is a reasonable prospect of conviction based on the evidence available but also whether a prosecution serves the public interest."

    Cases meriting charges could involve children or young people at risk, weapon, threats, acts of violence or isolated communities, according to the new directive.

    Houle said the federal agency has been reviewing its prosecution policies in light of public health research and the ongoing opioid crisis.

    Liberal MP Nathaniel Erskine-Smith, who has been pushing his own party on the issue and has introduced two private member's bills dealing with drug possession, said it's a step in the right direction. But he wants criminal offences for low level possession to be wiped off the books entirely.

    "There continue to be political challenges, but I do hope with prosecutors and police chiefs and more on board that that conversation changes very quickly," he said.

    "I'm more hopeful than I have been."

    continued below

    ReplyDelete
  93. The tweak comes amid a rising chorus of voices calling on the federal government to change its position on illicit drug decriminalization.

    Back in May more than 50 human rights, drug and legal policy groups sent a letter to the health and public safety ministers asking them to halt criminal charges for simple drug possession as part of its response to COVID-19, arguing the pandemic has led to more dangerous drug use practices and a spike in overdose deaths.

    A few weeks later the Canadian Association of Chiefs of Police — a non-profit that represents about 1,300 police chiefs from federal, First Nations, provincial, regional, transportation and military police services across the country — issued a statement calling on federal lawmakers to decriminalize the possession of small amounts of illegal drugs for personal consumption.

    "Arresting individuals for simple possession of illicit drugs has proven to be ineffective. It does not save lives," said CACP's president Chief Const. Adam Palmer at the time.

    And just last month British Columbia Premier John Horgan — whose province has seen a spike in overdoses during the pandemic — urged the prime minister in a letter to decriminalize possession for personal use.

    In his letter, Horgan said such a move would "reduce the systemic stigma associated with illicit drug use and support people to access the services that they need."

    Erskine-Smith said he hopes the issue will receive attention when Parliament resumes in September.

    "When Parliament resumes, the opioid crisis will not have gone away. The fact that our current laws have proven to be ineffective will remain true and we need to continue to pursue policies that treat drug use as a health issue and that means removing the criminal sanctions for low-level possession," he said.

    June was the worst month for overdose deaths in B.C. history with the BC Coroners Service recording 175 people dying of illicit-drug overdoses.

    The numbers for July are not available yet, but paramedics said they had their busiest months on record since the overdose emergency was declared four years ago.

    Across that province, paramedics responded to 2,706 overdose calls in July, well above the usual monthly average of around 2,000 calls, according to BC Emergency Health Services.

    https://www.cbc.ca/news/politics/simple-drug-possession-change-1.5657423

    ReplyDelete
  94. Advocates Blast BCs Overdose Crisis Response and Quit Consultations

    by Moira Wyton, The Tyee August 19, 2020

    Four leading experts and advocates for drug users are quitting provincial overdose crisis response committees over what they say is willful government inaction in the face of an increasingly deadly poisoned drug crisis.

    “I’m not going to stand at an open hole digging a grave with John Horgan,” said activist and journalist Garth Mullins.

    The premier’s July 16 comment rejecting comparisons between the government’s responses to COVID-19 and the overdose crisis was the last straw for Mullins, who is a member of the BC Association of People on Methadone and has consulted with government on a number of committees for years.

    Horgan said COVID-19 is “an insidious virus that affects anyone, at any time, and we have an opioid crisis that involves people using drugs — those are choices, initially, and then they become dependencies.”

    Horgan apologized for the comment the next day, but Mullins said his initial choice of words showed the government isn’t as committed to saving the lives of people who use drugs as it is to reducing transmission of COVID-19.

    “They derive a lot of legitimacy from having [drug users and activists] at the table,” said Mullins. “But honestly, they don’t have a plan.”

    Mullins, long-time drug user activist Dean Wilson, Moms Stop the Harm co-founder Leslie McBain and BC-Yukon Association of Drug War Survivors president Hawkfeather Peterson wrote Horgan Friday to tell him they were withdrawing their expertise from committees until they have a meeting with him to discuss their concerns.

    The letter was also addressed to Minister of Mental Health and Addictions Judy Darcy and Health Minister Adrian Dix.

    “In light of the record number of overdose deaths in British Columbia, especially during COVID, but also in [the] past five years, we are urgently seeking a meeting with yourself, the Minister of Health and the Minister of Mental Health and Addictions in order to plan the rapid implementation of safe supply to address the overdose crisis and also to reset the way our groups work with the provincial government,” the letter reads.

    McBain said consultation during the pandemic especially had felt like sitting at “the kids table.”

    Suggestions like a major expansion of safe supply programs to replace the increasingly poisoned and unpredictable illicit supplies were ignored, McBain said, even as overdose fatalities rose to their highest historical levels in May and then again in June. Numbers for July are expected next week, and advocates are bracing for another brutal monthly toll.

    Darcy will be reaching out to the four in the coming weeks, a spokesperson said in an email.

    “The perspectives of people with lived experience are at the core of the work we do as a ministry,” said the statement, noting the government has expanded safe supply. “There’s much more to do to save lives and we continue to listen to people as we evaluate that guidance.”

    But committee members said they felt complicit in “warm and fuzzy propaganda” rather than real change, and leaving was the only option.

    “They wring their hands as if it has nothing to do with them, when they’re the authors of it,” said Mullins. “We’re trying to figure out how we can get them to announce a real plan.”

    He would like to see the government set a goal of cutting overdose deaths at least in half within a year and develop a clear plan to achieve it.

    Other experts and committee members should withdraw from government consultations to support the effort to bring real change to an ineffective response, he said.

    “There’s a very easy metric to see if your program is working, because it’s written in the coroner’s report.”

    Mullins had not heard back from the government by Wednesday afternoon.

    https://thetyee.ca/News/2020/08/19/Advocates-Blast-Overdose-Crisis-Response/

    ReplyDelete
  95. BC marks 3rd straight month with more than 170 overdose deaths

    by Rhianna Schmunk, CBC News, August 25, 2020

    British Columbia has nearly matched its monthly record for deadly illicit drug overdoses, with 175 deaths during the month of July.

    The BC Coroners Service saw 177 fatalities in June, which surpassed the previous high of 174 deaths in May. The service initially reported 175 deaths for June but updated the number on Tuesday.

    A statement said the service has detected "a sustained increase" of illicit drug toxicity deaths since the first peak of the pandemic in March, and it's now confirming five straight months with more than 100 such deaths.

    Provincial Health Officer Dr. Bonnie Henry, who has led the response to the province's concurrent health crises of overdoses and the novel coronavirus, said the pandemic has led to more people using and dying alone.

    "It's dismaying to know that all of the work that we have done around responding to COVID-19 has been a contributing factor to the numbers of deaths that we're seeing from the toxic drug supply here in British Columbia and across Canada," she said at a news conference Tuesday.

    Chief Coroner Lisa Lapointe said the pandemic has restricted access to critical harm-reduction services. Still, she urged people to go to supervised injection site or drug overdose prevention sites to check substances for toxicity and not to use alone.

    "If you are using illicit substances, whether it be fentanyl, cocaine or methamphetamine, [use] only in the presence of someone else," she said.

    Just under 80 per cent of people who have died of an overdose in B.C. this year were men. Eighty-five per cent of the deaths happened indoors. No deaths have been reported at supervised injection sites or drug overdose prevention sites.

    There was a 93 per cent increase in the number of Indigenous people dying of an illicit overdose from January to May. Indigenous people make up 3.4 per cent of the population in B.C., but accounted for 16 per cent of overdoses in that time period — a rate five times higher than other B.C. residents.

    continued below

    ReplyDelete
  96. Fentanyl remains the most significant driver in the high number of deaths across all demographics. Opioids were found among all those who died, along with cocaine and the stimulants methamphetamine and amphetamine.

    Medical leaders, physicians and advocates speaking Tuesday all called for the same measures to save lives. They pushed for decriminalization, a safe supply for users and erasure of the stigma surrounding substance use.

    "Given the toxicity of the drug supply, now is the time for all of us to demonstrate compassion and empathy," said Lapointe.

    Lapointe and Henry described the current toxicity of the supply as "extreme," made more toxic than ever before due to the COVID-19 pandemic.

    Officials have said border closures during the pandemic have disrupted the usual flow of fentanyl into B.C., leading the supply to be replaced by an unstable and unpredictable substances produced locally by those who might be inexperienced.

    "The quality control has never obviously been there with fentanyl, but it's that much worse now, when drug traffickers and dealers are throwing the kitchen sink and whatever they have to make the product," said Dr. Dan Kalla, head of emergency medicine at St. Paul's Hospital in downtown Vancouver.

    Kalla also urged officials to act on decriminalization and safe supply.

    "I promise you, you're not stopping anybody by keeping it criminal and prosecuting the people who use as criminals rather than people with medical conditions and addictions issues," Kalla said.

    Last month, B.C. Premier John Horgan called for a national plan to help stem the overdose crisis as he backed the Canadian Association of Chiefs of Police in calling for the possession of small amounts of illegal drugs to be decriminalized.

    More people are dying of illicit drug overdoses in B.C. than due to homicides, motor vehicle incidents, suicides and COVID-19 combined.

    About 5,000 people in B.C. have died of illicit-drug overdoses since the public health emergency was declared in 2016.

    Judy Darcy, B.C.'s Minister of Mental Health and Addictions, said the province has escalated its response to the overdose crisis in an effort "to counter the effects of the pandemic."

    "British Columbians showed the world what we could do when it came to COVID-19 ... We must do the same for the overdose public health emergency in this province and we must do it now," she said in a statement.

    https://www.cbc.ca/news/canada/british-columbia/bc-overdose-numbers-july-2020-1.5698795

    ReplyDelete
  97. Decriminalization of drugs not a silver bullet for overdose crisis prime minister says

    CBC News · September 02, 2020

    Prime Minister Justin Trudeau would not back decriminalization of drugs as a public-health response to the country's escalating opioid crisis, insisting on Wednesday that the approach, while raised as an option by advocates and medical officials across the country, is not a "silver bullet'' solution.

    Trudeau is facing renewed pressure to decriminalize the possession of hard drugs, as officials in several provinces, including British Columbia, Ontario and Alberta, say they are grappling with an increasing number of deaths related to the toxic drug supply amid the COVID-19 pandemic.

    The prime minister was firm on his stance on the policy in an interview with CBC Vancouver on Wednesday, saying the government is prioritizing other options such as greater access to a safe supply of opioids.

    "I think in any crisis like this, there is not one silver bullet," the prime minister told The Early Edition on Wednesday.

    "We're prioritizing the things that are going to make the biggest difference immediately," he said, citing Ottawa's plans for "ensuring" a safer supply of drugs.

    "The opioid crisis is much more of a health issue rather than a justice issue."

    Many illegal drugs have been found to contain the opioid fentanyl — a substance up to 100 times more toxic than morphine. According to the B.C. Ministry of Mental Health and Addictions, it is one of the reasons why today's illegal drug supply is "so unpredictable and highly toxic" and a major part of the overdose crisis facing the country.

    More than half a dozen officials and groups — including the Canadian Association of Chiefs of Police, B.C. Premier John Horgan, Canada's Chief Public Health Officer Dr. Theresa Tam and many of her provincial counterparts like B.C. Provincial Health Officer Dr. Bonnie Henry — have called on the federal government to decriminalize the possession of small amounts of hard drugs in order to reduce the number of opioid-related deaths.

    B.C. Mental Health and Addictions Minister Judy Darcy said later Wednesday that while she hadn't heard Trudeau's comments directly, the provincial government will "continue to engage" with the federal government on the issue.

    "The position of our government has been from the beginning that addiction is not a moral issue. Addiction is not a character failure. Addiction is a health issue and it should be treated that way," Darcy said.

    "It should not be treated as a criminal issue. And so we will continue to press forward on that issue."

    Darcy added the province is working with federal officials on increasing access to safe supply.

    When asked what the province can do on its own to decriminalize, Darcy said pilot programs are underway in Vancouver, Abbotsford and Vernon and "showing really good results."

    In Abbotsford, Darcy said, police are teaming up with peer support workers.

    Instead of "criminalizing" people who have small amounts of drugs for personal use, she said, the teams connect them with health care, mental health and addiction supports.

    "We believe that's the way to go," Darcy said.

    continued below

    ReplyDelete
  98. Recent data has shown a spike in the number of people dying of illicit drug overdoses since the COVID-19 pandemic began.

    In June, B.C. reported an increase of 130 per cent in the number of deaths compared to June of last year. The number of people dying with "extreme" concentrations of fentanyl in their bodies has also risen.

    The B.C. government expanded access to a safe supply of prescription drugs in the spring.

    Officials have said border closures have disrupted the usual flow of drugs into B.C., leading the supply to be replaced by unstable and unpredictable substances produced locally by those who might be inexperienced.

    The pandemic also restricted access to supervised consumption sites, leaving users isolated at home with these potentially toxic drugs.

    Last week, the federal government announced it would be spending more than $580,000 on a new project to offer a safe supply of opioids in Toronto.

    "We are moving forward aggressively on ensuring a safer supply to be able to prevent people from having to get this terrible, terrible fentanyl, carfentanil into their systems. This is a significant step," Trudeau said Wednesday.

    "And that is what we've moved forward on without having to take the step to decriminalization."

    Last week, Ottawa also announced steps toward promised changes to federal drug policy, including funding to look at improving supervised consumption sites.

    Federal prosecutors are now also being instructed to criminally prosecute only the most serious drug possession offences that raise public safety concerns and to find alternatives outside the criminal justice system for the rest, including simple possession cases.

    Asked how much political pushback from the Opposition was influencing his hesitation on decriminalization, the prime minister replied, "very little."

    "Increasingly, Canadians are looking at a range of newer actions that they're encouraging us to look at. And we're going to continue to work to make sure that the decisions we take are grounded in science and are the right ones for Canadians."

    https://www.cbc.ca/news/canada/british-columbia/justin-trudeau-decriminalization-1.5709124

    ReplyDelete
  99. Act Now! Decriminalizing Drugs in Vancouver

    Pivot Legal Society - Technical Brief & Recommendation - 2020

    This report is a technical brief with one main recommendation:

    That non-federal orders of government implement decriminalization locally, by applying to the federal government for an exemption against the offence of simple possession. Though Vancouver is the focus, this recommendation is available to all jurisdictions in Canada, including provincial governments, and broad uptake is encouraged.

    "By every metric, drug prohibition has failed. The criminalization of drug possession for personal use (or “simple possession”) has been ineffective in reducing the use and availability of illicit drugs; fuelled stigma against people who use drugs; targeted and incarcerated racialized communities and poor people; discouraged access to health and harm reduction services; and driven an unregulated market of unknown toxicity. As skyrocketing rates of overdose deaths across Canada demonstrate, prohibition-based drug policy is a veritable death sentence for people who use drugs."

    https://www.pivotlegal.org/act_now_decriminalizing_drugs_in_vancouver

    Read the full report at:

    https://d3n8a8pro7vhmx.cloudfront.net/pivotlegal/pages/3494/attachments/original/1600280708/Decriminalization_Report_Final.pdf?1600280708

    ReplyDelete
  100. Federal health minister appeals to Alberta to reconsider closing opioid treatment program

    by Terry Reith · CBC News · October 18, 2020

    Canada's health minister is calling on the Alberta government to reconsider the closure of its injectable opioid agonist treatment program, which Premier Jason Kenney says will end in the spring when the province stops funding it.

    The service provides patients with severe opioid use disorder, a recognized condition, with injections of pharmaceutical-grade heroin, known as diacetylmorphine, or hydromorphone.

    "We are disappointed by this decision from the Alberta government, and we urge them to reconsider," a spokesperson for Patty Hajdu said.

    The health minister's call comes one week after a group of patients benefiting from Alberta's injectable opioid agonist treatment (iOAT) pilot program filed a lawsuit seeking an injunction to stop Alberta's provincial government from ending it.

    If the three Alberta clinics that offer the treatment close, few people east of British Columbia would have access to the program, which is a cornerstone of the federal government's latest strategy to combat the opioid crisis.

    "Many people are struggling with substance use, and in too many communities, the COVID-19 pandemic is compounding this ongoing public health crisis," the minister's statement said.

    From January 2016 to March of this year 16,364 Canadians died from opioid overdoses according to figures from the federal government. The numbers have shown an increasing trajectory, with 3,799 deaths last year, and over 1,000 in the first three months of 2020.

    The federal government began opening the door to community-based iOAT treatments in 2018 and has provided funding for pilot projects.

    The move followed decades of research — first in Europe, then in British Columbia. Multiple studies suggested that providing daily access to pharmaceutical grade injectable opioids allowed long-term chronic users to stabilize their lives, find homes and stop engaging in criminal activity many relied on to support their addictions. Most stuck with the program long term, and some were able to stop using injection drugs altogether.

    Alberta's previous NDP government launched the pilot program in late 2017. Kenney is giving the 60 patients currently enrolled one year to transition to other programs that do not involve injecting opioids. He has called the federal government's approach "facilitating addiction."

    "Handing out free narcotics to addicts is not compassion," the premier said in response to questions from CBC News in September.

    Patients enrolled in the program have have filed 11 affidavits in a lawsuit that is attempting to put a human face on the treatment. People who had focused their entire lives on the pursuit of drugs described awakening to a new world free of the stress and danger on the streets.

    Among them a once nationally ranked swimmer. Taylor Maxey began taking opioids following an injury in his late teens. He was soon homeless, panhandling on the streets and committing petty crimes.

    Maxey's drug habit was costing $900 a day. He watched friends die around him. He attempted suicide. He tried and failed multiple treatment programs.

    Today, at the age of 32, he says in an affidavit that he has stable housing, a new network of supportive friends, and hopes of becoming an outreach worker. Instead of hustling for street drugs, he is injected with opioids at the Calgary clinic slated to close in the spring.

    continued below

    ReplyDelete
  101. Maxey is terrified of what will happen.

    "My life would be shorter and much harsher if I returned to the streets and were denied access to iOAT," he says in an affidavit. "I would be subject to the violence of the streets and the unsafe and precarious world of opioid use. I would be exposed to unsafe supplies of opioids."

    The Alberta government has not filed a statement of defence in the case. The injunction application will be heard in November.

    What the research shows
    Beyond personal testimonials, iOAT is supported by a range of clinical research that began in Switzerland in the 1990s. on what was then known as heroin assisted treatment, or HAT. A two-year study of 1,000 people across several centres in Switzerland found "substantial improvements for illicit heroin use, health status and crime among HAT patients," according to a published review of the evidence. It also found a positive cost-benefit ratio because those provided with drugs had fewer medical issues and committed less crime.

    A groundbreaking study published in 2009 in the New England Journal of Medicine concluded heroin-assisted treatment was safe and effective. Researchers followed 251 people in Vancouver and Montreal over 12 to 15 months. They found 88 per cent of patients receiving heroin stayed with the program, and among them, there was a 67 per cent decrease in criminal behaviour.

    Overdoses and seizures were the most common adverse events recorded, though the study noted that since the patients were under close medical supervision, the overdoses were treated and the patients recovered.

    As fentanyl and carfentanil have increasingly tainted the illicit drug supply, creating an overdose crisis, the provision of pharmaceutical heroin has increasingly been seen as a potential solution.

    In 2019, the federal government formalized regulations, and the Canadian Research Initiative on Substance Misuse added clinical practice guidelines. At the time, Theresa Tam, Canada's chief public health officer, said expanding the availability of pharmaceutical-grade heroin "will save lives."

    Availability limited as overdose deaths increase
    But in spite of expectations the therapy would expand across Canada, it remains limited to a handful of sites in B.C., mostly in Vancouver. If the Alberta program shuts down, the only other places in Canada offering it will be Ottawa's Managed Opioid Program, which treats a maximum of 25 people in a residential setting, and a newly opened program in Fredericton, which currently serves seven patients.

    Rob Boyd, the program director of another Ottawa treatment centre, would like to offer iOAT but says he can't, because the drugs are not adequately covered by Ontario's health plan.

    "Lots of places want to do it," he said. "We would fill up right away."

    As overdose deaths increase — there have been more than 1,000 in British Columbia alone this year — Canada's health minister is urging provinces and regulatory bodies to adopt the treatment.

    "Do all you can to help provide people who use drugs a full spectrum of options for accessing medication," she wrote in a letter to her provincial counterparts and regulatory bodies on Aug. 24.

    "We need immediate action from all levels of government and health care practitioners to prevent further deaths from the contaminated illegal drug supply and COVID-19."

    this article was found at:
    https://www.cbc.ca/news/canada/edmonton/ioat-treatment-canada-1.5762541

    ReplyDelete
  102. Ottawa Agrees to Explore Drug Decriminalization in Vancouver

    Mayor hopes talks will be a step toward a ‘health-focused’ approach to drug policy amid overdose crisis.

    by Moira Wyton, The Tyee January 27, 2021

    The federal government has agreed to begin discussions about decriminalizing drug possession in Vancouver, Mayor Kennedy Stewart said today.

    “This is another hopeful and critical milestone on the path towards fully embracing a health-focused approach to substance use in the City of Vancouver,” said Stewart in a news release.

    City council backed decriminalization in November, and on Dec. 7 the city wrote to federal Health Minister Patty Hajdu asking for an exemption from possession prohibitions in the Controlled Drugs and Substances Act.

    Stewart hopes Vancouver’s decriminalization model would prioritize health interventions for substance use and end arrests and seizures when people have small amounts of drugs for personal use.

    In a Monday letter to Stewart and Vancouver Coastal Health chief medical officer Dr. Patricia Daly, Hajdu agreed to discussions.

    “Health Canada officials will work with officials from the City of Vancouver and Vancouver Coastal Health to better understand the framework you are proposing,” Hajdu wrote. “I am committed to our continued work to identify options that respond to the local needs of the City of Vancouver.”

    At least 367 people died of toxic drug overdoses in Vancouver between January and November 2020 in what is on track to be the deadliest year on record for overdoses in B.C.

    “This news comes at a time when the overdose crisis in our city has never been worse, with a person a day still needlessly dying due to poisoned drugs,” said Stewart.

    Decriminalization would remove criminal penalties for possession of illicit drugs for personal use. Manufacturing and distributing drugs would remain illegal.

    Experts in substance use and public health, including provincial health officer Dr. Bonnie Henry, her predecessor Dr. Perry Kendall and their federal counterpart Dr. Theresa Tam, agree on a public health approach to drug use and have called for decriminalization as a means of curbing skyrocketing overdose fatalities.

    Section 56 of the act grants the health minister to issue an exemption to any part of the legislation, including provisions making drug possession illegal, “if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest.”

    It is the same mechanism the city used to establish North America’s first supervised injection site, Insite, in 2003, and more recently to allow health-care providers to prescribe alternatives to street drugs as a part of safer supply measures.

    Hajdu also wrote that this is an opportunity to address racism and discrimination in the legal system as it relates to substance use.

    Indigenous peoples in B.C. are more likely to die of an overdose and across Canada are incarcerated at a rate nearly six times higher than non-Indigenous adults.

    “We must explore policy measures that reduce harm to racialized communities, and explore alternatives to criminal penalties that can begin to address the systemic inequities these communities face,” said Hajdu.

    Stewart said in November he hopes Vancouver’s model will be based on voluntary treatment and expanded support rather than relying on fines and mandatory treatment, as Oregon’s recently approved model does.

    “While 2020 looks to be the deadliest year on record for overdoses, I am hopeful that this news from Ottawa can mean that 2021 will be different,” Stewart said in the news release.

    https://thetyee.ca/News/2021/01/27/Ottawa-Agrees-To-Explore-Drug-Decriminalization-Vancouver/

    ReplyDelete
  103. Four New Safer Drug Supply Projects to Launch in BC

    by Moira Wyton, The Tyee February 1, 2021

    A first-of-its kind safer supply clinic in Vancouver’s downtown will begin to offer flexible, individual-centred care to people who use a variety of substances as early as this spring.

    The $5-million, four-year Safer Alternatives for Emergency Response program was one of four B.C. safer supply projects to share $15 million, the federal government announced today.

    The projects will provide pharmaceutical-grade medication as an alternative to the poisoned illicit supply.

    “This can help not only Vancouver Coastal Health, not only B.C., but the rest of the country in identifying new models for preventing overdose deaths,” said Coastal Health chief medical officer Dr. Patricia Daly.

    The government also announced funding for three similar projects, two in Vancouver and one in Victoria.

    Over the next three years, $3.6 million will go to the BC Centre for Excellence in HIV/AIDS and Providence Health Care Research Institute to run a safer supply and support services program in the Downtown Eastside.

    The Kílala Lelum Urban Indigenous Health and Healing Cooperative will receive $2.8 million over three years to operate safer supply and Indigenous Elder-led cultural healing programs at the co-operative in the same neighbourhood.

    And about $4 million over three years will go to AVI Health and Community Services in Victoria for safer supply programs.

    Safer supply programs aim to reduce overdoses and deaths by providing substance users with alternatives to the increasingly toxic illicit drug supply by prescribing pharmaceutical-grade substances to users.

    The four-year SAFER project will be run in partnership with Portland Health Services, Vancouver Coastal Health and the BC Centre on Substance Use in order to develop new models for successful safer supply delivery.

    PHS’s director of programs Susan Alexman said there are a number of barriers that make current safer supply models difficult for some people to access.

    “Is [the difficulty] coming into the clinic all the time, is it that you had a reaction to it, is it that the dosage wasn’t right?” said Alexman. “It’s looking at all those types of factors and working with the individual to prescribe something different and work on something better.”

    Daly noted some clients may be able to take doses home instead of coming to the clinic multiple times per day. But solutions will differ depending on client needs.

    SAFER will also embed peers with current or past experience with substance use in all parts of the operation in order to reduce the effect of stigma many substance users experience when seeking care.

    Wrap-around supports for housing, employment and other health needs will be integrated into the clinic.

    “Our goal is to really look at the individual in totality, not just in terms of their safer supply needs, but also ensuring they have access to other needs and that they continue to be successful,” said Alexman.

    continued below

    ReplyDelete
  104. Daly and Alexman said the model aims to be flexible and scalable for other communities in B.C. and across Canada and provide lessons as the BC Centre on Substance Use completes its ongoing evaluation of the pilot.

    “We want clients to be able to tell us they feel safe and listened to and that they had some choice in the medical care they were given,” said Alexman. “And that they have power over their own prospects and their decision-making and their health.”

    The federal government’s financial support for safer supply initiatives comes a week after it agreed to discuss decriminalizing possession of illicit substances for personal use within Vancouver city limits.

    “People can and do recover, if they have the right support, but the first step is to keep them safe,” said Vancouver Centre MP Dr. Hedy Fry. “Meeting someone where they are ensures they get the physical and mental help they need.”

    Fry also said securing a domestic supply of pharmaceutical grade heroin, also known as diacetylmorphine, is “at the top of the list of things being looked at by Health Canada.”

    Daly said diacetylmorphine can be an essential alternative for people with high tolerances or who are addicted to the powerful opioid fentanyl.

    A wider variety of available substances give individuals more choice and the opportunity to find a routine that works for them, making them less likely to access the street supply, Daly and Alexman said.

    “Right now, to determine what works best for someone, that is also based on what other kinds of pharmaceuticals are available,” said Alexman.

    But the programs will all be waiting for action on B.C.’s September announcement, days before the provincial election, that it would vastly expand the types of substances and eligibility for safer supply.

    More than four months later, that hasn’t happened.

    Currently, eligible substance users are most often prescribed opioid substitute hydromorphone in tablet form. Most then crush, dissolve and inject the substance.

    The province said about 23,000 people have availed themselves of some form of prescription alternative in the last year, including 3,348 people who were prescribed hydromorphone as of December. Research from the BC Centre for Disease Control in 2012 estimated as many as 83,000 people in the province were opioid-dependent almost a decade ago.

    For those who hydromorphone doesn’t help, injectable suboxone, methadone or limited amounts of diacetylmorphine may be used.

    Minister of Mental Health and Addictions Sheila Malcolmson said doctors, pharmacists, nurses and their colleges are working toward implementing the province’s promise of expanded safer supply.

    “We are not going to be moving forward until we’re confident that patient safety is at the forefront,” she said.

    Alexman and Daly hope SAFER will benefit from an increased array of substances as they seek to give substance users the same level of autonomy and choice as people with other health conditions.

    “We’re not telling people, ‘You’ll use injectable hydromorphone.’ Now we’re saying, ‘What might work better?’” said Alexman.

    https://thetyee.ca/News/2021/02/01/Four-New-Safer-Drug-Supply-Projects/

    ReplyDelete
  105. BC’s Deadliest Year for Overdoses and a ‘Shameful,’ ‘Unconscionable’ Response

    At least 1,716 people died in 2020, almost five years after the province declared an overdose health emergency.

    by Moira Wyton, TheTyee.ca February 11, 2021

    Almost five years after the overdose crisis was declared a public health emergency, at least 1,716 British Columbians lost their lives in 2020 without access to a regulated, safe alternative to poisoned illicit drugs.

    That surpasses the 1,549 people who died in 2018, up until now the deadliest year, and is a 74-per-cent increase from last year’s 984 deaths.

    About five people died on average day in the province.

    “Thousands of years of life and potential are gone,” said chief coroner Lisa Lapointe as she presented a report on the deaths today. “We must turn this terrible trajectory around.”

    Since March, the provincial government has blamed the surge in fatalities on pandemic disruptions to harm reduction services and an increasingly toxic supply of illicit drugs due to border closures and domestic production.

    Minister of Mental Health and Addictions Sheila Malcolmson said today the deaths were an “insidious impact of the pandemic,” wiping out progress made in 2019.

    But advocates and experts say the province’s small, slow steps to address the crisis, even after the potential impacts of the pandemic on overdose deaths became clear, are a slap in the face to the families and friends of the 6,733 people who have died since 2016.

    “We have had years to get ahead of this,” said peer advisor Guy Felicella of the BC Centre on Substance Use. “COVID showed how fragile what we had in place already really was.”

    Leslie McBain, who lost her 25-year-old son Jordan Miller to an overdose in 2014, says more than 200 members have joined her organization Moms Stop the Harm in just the last few weeks. “It’s a testament to the amount of grief this crisis is causing.”

    McBain said it’s “incredibly disappointing” that the death toll is still rising, five years after the public health emergency was announced.

    “What is wrong with this picture? The government is not doing enough, and they do not have a plan,” she said. “I think that is shameful and it is unconscionable.”

    The province has focused recent efforts on new treatment and recovery beds, training nurses to prescribe medications to treat substance use disorder and expanding eligibility for people to be prescribed pharmaceutical alternatives to illicit drugs.

    In September, the province announced it would expand eligibility for safer supply programs and allow more substances to be prescribed.

    But no details on timelines have been provided in the months since.

    Malcolmson said, “B.C. is leading the way.”

    “The work that B.C. is doing on the whole umbrella of prescribed medications associated with practice is groundbreaking in Canada,” she said.

    continued below

    ReplyDelete
  106. The Globe and Mail reported today that Malcolmson has asked the federal government to decriminalize possession of drugs for personal use in the province.

    Provincial health officer Dr. Bonnie Henry proposed a made-in-B.C. plan to decriminalize illicit drugs in April 2019, which the province rejected.

    In December, Vancouver made a similar request to the federal government seeking an exemption from personal possession laws. Talks are to begin next month.

    But Lapointe, McBain and Felicella said decriminalization isn’t enough.

    A safe supply of pharmaceutical-grade drugs is needed to stabilize people and separate them from the contaminated street supply, they said.

    Felicella said the government’s actions on safer supply have missed the mark. Instead of providing people with non-toxic replacements for drugs they now buy on the illicit market, programs have focused on prescriptions for drugs used in treatment.

    That leaves users dependent on often-poisoned illicit supplies, he added.

    “It’s another reiteration of a prohibition strategy, all of everything we have is rooted in punitive drug policy,” he said. “We need drug reform, and that’s regulated supply.”

    Felicella would like to see community compassion club-based models where people can buy pharmaceutical, regulated drugs without fear of contamination.

    Vancouver Mayor Kennedy Stewart supported a role for such a model when asked today, noting the city “would be looking forward to even more aggressive models as this crisis is just getting worse and worse and worse.”

    Jordan Westfall of the Canadian Association for Safe Supply said not everyone who dies of an overdose has a substance use disorder or addiction.

    And he noted that many people prescribed alternatives as part of a treatment program still access the illicit supply.

    “We know a lot of people using on the side are dying,” said Westfall in an interview. “We have to honour that, we have to invite them in.”

    When The Tyee asked what Malcolmson was doing to prevent deaths among intermittent users or those not ready for treatment, she encouraged people to use with a friend or use the provincial Lifeguard app.

    And when asked about expanding safer supply to provide safe replacements for the drugs people currently use, Malcolmson was vague, saying there is “still a lot of runway and work that’s under way” on expanding the current model.

    Westfall says the government has missed an almost infinite number of opportunities to avoid this tragic loss of life.

    “I think the summer was a critical chance to do more, to do much, much more,” he said. “Why do we wait for COVID to do safe supply? Why on Earth did we have to wait for a separate public health emergency? I think a lot of people got woken up by the response to COVID.”

    In the news conference today, Malcolmson denied that the difference between the government’s response to the pandemic and overdose crises showed some lives matter more than others.

    Westfall, Felicella and McBain hope this could be a turning point. But they want to see a major investment in the crisis response in the provincial budget expected in April.

    If the report on record deaths doesn’t spur bold action, they are not sure what else could.

    “It’s never been this bad before, and we’re still slow,” said Westfall. “We don’t need to keep tinkering at the margins when people are dying.”

    https://thetyee.ca/News/2021/02/11/BC-Deadliest-Year-Overdoses-Shameful-Unconscionable-Response/

    ReplyDelete
  107. For One Day, BC Activists Handed Out Clean Heroin and Cocaine

    Demonstrators aim to show how regulating drugs would keep people who use them alive.

    by Jen St. Denis, The Tyee, April 15, 2021

    Illicit drugs are usually bought in the shadows, and then often consumed alone. But as Canada’s black market drug supply has become increasingly tainted with unstable mixes of fentanyl and benzodiazepines, both are increasingly deadly activities.

    Activists gathered Wednesday in Vancouver’s Downtown Eastside neighbourhood to show how bringing drug use into the light could help save lives.

    The protest came as British Columbia entered its fifth year of a public health emergency because of rising deaths due to poisoned drugs. The group, the Drug User Liberation Front, staged a similar event last year.

    At Dunlevy and Hastings streets, members of the Drug User Liberation Front set up a table and gave out heroin, cocaine and methamphetamine in small cardboard boxes. The boxes were clearly labelled with what was in the drugs and at what percentage — for instance, 40 per cent heroin, 60 per cent caffeine.

    The group said the drugs had been tested before distribution and did not contain “fentanyl, fentanyl analogues, benzodiazepines and many other harmful cuts, buffs or adulterants.”

    Mary, a Downtown Eastside resident who picked up a box of heroin, said she had overdosed several times. She marvelled at the small box in her hand, with its label showing what exactly she would be taking. “We don’t do heroin — it’s fentanyl down here, or whatever somebody makes us in a bathtub,” she said.

    Mary has tried prescribed safe supply in the past, but it hadn’t worked for her because her doctor was not allowed to increase the dose of her prescribed opioid.

    Scott Joinson said he’d never had unadulterated cocaine, and he wanted to know what it was like. He said he had overdosed several times.

    “If it was done with government backing, then we would know what’s in our drugs. If it was sold in stores, people would know as consenting adults,” he said. “Take a look at what’s going on — the black market is forcing us to take adulterants, which is killing us.”

    Eris Nyx, one of the organizers of the event, said the drug handout was limited to people over 18 who already use illicit drugs. The group bought the clean drugs on the internet using cryptocurrency, she said.

    She said the event was modelled like a compassion club and showed that the model could work to supply people who use drugs with safe products.

    “Anyone can reproduce this model,” Nyx said. “It is a model that could be expanded immediately by drug users all over the country, if the government was ready to regulate it.”

    Drug-testing services and Overdose Prevention Society staff were present at the event.

    Dr. Mark Tyndall, a professor at the University of British Columbia’s School of Population and Public Health, said he supports the demonstration.

    continued below

    ReplyDelete
  108. The only way that supports for drug users seem to happen is when they take action, he said.

    “Somebody said at the rally last year, ‘Nobody’s coming to save us,’” Tyndall said. “I think these are sort of important demonstrations, going against regulations and just showing what can be done.”

    In 2016, community activists set up overdose prevention sites, which were technically illegal at the time. Faced with soaring death rates because of the increased use of the synthetic opioid fentanyl, the provincial government quickly moved to approve the model.

    Death rates finally began to fall in 2019. But all that progress was erased in 2020 as the COVID-19 pandemic brought more toxic drugs onto the streets, and more people used drugs alone as community connections were severed.

    In B.C., just over one-third of all deaths of people under the age of 44 last year were caused by poisoned drugs. The province had the highest number of deaths ever recorded from illicit drug toxicity in 2020 and is on track to continue that trend. Other Canadian provinces have seen a similar increase.

    While the provincial health officer created new public health orders to expand access to safe supply, advocates in B.C. have been frustrated by delays to the rollout and ongoing barriers.

    Tyndall said many doctors are still reluctant to prescribe prescription opioids. Just a few years ago, regulators were scrutinizing doctors who over-prescribed opioids to patients. There is skepticism that safe supply is the right treatment for people who are addicted to illicit drugs, as well as liability fears.

    “Although there are guidelines now, they’re just guidelines,” Tyndall said.

    “Physicians are still concerned that somebody they’re prescribing to will have an overdose and they’ll have the prescribed drugs in their system. They may very, very likely have other drugs in their system too. But there is quite a liability that physicians feel by doing this.”

    Tyndall, who created a vending machine system called MySafe that dispenses opioids, said safe supply needs to be seen as a harm reduction public health measure, not something that necessarily needs to be overseen by a doctor.

    “When we medicalize these things, the expectation is this is a stepping-stone to addiction care and treatment and detox and people want to make this a comprehensive kind of care package,” he said. “Many people aren’t ready for that or have failed that many times.”

    Dr. Andrea Sereda, a physician in London, Ont. started prescribing the prescription opioid Dilaudid in 2016 and now treats 300 patients. She said doctors in Ontario face similar barriers, but the idea has become more accepted over several years.

    “We’re different from B.C. as well in that all safe supply programs are pretty rigorously embedded in primary care,” Sereda said.

    continued below

    ReplyDelete
  109. Sereda said other doctors have come on board after she presented data “showing that we were keeping people alive, we were preventing a lot of infectious complications related to injection drug use of our clean supply,” as well as preventing HIV and controlling existing infections.

    Tyndall and Sereda said there needs to be a wider range of prescription alternatives provided to people. For instance, in Ontario Sereda can’t prescribe liquid hydromorphone at the concentration that patients who have developed a very high tolerance would need. She’d also like to see heroin and more fentanyl products made available to prescribe.

    Activists at the Downtown Eastside rally called for fentanyl and benzodiazepines to be added to safe supply. (Benzodiazepines are a depressant increasingly added to illicit opioids and stimulants and that can cause dangerous blackouts and breathing problems.)

    For political reasons, Tyndall said it’s trickier to advocate for a safe supply of stimulants and benzos. But he doesn’t disagree with the call to provide safe and regulated drugs of all types as an alternative to the current dangerous, unpredictable supply that is controlled by organized crime.

    “So many people are dying of too many opioids and contaminated products and especially fentanyl,” he said. “So I think that needs to be our main focus, but I do think a lot of the activist community may not even use opioids, they use other substances. Why should they be buying mystery drugs when we should be regulating them all?”

    In other parts of Canada, safe supply to prevent drug poisoning deaths isn’t yet part of the mainstream conversation, Tyndall said.

    In many provinces, setting up overdose prevention sites is still an uphill battle, even as death rates soar.

    In Saskatchewan, the government refuses to fund the only overdose prevention site in the province, located in Saskatoon. In August, the Alberta government cut funding to a site that had operated in Lethbridge and had been the busiest site in the country.

    For those politicians who are reluctant to fund or allow safe drug consumption sites, safe supply could actually be a more politically palatable alternative, Tyndall said.

    “Part of my epiphany about all this is spending time at overdose prevention sites and just watching a parade of people overdose every day,” he said.

    “The same people bring in the same stuff and overdose, and all we can offer them is naloxone and oxygen and work to save their lives, when we could be offering them drugs that they would use that won’t kill them.

    “Maybe these places that are still stuck on supervised injection sites could just open up clinics where you can give people a safe supply of drugs.”

    see photos and charts in this article at:
    https://thetyee.ca/News/2021/04/15/For-One-Day-BC-Activists-Handed-Out-Clean-Heroin-Cocaine/

    ReplyDelete
  110. Canada could decriminalize drugs. But we're headed in the wrong direction with the plan

    by Donald MacPherson, Executive Director, Canadian Drug Policy Coalition www.drugpolicy.ca

    Canada is on the cusp of something big: Vancouver has submitted a formal proposal to decriminalize drugs for personal possession and is waiting for approval by Ottawa. If approved, other cities will likely follow, and it could be the start of a Canada-wide policy shift. But the "Vancouver Model" has three serious flaws that could undermine its effectiveness and set a dangerous precedent for other cities—a "booby trap" as described by our partners at L’Association des intervenants en dépendance du Québec.

    In response, we along with our coalition partners today launched #DecrimDoneRight, a move to correct the errant path of this history-making proposal by Vancouver. We released our concerns in a joint statement, Decriminalization Done Right: A Human Rights and Public Health Vision for Drug Policy Reform
    https://www.drugpolicy.ca/wp-content/uploads/2021/05/Decrim-Done-Right-Statement-2-Update.pdf

    Three Big Issues

    1. Lack of input from people who use drugs. People who used drugs were only consulted after the plan was well developed. Because of this, it fails to reflect the realities of current drug use especially in the time of COVID-19, where the drug supply has become even more toxic. Having this first-hand knowledge and expertise is essential for the plan to succeed. Any proposal for decriminalization must be co-developed and co-lead by people who use drugs; this didn't happen.

    2. Drug threshold limits are too low. Because people who use drugs were not engaged in the design of the "Vancouver Model" from the beginning, the proposal has unrealistically low threshold levels (the legal amount of a drug someone would be allowed to carry). This seriously undercuts its intended benefits because the plan doesn't align with reality. The assumptions and "insight" that the City of Vancouver relied upon were outdated and inaccurate. Basing a precedent-setting proposal on bad intelligence is dangerous.

    3. Police involvement in the plan. From the beginning, the Vancouver Police had their hands on this proposal, shaping its contours to suit their policing aims. This is a conflict of interest as the whole point of "de"-criminalization is to remove police from the process, not bring them closer to it. We know that policing priorities conflict with public health aims when it comes to people who use drugs. A policy of decriminalization designed by police is for police, not the community it was intended to help. It would be like the fast food industry designing a nutrition guide for a community. It's paradoxical, anti-evidence, and dangerous.

    We support a move to decriminalize drugs in Canada. It's long past time, and it will save lives. But not like this. People who use drugs—for whom this plan is meant to help—know this policy is inherently flawed and dangerous. We must listen to them.

    The Harm Reduction Nurses Association released a public statement back in 2019 calling for the decriminalization of people who use drugs. https://www.hrna-aiirm.ca/wp-content/uploads/2019/08/nnpbc_hrna_statement_190806-2.pdf

    Back then, there were around 12,000 overdose deaths in Canada. Now, that number has soared to around 20,000. Canada is in a public health crisis that politicians are failing to adequately address. We need your help to change that.

    Share our advocacy link (using the hashtag #DecrimDoneRight) to your networks and social media communities
    https://www.drugpolicy.ca/decriminalization-done-right-a-human-rights-and-public-health-vision-for-drug-policy-reform/

    Contact the City of Vancouver here https://vancouver.ca/your-government/contact-the-mayor.aspx

    or the Minister of Health via this easy-to-use contact form set up by the Canadian Association of People Who Use Drugs and ask Health Canada to amend the current proposal
    https://www.capud.ca/action

    ReplyDelete
  111. Lawsuit filed in B.C. court argues criminalization of drugs is a charter violation

    by Brenna Owen · The Canadian Press September 02, 2021

    A group representing drug users has filed a lawsuit against the federal government in British Columbia Supreme Court seeking to decriminalize the possession of illicit drugs, arguing criminalization during the overdose crisis violates charter rights.

    The statement of claim filed Tuesday by the Canadian Association of People Who Use Drugs and four individual plaintiffs says drug dependence is well recognized as a medical condition, but criminalization means the toxic illicit market is the only source of most drugs.

    It says the illicit drug supply has become increasingly contaminated with the powerful opioid fentanyl and related substances since 2016, fuelling the drug poisoning and overdose crisis that's killing thousands of Canadians every year.

    The lawsuit argues criminalization has also created a high degree of stigma, leading many people to use drugs alone and in secret, heightening the risk of overdose.

    A statement of defence has not been filed in the court's online search system.

    Health Canada spokesman Mark Johnson said that Justice Canada is reviewing the claim.

    "Tragically, the COVID-19 pandemic has compounded the ongoing overdose crisis, with many jurisdictions having reported record high rates of harms, including deaths, throughout 2020 and into 2021," he wrote in an email to The Canadian Press.

    The lawsuit challenges drug possession offences in the Controlled Drugs and Substances Act, asserting that they breach charter rights to life, liberty and security of the person, equality rights and the right not to be subjected to cruel and unusual treatment.

    The civil claim, among other things, asks the court to strike down all drug possession offences, as well as certain drug trafficking offences related to subsistence.

    More than 21,000 people died of drug overdose in Canada between 2016 and 2020, the lawsuit says. It asserts that many of the deaths could have been prevented with a combination of decriminalization, a safe drug supply and harm-reduction services.

    The City of Vancouver has requested an exception to federal law to decriminalize the possession of small amounts of certain drugs for personal use, but Health Canada has yet to approve the request. The City of Toronto and the B.C. government have also backed decriminalization, while the lawsuit seeks an end to the prohibition across the country.

    https://www.cbc.ca/news/canada/british-columbia/lawsuit-filed-in-b-c-court-argues-criminalization-of-drugs-is-a-charter-violation-1.6163475

    ReplyDelete
  112. BC’s Overdose Failure: ‘Each One of these Deaths Was Preventable’

    BC Coroners Service reports 2021 will be the deadliest year on record and government has failed to respond adequately to the public health crisis.

    by Moira Wyton The Tyee August 31, 2021

    The first six months of 2021 have been the deadliest on record for toxic drugs in British Columbia, claiming the lives of 1,011 people, a third more than the same time last year.

    The BC Coroners Service reported today that 159 people died in June, the second-highest total for the month in history. In June 2020 185 people died.

    The report, a grim confirmation that 2021 will be the deadliest year ever without bold action, came as loved ones of the 21,000 Canadians lost to toxic drugs since 2016 marked International Overdose Awareness Day.

    “Each one of these deaths was preventable,” Chief Coroner Lisa Lapointe said today. “We continue to seek compassionate, courageous and meaningful solutions to stop the death toll.”

    B.C. is in its sixth year of the overdose public health emergency, but the province still isn’t treating it like a crisis, Lapointe said.

    “The public health emergency was declared in 2016 with the best of intentions... with expectation that response would be commensurate with the impact,” she responded to a Tyee question. “We haven’t seen that.”

    The lack of co-ordinated emergency response is mind-boggling to Leslie McBain, who lost her son Jordan to a fentanyl overdose and co-founded Moms Stop the Harm.

    “We are doing essentially nothing and expecting things to improve,” she said today. “Why would we allow this dismal and tragic situation to exist?”

    Meanwhile, the criminalized drug supply has grown increasingly unpredictable and poisoned.

    Fentanyl contributed to 87 per cent of deaths between 2018 and 2020. Carfentanil, an even more powerful synthetic opioid, has contributed to 96 deaths so far this year, compared to 65 in all of 2020.

    Paramedics are responding to more than 100 overdoses a day across the province, said Brian Twaites, an advanced life support paramedic for BC Emergency Health Services.

    And more and more often they are needing to use up to five times the normal dose of naloxone to reverse an overdose from synthetic opioids, which bind more strongly to receptors in the brain.

    Lapointe said widespread and accessible safe supply needs to be available to offer an alternative to the poisoned illicit supply, in addition to decriminalization of drug possession.

    “Prescribed drugs, including those prescribed by doctors as safe supply, are not a factor in the drug toxicity crisis. Safe supply is not creating a health-and-safety risk,” she said.

    continued below

    ReplyDelete
  113. Vancouver is currently waiting for federal approval for its decriminalization application.

    The provincial government has said it will also seek approval to decriminalize possession of drugs for personal use.

    The NDP promised an expanded safe supply program before last fall’s provincial election.

    But critics say current government prescribing guidance for safe supply doesn’t go far enough, and won’t stop 2021 and 2022 from becoming consecutive record years for fatalities.

    Lapointe said without targets for prescribers and access in every community, B.C. is “nowhere near the numbers” we need to stop deaths.

    Stigma and doctors’ reluctance to prescribe alternatives to illicit drugs continue to prevent people who use substances from seeking and being provided adequate health care, she noted.

    The “biggest barrier is how slow we are to change our perspective on what’s right and what’s wrong.”

    Notably absent from today’s announcement were provincial health officer Dr. Bonnie Henry, Health Minister Adrian Dix, Premier John Horgan and Minister of Mental Health and Addictions Sheila Malcolmson.

    None of their offices had released statements to mark International Overdose Awareness Day or acknowledge the new report on deaths when the press conference concluded this morning.

    Just before 11 a.m. Malcolmson’s office released a statement expressing sorrow for the more than 7,000 lives lost in B.C. over the last five years.

    “Our government has been creating new drug policy in Canada that will save lives by supporting access to prescribed safer supply and connecting people to health-care services, and by moving forward on decriminalization of people who use drugs,” said Malcolmson in the statement. “We will do everything we can to turn this drug poisoning crisis around.”

    The province’s all-hands-on-deck pandemic response is “absolutely what we need for the drug toxicity crisis,” Lapointe said.

    “What we have seen is small steps primarily left to one ministry.”

    Toxic drug deaths are now the leading cause of years of life lost in the province, affecting mostly men ages 19 to 39.

    And they are the leading cause of death among young people aged 19 to 39, and come second in the general population, after malignant cancers.

    McBain said the people dying in communities across the province are important, loved and loving. “They are us,” she said.

    The June data was reported a month late due to the nearly 600 heat-related deaths in late June’s heat wave, which overwhelmed the BC Coroners Service. The delay will be corrected when July and August data are reported together at the end of September.

    https://thetyee.ca/News/2021/08/31/BC-Overdose-Failure-Deadliest-Year-Preventable-Coroners-Report/

    ReplyDelete
  114. Vancouver clinic first in North America to offer take-home medical-grade heroin

    A safe supply of medical-grade heroin can be a lifeline for those battling opioid addiction

    CBC News September 16, 2021

    The Providence Crosstown Clinic in Vancouver is pioneering a new step in harm reduction by enabling some of its patients to take home medical-grade heroin.

    The program is the first of its kind in North America.

    Dr. Scott MacDonald, the physician lead at the Providence Crosstown Clinic, said the change came about partly because of the COVID-19 pandemic.

    Some of the patients at the clinic that had COVID-19 were forced to isolate at home or in a hotel. Staff at the clinic, supported by the health authority, were able to deliver diacetylmorphine syringes (medical-grade heroin) to the patients so they could successfully isolate for 10 to 14 days.

    "Having done that and done that successfully without any problems, we were able to show and demonstrate the strict requirement of the medication to only be [administered] at the clinic was not necessary," MacDonald told guest host Bal Brach on CBC's On The Coast.

    MacDonald said allowing patients to take home their doses gives them a greater deal of flexibility — especially for patients who are working and cannot stop by the clinic for another dose during their shift.

    "The ability to pick up two doses ... for the day allows people to work and get on with living their lives," he said.

    Around 11 patients are participating in the program, but MacDonald says opening the program to more people is a key step in fighting the province's opioid crisis.

    "Their lives can change dramatically. People can go from accessing street opioids, perhaps having unstable housing and unable to work to stabilized and being able to work, and some people working full-time," he said.

    More than 1,000 people died of an illicit drug overdose between January and June in B.C., the highest rate ever recorded in the first six months of a calendar year. The B.C. Coroners Service says drug toxicity is now the leading cause of death in B.C. for people between 19 and 39 years of age.

    "We need a safe, regulated supply that separates people from the poisoned street supply and expansion of diacetylmorphine is one thing that needs to happen," said MacDonald.

    "There's an urgent need. We know it's safe. It's clinically effective. It's cost effective. It reduces mortality and also reduces crime. What's not to like?"

    https://www.cbc.ca/news/canada/british-columbia/take-home-medical-heroin-1.6179280

    ReplyDelete
  115. Prescription Inhalable Heroin Is Coming to BC.

    Will the Province Embrace It? Experts say it’s past time to expand life-saving therapy for drug users.

    Moira Wyton, The Tyee September 17, 2021

    Many drug users could have access to life-saving inhalable prescription heroin for the first time in Canada — if British Columbia’s provincial government gets on board.

    The first shipment of inhalable prescription heroin procured by B.C.’s only non-profit pharmaceutical company will arrive from Europe by the end of the month, a step that experts hail as key to curbing the surging overdose crisis.

    But provincial government efforts to expand safe alternatives to increasingly poisoned and fatal street drugs have so far stopped short of prescription heroin.

    Vancouver’s health authority and a number of clinics are eager to start dispensing it and can do so without provincial sign-off, but will be limited in the amount they can purchase and distribute without provincial support.

    “People are dying, so we have not stopped trying to get them what they need. The numbers are worse than ever in terms of overdose deaths,” said Dr. Martin Schechter, co-founder of the non-profit Fair Price Pharma, which has agreed not to name its federally licensed European supplier.

    Schechter and former B.C. provincial health officer Dr. Perry Kendall formed Fair Price Pharma last year to offer prescription heroin on their own, in the face of what Schechter called “entirely political” decisions not to pay to expand the project that currently offers injectable heroin-assisted treatment to a small group of people.

    “Our strategy in B.C. has not been successful. It really is time to do something different,” he said.

    The initial batch could support as many as 400 people for four months depending on dosages, Schechter said, and would more than triple the number of people accessing prescription heroin in B.C. Subsequent shipments are already being arranged, he said.

    Fair Price Pharma’s announcement comes after years of Canadian governments citing high costs and lack of a domestic supply as reasons not to import or manufacture more pharmaceutical-grade heroin, known as diacetylmorphine or DAM, for substance users.

    In the 20 months since COVID-19 sent the overdose crisis into a tailspin, more than 2,500 British Columbians have died in what will be back-to-back record years for overdose deaths. Vancouver has been the hardest hit municipality in Canada, reporting at least 651 residents dying between January 2020 and June 2021.

    Heroin-assisted treatment is a form of safe supply that aims to separate patients from the toxic, unreliable and criminalized street drug market.

    Currently, only 150 patients in Canada, all in Vancouver and Surrey, receive two to five supervised injections of prescription heroin at a specialized clinic. The Crosstown Clinic in Vancouver’s Downtown Eastside neighbourhood recently began to allow about a dozen patients to take home their remaining doses after a morning check-in, a first in North America.

    Decades of evidence from a number of European countries and two landmark trials in B.C. have shown the treatment to be astoundingly successful at saving lives and improving quality of life for entrenched substance users for whom first-line treatments have not been effective.

    Once enrolled in the treatment, patients in B.C. were more able to find and keep jobs and stable housing, had better health overall and were less likely to commit survival crimes or be admitted to the hospital. Treatment costs about $45,000 per patient per year but saves about $140,000 annually in policing and costs per individual, the studies found.

    “That’s why it’s so mystifying, why the one injectable treatment that has been studied medically the most is the same one being omitted from the [provincial] guidelines in B.C.,” said Schechter.

    continued below

    ReplyDelete
  116. The number of patients accessing heroin-assisted therapy in European countries has also remained stable for decades at around five to eight per cent of people who are opioid-dependent. There are about 1,000 patients enrolled in European Union countries and 1,400 more in Switzerland.

    “Patients are able to work, care for their families, have more free time and do things that are more conducive to a good quality of life,” said Dr. Scott MacDonald, medical lead at Crosstown Clinic that treats about 90 individuals in the Downtown Eastside. “Even without other changes, [prescription heroin] reduces the cost of the status quo.”

    But Vancouver alone is in need of hundreds more spaces in these programs, he said, as are communities across Canada. Only about 0.3 per cent of all 83,000 people estimated to be opioid-dependent in B.C. are able to access prescription heroin, far behind the number that have benefited in Europe for decades.

    “The reason it’s not available is really just on willingness to pay, which comes down to stigma,” said MacDonald.

    Fair Price Pharma wants to start with inhalable heroin before it begins to process the raw materials for injection, Schechter said.

    Providing inhalable in addition to injectable heroin is an important step to ensure there are diverse options to meet people where they’re at, MacDonald said.

    Many people who use substances choose to inhale because they feel it’s safer than injecting, he said, but there is still a risk of overdose and dying.

    Schechter said there’s been strong support for the medication from Vancouver Coastal Health and clinics who say they are ready to start administering it.

    MacDonald said he expects there to be some version of a domestic supply of prescription heroin in Canada by mid-2022, based on conversations with health officials.

    But the health authority declined to comment and directed The Tyee’s request for confirmation to the province.

    In an emailed statement, a spokesperson for the Ministry of Mental Health and Addictions said the province’s new guidance focuses on pharmaceutical alternatives like fentanyl patches based on guidance from medical experts on what could benefit people using substances the most.

    MacDonald said patches and oral medications can be useful for some, but keeping a consistent method of administration, like injection or inhalation, is essential for many substance users to continue treatment.

    “If there are hundreds of people accessing supervised consumption sites on a daily basis to inhale their substances, then clearly the current options are not attracting them or keeping them in care,” said MacDonald. “The flexibility and de-medicalizing the access and the options is really key.”

    When COVID-19 pushed Crosstown to start delivering DAM to some patients in isolation, and then move to allow some patients to take doses home with them this summer, MacDonald was surprised by how easy it was when patients, doctors, the health authority and government worked together.

    It could be just as easy to expand prescription heroin treatment, MacDonald said, if there is the political will.

    “It’s been possible for years,” he said, “and all these life-saving treatments are sitting on the bench.”

    https://thetyee.ca/News/2021/09/17/Prescription-Inhalable-Heroin-BC/

    ReplyDelete
  117. Drug decriminalization movement gaining momentum in Canada as overdose deaths surge

    Prominent mental health teaching hospital joins calls to decriminalize all illicit drugs

    by Lauren Pelley · CBC News · September 29, 2021

    As overdose deaths keep surging in Canada, the movement to decriminalize illicit drugs is gaining steam, with one of the country's largest mental health facilities joining national advocates and several major cities in putting pressure on the federal government to act.

    Earlier this summer, mayors from across B.C. signed a letter in support of Vancouver city officials who are seeking Health Canada's approval to decriminalize the possession of small amounts of illegal drugs.

    Toronto is gearing up to submit a similar request, a move which follows the city recently hitting its highest one-day opioid overdose count in late July.

    Now, the country's largest mental health teaching hospital, the Centre for Addiction and Mental Health (CAMH) in Toronto, is for the first time formally pushing for countrywide drug decriminalization as well, CBC News has learned.

    In a new policy statement being released publicly on Wednesday, the hospital is calling on the federal government to decriminalize all drugs while working with the provinces to ramp up treatment and harm-reduction services and replace the "unregulated, toxic drug supply."

    "The driving factor behind the shift has been the harms we're seeing," said Dr. Leslie Buckley, chief of the addictions division at CAMH, during an interview.

    Buckley says the legal framework around substance use hasn't been successful at curbing drug use, and instead causes social harms which disproportionately affect racialized communities.

    "We should be thinking about substance use through a health lens," Buckley said, "and focusing on how to help people be well, rather than face criminal penalties."

    CAMH is specifically calling on the federal government to "ensure decriminalization applies across the country and to all currently illicit drugs" — rather than a piecemeal approach relying on regional or substance-specific exemptions — with no fines or other administrative penalties.

    The push comes as overdose deaths are hitting new highs in much of the country, in part fuelled by an increasingly toxic illegal drug supply and, advocates say, by the social isolation and stress sparked by the ongoing COVID-19 pandemic.

    Federal data shows there were nearly 7,000 apparent opioid toxicity deaths reported in Canada between April 2020 and March 2021 — an 88 per cent increase from the same time period prior to the pandemic — with the bulk of the most recent deaths reported in British Columbia, Alberta and Ontario.

    "We have not seen a commensurate response in prevention that signifies that there is urgency," said Angela Robertson, executive director of the Parkdale Queen West Community Health Centre, which operates sites for safer, monitored drug use in Toronto.

    "Here is a public health crisis that warrants a public health crisis response."

    There were some signals on the campaign trail that the Trudeau government may be open to exploring new avenues to tackle overdose-related deaths.

    Although the Liberal platform didn't mention decriminalization specifically, or offer a commitment to providing a safe drug supply — approaches which were backed by other parties — Prime Minister Justin Trudeau has expressed a willingness to work with groups pursuing those solutions.

    "We've seen a number of provinces, particularly British Columbia, very interested in moving forward on some forms of decriminalization and we are absolutely open to working with them," Trudeau said during an announcement on mental health commitments.

    continued below

    ReplyDelete
  118. Fewer Canadians are also being charged with drug possession in recent years, with the number of people facing charges dropping from more than 35,000 people in 2015 to roughly 18,000 in 2019, the latest available Statistics Canada data show.

    'People are really listening now'

    It's a shift not lost on advocates like Arlene Last-Kolb, who lost her 24-year-old son Jesse to fentanyl poisoning in July 2014.

    The Manitoba mother has since been calling for changes in how Canada handles the opioid crisis.

    "We talk about decriminalization for people that have no choice but to go to the streets to get what they need, and they're most likely going to die from that," said Last-Kolb, who is a board member of the advocacy group Moms Stop the Harm and co-founder of Overdose Awareness Manitoba.

    "Why are we not talking about making it safer?"

    Recently, there's been growing momentum around those kinds of harm-reduction approaches, she said. "What is new is that people are really listening now — and they're really starting to understand it."

    Yet drug use policies remain a patchwork across the country, with varying levels of support and access to facilities like supervised injection sites, even as deaths have surged in recent years.

    In Edmonton, daily drug poisonings are now putting extra strain on a health system that's also being overwhelmed by patients battling COVID-19, said family physician Dr. Ginetta Salvalaggio, an associate professor at the University of Alberta.

    As co-chair of the Edmonton Zone Medical Staff Association's opioid poisoning committee, Salvalaggio is part of a group advocating for the urgent expansion of new overdose prevention sites in all of Alberta's major cities and broader access to a safer drug supply to tackle the current crisis — and she said longer-term, decriminalization needs to remain part of the conversation.

    "The drug supply that is currently circulating is, if anything, just getting from bad to worse, and that's not going to get solved by trying to take what's currently on the street off," Salvalaggio added. "So we need a much more comprehensive approach."

    According to Buckley, the physician from CAMH, curbing the overdose crisis in both the short and long term requires a slate of tactics — including decriminalizing drugs, improving access to a safer drug supply and addiction treatments, and educating Canadians on the potential harms of drug use.

    "We know that there is a possibility that we can be normalizing substance use, which we know can lead to people thinking it's less harmful," she acknowledged.

    "Today's substances are not your parent's substances. The context has really changed."

    Last-Kolb stresses that people like her late son have long used illegal drugs for a variety of reasons, and she maintains they deserve safer, legal options — just like those available to Canadians who choose to drink alcohol or smoke cannabis.

    "My son would be married now with children. That's what I want for other people. I want people to be safe, I want our children to be safe," she said.

    "And I don't want them to have to go to the streets and get something illegal that will most likely kill them."

    https://www.cbc.ca/news/health/drug-decriminalization-camh-1.6192785

    ReplyDelete
  119. Vancouver votes to support application that would create safe drug 'compassion clubs'

    Akshay Kulkarni · CBC News · Oct 07, 2021

    Vancouver City Council has voted to support a federal application that would allow a "compassion club" model and provide tested drugs in the city.

    The application was put forward by the Drug User Liberation Front (DULF), which had previously handed out tested drugs in front of the Vancouver Police Department.

    It calls for an exemption to Section 56 of the Controlled Drugs and Substances Act, which would allow them to open a safe supply fulfilment centre and hand out clean tested drugs.

    The motion by Councillor Jean Swanson passed near-unanimously Thursday evening, after an amendment to ensure the drugs would be purchased through legal means.

    "We've tried every other avenue to prevent this death. And we know what we're doing will work," Eris Nyx, co-founder of DULF, told CBC News.

    If the federal exemption is granted, DULF would work with organizations like Fair Price Pharma to obtain, test and package legally-sourced drugs before handing them out.

    Nyx says the tested drugs DULF provides will ensure people know the dosage amounts they are taking. The motion says this will help prevent overdoses.

    Council has now endorsed the DULF exemption application and Mayor Kennedy Stewart will write a letter in support of it to the federal government.

    The application has the support of Vancouver Coastal Health and numerous policy experts, including from the B.C. Centre on Substance Use and the Canadian Drug Policy Coalition.

    Nyx says any decriminalization efforts on the part of the city would not work without safe supply, and that this application was one step towards that.

    Safe supply advocates have criticized Vancouver's approach to decriminalization and safe supply in the past, saying the city's solutions were flawed.
    Supply currently sourced through illicit means

    DULF had previously sourced some of their clean drugs from the dark web, which was the cause of much debate in council.

    The dark web is a hidden part of the internet that does not turn up on search engines, and requires a special browser to access. Websites on the dark web include those involved in illegal activity, such as street drug delivery.

    Nyx says she had no interest in participating in criminal activities, but without the exemption granting DULF legal pathways to access clean supply, they would have to resort to illicit means.

    "We're not criminals, we're just people who have lived and worked in this community that suffered so immensely. So many folks have passed away," she said.

    Thus far, Nyx says no overdoses or deaths have been reported from the clean drugs DULF has handed out.

    She says the group will be going ahead with the exemption application soon, including going to court or judicial review if necessary.

    "We will go and challenge the government of Canada on our fundamental rights. We will say we have the right to use drugs, without being condemned to not know what their content is and to not be safe."

    https://www.cbc.ca/news/canada/british-columbia/vancouver-supports-safe-drugs-compassion-club-1.6204380

    ReplyDelete
  120. BC applies to decriminalize use of small amounts of illicit drugs in effort to reduce deaths

    by Michelle Ghoussoub · CBC News · November 01, 2021

    B.C. is applying to the federal government to decriminalize the possession of small amounts of illicit drugs for personal use, in an effort to reduce and prevent future drug poisoning deaths.

    The move announced on Monday will make the province the first in Canada to seek the exemption from Health Canada under the Controlled Drugs and Substances Act. If approved, the allowable threshold would be 4.5 grams and would apply to those 19 and above.

    Mental Health and Addictions Minister Sheila Malcolmson said removing criminal penalties for people who use drugs is key to stemming the overdose crisis, which has dramatically worsened since the start of the COVID-19 pandemic.

    "Substance use and addictions is a public health issue, it is not a criminal justice issue," she said during a press conference in Victoria on Monday, adding that "shame and fear keeps people from accessing life saving services and treatments."

    Malcolmson said the application to Health Canada was a collaborative effort that included health and social services organizations, Indigenous organizations, municipalities, people with lived experience, law enforcement organizations and research groups.

    The application will be submitted to Ottawa this week, but it's not known how long it will take for Health Canada to review the file.

    Provincial Health Officer Bonnie Henry, speaking Tuesday on CBC's The Early Edition, said she hopes Ottawa looks at the application "favourably and quickly."

    "This is the first and the best option, and I'm very supportive of the fact that they put this application in," said Henry.

    Henry said she favours a province-wide exemption because it means there will not be different approaches by different police detachments across B.C.

    "We're going to do this together," she said.

    continued below

    ReplyDelete
  121. Prior to the COVID-19 pandemic, B.C. had seen a decrease in deaths due to toxic drugs. But the pandemic reversed that trend, causing toxic drug poisoning deaths to reach an all-time high.

    Figures released in September from the B.C. Coroners Service show there were 1,204 illicit drug toxicity deaths between January and the end of July — a 28 per cent jump over the same period in 2020.

    The coroner says the first seven months of this year were the deadliest since a health emergency was declared in 2016, and July was the 17th straight month in which more than 100 B.C. residents died from toxic drug supply.

    Chief Coroner Lisa Lapointe said she anticipates opposition to the move, but that years of criminalizing drug users has failed to end the crisis and the province needs to shift to a health-focused approach.

    "Criminalizing people using drugs has meant punishing those that are already suffering," she said on Monday.

    "The goal of decriminalization is to reduce suffering and death. It is a compassionate and rational response to a health crisis."

    While advocates think this is a positive step, some are saying the allowable threshold amount is too low, adding that the 4.5 gram allowance is not enough to decriminalize the majority of users.

    "If the goal is to decriminalize drug use, like drug users, then you have to look at what drug users actually possess," said Garth Mullins, a member of the Vancouver Area Network of Drug Users.

    "I want decriminalization to work for the people with the biggest habits who are most at risk, who are most policed, who are most oppressed."

    In a statement, the B.C. Association of Police Chiefs said while it supports the decriminalization of small amounts of illicit drugs for personal use, it does not support the recommendation to decriminalize 4.5 grams, arguing the amount is too large.

    "Most people will purchase drugs in the milligrams — 100 mg would be what a person would use for a single dose of heroin, for example. So 4.5 grams represents 45 individual uses for a person who uses drugs," said Abbotsford police Chief Mike Serr.

    He said the association is worried about organized crime and public consumption, among other concerns. They're asking the province to adopt a more measured and incremental approach.

    "We're very open to continue to look at increasing thresholds. But after we've built. We don't want to fly a plane while it's in the air, we want to build the infrastructure in place and do this the right way to support people," he said.

    Leslie McBain is the co-founder of Moms Stop the Harm and says the allowable amount decision should be made in consultation with users, not police.

    "[Police] are not the people who know what a person who uses drugs needs, what their needs are, what they're using, what their tolerances are," she said.

    "We're doing this to protect people who use drugs. So who are the people we should be talking to and listening to? It's the people who use drugs."

    Don Davies, the NDP's federal health critic and member of parliament for Vancouver Kingsway, said decriminalization is a necessary first step, but only part of a bigger solution that should include a regulated, safe supply of drugs for users.

    "Everybody knows it's the toxic poison street supply supplied by criminals that is actually killing people. So, if we don't address that part of the equation, simply decriminalizing possession won't solve the problem," said Davies, also speaking on The Early Edition Tuesday.

    Last month, Toronto said it was also preparing to ask Health Canada for an exemption under the Controlled Drugs and Substances Act to decriminalize the possession of illicit drugs for personal use in the city, following a similar request made by Vancouver in May.

    https://www.cbc.ca/news/canada/british-columbia/toxic-drug-measures-1.6232746

    ReplyDelete
  122. BC’s ‘Starting Point’ to Decriminalize Drug Possession Has Far to Go, Say Advocates

    by Moira Wyton | TheTyee.ca November 2, 2021

    British Columbia could become the first province to decriminalize personal possession of some illicit substances in a bid to curb deaths due to toxic drugs.

    But only if the federal government accepts its application, announced Monday, for an exemption from Section 56 of the Controlled Drugs and Substances Act.

    The exemption would prohibit charges or drug seizures if someone has 4.5 grams or less of heroin, fentanyl, crack and powder cocaine and methamphetamine for their own use.

    Section 56 lets the federal health minister issue an exemption to the legislation if “the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest.”

    Decriminalization, the province’s submission says, would reduce stigma and drug-related harms for people using substances that drive them to use alone, as more than 80 per cent of people dying in B.C. do right now.

    “Criminalizing drugs has meant punishing those who are already suffering,” provincial health officer Dr. Bonnie Henry said Monday. “It has meant removing dignity.”

    In 2019, Henry outlined a path for B.C. to decriminalize people who use substances that was dismissed by the NDP government at the time.

    Decriminalization has been endorsed by doctors, researchers, elected officials and the Canadian Association of Chiefs of Police.

    Instead of being arrested or having their drugs seized, law enforcement would provide people who use substances with access to health and social service resources.

    The exemption request to the federal government comes in the sixth year of B.C.’s overdose death public health emergency, with more than 7,700 people having lost their lives since 2016. This year is on track to be the second consecutive most deadly year for overdose deaths in B.C.

    Critics and advocates say B.C.’s proposal won’t solve the deadly problem.

    The 4.5-gram limit is too low, they say, and safe supply is needed to address the root cause of deaths — poisoned drugs.

    Many people carry multiple days’ worth of substances with them, especially people with limited supply, and many also use multiple substances which would tip them easily over the total limit.

    “A cumulative threshold of 4.5 grams does not reflect the needs or substance-use patterns of people who use drugs — especially for folks living in rural and remote locations of the province, and polysubstance users,” said Amber Streukens of the Rural Empowered Drug Users Network in a statement from Pivot Legal Society.

    continued below

    ReplyDelete
  123. Minister of Mental Health and Addictions Sheila Malcolmson said the submission is intended to be a starting point using the best data available to decriminalize the most people possible.

    “We have to hear from all partners and continue to modify our approach as we gain some experience,” said Malcolmson.

    Streukens, who consulted on the submission, said the province’s application missed the mark.

    “If our drive towards decriminalization is truly propelled by public health with the intent to reduce harm, we need to be pushing forward policy that fits the actual needs of the people who use drugs. This is not that.”

    The province’s exemption submission also does not apply to youth, who make up a small but vulnerable portion of people overdosing and dying from toxic criminalized drugs.

    “This is not what we families want for our kids. We need to protect youth from laws that cut short their progress to adulthood — not saddle them with a criminal record,” said Leslie McBain, co-founder of Moms Stop the Harm.

    Malcolmson expressed optimism that Ottawa will accept the submission and said B.C. would explore provincial options if the request is not granted.

    Advocates say that without major changes like increased access to safe supplies of drugs and realistic thresholds for possession, the B.C. government is tinkering around the margins while six people are dying every day.

    https://thetyee.ca/News/2021/11/02/BC-Starting-Point-Decriminalize-Drug-Possession-Far-To-Go/

    ReplyDelete
  124. BCs Toxic Drug Crisis Is Getting Worse

    by Moira Wyton 9 Nov 2021 | The Tyee

    Toxic drugs took the lives of at least 333 British Columbians in August and September, with 2021 on track to be the province’s worst year for drug deaths.

    At least 181 people did in August and 152 in September, the most deaths ever recorded in each calendar month.

    In the first nine months of 2021, 1,534 people have died — 24 per cent more than in the same period last year — as the province slowly rolls out safe supply and decriminalization efforts to stop deaths.

    The BC Coroners Service reported deaths for both months today. Reporting has been delayed because the service said it was dealing with the nearly 600 deaths related to the heat wave that began in June.

    In 2020, 1,736 people died of toxic drugs. At the current rate of about 5.5 deaths per day, B.C. will surpass 2,000 deaths by the end of the calendar year.

    Increasingly unpredictable and deadly combinations of substances in the criminalized supply during the pandemic, combined with reduced access to harm reduction services, have meant toxic drug deaths have skyrocketed since March 2020.

    The powerful opioid fentanyl, up to 50 times as potent as heroin, is present in about 84 per cent of deaths, the report said.

    And carfentanil, even more potent than fentanyl, has contributed to 137 deaths so far in 2021, more than twice the 65 deaths it caused in all of 2020.

    Drug user advocates and doctors have repeatedly called for safe supply programs, including non-medical compassion club models, to stop deaths by providing uncontaminated drugs.

    “If we had a contaminated food supply that was making people ill, we would pull that supply off the market and replace it with a supply that was not contaminated,” said Vancouver Coastal Health chief medical officer Dr. Patricia Daly in an Oct. 21 presentation to Vancouver city council. “We haven’t done the most basic thing to address this crisis.”

    Daly noted the unequal responses to COVID-19 and the more deadly toxic drug crisis.

    COVID-19 has taken the lives of 2,200 individuals in B.C. since March 2020, compared to more than 3,100 people who died of toxic drugs in the same period.

    This month’s rate of 39 toxic drug deaths per 100,000 individuals places the crisis just slightly behind COVID-19 in terms of mortality, which has killed about 41 individuals per 100,000 overall.

    And B.C.’s death rate of 39 per 100,000 people is higher than overdose-ravaged states like Ohio (38.3), Maryland (38.2) or Pennsylvania (35.6) — but not quite as dire as Delaware (48) or West Virginia (52.8).

    B.C.’s recent submission requesting permission to decriminalize personal possession of small amounts of drugs is now in the federal government’s hands, along with Vancouver’s earlier request to do the same.

    It’s a move provincial health officer Dr. Bonnie Henry supported in 2019, but which was dismissed by the NDP government at the time.

    continued below

    ReplyDelete
  125. Minister of Mental Health and Addictions Sheila Malcolmson today acknowledged the “heartbreaking” deaths and said the province was leading the way on efforts to reduce deaths through prescription alternatives to street drugs and decriminalization.

    “But people who use drugs continue to die, so clearly we must do more,” she said during an announcement of 10 new treatment beds for substance use in Surrey and new social workers for substance use at two hospitals in Fraser Health.

    While Malcolmson has said non-prescription, compassion club means of distributing untainted, regulated safe supplies of criminalized street drugs have a place in B.C.’s toxic drug response, she has not funded or spoken to next steps for getting these solutions off the ground. Only about 20 per cent of the approximately 100,000 people in B.C. who could benefit from safe supply are connected to a prescription alternative right now.

    Drug user advocates have criticized the province’s decriminalization plan as ineffective, noting it excludes youth and still allows police to arrest people for possessing small amounts of drugs.

    And without widespread access to a safe supply of substances, people will still die despite any decriminalization efforts, they say.

    “If our drive towards decriminalization is truly propelled by public health with the intent to reduce harm, we need to be pushing forward policy that fits the actual needs of the people who use drugs. This is not that,” said Amber Streukens of the Rural Empowered Drug Users Network in a statement last week from Pivot Legal Society.

    https://thetyee.ca/News/2021/11/09/BC-Toxic-Drug-Crisis-Getting-Worse/

    ReplyDelete
  126. Overdose Prevention Sites Bring Broad Health Benefits, Study Finds

    by Moira Wyton December 2,2021 | TheTyee.ca

    New and mounting evidence that overdose prevention sites bring broad health benefits to individuals and positively impact their communities has one advocate asking why British Columbia isn’t working harder to open more of them.

    Ann Livingston has been an activist for drug user rights for 30 years. She supports a number of overdose prevention sites where people can use substances and connect to health and social services in the Lower Mainland.

    But despite the need for the sites in every community in B.C., few outside Vancouver get off the ground due to municipal and neighbourhood opposition that ignores the evidence of their benefits.

    “People are trying to save each other’s lives,” said Livingston in an interview. “And then nothing happens because they can’t find anywhere to lease.”

    Overdose prevention sites are a form of harm reduction where people who use substances can go for clean supplies and to use drugs under supervision from trained peers who also have lived experience with substance use.

    People can get clean supplies to prepare and take their drugs, socialize and be monitored after using in case they overdose. About 89 per cent of people who die from toxic drugs had been using alone, according to data from the BC Coroners Service.

    “Isolation is what kills drug users,” said Livingston. “OPSs should be run very locally. What you want is people, even if it’s cold out, they should take the time to go over there and take their drugs there.”

    After B.C. declared a public health emergency over the overdose crisis, the province issued an order to rapidly expand OPS services, which are more casual and can be established quickly. Because they are not an explicitly medical service like the Insite supervised consumption site, they are also not under federal regulation.

    Between January 2018 and July 2021, there were more than 2.5 million visits to overdose prevention sites in B.C., with 14,000 overdoses attended and zero deaths. There are now 35 sites across B.C., 10 of which are in Vancouver.

    And their benefits are wide-ranging and distinct from the more medical and regulated supervised consumption sites, a study by researchers at the BC Centre on Substance Use and the University of British Columbia found.

    After the expansion of OPS sites in December 2016, the proportion of substance users who accessed supervised consumption sites climbed from 41 to 47 per cent.

    continued below

    ReplyDelete
  127. Seventy per cent of substance users accessed treatment and recovery services, up from 65 per cent before the sites opened, and the proportion who reported injecting in public fell from 36 to 30 per cent.

    The OPS expansion also halved the number of people who reported sharing syringes, a key reason for the spread of HIV-AIDS and other blood-borne illnesses, from five per cent to two per cent.

    “What we’ve seen with OPS, these services can really be more responsive to people who use drugs because they minimize barriers to access,” said Dr. Mary Clare Kennedy, lead author of the study.

    Many face stigma from medical professionals and are less likely to want to access other health services. Some also want to share drugs or use alongside friends, which supervised consumption sites don’t allow.

    “Having services operated by and for people who use drugs is shown to increase access. People feel safer,” said Kennedy in an interview.

    The findings build on decades of evidence that supervised consumption and overdose prevention sites are beneficial to both users and communities, Kennedy said, because the injection of drugs in public decreases an individual’s risk of overdose as well as perceived “social disorder.”

    But the health benefits need to be at the centre of every new push for more overdose prevention sites, because local residents’ concerns about their impacts are often not based on evidence.

    “With harm reduction services, we’re often asking what the benefit is for the broader community,” Kennedy said, “and we wouldn’t ask that of any other health services.”

    Since August 2020, the province has opened seven new overdose prevention sites in B.C., and nine more are being planned, including five in the Fraser Health region, a Ministry of Mental Health and Addictions spokesperson wrote.

    Budget 2021 sets aside $45 million over the next three years to support OPSs across B.C., she added.

    The Ministry declined to comment directly on Livingston’s calls to be more proactive, and said “Health authorities continue to work closely with communities and partners to situate these sites where they will have the biggest impact.”

    “The recent report published by the BC Centre on Substance Use is positive and confirms that overdose prevention services are vital health services that benefit people and their communities,” the statement read.

    But Livingston wants to see the province take a more proactive approach to ensure municipal bylaws and hesitant landlords don’t prevent these sites from saving lives.

    The lease for an OPS in Nanaimo was terminated in November, Livingston said, and Chilliwack passed a bylaw earlier this year to require approval from neighbours and city council before an OPS can open.

    When the evidence to support the sites is this clear and lives are at stake, governments should be working overtime to remove any barriers that prevent them from opening, she added.

    “Everyone needs places to use drugs,” said Livingston. “And when a facility exists for people to use drugs safely, it sends a very powerful message to people who have nothing but hatred.”

    https://thetyee.ca/News/2021/12/02/Overdose-Prevention-Sites-Bring-Health-Benefits/

    ReplyDelete
  128. NYC Opens Nations First Safe Drug Injection Sites; 15 Lives Saved in First Week of Operation

    Democracy Now December 7, 2021

    AMY GOODMAN: This is Democracy Now! I am Amy Goodman with Juan González. Officials in New York City say nine lives have been saved so far after the opening of two new supervised illegal drug injection sites. The government-approved facilities are the first of their kind in the United States. They come as U.S. overdose deaths topped 100,000 during the first year of the pandemic. Locations offer clean needles and can administer the opioid reversal medication called Naloxone as well as provide medical care and drug dependency treatment options. Advocates have long fought for better and safer resources for people with addiction. There are now over 120 drug injection sites operating worldwide.

    For more, we are joined by Kassandra Frederique, Executive Director of the Drug Policy Alliance, a national nonprofit fighting to end the so-called War on Drugs and to build alternatives. Kassandra, welcome to Democracy Now! Explain what is happening at these sites. These are illegal drug injection sites that are approved by New York City, the first in the country.

    KASSANDRA FREDERIQUE: Thank you so much for having me. Yes, these overdose prevention centers are places where people who are already publicly injecting, we are incentivizing them to come into these places so that they can sit down, learn strategies around injection that really reduce the harms that come with injection, that are able to have conversations about the substances that they are using and to use under the supervision of other people.

    Part of the reason why this issue is so urgent is because our drug supply currently is being adulterated with a more fast-acting opioid called fentanyl. When this happens and the drug supply is contaminated, we are in a situation where people are using and overdosing faster and then we are getting more deaths. That is part of the reason why we are seeing such a surge. With these overdose prevention centers, people are being able to use under supervision, therefore if someone is overdosing, there is a greater chance—people will be able to revive them. What I would offer is that the latest stats are that 15 people have been saved in the six days that these sites have been open, and we only see that number increasing.

    JUAN GONZÁLEZ: I wanted to ask you about the overall implications of the epidemic of overdose deaths that the nation is undergoing now. Back in the 1970s—I think Richard Nixon launched his War on Drugs in 1971. Back then during the heroin epidemic, I think the total number of overdose deaths in any one year back in the 1970s was about 7,000. Then in the 1980s at the height of the crack cocaine epidemic, the largest number of overdose deaths was less than 9,000 in any one year. Now we’re dealing with 100,000 in a 12-month period according to the CDC, ten times the number of people dying from drug overdose deaths now than back in the 1970s and 1980s. The implications of that for public health and in terms of how government policy is shaped?

    continued below

    ReplyDelete
  129. KASSANDRA FREDERIQUE: This is an incredibly important point. I think the thing that we point to is the role that criminalization plays in exacerbating the public health crisis. The explosion of mass incarceration, the consistent policies that focus on control as opposed to public health have only exacerbated the issues that we are in right now. If we think about the heroin crisis in the 1970s and we think about the role of methadone, and we think about how restrictive it is, we think about the lack of access to new medications like buprenorphine and the insidious racial disparities about who has access, we recognize that this moment is policy-created. Our policies have put us in this situation. We are really in a moment where these prevention centers are about us creating more tools for us to deal with the problem that our decision-makers have created.

    JUAN GONZÁLEZ: In terms of the demographics of the drug overdose situation, obviously back in the 1970s and 1980s, it was largely within the inner cities among African Americans and Latinos. Now this epidemic started really in the rural areas and has moved into the cities, hasn’t it? It largely started first among working-class and poor whites and now is increasingly into the Black and brown communities as well?

    KASSANDRA FREDERIQUE: I think it has been more of a mix. It has been rural white folks that have been suffering from overdoses but I think part of the reason why you have seen a marshaling of resources is because this was also hitting middle-class well-resourced white folks. That is what gets the government and the status quo to respond, is because there is also a class as well as race implication that’s happening, which has marshaled the kind of response that you have seen.

    What we’re seeing now is that there is a dramatic increase of the overdose crisis hitting Black and Latino communities in this country. In fact, in New York where we have opened the overdose prevention center, Black New Yorkers had the highest rate of overdose deaths and the largest absolute increase in rate between 2019 and 2020. So we’re seeing such a dramatic increase. There have been studies that have shown that—there have been four states in the United States, at a study that was run out of Columbia, where Ohio, Kentucky, New York, where they have the highest overdose rates—the increase is happening among Black communities. And there are multiple states—there was another study that showed that in states like West Virginia, Washington, D.C., Missouri, Illinois, Michigan, Wisconsin, Minnesota, these places, the Black opioid overdose death rate is higher than white folks.

    continued below

    ReplyDelete
  130. So it is really important for us to recognize—and also this is what history shows—there’s no crisis that is happening in the United States that is solely going to impact white folks. If white folks start to get impacted, we will see a dramatic increase in the devastation that will happen to communities of color. The thing that we as advocates are pushing for is usually when that happens, the pendulum swings really rapidly back to criminalization. We are seeing that at the federal level with the Biden administration continuing to push the criminalization of fentanyl. We as advocates know that when that happens, the public health push will recede and that criminalization will take its place. So it’s really important for us to have a conversation about how we need to keep public health at the center and at the forefront of our strategy in order to make sure that we do not continue the policies that have put us in this situation in the first place.

    AMY GOODMAN: Can you talk about where we stand in the world? Safer consumption spaces have been in operation in Europe, what, since the 1980s? In Canada, since 2003. Around 120 sites are operating around the world. Here in New York, we now have these first legal injection sites. Now Boston, San Francisco, Washington state all considering this, these safe spaces away from police and incarceration. Talk about how this contributes to ending the War on Drugs.

    KASSANDRA FREDERIQUE: We want to keep people alive, and the War on Drugs is a war on people, as many people have said before. In order for us to actually win, we need our loved ones to be here with us and that includes people who use drugs. And I want to be really clear—these are the first sanctioned overdose prevention centers. People who use drugs have been fighting strategies to keep themselves alive and well for very long time. This comes out of a deep history and strategy of harm reduction. People who use drugs were the first people who were pushing for giving people who use drugs clean equipment like sterile syringes. They have been operating these kinds of places for a long time to help save each other. This is us moving to help them to bring this out from the underground, to make sure that we can create an infusion of resources and for us to actually have conversations about what it is that we need to keep our loved ones safe.

    Often times when we have these conversations, people are focusing on, “We want to get people to stop using drugs. We want people to return back to our lives.” What we have consistently heard from people who use drugs is that they need things to slow down around them. Overdose prevention centers give us the opportunity to give people who use drugs the resources and the time and the consultation to look at the choices that they have made, create the connections that they want and also slow down the chaos that comes with criminalization. What I would offer is that this is an opportunity for us to look at how do we center the needs of people who use drugs, how do we listen to them and create resources that are anchored in that.

    AMY GOODMAN: Kassandra Frederique, Executive Director of Drug Policy Alliance, thank you so much. Juan and I hope you’ll join us tonight for the virtual celebration marking Democracy Now’s 25th anniversary at 8:00 p.m. Eastern Time at Democracynow.org. We will be speaking with Noam Chomsky, Angela Davis, Martín Espada, Winona LaDuke, Arundhati Roy, Danny Glover, Danny DeVito and more. I’m Amy Goodman with Juan González.

    https://www.democracynow.org/2021/12/7/ny_first_drug_injection_sites

    ReplyDelete
  131. Jail not the answer for people caught dealing fentanyl to support their own drug addictions, B.C. judge says

    by Jason Proctor CBC News December 07, 2021

    A Vancouver Island judge says courts need to reconsider automatic jail sentences for people caught dealing fentanyl to support their own drug addictions.

    In a ruling likely to send shockwaves through B.C.'s justice system, Campbell River Provincial Court Judge Barbara Flewelling last week broke with years of precedent set by the province's top court — suspending a sentence for a woman facing up to three years in jail for trafficking in fentanyl and placing her on probation instead.

    Sarah Runyon, the defence lawyer who won the case, said the ruling has the potential to be groundbreaking.

    "It's really just forcing the court to step back and say, 'Wait a minute, are we really just playing whack-a-mole here?' Taking one marginalized street person, throw them into custody [then] somebody else pops up, and what problem are we really solving?" Runyon told the CBC.

    "It's important because it's re-evaluating our approach to punishing people who use drugs and sell drugs to survive."

    The decision centred around the harrowing testimony of Tanya Lee Ellis, a 43-year-old woman who sold spitballs containing fentanyl to an undercover RCMP officer in late 2019.

    The Crown was asking for a three year prison sentence.

    According to Flewelling, Ellis testified candidly about her life and her addiction. She grew up watching her father assault her mother. She was introduced to crack cocaine by an older man in Grade 8, and she started using heroin in her 20s.

    The father of her two daughters spent significant time in jail before dying of a suspected overdose two days after they had both completed treatment at a five-day residential facility.

    She was heartbroken.

    She told the judge what it was like to be addicted, saying her arms are scarred so badly she has to wear long sleeves.

    "My veins are collapsed," she said. "I ... have to go in my feet sometimes, which is painful … it's horrible ... then try to smoke and ... it just doesn't do it.

    "I try and try for hours, sometimes bleeding everywhere … in the hot bath to try and bring my veins out, [I] drink water, whatever I can do. But still it's … absolutely disgusting."

    Ellis had one prior conviction for trafficking almost 20 years ago and numerous busts for shoplifting since. She has spent a total of 240 days in jail spread over two decades and has been on constant probational supervision.

    "When asked why time in jail hasn't stopped her from being addicted, she testified that she cleans up but comes back to the same problems and the same struggles," Flewelling wrote.

    "She appeared very sad and defeated."

    In 2017, B.C.'s Court of Appeal bumped the range of sentencing for first-time offenders convicted of trafficking in fentanyl to between 18 and 36 months. Before that it had been about six months.

    Flewelling said at the time of that decision, the public was just becoming aware of the toxicity and supply of fentanyl.

    continued below

    ReplyDelete
  132. A change in approach to punishment was warranted by "the proliferation of fentanyl and the fatal consequences of its illegal sale and distribution," the appeal judges said.

    Lower courts usually follow the path set by higher courts, but Flewelling said the practice is not a "straitjacket" and "trial courts can reconsider binding precedent if there has been a shift in the legal or social landscape."

    Flewelling heard testimony from Dr. Ryan McNeil, the director of harm-reduction research for the program in addiction medicine at Yale University in New Haven, Conn., who said he didn't know Ellis personally, but that her story was common.

    McNeil, an affiliated assistant professor at the Vancouver-based University of British Columbia, said incarceration doesn't reduce overdose risk. Instead, the period after release from jail represents "some of the greatest overdose risks that a person can have," he said.

    The judge cited a statement last month from B.C. Chief Coroner Lisa Lapointe, who said the province is on track for another record-breaking year for deaths from toxic drugs.

    "Criminalizing those who use substances has done nothing to address this complex health issue and has resulted in greater suffering and marginalization," Lapointe said.

    "How many more deaths are we willing to accept to maintain drug policies and laws that have no basis in evidence?"

    Flewelling said a "fundamental shift" has occurred in the time since the appeal court decision in society's understanding of drug addiction and its relationship to low level trafficking by people desperate to avoid withdrawal.

    She concluded the sentencing range should reflect the difference in "moral culpability" between street dealers like Ellis and people higher up the chain.

    "Assessing a fit and just sentence is probably one of the most difficult tasks a judge undertakes in her judicial career," Flewelling wrote.

    "I conclude that drug addicts who sell small quantities of drugs at the street level for the primary purpose of ensuring their own drug supply, are far less morally culpable than those farther up in the hierarchy. They are motivated, not for profit or greed, but to ensure their own supply and to avoid the severe effects of withdrawal."

    The judge suspended sentence and gave Ellis a year's probation, during which she has to keep the peace and be of good behaviour.

    Runyon said the Crown will likely appeal the decision. She says the case could go all the way to the Supreme Court of Canada.

    https://www.cbc.ca/news/canada/british-columbia/judge-drugs-addicts-sentencing-1.6275724

    ReplyDelete
  133. Decriminalization Done Right: A Rights-Based Path for Drug Policy

    Donald MacPherson
    Executive Director
    Canadian Drug Policy Coalition
    www.drugpolicy.ca

    The chorus calling for change grows louder every day. Over 43 cities, including Vancouver, Toronto and Montreal, have called for decriminalization of drugs in response to the drug toxicity crisis that continues to break record after record for poisoning deaths.

    Now, after months of collaboration and work with 20 other leading human rights and justice organizations, including organizations led by people who use drugs, we are releasing one of the first, comprehensive right-based platform for decriminalization of drugs in Canada.

    Decriminalization Done Right: A Rights-Based Path for Drug Policy calls for full decriminalization of all drug possession for personal use—as well as sharing or selling of drugs for subsistence, to support personal drug use costs, or provide a safe supply.

    The platform also calls for the redistribution of resources from enforcement and policing to non-coercive, voluntary policies, programs, and services that protect and promote people’s health and human rights.

    More than 100 Canadian organizations have endorsed this unprecedented vision for the future. We need your support to help ensure this platform becomes law and ends the century of punitive, ineffective, and costly drug policies that have injured, killed, and needlessly incarcerated thousands of Canadians.

    These laws have fuelled stigma and led to epidemics of preventable illness and death, poverty, homelessness, and widespread and egregious violations of human rights. Prohibition is rooted in, and has reinforced, racism, sexism, and colonialism. It has disproportionately affected Black and Indigenous Canadians who are at much higher risk of arrest and severe punishment.

    It is time to choose evidence over ideology and embrace a public health and human rights-based vision for drug policy. Join us in making this visual a reality.

    ReplyDelete
  134. As overdose deaths hit a grim new record officials push Ottawa to stop treating addiction as a crime

    by Chris Hall CBC News December 11, 2021

    As British Columbia marks another tragic milestone in overdose deaths, pressure is growing on the federal government to decriminalize personal possession of drugs, including opioids.

    The province announced a record number of people in B.C. have died so far this year from overdoses — 201 in October alone.

    "Simply put, we are failing," said B.C.'s chief coroner Lisa Lapointe. She's been echoing calls from officials in Toronto and MPs from across the country and across party lines to start treating addiction to drugs like fentanyl as an urgent health problem, rather than a criminal offence.

    B.C., Vancouver and Toronto are formally asking the federal government to exempt them from the law in order to permit decriminalization of small-scale possession. They're wording it more as a demand than a plea.

    "The status quo is not working," said Toronto Mayor John Tory. "And in cities all across this country, literally hundreds of people are dying, often alone and in alleys where they shouldn't be.

    "And they haven't (got) a legal problem, not a moral problem. They have a health problem."

    Decriminalization of so-called hard drugs is an official policy of the Liberal Party, endorsed back in 2018 at its convention in Halifax.

    At the time, Prime Minister Justin Trudeau — still dealing with his government's promise to legalize marijuana — wasn't interested in tackling another politically risky change to federal drug laws.

    "On that particular issue, as I've said, it's not part of our plans," Trudeau told reporters back then.

    It now appears the federal government's reluctance is waning.

    "We are looking at these proposals very, very seriously," said Carolyn Bennett, the first ever federal minister of mental health and addictions.

    In an interview airing this weekend on CBC's The House, Bennett spoke about how her father, a police officer, lived through the Prohibition era in Canada after the First World War, and how that experience shapes her own thinking.

    "And I think until the day he died at 93, he felt Prohibition never worked and that this was a health problem," she said.

    "I think we've come through generations of thinking about how the criminal justice system is being used for what is a health problem."

    Still, Bennett — who is a medical doctor — isn't setting a timeline for a decision because she said she believes decriminalization alone isn't the answer to the opioid epidemic.

    Other options are also being considered, she said — including the idea of establishing a safe supply of opioids to give addicts an alternative to the increasingly toxic fentanyl now on the streets. The federal government is also looking at setting up more safe injection sites and making counselling more available.

    "There have been other proposals of a more collective approach to getting safe supply to the people using drugs. This is about dignity and saving lives, and we are prepared to really examine all of these innovative approaches," she told The House.

    Just a few weeks into her new job, Bennett went to Vancouver to tour with her provincial counterpart Sheila Malcolmson the downtown east side area that's become a symbol of the lives destroyed by fentanyl addiction.

    "I feel she shares our government's feeling of urgency," Malcolmson told reporters this week. "And so far, no barriers have been identified by Health Canada staff to a speedy processing and approval of our decriminalization."

    continued below

    ReplyDelete
  135. Decriminalization is also supported by many experts.

    Don MacPherson is executive director of the Canadian Drug Policy Coalition at Simon Fraser University. He was part of a task force appointed by previous federal health minister Patty Hajdu to advise her on drug policy. He said charging people with simple possession, and seizing their drugs, makes no sense.

    "There's mountains of evidence that show it's a bad thing. It's harmful, it hurts people and there is not really an upside to it," he told The House.

    "So the task force … came fairly quickly to the conclusion that the federal government should immediately start work on putting forward a plan to decriminalize simple possession of drugs across the board."

    The task force submitted its report just before the election and has since followed up with Bennett and the new Minister of Health Jean-Yves Duclos. MacPherson said they have yet to hear anything back.

    Decriminalization is also on the minds of many MPs.

    Yukon MP Brendan Hanley — who was the territory's medical officer of health before running for the Liberals this year — rose in the Commons Tuesday to acknowledge that Yukon had Canada's highest rate of opioid deaths.

    "Safe supply, supervised consumption, better access to treatment, effective prevention and decriminalization are all approaches that can help prevent more deaths," he said.

    Green Party MP Mike Morrice was on his feet a day earlier, after front line workers in his riding of Waterloo responded to 42 suspected overdoses in just three days.

    "So far this year, we have lost 120 community members to a poisoned drug supply. Each one was a preventable death," he told the Commons.

    "Even the Canadian Association of Chiefs of Police [has] joined calls to decriminalize simple possession of illicit drugs. They have recommended removing mandatory criminal sanctions, replacing them with harm reduction and treatment services. When will the government move forward with decriminalization and save lives?"

    Bennett said the government is working as quickly as it can on the decriminalization requests. It's not clear if the government is prepared to grant exemptions without being specifically asked by other levels of government.

    Bennett said there are other factors to consider.

    "Decriminalization on its own, with a toxic drug supply, will not save the lives that we need (to)," she told The House.

    "And so it means that we actually have to examine the other proposals that are coming around about how we make sure that, for people using drugs, that there is a safer supply."

    https://www.cbc.ca/radio/thehouse/federal-government-drug-decriminalization-1.6281671

    ReplyDelete
  136. Government Policies Blamed as Toxic Drug Deaths Soar

    by Moira Wyton December 9, 2021 | TheTyee.ca

    Five years after B.C. declared a public health emergency, toxic drugs are killing more people than ever before.

    The BC Coroners Service reported today that 201 people died in October, the most ever recorded in a single month.

    This brought 2021’s total number of deaths to 1,782. Last year had previously been B.C.’s deadliest year on record, with 1,765 people lost to toxic drugs.

    The province’s per capita death rate is now 41.2 per 100,000 people, double what it was in 2016 when the public health emergency was declared, and nearly eight times what it was when documentation of toxic drug deaths began in 1995.

    The death, grief and pain for 201 more families and communities is yet another reminder of government apathy towards the lives of people who use drugs, advocates and experts say.

    “It’s hard to describe the feeling, because it’s shocking but it’s expected,” said Leslie McBain, co-founder of drug policy advocacy and grief support group Moms Stop the Harm. “Why would the number of deaths go down if nothing different is being done?”

    As deaths have surged the provincial government has promised to decriminalize personal possession of drugs, provide more pharmaceutical alternatives to street drugs and expand treatment and recovery options.

    It has succeeded with some small pilot projects and clinics providing prescription versions of illicit drugs, known as safe supply, to separate people from the toxic drug supply.

    But Downtown Eastside advocate and City of Vancouver drug policy advisor Karen Ward said none of these strategies will curb deaths without widespread, barrier-free safe supply.

    “The solutions aren’t more treatment. It’s housing, it’s poverty reduction, it’s actually giving people a chance and options,” Ward told The Tyee. “And without addressing supply it’s not going to change.

    “They’re so determined to not change the system that they’re going to let thousands of people die.”

    The drug supply in B.C. has become increasingly toxic, volatile and unpredictable as pandemic measures tightened the border and brought more potent and dangerous combinations of drugs.

    That has included an increased presence of benzodiazepines, a group of nervous system depressants often used to treat conditions like anxiety and insomnia. When combined with opioids, benzodiazepines are more likely to cause a fatal overdose.

    Drug user advocate Dean Wilson, who is the peer lead at the BC Centre on Substance Use, said the new combinations mean “we’re losing the people who are close to being stabilized on opioids.”

    “It’s just barbaric what’s happening.”

    And fentanyl is now contributing to 84 per cent of deaths, up from just five per cent in 2012.

    continued below

    ReplyDelete
  137. This year has also seen 152 people die due to carfentanil, a synthetic opioid more powerful than fentanyl. Two-and-a-half times as many people have died due to carfentanil so far in 2021 than in all of 2020.

    These new mixtures make it difficult for anyone, whether a frequent or casual substance user, to know how much and what exactly they are taking.

    “Those 201 people who died last month were not idiots,” said Wilson. “They didn’t want to die. It’s just uncontrollable if you don’t know what you’re taking, and the benzos make it really hard to bring people back once they’ve overdosed.”

    Ward and McBain consider the horrific rise in deaths a policy choice on the government’s part. It’s clear that providing safer supplies of substances will save the most lives, they say.

    “This is predictable, and preventable, and they chose otherwise,” Ward said.

    “It seems the government is OK with letting hundreds of people die while they work on safe supply,” added McBain.

    The vast majority of people dying are men aged 30 to 59, according to the report, with Vancouver, Victoria and Surrey recording the most deaths.

    But no community has been spared by the toxic drug supply. Vancouver Coastal Health has the highest per capita number of deaths at 47.6 per 100,000, while the Interior and Northern regions have 45 and 44.8, respectively.

    B.C.’s overall rate of 41.2 per 100,000 exceeds 2019 rates in U.S. states ravaged by toxic drugs and where harm reduction is limited or criminalized, such as Pennsylvania (35.6), Ohio (38.3) and Maryland (38.2).

    And deaths are likely accelerating among those most affected by poisoned drugs, including poor, racialized and disabled people.

    Last year, First Nations individuals were more than five times as likely as non-First Nations people to die of an overdose. For First Nations women the risk was 10 times higher than their non-First Nations counterparts.

    Ward and McBain agree that while some people may hope today’s report is a wake-up call, the provincial government won’t change course despite the soaring deaths.

    Only public attention and outrage might change political decisions not to pursue evidence-based solutions, Ward said.

    In her work advocating for change and educating families and the public about drug policy and substance use, McBain finds sadness and glimmers of hope. She lost her son, Jordan Miller, to a toxic drug overdose in 2014 when he was 25 years old.

    “We who have lost our children, our main goal is to not lose any more.”

    https://thetyee.ca/News/2021/12/09/Government-Policies-Blamed-Toxic-Drug-Deaths-Soar/

    ReplyDelete
  138. BC Government Defends Failure to Halt Rising Drug Deaths

    by Moira Wyton December 13, 2021 TheTyee.ca

    As British Columbia records more toxic drug deaths than ever, the minister responsible defended what experts and advocates have called a delayed and inadequate response to B.C.’s six-year-old public health emergency.

    “We are in two public health emergencies, compounded by decades of stigma and isolation and alienation from health care from some of the most vulnerable people in our society,” Minister of Mental Health and Addictions Sheila Malcolmson said in an interview with The Tyee Thursday.

    “We are making up lost ground.”

    The same day, the BC Coroners Service confirmed 201 people died of poisoned drugs in October, the highest number ever.

    And after 10 months, 2021 is already the second consecutive most fatal year on record with 1,782 lives lost. Last year, 1,765 people died.

    In the nearly six years since toxic drug deaths were declared a public health emergency, the rate of deaths has doubled to 41.2 per 100,000. More than 8,500 British Columbians have died in that time. Toxic drugs are the leading cause of unnatural deaths in B.C., more than car accidents, homicide and suicide combined.

    Chief Coroner Lisa Lapointe said the slow response to the toxic drug crisis will be a “stain on our province for decades to come.”

    “Simply put, we are failing,” Lapointe said Thursday. “This crisis is not going to turn itself around, this crisis needs some true intervention on a meaningful provincial scale.”

    BC Green Party Leader Sonia Furstenau again called for an emergency all-party legislative committee to expedite legislation “to end the brutal loss of life.”

    “That would take politics out of the process, and we can be bold,” said Furstenau in an interview, noting a similar committee facilitated a rapid government response to COVID-19.

    The BC Liberals also renewed their calls for more addiction treatment beds and for a similar all-party committee to take immediate action to stop deaths.

    “We need action, concerted and focused action, that attacks the problem — not empty words,” said MLA Trevor Halford, Opposition critic for mental health and addictions in a Thursday news release.

    Malcolmson acknowledged there is much more work to be done. But she did not indicate her ministry would be changing course despite the evidence its current strategy has failed to curb deaths.

    Without any budget to administer its own programs, Malcolmson’s ministry has also been criticized as a way to deflect criticism from the Health Ministry, which is ultimately responsible for administering overdose prevention programs through health authorities.

    continued below

    ReplyDelete
  139. Asked whether the current number of deaths represented a failure in her mandate or warranted her resignation, Malcolmson did not directly answer the question and ended the interview.

    “The fact that the drug toxicity increases are outpacing the ability of our health-care system to implement solutions and set up resources within health care is tragic, and something that just further reinforces our determination to do more,” she said before hanging up.

    Furstenau said Malcolmson needs to be transparent about how she is measuring success in her ministry’s response, and what accountability will look like if she does not achieve it.

    If its main metric is the number of toxic drug deaths decreasing, then “no, the ministry has not achieved its goal,” she said.

    Lapointe said new and potent combinations of criminalized substances like fentanyl, carfentanil and benzodiazepines continue to escalate the crisis and increase deaths.

    Lapointe has called for rapid access to safe, regulated supplies of criminalized substances, known as safe supply, to prevent deaths by separating people from the increasingly toxic drug supply.

    “We have not seen a rollout of safe supply on a scale commensurate with the risk to health and safety in our province,” said Lapointe, noting that co-op models, compassion clubs and other solutions need government support to reach as many people as possible.

    “There is intent, there is good will, there are plans. To my mind, they’re not urgent enough.”

    Malcolmson pointed to the province’s expansion of prescribed safe supply, which it began in March 2020 in response to the pandemic and said it would expand again in September 2020.

    But that promised expansion in the program did not come until 10 months later in July. In that time, at least 1,694 more people died of toxic drugs.

    Drug user advocates and experts said the new measures were too small and too slow.

    Malcolmson said the benefits of the expanded program would be seen in the “weeks and months” ahead.

    Furstenau said blaming delays on “lost ground” before the government’s time in power would be acceptable “maybe in year one, but not in year five.”

    Lapointe, whose agency’s mandate is to investigate the cause of death and make recommendations for death prevention, declined to place blame on any individual or organization.

    But she said without widespread access to low-barrier safe supply, other government efforts to decriminalize personal possession of substances and expand treatment and recovery options for people with substance use disorder will not end this crisis.

    “As long as people are dependent on the for-profit, unregulated illicit drug market, their lives are in jeopardy,” said Lapointe.

    https://thetyee.ca/News/2021/12/13/BC-Government-Defends-Failure-Halt-Rising-Drug-Deaths/

    ReplyDelete
  140. How two doctors are changing the rules in the fight against opioid addiction

    by Nick Purdon & Leonardo Palleja, CBC News January 09, 2022

    It's a weekday morning and Dr. Louisa Marion-Bellemare, 44, drives her minivan through the snowy streets of Timmins, Ont., to pick-up one of her patients.

    With an opiate-overdose crisis gripping her hometown, this is the sort of thing she says you have to do.

    "We'll do home visits and see patients and treat them for their substance-use disorder. It's not uncommon for us to do that. We meet patients where they're at."

    Marion-Bellemare is in the fight of her life, and along with another doctor, has launched a unique program to address the tragic effects of opioids in Timmins.

    Over the past few years, the death rate from opiate overdoses here has been among the highest in the country. In 2019 the rate in Timmins was 46.8 deaths for every 100,000 people – four times the Ontario average and twice as high as Vancouver, which is generally considered ground-zero for the opioid crisis.

    In 2020 the death rate rose even higher to 72 deaths per 100,000.

    "Our city of 42,000 people having had death rates higher than Vancouver, higher than Toronto, it didn't make sense," Marion-Bellemare said. "That's when I said wow, we have to change something here in our community. This is not right."

    A major change in tactics in the fight against opioid addiction is what Dr. Marion-Bellemare, along with her colleague Dr. Julie Samson, have brought to the northern Ontario mining town.

    Casper Sutherland, 48, kicks the snow off his shoes and climbs inside Dr. Marion-Bellemare's vehicle. An opiate user for 10 years, Sutherland has been in recovery for six months.

    "How's your day," he asks the doctor as they small-talk for a few blocks.

    Sutherland is back living with his children and looking for work. It's still early in his recovery, but in a town in the middle of a crisis he is a glimmer of hope.

    "I feel great. Like, I wake up with the smile," he said. "It's been a long, long time. I forgot how it feels to be normal."

    Sutherland accompanies Marion-Bellemare inside the hospital for a check-in, but before Timmins revamped its approach to addiction the town's hospital wasn't a welcoming place for people like him.

    "Before, I would come here and the doctors and nurses would just think I'm seeking pills and just totally ignore me," Sutherland said.

    "Sometimes I would OD and I would come here. They would bring me here in an ambulance, and I would wake up here and I'd know how I'm getting treated right away, and so I'd just leave."

    Chris Loreto, a long-time emergency room doctor at the Timmins hospital, admits that was true.

    "We didn't have a formalized way of treating people with substance abuse. We termed them 'addicts,' and we just sort of said there were no resources available for their treatment," Loreto said.

    "So we just sort of babysat them, gave them something for their anxieties, and then sent them on their way."

    A year ago there wasn't a single detox bed in the Timmins hospital, even though use of the highly addictive drug fentanyl was rampant in the city.

    And even when Dr. Marion-Bellemare persuaded the hospital to open two detox beds (she has since asked the provincial government for funding for 14 additional beds but hasn't heard back), some emergency room doctors weren't convinced that treating people with addictions was even their job.

    "I've got to be honest, I was not a big fan of this program," admitted Dr. Loreto. "I didn't think we had the resources. I didn't think we had the time … I didn't think this population deserved it.

    "I blamed the patient. I thought they were in that situation because of their own life choices — you know, if they want to stop they can stop."

    Dr. Marion-Bellemare and Dr. Loreto have had many ...

    ReplyDelete
  141. ... disagreements over the past year about how to care for people with addictions, and Loreto says he now sees things in a new way.

    "You realize why I do this job to take care of people – because people matter," he said.

    "You can't triage who we show compassion to and who you don't. And I think the fact that the team is able to convince an old-school guy like myself and some of my colleagues, I think it is a big step in the right direction."

    Making the hospital a place where people with addictions feel welcome was the first step, the other big change has been the treatment itself.

    Brian Tomagatick lies on a hospital bed and holds a freezer pack against his belly. Tomagatick, a long-time opioid user, is getting his "shot" – his eighth.

    The Timmins approach is to give a monthly injection of a drug called Sublocade, which delivers an extended release of buprenorphine. Once injected, the drug forms a small lump under the skin near the abdomen and lasts for a period of 30 days.

    Each injection costs between $550 and $650. The goal of the treatment is to control the intense cravings that opioid users experience, and allow them to stop chasing their next high.

    Dr. Julie Samson preps the syringe and asks if he's been experiencing any cravings. Tomagatick shakes his head.

    "All right. Is it nice and frozen?" asks Dr. Samson.

    Tomagatick nods.

    It took courage, but Dr. Samson and the Timmins team decided to start a treatment method that nobody else in the country was doing.

    "When I'm giving the injection I'm so happy for them, because they're doing so well and they haven't died," Dr. Samson said.

    The regular protocol is to give a patient daily doses of buprenorphine, and only after a week start them on the injectable. But Dr. Samson says patients would almost never wait the week, and instead would leave the hospital and drop out of the program.

    "We had five overdose deaths in seven days. We had to stop it," Samson remembered. "The nurses even asked us, why don't we change the protocols – and our clients too asked why we didn't go faster."

    So what the doctors in Timmins did was to give the extended-release Sublocade shot almost immediately – within 24 to 48 hours of when a patient arrives in care.

    "We don't have time to wait for data for randomized controlled trials," said Dr. Samson. "People are dying. We had to change what we were doing, because what we were doing initially and following the protocols wasn't working."

    continued below

    ReplyDelete
  142. Since it started a year ago, 130 patients have come through the Timmins program. The doctors are currently looking at their data to determine just how successful the program has been.

    "It seems to be pretty good," Dr. Samson said. "Anecdotally, I would say probably over 70 per cent of retention to our program."

    Dr. Samson readies the needle, smiles at Brian Tomagatick and pushes it gently under the skin near his abdomen.

    "It stings a little bit. Almost done. There we go," she said.

    Tomagatick has been off opiates for nine months. He says when other people struggling with addiction see how well he's doing, they want in.

    "They come over and we talk. 'How do you get on the program? I want to be clean like you. How do you make it look so easy?' I'm like, 'I got someone in the hospital who I can call,'" Tomagatick said.

    "I usually pay their cab to the hospital or I bring them myself just to make sure they go," he added.

    When asked why he would drive people or pay their cab fare to the hospital, Tomagatick's tone gets more serious.

    "I have had a lot of friends die from the stuff. A lot of friends," he said. "Like, at least 20 friends around town within a short period of time."

    Dr. Marion-Bellemare says the changes they have made inside the hospital in Timmins in the past year aren't enough, and more needs to be done out on the street.

    "There are still a substantial group of people out there who want to quit using drugs, but actually can't and don't know how," Marion-Bellemare said.

    This is why even in winter, doctors Marion-Bellemare and Samson walk the streets and alleyways of the city's downtown with local outreach workers to encourage people to join the treatment program. The doctors spend a few hours trudging through the snow, introducing themselves to everyone they meet.

    "We need to be going to find them because the next day, if we don't find them and they want help, they could be dead," said Marion-Bellemare.

    Two emergency doctors doing addiction outreach is surprising enough – but there's another big change on the streets of downtown Timmins.

    continued below

    ReplyDelete
  143. Even though street opiates are illegal, the local police have started to do outreach as well.

    Constable Leah Blanchette, a 20-year veteran, is the Outreach Community Safety Team officer on the force. For the past year she's regularly been out walking in downtown Timmins with her trademark box of muffins.

    "When I started, people would run away from me. They would say to me, 'Well, we can't be seen with you, because you're a rat or you're in trouble if you're seen with the police,'" Blanchette said.

    "That's why I started baking the muffins. And this way they would come to me and talk to me, and I would be able to offer my services while I was handing them the muffin."

    It's tempting to see what Constable Blanchette is doing as a gimmick, but outside the downtown library as she hands out her muffins, a man named Norman asks for help with his drug use.

    "OK. And do you think that you can go into a rehab centre or a detox centre and go without for a few days? Can you manage that?" Constable Blanchette asked the man.

    He nods and takes the officer's business card.

    "I'm proud of you for coming in and asking for help," she told him. "If there's anything more, give me a shout."

    Someone admitting they have a drug problem to a police officer and asking for help is something remarkable that Timmins has accomplished. Constable Blanchette has referred more than 100 people to the hospital treatment program in the past six months.

    Of course, those numbers are also further proof that Timmins remains a town in trouble. And doctors Marion-Bellemare and Samson see the effects of drug addiction every day.

    On the street in front of the downtown shelter, accompanied by a crew from CBC's The National, they recently ran into Joey Perreault – a former patient in the program. Perreault came to the hospital in January of 2021 when Marion-Bellemare was working after he'd overdosed. He was given Narcan – an emergency medicine that helps people survive overdoses.

    At that time Perreault was admitted to one of the hospital's acute withdrawal management beds, but he declined the Sublocade treatment and soon afterwards he left the hospital.

    On the street, Marion-Bellemare reminds Perreault that their doors are always open.

    "Joey, any time you want help, you go to the hospital and you ask for help, right?" she said. "You can go to the Emerg 24 hours a day and all you have to say is, 'I'm here to get help for my addiction.' And they will set you up."

    "Sounds good," replied Perreault.

    The doctors never saw Perreault again. A few weeks later, he died of an overdose.

    Solving the addiction crisis is one of the toughest challenges for any town, but Marion-Bellemare and Samson aren't giving up. The calls they've had from other doctors and addiction programs across the country about what they've done in Timmins is recognition they say helps them keep going in the fight to help their hometown.

    "I never would have thought in a million years that people would look at Timmins and say, 'Wow, that community is really trying their best to make a difference for people who are dying from opiates,'" said Marion-Bellemare.

    "I think, to be honest, in our community everybody wanted something to change, but they needed a driving force to get it going. And I think we were the engine to do it."

    https://www.cbc.ca/news/health/opioids-timmins-treatment-program-outreach-1.6279543

    ReplyDelete
  144. BC Is in a ‘Worse Place than Ever’ for Toxic Drug Deaths

    Moira Wyton | TheTyee.ca February 9, 2022

    British Columbia must do whatever it takes to expand safe supply programs to prevent toxic drug deaths, B.C.’s Chief Coroner Lisa Lapointe said today, as her office confirmed that 2,224 people died in 2021.

    Lapointe said the province’s efforts to provide prescribed safe supply to keep people from depending on the toxic drug supply are inadequate when seven lives are lost in B.C. each day. Nearly 10,000 people have died in the last decade.

    “2021 was the sixth year of the public health emergency, and it is with tremendous sadness that I report our province is in a worse place than it has ever been in regards to this crisis,” she said today.

    The illicit supply is completely profit-driven, Lapointe said, and is increasingly contaminated with fentanyl, carfentanil and benzodiazepines, which were found in half of people who died in December.

    Benzodiazepines make it more difficult to reverse an overdose because they don’t respond to naloxone like opioids.

    Meanwhile, there are few spaces where people can be supervised while they inhale their drugs, as did more than half of people who died in 2021, and no meaningful access to a regulated supply.

    “We don’t have time to be cautious,” said Lapointe in an interview. “We don’t have to wonder what will happen when we do nothing, we know. We are losing 200 people a month.”

    There are currently four federally funded pilot programs for safe supply in the Lower Mainland and Victoria, each serving a few hundred patients at most. A small number of individual doctors are prescribing it.

    The efforts reach a tiny portion of people who could benefit from a regulated supply of drugs.

    In the last two years, 12,000 people have been prescribed safe supply in total, according to the Ministry of Mental Health and Addictions. It is conservatively estimated by the BC Centre for Disease Control that there are at least 90,000 regular opioid users in the province, and many more who use methamphetamine and benzodiazepines.

    The programs’ failure is partially due to pressure from the College of Physicians and Surgeons, Lapointe said, which takes a very cautious approach to its members prescribing substances that are usually criminalized.

    She said more needs to be done to explore safe supply based on non-medical, compassion club models, and to scale up the projects that have proven effective in B.C. already.

    continued below

    ReplyDelete
  145. The Drug User Liberation Front advocacy group has applied for federal approval to run a compassion club for cocaine, heroin and other substances, which it has also distributed this year at a number of demonstrations.

    “What we’ve tried hasn’t worked, so let’s be brave and bold enough to try something different,” Lapointe said.

    Mental Health and Addictions Minister Sheila Malcolmson said today the deaths were “tragic” and “unacceptable.”

    She touted B.C.’s application to the federal government to decriminalize personal possession of some drugs, expansion of safe supply and prescribed medication-assisted treatment options and spending on treatment and recovery spaces.

    Malcolmson defended her government’s response to the crisis.

    “The loss of life tells us that we need to do more,” she said in a media availability, acknowledging that the college’s actions have had a “chilling effect” on doctors prescribing safe supply.

    But what more, if anything, the province will do remains unclear.

    Asked by a reporter why B.C. had not seen an emergency response commensurate with the loss of life, Malcolmson defended the province’s slow expansion of prescribed safe supply and said it was building a system of care at the same time as it tried to respond to the crisis.

    “We are making up lost ground,” she said, echoing her response to the question in a December Tyee interview.

    DULF, the BC Association of People on Methadone and the Vancouver Area Network of Drug Users all called on Malcolmson and Health Minister Adrian Dix to resign in a news release today.

    Lapointe, whose role it is to make recommendations to prevent future deaths, not place blame, said she shares the frustration with how slowly governments have responded for the last six years of the public health emergency.

    “For me, it’s very personal. This is about human beings who are dying every day.”

    https://thetyee.ca/News/2022/02/09/BC-Worse-Place-Ever-Toxic-Drug-Deaths/

    ReplyDelete
  146. Over 2,200 people died in B.C. in 2021 due to illicit-drug overdoses, coroner reports

    Bridgette Watson · CBC News · Feb 09, 2022

    "I am so sorry for your loss."

    The voice of British Columbia's Chief Coroner Lisa LaPointe was filled with emotion Wednesday morning as she expressed her condolences to the loved ones of the 2,224 people who died due to suspected illicit-drug overdoses in the province last year.

    It is the deadliest year ever recorded, representing a 26 per cent increase over 2020's death toll of 1,765.

    The latest numbers, released today by the B.C. Coroners Service, show that last year, about six people were dying daily — and those numbers spiked in the last two months of the year.

    In November and December, there were 210 and 215 suspected illicit-drug toxicity deaths, respectively, according to the coroner — two of the largest monthly numbers ever recorded, and equal to about seven deaths per day.

    "The suffering that is happening in our province is sometimes unbearable," said LaPointe, who called on policy makers to do more.

    Advocates, academics, health experts and LaPointe herself have called for a safe supply of drugs to reduce deaths. LaPointe warned drug users Wednesday the supply on the streets has never before been this toxic.

    Fentanyl was detected in 83 per cent of deaths in 2021. Carfentanil, a stronger analogue of fentanyl, was found in 187 deaths.

    LaPointe also flagged the increasing presence of benzodiazepines, which are typically prescribed as a sedative. They are particularly dangerous when paired with an opioid like fentanyl because the sedation increases the risk of an overdose, according to Health Canada.

    B.C. has applied to the federal government to decriminalize the possession of small amounts of illicit drugs for personal use, in an effort to reduce and prevent future drug poisoning deaths.

    LaPointe called for the federal government to grant that exemption now. She also called for greater access to treatment and recovery.

    "People are dying on waiting lists," she said.

    In 2021, 71 per cent of those dying were aged 30 to 59, and the vast majority were male.

    Nel Wieman, deputy chief medical officer with the First Nations Health Authority, said Indigenous people are suffering disproportionately in the overdose crisis.

    According to Weiman, Indigenous people are dying from illicit drug overdoses at five times the rate of non-Indigenous people in British Columbia.

    continued below

    ReplyDelete
  147. Perry Kendall, B.C.'s former provincial health officer, declared a public health emergency on April 14, 2016, due to a rising number of drug deaths.

    Before the declaration, Kendall said, British Columbians outside of Vancouver didn't have much access to supervised consumption sites and other services to manage addictions.

    Still, Kendall said, the province has a long way to go when it comes to fighting its overdose crisis. Tackling the supply chain is an essential element, he says.

    Guy Felicella, a peer clinical advisor with Vancouver Coastal Health, says decades of failed policy at all levels of government is largely to blame for the death toll.

    "Where is the apology?" he asked aloud at Wednesday's press conference. "Their failure is represented by more than 2,200 deaths last year."

    In response to the coroner's report, the B.C. government released a joint statement from Provincial Health Officer Dr. Bonnie Henry and Minister of Mental Health and Addictions Sheila Malcolmson.

    "We know one of the most important ways to keep people alive in this crisis is to ensure a safer supply to replace toxic illicit drugs and the expansion of this life-saving program is now underway across our province," said the statement.

    Malcolmson spoke publicly Wednesday afternoon, saying the latest report represents an unspeakable, and unacceptable loss.

    She said the province has made "historic" investments and systemic changes to help, including authorizing nurses to prescribe safe alternatives to toxic street drugs and financing hundreds of treatment beds.

    Malcolmson also noted the increase in safe consumption sites under the current NDP government, growing from one in 2016 to 39 now — 13 of which also have safe inhalation sites.

    The minister also acknowledged it hasn't been enough.

    "We are swimming against a rising tide of need," said Malcolmson.

    Like LaPointe, she also spoke directly to drug users, reminding them not to use alone. The Lifeguard App, she said, is one tool people can use to keep themselves safer.

    The free app serves as a digital check-in, requiring drug users to respond at certain time intervals in order to show they are OK. If 75 seconds pass with no user response, the app uses a text-to-voice call to alert 911 dispatchers to a potential overdose.

    "Using alone often means dying alone," warned Malcolmson.

    B.C. Green Party Leader Sonia Furstenau said the B.C. NDP government is not doing enough.

    "We urgently need low-barrier safe supply that does not require a diagnosis, daily lineups, or finding a sympathetic doctor," she said in a statement.

    B.C. politicians returned to the legislature yesterday. In her statement, Furstenau called for the urgent convening of an all-party committee to create immediate, stabilizing solutions to the toxic drug crisis.

    https://www.cbc.ca/news/canada/british-columbia/bc-toxic-drugs-deaths-december2021-1.6344991

    ReplyDelete
  148. These 5 myths about B.C.'s toxic drug crisis are hurting efforts to stop the deaths, say experts

    Bethany Lindsay · CBC News · Feb 11, 2022

    In the five years and 10 months since B.C. declared a public health emergency because of drug-related deaths, the problem has only gotten worse.

    Statistics released by the B.C. Coroners Service this week confirmed that 2,224 lives were lost in 2021, making it the deadliest year on record.

    Advocates argue part of the problem is that many people with the power to make a difference are relying on outdated or incorrect ideas.

    "People don't want to actually confront some serious realities here, and so these comforting lies are embraced in many ways. It's horrible because it prevents all of us from actually addressing this in a real way," said Karen Ward, a drug policy consultant with the City of Vancouver.

    To get a better handle on some of the misconceptions, CBC spoke to experts who are experiencing the crisis from three different viewpoints: Leslie McBain, co-founder of Moms Stop the Harm, chief coroner Lisa LaPointe, and Ward.

    Here are five of the most common myths they've encountered.
    It's an 'opioid' or 'overdose' crisis

    These shorthands for the emergency have only become less accurate as the years wear on.

    "People are actually trying to find opioids," Ward said. "The problem is that they're getting basically unknown substances."

    If people don't know what they're taking, the word "overdose" — which implies someone has simply taken too much — hardly captures what's happening.

    LaPointe adds that unlike in other parts of North America, B.C.'s crisis has never been about over-prescription of painkillers like oxycodone, and attempts to address the problem by limiting doctors' ability to prescribe opioids have been misguided at best.

    The latest statistics from the coroner show a mishmash of drugs linked to deaths in B.C., with fentanyl and analogues like carfentanil detected in 91 per cent of fatal doses in December, and stimulants like methamphetamine and cocaine in 73 per cent

    Perhaps most alarmingly, benzodiazepines were found in half of the samples, up from just 15 per cent in July 2020.

    There could be some serious consequences as a result. For one thing, benzodiazepines are highly addictive, LaPointe notes.

    "Withdrawing from opioids is difficult but it's nothing compared to withdrawing from benzodiazepines," she said.

    There's also the fact that naloxone, one of the key planks in B.C.'s harm reduction strategy, will not reverse overdose from non-opioid drugs like benzodiazepines.

    "Naloxone doesn't touch benzodiazepines," McBain explained.
    B.C. has a safe supply of drugs

    As it's been nearly two years since B.C. announced plans to provide a safe supply of drugs during the COVID-19 pandemic through access to prescription alternatives, shouldn't safe supply be widely available by now?

    "I dearly wish that was true," LaPointe said.

    She says she checks in regularly with health authorities to see how many people are able to access safe supply.

    "The answer is always hardly anybody."

    continued below

    ReplyDelete
  149. There are just a handful federally funded safe supply programs in B.C., all located in Vancouver and Victoria.

    "How do you actually access them? Nobody really knows," Ward said. "If you have the social power to have your own doctor … you might be able to do something."

    McBain also takes issue with the drugs offered through the programs she's seen.

    "If you're a person who, let's just say, is addicted to fentanyl, the government isn't willing to give you fentanyl. They say, 'Well, we're just going to give you some hydromorphone,'" she said.

    "That doesn't work for people."
    Only 'addicts' are dying

    According to LaPointe, the B.C. Coroners Service convened a death review panel in December to discuss the drug poisoning crisis, and the data they reviewed show that people with severe drug dependencies do not represent the majority of deaths.

    "You can be a first-time user, you can be a weekend user, you can be every few days, you can be a daily user," she said. "The supply is the unknown."

    Ward says the increasingly toxic drug supply is making her feel more and more worried about the dangers of what she describes as "the normals" — people who might dabble in drugs for fun at a party, for example.

    "If you're a regular user of an opiate, you've actually got the tolerance," she said. "But … the vast majority of people who use drugs just do it a once in a while."
    People die from injected drugs

    The image of someone dying with a needle stuck in their arm just doesn't match up with B.C.'s reality. According to the latest report from the coroner, only 19 per cent of toxic drug deaths in 2020 could be traced to consumption through injection.

    By far the most common path to a drug-related death in 2020 was through smoking, at 56 per cent.

    "There is another myth that smoking is safer, but it is not," LaPointe said.

    This is significant in part because of the role that supervised consumption sites and overdose prevention sites play in saving lives. According to the coroner, no one died of illicit drug poisoning at these sites in 2021, but they are still largely geared toward injection drug users.

    "If we want to keep people safe, then consumption sites only for intravenous use or needle users are not going to be effective," LaPointe said.

    She acknowledged concerns about protecting staff from drug fumes, but said overdose prevention sites are now beginning to accommodate more smokers.
    It's a Downtown Eastside problem

    LaPointe describes this as one of the most frustrating myths she encounters.

    "The drugs are toxic, so it doesn't matter where you live in the province or your socioeconomic status or your job. If you take a drug that is toxic, you will die," she said.

    Even so, services for drug users in B.C. are largely concentrated in the downtown Vancouver core and other urban areas.

    It's true that the largest number of toxic drug deaths happen in Vancouver, but every corner of the province is seeing people die from drug poisoning: the Thompson Cariboo, Northwest, Northern Interior and Fraser East regions saw some of the highest death rates in 2021.

    "It is in every community in B.C.," McBain said.

    "It is in rural communities, it's in small towns, it's in bigger towns, it's urban, and it just so happens that the people in the Downtown Eastside are more visible."

    https://www.cbc.ca/news/canada/british-columbia/5-myths-toxic-drugs-1.6347454

    ReplyDelete
  150. The War on Drugs Is a Century Old. These Vancouver Activists Are Pushing to End It

    Jen St. Denis | TheTyee.ca Feb 10 2022

    It’s a rainy October morning in Vancouver’s Gastown neighbourhood. It’s early and the streets are empty, except for a small group of unhoused people huddled under the awning of a closed shop, their belongings stacked around them.

    Gastown, filled with upscale restaurants and fashion boutiques, lies beside the city’s poorest neighbourhood, the Downtown Eastside. Scenes like this prompt complaints that the Downtown Eastside is “spilling over” into Gastown, and questions about whether the neighbourhood will ever “get better.”

    Just a few floors above the group under the awning, Eris Nyx, a 30-year-old musician and harm reduction worker at the SRO Collaborative, is trying to order heroin on the dark web while her cat, Mewsolini, prowls around her tiny studio apartment.

    It’s not easy. “One guy retired from his market, so he shut it down — it was one of the biggest and best ones on the dark web,” Nyx says. Another large, reliable market called Canada HQ also recently shut down after being targeted by multiple denial of service attacks.

    Today Nyx has her eye on two other markets. Buying drugs this way is tedious — like ordering from a buggy, slow version of Amazon that keeps crashing — but Nyx says it’s the only place to find drugs that are what the seller says they are.

    Nyx and Jeremy Kalicum, a 26-year-old drug-checking technician at Substance, a drug-checking project on Vancouver Island, have been buying heroin, cocaine and methamphetamines this way since 2020.

    In spring of that year, the two formed an organization called the Drug User Liberation Front, or DULF, to push for changes to the way people in Canada think about and use drugs.

    The group isn’t just advocating for change. They’re breaking Canadian laws to show how drug use could be safer if people had legal access to tested, untainted drugs — and they’re working to create a compassion club model for users of heroin, cocaine and methamphetamine.

    “We still aren’t sanctioned, and I’m constantly afraid of arrests,” Nyx says. “Nothing about what we’re doing is legal.”

    British Columbia first declared a public health emergency because of a rise in opioid deaths on April 14, 2016. This emergency has never been lifted.

    The grab-bag of statistics related to the crisis offers nothing but grief and heartbreak.

    B.C. has the highest rate of drug toxicity deaths in Canada, at 40 deaths per 100,000 people — a higher rate than Ohio or Pennsylvania. Across Canada, overdoses have killed 21,000 people since 2016. Currently, around seven people die every day of drug toxicity in B.C., up from six last year, and drug toxicity deaths are now the number one killer of people aged 18 to 39.

    After three years of expanding harm reduction services like overdose prevention sites and access to naloxone, a drug that can reverse opioid overdoses, the number of deaths in B.C. finally started to drop in 2019.

    But all that progress was erased when the COVID-19 pandemic hit Canada in early 2020. With borders closed and the movement of goods backlogged, the illicit drug supply has become more dangerous with every passing month.

    Since 2016, the rising number of overdoses has been driven by fentanyl, a powerful synthetic opioid that has largely replaced heroin in the illicit opioid supply, and benzodiazepines, which increase the risk of fatal overdose when combined with fentanyl.

    Stimulants like cocaine and methamphetamines have also increasingly been contaminated with fentanyl.

    This has led to a situation where more people have died of drug toxicity than COVID-19 during the pandemic in B.C. — 3,389 in total between March 2020 and October 2021, compared to 2,656 deaths from COVID-19. Drugs sold on the street today are so dangerous that users risk death every time they consume them.

    continued below

    ReplyDelete
  151. While many people in B.C. first learned of the increased risk of overdoses after Patricia Daly, the chief medical health officer for Vancouver Coastal Health, briefed Vancouver council in April 2020, Nyx and Kalicum were seeing the worsening situation play out on the streets of the Downtown Eastside — and they decided to take action.

    The idea was to find a dealer who had heroin and to test it to make sure it wasn’t contaminated. But that attempt didn’t go very well: a friend of Nyx and Kalicum’s bought heroin, but when Kalicum tested it, he found it had fentanyl in it. When the friend tried to get his money back, he was attacked with bear mace.

    Nyx and Kalicum were able to purchase cocaine from a local dealer, which they tested and found to be uncontaminated with other drugs like fentanyl, carfentanil and benzodiazepines. On June 23, 2020, they held their first event in the Downtown Eastside, handing out 280 doses of cocaine.

    The event went relatively smoothly — the biggest problem, Nyx quipped, was letting attendees have access to the open mic. No one overdosed. And Nyx and Kalicum didn’t get arrested.

    The ‘birthplace of prohibition’ — and activist intervention

    In December 1988, a donor offered to buy several hundred new needles for a Downtown Eastside group led by a former drug user named John Turvey. Turvey put the clean needles in a backpack and started handing them out as he walked around the streets and alleyways.

    The point of the program, Turvey explained to the New York Times, was not to decrease drug use, but to save lives in an era when HIV, then a death sentence, was swiftly spreading.

    The “war on drugs” — an approach that emphasizes the creation and enforcement of laws against making, selling and consuming certain substances — is often viewed as a largely American endeavour. But Canada has its own deep history of drug prohibition.

    The Canadian Drug Policy Coalition calls Vancouver “the birthplace of prohibition,” because the federal government introduced a law to prohibit opium in response to a racist riot that targeted Chinatown in 1907. In 1911, cocaine and morphine were also restricted for non-medical use, and penalties for drug trafficking were increased.

    In the decades that followed, using drugs was seen as a moral failure — a “vice” — and abstinence the only way out of the grip of addiction.

    Though North America’s short-lived prohibition against alcohol in the early 20th century was short-lived, the prohibition against drugs has lasted for decades. And pretty much every effort to make using drugs less dangerous under prohibition has required drug users, advocates or health-care workers to break the law.

    In San Francisco in the late 1980s, harm reduction activists were arrested after using baby carriages to hide clean needles. Turvey was also very much breaking the law when he first started handing out clean needles in the Downtown Eastside.

    Though this has now changed in Canada and some American states, in the 1980s and 1990s it was common for legal needle exchanges to limit the numbers of needles they would hand out, or to require drug users to exchange a used needle for a clean needle.

    In fact, a needle exchange run by Turvey in 1995 was criticized for its role in an HIV outbreak because the exchange limited the number of needles it would distribute, according to media reports from the time.

    Two unsanctioned safe injection sites operated intermittently in the Downtown Eastside in the mid-’90s and early 2000s before Insite, North America’s first legal safe injection site, opened in 2003.

    The second such site, the Dr. Peter Centre in Vancouver, got the OK to open in early 2016.

    continued below

    ReplyDelete
  152. But it wasn’t until overdose deaths started rising sharply in 2015 and 2016, and Vancouver activists broke the law again to set up unsanctioned overdose prevention sites, that government rules were changed to allow the sites across B.C. and other parts of Canada.

    Compared to Insite, which is staffed by nurses, overdose prevention and safe consumption sites are a lower-barrier model where trained volunteers and employees provide first aid if someone overdoses. Today, over 30 such sites are now in place across Canada, although some still face pushback from residents and politicians.

    The same spirit of law-breaking for the greater good can be found in the story of cannabis in Canada. Before it was legalized in Canada in 2018, people who used the drug for health conditions purchased it illegally from compassion clubs.

    “The whole ethos of the compassion club in the old day was, this was a civil disobedience,” says Donald MacPherson, executive director of the Canadian Drug Policy Coalition. “It was bringing medicine to patients.”

    Kalicum and Nyx see themselves as part of this bold and desperate tradition. Though it’s estimated that deaths in B.C. would be twice as high if overdose prevention sites and other harm reduction services were not available, accidental deaths due to drug toxicity are still on the rise.

    Like the drug user activists before them, they say they have no choice but to break the law in order to save lives.

    ‘The summer I turned 21, I responded to over 100 overdoses’

    Nyx and Kalicum, who met in 2019 while organizing a conference on safe supply, both struggled growing up — Nyx in Ontario, and Kalicum in B.C.

    When Kalicum started getting into trouble as a young teen living in Nanaimo, a community group stepped in and offered to send him to a boarding school for disadvantaged kids near Chicago, an experience that set him on the path he’s on today.

    By age 20, he was at university studying chemistry in Nanaimo. One day, he saw a television news story about how many people were dying of overdoses.

    “I was like, ‘That’s crazy, that’s so bad — I can’t believe no one’s doing anything about it,’” he says.

    Kalicum met with a city councillor who also wanted to do something about the problem, and he got involved helping to support an overdose prevention site that operated from a parking lot at Nanaimo’s city hall.

    Later he worked for PHS Community Services Society in the Downtown Eastside. The organization runs supportive housing and overdose prevention sites in Vancouver and Victoria and made history when it opened Insite.

    Kalicum described his experience working for PHS to Vancouver city councillors last fall as they prepared to vote on a motion to support DULF’s compassion club model for heroin, cocaine and methamphetamines.

    “The summer I turned 21, I personally responded to over 100 overdoses and encountered multiple dead corpses of people who were found too late to be saved,” Kalicum told the council. “People from all walks of life, all ages are exposed to the risk of this unregulated market.

    “Perhaps the most memorable of these interactions were multiple instances of parents asking me to test the drugs which maybe had killed their child. Usually, what their child thought was MDMA was N-ethylpentylone, which typically results in death when taken as an MDMA-sized dose.”

    N-ethylpentylone is a drug that is similar to MDMA, also known as ecstasy, but is three times stronger than MDMA.

    Like Kalicum, Nyx’s teen years were turbulent — and led her to work in harm reduction.

    “There was nothing to do where I lived,” Nyx says, “so we’d smoke weed and break shit and be fucking morons and play loud music and go see punk music and do drugs.”

    Growing up in a Toronto suburb, Nyx did drugs, got in trouble with the police and couch surfed at friends’ places.

    continued below

    ReplyDelete
  153. She’s transgender, which her family didn’t accept. In her last year of high school, she buckled down to make the grades and get into university and ended up studying at the University of British Columbia. It was an escape route, Nyx says.

    After graduating, she worked at shelters and supportive housing run by RainCity, a Vancouver-based organization. For a few months, she worked at the BC Centre for Disease Control, but she says her “radical” style wasn’t a great fit for the government agency: “They fired me.”

    Nyx plays in more than one punk band and keeps an array of sunglasses and bowties by her front door. For a drug handout in April, she dressed as a cartoon revolutionary, complete with a black beret and owlish dark sunglasses. For a protest in front of city hall in July, she donned a Willy Wonka costume and handed out heroin and cocaine alongside Coun. Jean Swanson.

    “Someone’s got to go insane,” Nyx explained. “If everyone kept the same way of thinking, do you think anyone would dress up like Willy Wonka and mail the police giant golden tickets and hand out heroin in front of the police station? That’s not a sanity move.”

    Nyx has always used drugs — to have fun, to escape, to stay up, to fall asleep. To be able to work 16-hour days to write grants and run naloxone training sessions and organize meetings with politicians.

    But no matter how hard she works, the people around her keep dying. Drugs can help her fall asleep, but they can’t stop the nightmares.

    “I feel like everyone else is dancing around,” she said, “while I’m like… there are corpses everywhere.”

    ‘Please help me, I’m going to die’

    Drug users in Vancouver have run their own informal compassion clubs in the past, but the idea to start a more organized program emerged after Nyx and Kalicum read a paper published by the BC Centre on Substance Use in 2019.

    They assumed someone — the centre, or maybe PHS — would use the detailed model outlined in the paper to set up a program that would give drug users some sort of certainty about the drugs they were taking. But that didn’t happen.

    So they decided to do it themselves.

    After their first drug handout in June 2020, which involved drugs obtained via the local illicit market, Nyx and Kalicum tried out the dark web. It worked: the drugs, shipped to a post office box in Vancouver, tested as pure forms of what the sellers said they were.

    At three more events throughout 2021, they handed out cocaine, heroin and meth to people who were over 18 and already using drugs.

    After running the events successfully and safely, Nyx and Kalicum realized the model could be scaled up. They hadn’t been arrested, and there was support from the public, including donations to purchase the drugs.

    “We learned that it was politically palatable,” Kalicum says. “The response from the public and the police not responding, I think really spoke to this as something that we could do.”

    Canada’s Controlled Drugs and Substances Act allows the federal health minister to issue an exemption from any part of the legislation “for a medical or scientific purpose or is otherwise in the public interest.”

    Getting Health Canada to grant an exemption from the act paved the way for Insite to open, and now DULF is also trying to get an exemption to run a sanctioned compassion club.

    DULF’s application for an exemption, submitted to Health Canada on Aug. 31, outlines how the compassion club would work. Organizers would still get their drugs from the dark web until a legal, domestic source for drugs like heroin becomes available. Those drugs would be tested and stored in a secure place. Volunteers or staff would ensure that all the members of the compassion club are over 18 and currently use illicit drugs.

    continued below

    ReplyDelete
  154. The tested drugs would be repackaged and clearly labelled so drug users would know what they were taking. The packaging DULF has proposed would resemble cigarette packaging in Canada, with warnings about the addictive nature of the drugs and to keep the substances away from children and pets.

    “In full operation, the screening process will also be used to determine other needs that are not being met by club membership, such as assistance to navigate social support systems or accessing recovery/detox services,” the exemption request adds.

    The pilot program DULF has proposed would be open to 200 people and would initially last for 15 months.

    But as DULF has pushed to make the compassion club model legitimate, the source of the drugs they’ve been handing out has become a sticking point for some potential supporters.

    The dark web is an encrypted network that allows people to access the internet anonymously; it first came to public prominence in 2013 when the man behind Silk Road, a large online marketplace for illegal drugs, was arrested and charged with drug trafficking, money laundering and computer hacking after an FBI investigation.

    The anonymity of the dark web, which relies on cryptocurrency for payments, can be used to hide criminal activities — some, like purchasing drugs, may be broadly publicly palatable, but others, like child pornography or terrorist activities, are definitely not.

    “You had mentioned in your answers to Coun. Swanson that you have no interest in supporting organized crime,” Melissa De Genova, a Vancouver councillor with the centre-right Non-Partisan Association, asked Nyx during a council meeting on Oct. 6.

    “I’m wondering though, if the illicit products that you’re purchasing are coming from the dark web — do you acknowledge that you are supporting organized crime?”

    De Genova wasn’t the only city councillor to raise concerns about the dark web during the council meeting. Despite those concerns, De Genova voted along with other councillors to unanimously support DULF’s exemption application to Health Canada.

    But her persistent questions about the dark web’s role in facilitating child pornography and sex trafficking have continued to rankle Nyx, who has accused De Genova of further stigmatizing people who use DULF’s compassion club.

    The appearance of a button calling De Genova a “pumpkin-headed fuck” and a shirt reading “Melissa Spaghetti De Genova” for sale on a site selling merchandise to support DULF prompted condemnation from other centre-right politicians. (The pin and shirt are no longer listed on the site, and DULF apologized for the stunt.)

    Nyx and Kalicum say they’d rather get drugs for the compassion club through legal sources: domestically produced heroin and cocaine that is manufactured in Canada and regulated by the government. That would undercut organized crime, they say, by sourcing regulated drugs that are cheaper than the substances being sold on the street.

    But that regulated source doesn’t exist yet. The one tiny prescription heroin program that operates in Canada, at Crosstown Clinic in Vancouver, imports the pharmaceutical-grade drug, which is also known as diacetylmorphine, from Europe.

    A domestic source could be in place soon, however. In October, Fair Price Pharma, a non-profit company set up by Dr. Perry Kendall, a former B.C. provincial health officer, imported the materials needed to make diacetylmorphine for the first time in Canada.

    continued below

    ReplyDelete
  155. The company plans to lease industrial space in the Lower Mainland and manufacture an inhalable form of diacetylmorphine. That locally made prescription heroin would then be shipped around the province to clinics running their own safe supply programs.

    Under Canada’s current drug laws, it would only be possible to give this diacetylmorphine to people who had a prescription from their doctor. But Dr. Martin Schechter, a co-founder of Fair Price Pharma, said he’s written a letter of support for the compassion club model. If DULF gets an exemption from Health Canada, he says, Fair Price Pharma could supply diacetylmorphine to compassion club members.

    Schechter, a professor of medicine at the University of British Columbia, was involved in the NAOMI clinical trial, which predated the prescription heroin program and ran at Crosstown Clinic from 2005 to 2008.

    The NAOMI trial was the first of its kind in North America, involving participants who were addicted to illicit opioids and were not able to successfully use other forms of addiction treatment. Some participants were given diacetylmorphine, while others were given methadone.

    The results of the trial found that the participants who’d been prescribed diacetylmorphine had improved physical and mental health. The study also found that those who had been prescribed diacetylmorphine were 62 per cent more likely to remain in addiction treatment and 40 per cent less likely to use illegal drugs and commit crimes to support their drug habit than participants who were treated with methadone.

    But while a small number of trial participants continue to receive diacetylmorphine, the model has never been expanded in Canada because of what Schechter says are purely political reasons.

    While the prescription opioids Dilaudid and hydromorphone have increasingly been prescribed to provide drug users safer alternatives to illicit opioids, drug users have been frustrated by the comparatively slow pace of efforts to provide a wider range of drugs they say should be made available to drug users.

    Nyx, Kalicum and other advocates are pushing for access to heroin, cocaine and methamphetamines that don’t contain fentanyl, benzos or other adulterants responsible for toxic drug deaths.

    Unlike the way diacetylmorphine was prescribed and carefully studied during the NAOMI trial, Schechter said the compassion club model is untested. But he thinks it’s worth trying as a pilot project.

    “I think that DULF and others should get these exemptions and they should be subject to evaluation to demonstrate that they do indeed work,” Schechter says.

    “Because six people are dying every day, and drug prohibition has been a massive failure. Everybody knows that. It’s just a question of whether you’re willing to say it out loud. And so I think we have to try new things.”

    While Schechter is frustrated that access to safe supply is limited, Dr. Julian Somers is worried about the increasing acceptance of the idea. Somers says comprehensive treatment for addiction, which includes housing and other supports, is chronically underfunded by governments.

    continued below

    ReplyDelete
  156. Poor people who can’t fund their own treatment are the ones who miss out, Somers said, and he fears that “safe supply” will become the only option available for the most disadvantaged drug users.

    “There isn’t a community where an increase in prescribing works,” says Somers, a psychologist and professor in the health sciences department of Simon Fraser University. “We are so preoccupied with prescribing our way out of the problems we face.”

    Dr. Vincent Lam, a doctor in Toronto, recently wrote in the Globe and Mail that he can’t reconcile the potential harms of prescribing hydromorphone to replace someone’s need for fentanyl or heroin.

    Lam wrote that he’s heard from some drug users that a prescription has helped turn their lives around and avoid dying from the contaminated illicit supply, but he’s also spoken to others who say the availability of prescribed alternatives to illicit supply has pulled them back into addiction.

    “Patients of mine who were free of illicit opioids for years now struggle with hydromorphone, which they are buying from those to whom it is prescribed,” Lam wrote.

    Somers and Lam say there is little hard evidence that safe supply is beneficial for people who use drugs, and they object to the term itself. “There’s no such thing as safe supply — that’s a marketing term,” Somers says.

    Schechter disagrees. Several studies, he says, have shown that prescribing diacetylmorphine is effective for people who haven’t had success with methadone or suboxone, drugs that are prescribed to prevent opioid withdrawal symptoms and cravings.

    “Not only are they more effective, but they cost less,” he said, “because when you use things like diacetylmorphine, crime goes down, hospitalizations go down.”

    In an unpublished opinion piece written to respond to Lam’s Globe and Mail article, Nyx and Kalicum said Lam misunderstands the purpose of safe supply: to “save lives amid a toxic, unregulated supply of drugs.”

    “Meaningful change cannot happen without addressing the source of these deaths: the unpredictable drug supply created by prohibition,” Nyx and Kalicum wrote. “The scale and urgency of this crisis requires new approaches, and we ask our colleagues in medicine and in enforcement to heed that the times are changing.”

    Though some doctors have raised concerns, many support increasing access to safe supply.

    Vancouver Coastal Health, B.C.’s second largest health authority by population, supports DULF’s exemption application and has pledged to help implement the compassion club if it’s approved. The proposal is also supported by the BC Centre on Substance Use and the B.C. First Nations Health Authority.

    Vancouver city council — including De Genova, the councillor who repeatedly voiced concerns about DULF buying drugs using dark web marketplaces — voted unanimously to endorse DULF’s exemption application.

    Sonia Furstenau, a B.C. MLA and the leader of the provincial Green Party, has also said she’ll support the compassion club idea and will work with MLAs in other parties to build support for the exemption request.

    Back in the Gastown apartment with the prowling cat, Nyx has managed to order some drugs, but the experience has mostly been frustrating. She wishes the politicians and bureaucrats who have the power to change things could feel the urgency she does every day when people overdose on the street, or see the pleas that face her every time she opens her email.

    “My inbox is filled with messages: ‘Please help me, I’m going to die,’” Nyx says.

    So far, she has no answers.

    https://thetyee.ca/News/2022/02/10/War-On-Drugs-Century-Old/

    ReplyDelete
  157. Experts Reject BC’s Safe Supply Claims

    by Moira Wyton 3 Mar 2022 TheTyee.ca

    Seventeen months after the B.C. government committed to expanding safe supply, only about 500 people are able to access real replacements for increasingly poisoned drugs.

    In February, Minister of Mental Health and Addictions Sheila Malcolmson said 12,000 people had been prescribed what she has called both “safe supply” and “safer supply.”

    “Since we first introduced prescribed safe supply in March 2020, there have been more than 12,000 people helped with this groundbreaking response,” Malcolmson said.

    But public health experts and advocates say the B.C. government is misrepresenting its safe supply programs as toxic drug deaths soar, with seven people a day dying in November and December.

    The government’s claim that 12,000 people have accessed safe supply is actually a count of people who have received prescriptions for withdrawal management substances and alternatives like hydromorphone.

    But only about 500 British Columbians have access to true safe supply through a handful of mostly federally funded pilot projects in the Lower Mainland and Victoria.

    It is conservatively estimated 83,000 people have opioid-use disorder in B.C. That doesn’t include people whose opioid use wouldn’t be considered an addiction or who use other substances like methamphetamine, cocaine or benzodiazepines — substances that are also linked to deaths from toxic drugs.

    Critics say the government is misleading the public and substance users about its commitment to saving lives.

    “The government is saying they’re doing safe supply but in reality, they’re relying on the old-school approach of ‘we want to stop people from doing drugs,’” said Dr. Mark Tyndall, a professor at the University of British Columbia and former executive director of the BC Centre for Disease Control. “But right now, people really need an alternative supply of drugs.”

    Safe supply is a method of harm reduction aimed at providing regulated substances for people instead of the poisoned and unpredictable criminalized supply, which killed 2,224 people in B.C. last year.

    It provides low-barrier access for regular, intermittent and casual users to predictable, non-poisoned street drugs like fentanyl, cocaine, heroin and methamphetamines.

    A December death review panel convened by the BC Coroners Service found a majority of people dying of toxic drugs were not frequent users and did not have diagnosed substance use disorders.

    But information provided by the ministry and data from the BC Centre for Disease Control show the government’s claim of extending safe supply to 12,207 people is a count of those prescribed pharmaceutical alternatives to manage withdrawal from street drugs.

    Many of these prescriptions happened under early pandemic prescribing guidance that encouraged doctors to connect people at high-risk of COVID-19 and overdose with alternatives to minimize drug-seeking that may transmit the virus. They generally provided short-term prescriptions under three weeks, according to BCCDC data.

    continued below

    ReplyDelete
  158. Tyndall said that’s not safe supply and doesn’t allow people to avoid using toxic illicit substances long-term.

    About 58 per cent of the 12,207 people received prescription opioids like oxycodone or hydromorphone, 17 per cent received stimulants like Ritalin, 13 per cent received benzodiazepines and the remaining 24 per cent received alcohol withdrawal medications.

    The substitutes aren’t safe supply, Tyndall said, and don’t replace criminalized substances. That’s key to making safe supply a viable solution for people who would otherwise access the toxic street supply.

    “For someone using fentanyl, being prescribed hydromorphone is a drop in the bucket,” he said, noting that many of these prescriptions are less than two weeks long.

    “It’s not real safe supply at all.”

    Hydromorphone, sold as Dilaudid, is a moderate to strong opioid prescribed for pain management. It is less potent than heroin, and far less strong than fentanyl or carfentanil.

    Tyndall said using an alternative like hydromorphone often reduces use of the illicit supply and therefore lowers the risk of drug poisoning.

    But under current prescribing rules patients are cut off if they are also using street substances, and many doctors won’t even prescribe alternatives to those also using illicit drugs.

    That means many people are denied access to prescription alternatives.

    When asked to respond to criticism that the province is misrepresenting the availability of safe supply, Malcolmson did not respond directly.

    “I have heard from prescribers, care providers and people with lived experience, and I agree — expanding safer supply is a vital step to reduce deaths from toxic drugs. That’s why we have expanded our program,” she said in a statement to The Tyee.

    What B.C. is calling prescribed safer supply evolved from Risk Mitigation Guidance issued by the province and the BC Centre on Substance Use in March 2020 so doctors could prescribe withdrawal management medications for people at heightened risk of toxic drug poisoning who needed to isolate due to COVID-19.

    The directive was expanded in mid-2021 after a promised expansion of safe supply in September 2020, and now includes fentanyl patches.

    “These guidelines are not intended for treatment of substance use disorders but rather to support individuals with substance use disorders to self-isolate or social distance and avoid risk to themselves or others,” the guidance noted.

    They require people to have a substance use disorder to receive a prescription. The vast majority of those covered — 94 per cent — must access a single day’s medication every day and use it at the pharmacy.

    That’s a barrier that makes it impossible for many people to participate.

    Garth Mullins, an advocate who helped develop the initial Risk Mitigation Guidance, said the goal was to move quickly on any actions that would reduce toxic drug deaths occurring during the pandemic, rather than making transformative change in the province’s response to the toxic drug crisis.

    continued below

    ReplyDelete
  159. Tyndall said pressure from the College of Physicians and Surgeons means most doctors are trying to taper people off the risk management prescriptions and, for opioid users, onto long-term treatments like Suboxone and methadone as soon as they can.

    BCCDC data suggests the prescriptions were intended as a step toward treatment rather than to provide access to a non-poisoned drug supply.

    The government continues to rely on abstinence-focused approaches, Tyndall added.

    Mullins, a board member for the BC Association of People on Methadone, said B.C. lags behind other jurisdictions around the world in providing access to opioid agonist therapy, which aims to replace illicit opioids with prescribed substitutes that manage withdrawal symptoms but don’t replicate the effects of the drugs.

    City of Vancouver drug policy advisor Karen Ward said the government’s claims about “safe supply” misrepresent the nature of the toxic drug crisis.

    “We have to take a public health approach,” she said in a message to The Tyee. “Arguments about how many prescriptions are active misses the point: they are not addressing the supply.”

    Switching to a safe supply model could include the use of compassion clubs, like those that led in providing medical cannabis. Vancouver city council has supported the Drug User Liberation Front’s application for federal permission to start a compassion club for heroin and other substances in Vancouver.

    Tyndall and Mullins agreed the focus on programs that require prescriptions ignores the limits of a medical model of safe supply. The barriers to meeting the requirements for a prescription mean few people at risk can access non-poisoned drugs.

    “As long as it’s a medical model where you need a prescription, it’ll never be able to be scaled up to the point where it makes a difference in people’s overdoses,” said Tyndall.

    All three are also concerned that mislabelling the current program as safe supply will confuse the public and allow leaders in B.C. and elsewhere to dismiss the potential of safe supply before it is even really attempted.

    Such arguments were recently made at a controversial Alberta panel to explore safe supply, and in Vancouver Sun columns which also mischaracterized the nature of safe supply.

    “When the deaths continue to rise, they’ll say, ‘We tried nothing and we’re all out of ideas,’” Mullins added. “But compared to the scale of the problem, we really haven’t tried to implement the solutions.”

    For drug users who thought they would soon have a safe supply option, the government’s claims feel like a betrayal.

    “We haven’t changed the options for people… who continue to use and risk their lives every time,” said Tyndall.

    “We need to pull back on the prohibition and offer people a safe supply of drugs.”

    https://thetyee.ca/News/2022/03/03/Experts-Reject-BC-Safe-Supply-Claims/

    ReplyDelete
  160. I Want Them to Break Up with Their Drug Dealer

    A new Vancouver program provides prescribed fentanyl with few barriers

    by Moira Wyton TheTyee.ca April 11, 2022

    A groundbreaking new program from Vancouver’s PHS Community Services Society will allow people to buy fentanyl instead of relying on the increasingly contaminated and unpredictable illicit supply.

    The new enhanced access program is a major step in expanding safe supply as government promises of action have stalled.

    Substance users and public health experts say such regulated drug sales are essential to ending the toxic drug crisis emergency as it nears its sixth anniversary. More than 9,000 people have died since the public health emergency was declared.

    The program made its first sale Thursday. It is legal because the fentanyl — already widely used medically for pain management — is prescribed.

    PHS medical lead Dr. Christy Sutherland said the benefits should be huge.

    “This program gives people dignity, it treats them just like every other person for how they access medication,” she said. “This is an exit from the Downtown Eastside, it’s an exit from the daily grind and it’s an exit from violence and HIV risk.”

    “I want them to break up with their drug dealer.”

    The illicit market is currently saturated with fentanyl, an opioid 100 times more powerful than heroin. Fentanyl has been found in many other substances sold on the illicit market. In 2021 it was found to have contributed to 84 per cent of the 2,332 deaths due to toxic drug poisoning in B.C.

    “Organized crime is controlling the supply, the content and the price of drugs, for some people, but not others,” said Sutherland. “Why can I go and buy a bottle of wine, of a known quantity and purity… but my patients who are using opioids do not have that option of safety?”

    Many people using substances have become habituated to fentanyl’s potency, and can no longer be stabilized on other prescription options like heroin, methadone or Suboxone, Sutherland and her colleagues have observed.

    continued below

    ReplyDelete
  161. Fentanyl is now required in order to provide a viable alternative to the illicit supply for people who use opioids like heroin or fentanyl itself.

    “This patient population deserves the same safety, and that the longer we wait before we intervene, the further along the poisonous drug market will go, and the higher their tolerance will be,” said Sutherland, who has worked in the Downtown Eastside for 12 years. PHS is a non-profit that runs harm reduction services, housing and other resources in the neighbourhood.

    “If I were doing this 100 years ago, I’d be prescribing opium tea.”

    Patients will be assessed and prescribed powdered fentanyl, with buffers caffeine and dextrose, in capsule form. It can be snorted, smoked or cooked for injection.

    Patients will all have access to a full suite of primary care, as well as optional additional treatment and recovery resources.

    Patients will initially have to use the fentanyl through injection or snorting under the supervision of a PHS nurse. Once appropriate doses are established, they can begin to take capsules home daily and larger quantities from the pharmacy less frequently.

    Sutherland worked with a national pharmaceutical supplier and a local compounding pharmacy to obtain and process the fentanyl.

    The fentanyl will be sold at market value, about $10 for a tenth of a gram, known as a point. It is not covered by PharmaCare. This reduces the incentive to resell or risk of diversion, Sutherland says.

    The program’s flexibility also provides more freedom for patients to live and work as they aren’t required to attend at the pharmacy every day for witnessed consumption or daily dispensing.

    “If people are stabilized, they switch to a less dangerous route of use, because they feel secure in their supply, and they’re not going to go into withdrawal,” said Sutherland, noting that smoking carries less risk of infection or harm to veins than injection.

    The program is only open to her current patients right now, but she says there is capacity to scale-up to reach hundreds and even thousands of people across B.C.

    The program is being evaluated by the BC Centre on Substance Use, which Sutherland hopes will help establish the evidence base in support of other modes of safe supply in B.C., including compassion clubs and other non-medical models.

    In a way, the groundbreaking program is “business as usual” for doctors, who prescribe medications for their patients every day.

    “We’re just giving someone a mechanism to purchase them in a safe way, rather than having to navigate the system of danger and violence with organized crime,” said Sutherland.

    https://thetyee.ca/News/2022/04/11/I-Want-Them-To-Break-Up-Drug-Dealer/

    ReplyDelete
  162. An actor, a hockey reporter, a 12-year-old: These are some victims of B.C.'s toxic drug crisis

    Over 9,400 people have died in the 6 years since B.C. declared public health emergency due to overdose deaths

    CBC News April 14, 2022

    Six years ago, Dr. Perry Kendall — then B.C.'s chief public health officer — declared a public health emergency due to the escalating number of overdose deaths in the province.

    Talking recently about the announcement, Kendall said it was "meant to bring public and political attention to the emerging crisis."

    But while he says he has seen some progress on the issue, it has not been enough to save thousands of lives from toxic drugs.

    "We have seen a shocking, unacceptable and unconscionable increase in the number of deaths," Kendall said.

    According to the B.C. Coroners Service, more than 9,400 people across the province have now died from ingesting toxic, illicit drugs over the past six years.

    Chief coroner Lisa Lapointe says while there are some patterns — such as people using alone, and a higher number of deaths among men aged 30 to 59 years old — victims of the crisis come from all walks of life.

    CBC Explains
    Why is Canada's illicit drug supply so deadly and what's being done about it? https://www.cbc.ca/news/canada/canada-illicit-drug-supply-explainer-1.6361623

    These 5 myths about B.C.'s toxic drug crisis are hurting efforts to stop the deaths, say experts https://www.cbc.ca/news/canada/british-columbia/5-myths-toxic-drugs-1.6347454

    Lapointe says there is a misconception that the only people at risk are regular drug users. In fact, she says, many are first-time or casual users who think they are purchasing a certain drug only to get something contaminated with fentanyl or other, even more lethal, substances.

    "The drugs are indiscriminate," she said.

    "We are just seeing lives being lost month after month, year after year. It is heartbreaking."

    The victims of the crisis range from teenagers to seniors, and include athletes, musicians and academics.

    On the sixth anniversary of the public health crisis being declared, here are the stories of six victims of B.C.'s toxic drug crisis.

    READ THOSE STORIES AT:

    https://www.cbc.ca/news/canada/british-columbia/toxic-drug-death-six-years-public-health-emergency-1.6419363

    ReplyDelete
  163. 'Mass poisoning crisis': Canadians need to change how we talk about drug deaths, advocates say

    Harm reduction backers say rising number of deaths will continue until public outrage spurs government action

    by Laura McQuillan · CBC News · May 24, 2022

    There's a poisoning crisis gripping Canada, and it's killing thousands of people each year.

    It doesn't involve contaminated meat, lettuce or baby formula – the kinds of safety issues that prompt public concern, product recalls, and holding those responsible to account.

    It's a vastly different response to Canada's toxic drug supply, as more and more people – including children – die from what harm reduction specialists say are preventable poisonings.

    "If we had poisoned lettuce that was contaminated with listeria or something, they would pull all of that out of the shop, there would be warnings … but because the substances that we use are unregulated, there's not a regulatory response," said Natasha Touesnard, the Halifax-based executive director of the Canadian Association of People Who Use Drugs.

    Touesnard is one of many advocates who say Canadians need to change the way we discuss drug use, as an average of 20 people die each day from toxic street drugs. Many of those deaths are the result of drug sellers mixing fentanyl, benzodiazepines or other substances in with drugs like heroin, cocaine, methamphetamine or MDMA to stretch their supply – without giving any warning to customers.

    Between January and September last year, at least 5,368 Canadians died from "apparent opioid toxicity," which is how the Public Health Agency of Canada classifies substance use deaths involving an opioid.

    The number of deaths has soared over the pandemic, as people experienced new isolation, stress and struggles, and as street drugs became increasingly noxious.

    But the problem isn't new: since 2016, 26,690 Canadian deaths have been attributed to opioid toxicity.

    "It is a mass poisoning crisis that's happening across our country, and the government has the power to fix that," said Touesnard.

    Doctors, policy experts, coroners and police forces continue calling for the federal government to enact drug reform that ensures people who use drugs are kept safe, pointing out that models of abstinence and criminal punishment haven't stopped people using drugs – they've only made it more dangerous to do so.

    "We have to change, because the drug supply isn't. It's going to increasingly get more potent," said Guy Felicella, a peer clinical advisor for the B.C. Centre on Substance Use in Vancouver.
    Changing views on drug use

    Advocates say it shouldn't take the deaths of thousands of Canadians for that change to happen – but they're still waiting to see widespread public outrage that will force government action.

    "It doesn't seem like there's enough care when people are dying from poisoned supply," said Jonny Mexico, Winnipeg network coordinator for the Manitoba Harm Reduction Network. "I don't know if that starts at the top because politicians don't seem to care, or if it starts with the amount of stigma that is around people who use drugs."

    Part of the work involves changing stereotypes about people who use drugs, said Leslie McBain, co-founder of Moms Stop the Harm, a network of families who have lost loved ones due to substance use.

    "This is not just those marginalized, vulnerable people. It is our brothers or sisters, our kids."

    continued below

    ReplyDelete
  164. Some people use drugs for fun, some have a dependency, and some die the very first time they ever try a drug, but "nobody who's using drugs is wanting to die," Mexico said.

    That's why, in most cases, the word "overdose" might not accurately reflect why a death occurred. In many cases, the victim took a drug without knowing that fentanyl or another potentially toxic substance was mixed in.

    "[Overdose] suggests that if they'd just been more careful, they wouldn't have died, when we know for a fact [that] the market is so toxic right now that there is absolutely no way for people to know what's in the substance that they're buying," said Lisa Lapointe, chief coroner for British Columbia, where more than 9,400 people have died from drug toxicity over the past six years.

    In other cases, a person who intended to use fentanyl was unaware they were taking a dose far more concentrated than what they were used to.

    "When I'm buying illicit drugs off the street, it doesn't have any of the ingredients. So you tell me what it is – it looks the same to me, I purchase it, I die. That's poisoning," Felicella said.
    How to get the poison out of the supply

    One solution to the toxic drug supply is to crack down on those who are poisoning it, as happens on rare occasions in Canada. However, harm reduction advocates said arresting individuals isn't the solution to a much larger problem.

    "It's the whack-a-mole thing – if you bust ten drug dealers, there's 100 to take their place in two days," McBain said.

    "Taking away the market is the way to impact those people and taking away the market means implementing safe supply."

    Once again, however, those words – safe supply – mean different things to different people.

    The federal government has signalled its willingness to try a medical model, funding a limited number of "safer supply" pilot projects, where people can access prescriptions for pharmaceutical-grade opioids, stimulants and benzodiazepines.

    However, many advocates say a bolder model is needed, where drugs are decriminalized or legalized, and regulated in the same way as alcohol or cannabis, to keep people safe and disrupt the toxic drug trade.

    As part of that approach, British Columbia, Toronto and Montreal have all applied for federal exemptions to decriminalize personal possession of small amounts of drugs. The Canadian Association of Police Chiefs has thrown its backing behind the move.

    There are also signs of growing public support: in an Angus Reid poll last year, 59 per cent of respondents said they favour decriminalization of all illegal drugs, while the remaining 41 per cent were opposed.

    But there is still resistance from other quarters. Alberta's police chiefs said earlier this year that it's too soon to decriminalize drugs, especially without more health supports and treatment services in place.

    Prime Minister Justin Trudeau has also voiced his opposition to decriminalization, saying it wouldn't be the "silver bullet" that advocates suggest.

    Lapointe, B.C.'s chief coroner, meanwhile, supports decriminalization and policies to make the drug supply safer. She said there's evidence that drugs can be used safely if the drugs themselves are safe.

    "For my office, it's not an ideology. It's very practical," she said.

    "We look at what could be done to prevent the deaths, and the only way we are going to prevent the number of deaths we are seeing in our communities is to stop their reliance on the toxic drug supply."

    https://www.cbc.ca/news/health/drug-poisoning-deaths-language-1.6457834

    ReplyDelete
  165. Drug Decrim Plan for BC Panned as Inadequate

    Moira Wyton, May 31, 2022 TheTyee.ca

    British Columbia will be the first jurisdiction in Canada to decriminalize possession of small amounts of drugs like heroin, fentanyl, cocaine, methamphetamine and MDMA in an effort to save lives amid the province’s escalating toxic drug crisis.

    Adults over 18 in B.C. will be able to carry up to a combined 2.5 grams of these substances without arrest, charge or seizure of the drugs by law enforcement, according to an exemption from federal drug laws granted by Health Canada today.

    But people who use drugs, advocates and public health experts say the threshold is too low and doesn’t reflect current use patterns which have changed with the increasingly toxic drug supply.

    The goal of decriminalization is to reduce the harms of arrest and drug seizure on individual users, officials said, and to reduce the stigma around substance use that prevents people from seeking health care or accessing adequate housing and employment.

    Decriminalization is not legalization. The drugs themselves remain illegal and selling, importing, exporting and trafficking substances is still subject to arrest and charges.

    “Today we take the first steps in a much needed bold action and significant policy change,” said federal Minister of Mental Health and Addictions Carolyn Bennett from Vancouver.

    “It must be seen as one additional tool to be used in response to the overdose crisis.”

    The exemption will apply to adults over 18 within B.C. from Jan. 31, 2023 to January 2026.

    It excludes adults on the premises of schools and child-care facilities, in airports, aboard Canadian Coast Guard vessels and helicopters, and anyone in a vehicle operated by a minor whether it is moving or not. Like alcohol, substances must be safely stored out of reach of an adult driver of a vehicle for the exemption to apply.

    The exemption will be rigorously monitored and amended as needed, Bennett and provincial counterpart Minister Sheila Malcolmson said today.

    “In the short term, decriminalization will stop seizures and arrests and connect people with services and supports,” said Malcolmson, noting that reducing stigma will be a long-term goal.

    Fear of arrest and of losing employment, housing or custody of children often prevents people who use drugs from accessing harm reduction and health supports, or from telling family and friends about their substance use.

    The stigma criminalization creates directly contributes to the unprecedented number of deaths B.C. has seen as the drug supply has only become more toxic.

    More than 80 per cent of the 9,364 people who have died of toxic drug poisonings in B.C. since April 2016 were using alone, according to data from the Coroners Service.

    “This is a philosophical approach that supports people who are using drugs… and trying to not get them into a cycle that causes harm,” said provincial health officer Dr. Bonnie Henry, who first advocated B.C. decriminalize personal possession of small amounts of drugs in 2019.

    The granted exemption unveiled today represents a flawed but significant development in the province’s response to the toxic drug crisis, according to organizers and public health experts.

    British Columbia had requested a threshold of 4.5 grams in its November decriminalization submission to Health Canada.

    continued below

    ReplyDelete
  166. Advocates who advised the province say they pushed for a higher threshold that would apply separately to each type of drug carried by an individual, but law enforcement was vehemently against it.

    Now, people who use drugs, public health experts and advocates say the 2.5-gram threshold is far too small to decriminalize people who use often, buy hits in bulk due to mobility issues or who might sell small quantities to fund their own use.

    “People think of this policy as in grams… I think of human beings, I think of all the people I know who have bigger habits than that and are still being criminalized,” said Garth Mullins, a board member of the Vancouver Area Network of Drug Users who sat on the B.C. Core Planning Table to advise on the submission.

    “The fewer people you decriminalize, the less efficacious it will be.”

    The low threshold raises concerns that the drug supply will adjust to it, and that people will interact with the unregulated market more often to purchase smaller amounts.

    “Any step forward is something positive. But we really have strongly always believed in decriminalization for all. And this is not for all,” said Caitlin Shane, staff lawyer for drug policy at Pivot Legal Society in Vancouver.

    And the exemption grants a lot of power to police to determine what is and isn’t personal use, Shane noted.

    The Tyee previously reported that drug seizures continued at the same rate even after the Vancouver Police Department said it would not arrest people for simple possession.

    This is particularly an issue for Black, Indigenous and other racialized, marginalized and low-income people, an April letter signed by VANDU, Pivot and more than 20 other drug policy advocacy and research organizations cautioned.

    “A 2.5-grams threshold flies in the face of your governments’ commitment to evidence-based drug policy, anti-racism, and reconciliation with Indigenous communities,” the organizations wrote.

    “It disregards the recommendations put forward by B.C.’s Core Planning Table and caters to the unsubstantiated, stigma-based requests of police.”

    When asked about the low threshold, Bennett and Malcolmson said it balanced public safety and responding to the public health emergency.

    There is little research on the efficacy of thresholds but officials said law enforcement data indicated about 80 per cent of drug seizures were for less than 2.5 grams.

    “We’re going to start by starting,” said Bennett, noting the efficacy of decriminalization will be evaluated independently.

    While decriminalization is a good start, Mullins said it must also be accompanied by safe, regulated supplies of substances to separate people from the toxic drug supply all together.

    Henry and Vancouver Mayor Kennedy Stewart echoed his call for safe supply earlier in the day.

    As long as the market remains unregulated, it will continue to change and become more potent, Mullins said.

    “We’ve got to legalize these substances, it’s the fact that they’re banned that makes them so dangerous,” he added.

    “I feel a little happy today, but I also feel a bit exhausted thinking about the fight ahead.”

    https://thetyee.ca/News/2022/05/31/Drug-Decrim-Plan-BC-Panned-Inadequate/

    ReplyDelete
  167. B.C. decriminalization plan won't do much to stop toxic drug deaths, says chief coroner

    Bethany Lindsay · CBC News · May 31, 2022

    The federal government framed its announcement that possession of small amounts of drugs will be decriminalized in B.C. as a major policy breakthrough, but for those close to the deadly drug crisis, the news has been met with skepticism.

    On Tuesday morning, British Columbians heard that Canadians 18 years of age and older will be able to possess up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA within the province as of Jan. 31 next year.

    While many people on the ground in B.C. say it's a step in the right direction, they also had strong words of criticism about the low threshold for the amount of drugs, the long delay before implementation and the continuing potential for racial discrimination.

    The skeptics include Lisa Lapointe, B.C.'s chief coroner and a vocal critic of the response to the crisis from all levels of government.

    "It's been described as decriminalization. I'm not sure that it is," Lapointe told The Current host Matt Galloway.

    The exemption from federal drug laws comes as the result of a request from the B.C. government, which suggested a threshold of up to 4.5 grams of illicit drugs — an amount that many critics already believed was too low. The federal government's threshold nearly cuts that recommendation in half.

    "I would have to say, honestly, that this guideline for non-enforcement for small amounts of substances is not going to make a significant difference in the short term," Lapointe said.

    She said the threshold is too low to help most drug users or to prevent many deaths caused by B.C.'s tainted illicit drug supply, which has already killed more than 9,400 people since 2016.

    "Decriminalization, to my mind, would be if you have a substance for personal use, then it's for personal use, and the police should not have a role to play in that. … What you decide to use for your personal needs is your choice," Lapointe said.

    She's also worried about racial bias and other prejudices influencing how police officers interpret the new guidelines, especially when it comes to who is stopped to see if their drugs are over the threshold.

    "When a police officer has that much discretion, bias can creep through, whether it's conscious or unconscious," she said.

    Lapointe said she'll be watching how the province develops training and guidelines for police officers, as well as how Crown prosecutors apply the new rules in their role approving charges.

    continued below

    ReplyDelete
  168. Garth Mullins, a member of the Vancouver Area Network of Drug Users (VANDU), which was among the organizations consulted by the B.C. government when it applied for decriminalization, said the proposal for a threshold of 4.5 grams was considered an acceptable three-day supply based on extensive research the group had done.

    But entrenched drug users often hold multiple drugs and could consume 2.5 grams "for breakfast," so the exemption may not help them much, Mullins said.

    While the B.C. First Nations Justice Council largely applauded the move, chair Doug White expressed concern that the low threshold seems to have been decided without consideration of drug users in more remote areas, where it's more difficult to replenish supplies on a regular basis.

    "Addiction has no geographical boundaries. If we are working toward harm reduction by decriminalization to reduce users' fear and isolation, the needs of those living in remote communities must also be considered," White said in a written statement.

    "We hope to see the threshold raised to four grams for personal use as soon as possible."

    He also argued that people with criminal records for drug possession should be pardoned and their criminal records expunged.

    For former VANDU president Dean Wilson, the low threshold is much less of an issue than the time frame.

    "They say this is very urgent, but we're not doing it for seven months. Like, are you kidding me? What does 'urgent' mean?" he said.

    He pointed out that with five or six people dying every day as a result of B.C.'s tainted drug supply, another 1,200 people or more could be dead by the time the new structure is in place next year.

    Lapointe shared those concerns, and said she also recognized that for many people, any move toward decriminalization may seem scary.

    "For decades, we've been told drugs are bad," she said.

    That might explain why the plan has been rolled out this way, Lapointe speculated.

    "I think the federal government is probably being very cautious because there's probably a bit of a political football," she said.

    But she argued that the only way to deal with the immediate issue of people dying from a tainted drug supply is to bring in a regulated safe supply of drugs that is easily available to anyone who needs it.

    https://www.cbc.ca/news/canada/british-columbia/b-c-decriminalization-toxic-drug-deaths-chief-coroner-1.6473060

    ReplyDelete
  169. Why decriminalizing drug possession won't fix Canada's toxic supply

    Adam Miller · CBC News · June 04, 2022

    Canada's toxic drug supply problem can't be fixed by decriminalizing the possession of small quantities of drugs alone — a move that advocates say is a step in the right direction but a far cry from addressing the worsening overdose crisis.

    In response to the crisis, the federal government announced a plan this week to allow adults in British Columbia to possess small amounts of some illicit drugs — up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA within British Columbia.

    But in the past decade, the illicit drug supply has gone from unthinkably bad to unimaginably worse as fentanyl has completely overtaken heroin and even more dangerous drugs have entered the supply.

    Since 2016, 26,690 Canadians have died from suspected opioid overdoses, and in B.C. alone there were 2,224 suspected overdose deaths in 2021 and more than 9,400 since 2016 — the leading cause of unnatural deaths in the province.

    "No one knows, no one can know, what they're selling or what they're putting in their bodies," Karen Ward, a drug user and advocate in Vancouver's Downtown Eastside, told CBC News in a recent interview.

    "I don't even want to think about how much worse it could get."

    The dramatic rise of fentanyl in Canada has been stark. In 2012, only 217 of the street drug samples seized by law enforcement agencies across Canada tested positive for fentanyl. In 2021 that number grew to over 16,000 samples — an increase of more than 7,000 per cent.

    Of the more than 24,000 opioid drugs seized by law enforcement agencies across Canada last year, 72 per cent contained fentanyl or fentanyl analogues, as well as 45 per cent of the heroin samples confiscated.

    But at the same time, the actual amount of heroin in Canada fell by more than 60 per cent over five years as fentanyl took over — leading to an unpredictable and dangerous supply.

    "A lot of people talk about the heroin supply being contaminated with fentanyl, but we haven't had heroin supply for a long time — the supply is fentanyl," Nick Boyce, director of the Ontario Harm Reduction Network, said in a recent interview.

    "You don't know what dosing you'll get and there's many different fentanyl analogues out there, some which are more potent than others."

    Carfentanil in particular is one of the most dangerous opioids in the drug supply: 100 times more toxic than fentanyl, 10,000 times more toxic than morphine and undetectable by sight, smell or taste. And after declining in 2019, it's now on the rise in Canada again.

    The statistics are compiled by Health Canada's Drug Analysis Service (DAS), which tests approximately 125,000 samples of drugs apprehended by the Canada Border Services Agency, the Correctional Service of Canada and police forces across the country each year.

    And while it merely provides a snapshot of the crisis, it also paints a tragic picture, one that simultaneously shows the disappearance of heroin as fentanyl and other dangerous opioids contaminated the supply while the number of overdose deaths skyrocketed.

    "It's a scary situation — it's like the well was poisoned," said Ward. "This whole community is just falling apart because so many people have died."

    In the first year of the pandemic alone, there was a 95 per cent increase in suspected opioid-related deaths, with 7,224 lives lost in Canada, compared to 3,711 in 2019.

    "This is the worst public health crisis we've ever seen with regard to toxic drugs in the history of our country," said Donald MacPherson, executive director of the Canadian Drug Policy Coalition, a policy advocacy group made up of about 50 organizations.

    "We have never seen anything like this before."

    continued below

    ReplyDelete
  170. But the federal government's decriminalization plan doesn't come into effect for another seven months and falls short of the 4.5 gram threshold that the province and harm reduction advocates called for — an amount that many critics already believed was too low.

    "If this is intended to make enough of a difference to save lives, why does it not take effect for another seven months?" Ward said in reaction to the announcement, adding that it does little to address the toxic supply of drugs in Canada.

    MacPherson said that while the announcement "signals the direction that we need to go" as a country, it should have been rolled out at a national level in order to make a real impact in Canada given that the overdose crisis isn't just a B.C. problem.

    "This is discriminatory, if you live in another province, you're not really going to have the benefits of this model. It's for B.C. residents only, so that's disappointing," he said.

    "And it's really not going to have a huge impact on the toxic drug supply — that is the number one problem."

    The federal government has signalled it is open to discussing expanding the scope of decriminalization beyond just B.C. to other provinces and cities across the country, but Saskatchewan, Manitoba and Nova Scotia already said they won't be next in line.

    Kayla DeMong, executive director of Prairie Harm Reduction in Saskatoon, said that while decriminalization overcomes a century of "highly discriminatory" drug policy, it falls short of addressing the overdose crisis in a meaningful way.

    "Do I think it's going to have a huge impact on our toxic drug supply? No," she told CBC News. "What I do hope is that it will provide better support and resources and less criminal enforcement for people that use substances."

    MacPherson said that while some drug users in B.C. who are stopped by police with small amounts of drugs will benefit from the decriminalization move, police already don't arrest many people for possession in Vancouver and it likely won't lead to major changes there.

    "It also means we're going to be spending the next seven months putting together a model of a policy change that really isn't about the toxic drug supply," he said. "So the focus of the response is in the wrong place."

    Advocates have been calling for a safe and regulated drug supply for decades in order to enable people who use drugs to access regulated substances, such as medical-grade heroin, from a legal source, rather than potentially toxic versions from the illicit market.

    "There's so much so much more to do in the area of giving people alternatives to the toxic drug market that is not happening — that's where the real crisis is," MacPherson said.

    "That kind of action needs to start happening, and in combination with decriminalization that would make sense. But decriminalization on its own? When over 90 per cent of people who die are dying from drug toxicity? That needs to be dealt with."

    Ward said until the toxic drug supply issue is addressed head on in Canada, people who use drugs will continue to die at an unfathomable rate.

    "The problem is they're not illegal because they're dangerous, they're dangerous because they're illegal," Ward said.

    "People are dying. I'm surprised I'm still alive. People are falling apart. We've been through so much. They've suffered so much, and they've been poisoned to death by the policy that we've decided not to change."

    https://www.cbc.ca/news/canada-overdose-crisis-toxic-supply-decriminalization-1.6477015

    ReplyDelete
  171. Canada took a step toward decriminalizing hard drugs. Here's what it can learn from other countries

    Laura McQuillan · CBC News · June 07, 2022

    When British Columbia decriminalizes small amounts of some illicit drugs next year, Canada will join a growing number of countries that have taken strides toward removing penalties for drug use.

    But as many Canadian public health experts call on lawmakers to go a step further — and replace black market street drugs with a regulated safe supply — their international counterparts say they are watching to see what their countries can learn from one another.

    Ottawa announced last week that from Jan. 31, adults in B.C. will be allowed to possess up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA — a signal it will treat addiction as a mental health issue rather than a judicial one.

    The federal government has not yet made any commitments about a regulated safe supply; in fact, a private member's bill from the NDP calling for a strategy that would include one was defeated in the House of Commons on Thursday.

    But advocates have proposed a number of safe supply models for Canada, with options ranging from prescribing pharmaceutical-grade drugs — as already happens to a very limited degree — to allowing drugs to be sold at licensed entertainment venues or dispensaries.

    If adopted, those more liberal models would put Canada in uncharted territory internationally, says Jonathan Caulkins, a professor of operations research and public policy and a drug policy researcher at Carnegie Mellon University in Pittsburgh.

    "No country in the world has gone farther, faster than Canada has in that direction with cannabis, and no country in the world has even really seriously thought about doing that for heroin or fentanyl or cocaine."

    So as Ottawa navigates decriminalization, jurisdictions around the world say they'll be watching to see what, if any, safe drug supply model is adopted.

    And CBC News spoke with some of those international drug policy experts to see what Canada might learn from their countries' experience with decriminalization.

    When Estonia decriminalized all drugs in 2005, the black market for illegally manufactured fentanyl was on the rise.

    With almost no harm reduction measures or treatment options in place, the country quickly became Europe's drug overdose capital.

    Estonia's fatal overdose rate began to fall from 2017 after a major fentanyl bust – but it's still playing catch-up on harm reduction.

    "We don't have a safe supply, and we don't have safe consumption rooms and we don't have state-supported drug checking," says Aljona Kurbatova, the head of the Drug Abuse and Infectious Diseases Prevention Centre at Estonia's National Institute for Health Development.

    "Having harm-reduction responses as basic as needle and syringe exchange programs has been quite a challenge for us in the last two decades because of a very strong public opposition to it."

    She said it's encouraging that Canada already has a strong harm-reduction model ahead of decriminalization, and Kurbatova said she's hopeful it will have "the courage to try out new things" — including a regulated supply of drugs.

    "If Canada will introduce safe supply, it will definitely be an argument even for our politicians to actually listen up and say that perhaps we also, in order to avoid a repetition of previous mistakes, should have something like that."

    Back in 2001, faced with a crisis of heroin overdose deaths, Portugal became the first country in the world to decriminalize the possession and use of all illegal drugs. Instead of sending people to court for drug possession, its model focuses on education, treatment and harm reduction.

    Portugal's drug-related death rate is four times lower than the European average, according to the continent's drug-monitoring agency in 2017.

    And those figures are despite...

    ReplyDelete
  172. all of the country's drugs coming from a black market.

    To date, fentanyl hasn't emerged as an issue there, though it's likely only a matter of time, says Dr. João Goulão, the main architect of Portugal's decriminalization model and head of the country's General-Directorate for Intervention on Addictive Behaviours and Dependencies.

    As a result, a safe supply model isn't part of the plan now.

    "We are comfortable with what we have," Goulão said. Of course, we are open to innovate, but this core discussion about the legal framework for drugs is not the primary concern."

    Instead, Goulão is focused on expanding harm reduction services, like drug checking and safe consumption sites, which are in their infancy in Portugal.

    "I saw more resources in downtown Vancouver than what we have all over the country," Goulão told CBC News in an interview from Lisbon, before flying to Canada for a conference this week.

    Portugal isn't looking to export its decriminalization model, he said, but it does hope to inspire other countries to evolve.

    "You in Canada, and the Americans, you are living a moment that is similar to our epidemic in heroin in the '90s … This is, in my view, a window of opportunity to change things."

    Although Switzerland has yet to decriminalize drugs, it took a groundbreaking step toward safe supply in 1994 by prescribing pharmaceutical-grade heroin to long-term users.

    The result was fewer overdose deaths, as well as falling rates of HIV and hepatitis C infections and a drop in crime.

    "The outcome is: you don't have people on the street [using drugs], you don't have people dying from overdoses in the street or in private places … And there is a very good relationship between the people [using drugs] and the health sector," said Jean-Félix Savary, secretary general of the Romand Group of Addiction Studies (GREA) in Geneva.

    During the pandemic, the country allowed people to use prescription heroin at home instead of restricting its use to supervised sites.

    "It was a very big success," Savary said.

    Although far fewer people access prescription heroin than other treatments such as methadone, there is now debate in Switzerland about expanding prescription heroin.

    "There is still this moral thinking that if you give a drug to somebody, it has to be nasty … so we prefer to give methadone — which is really bad for the body — than to give heroin," Savary said, noting heroin is much better than methadone from a medical perspective.

    "It's just a medication."

    If Canada wants to know what decriminalization looks like without a safe supply of drugs, it only needs to look about 600 kilometres south of the border. Faced with rising opioid-related deaths, Oregon became the first U.S. state to decriminalize drugs in 2020, following a referendum.

    Since then, deaths have continued to rise – as they have in Canada – as the drug supply has become more toxic in both countries.

    "Just decriminalization isn't going to stop people from dying from drug overdoses," said Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance.

    She and other drug reform advocates in Oregon are still working to implement safe consumption sites and other harm reduction measures, which they hope will keep people safer over time.

    "We're trying to solve these huge problems with these incremental steps, and incremental steps are sometimes the only thing you can get people to get done."

    As street drugs become increasingly dangerous on both sides of the border, Hurst is watching closely to see if Canada — where she grew up — listens to the calls for some form of a regulated safe supply.

    "Safe supply feels like such an important conversation when we're watching so many people die right now," she said. "And it feels so far from where most people are when it comes to drugs."

    https://www.cbc.ca/news/health/safe-supply-around-the-world-1.6479317

    ReplyDelete
  173. Over 10,000 people in B.C. have died due to toxic drugs since health emergency was declared in 2016: coroner

    CBC News · August 16, 2022

    More than 140 people died from illicit drug toxicity across B.C. during the month of June, the provincial coroners' service says, pushing the total number of fatalities this year past 1,000.

    The number of drug toxicity deaths in the first six months of 2022 is the highest ever recorded in that period of a calendar year, according to preliminary data released by the B.C. Coroners Service on Tuesday.

    The tally also means more than 10,000 people have now died as a result of toxic drugs in B.C. since a public health emergency was declared in April 2016.

    "These were men, women and youth from all walks of life. They lived in our neighbourhoods, worked in our workplaces and played on our sports teams. Some lived ordinary lives, while others faced enormous challenges," Chief Coroner Lisa Lapointe wrote in a statement.

    "All of them fell prey to the lethal supply of illicit drugs that is omnipresent."

    The co-founder of Moms Stop the Harm said Tuesday it's difficult to see the sheer number of deaths continue, month after month, more than six years into a public health emergency.

    After so long, she said, it's challenging to hold the wider public's attention.

    "Each individual who dies leaves behind just a trail of grief. I just want people to understand that this tragedy, this dynamic that we're going through, is focused on actual individuals," said Leslie McBain, who lost her son to a prescription drug overdose in 2014.

    "Every month when these numbers come out ... it gets to be sort of, 'Oh, yeah, here comes the coroner's report. There's going to be a bunch of deaths.' And I don't blame people. It's difficult to keep focused on that.

    "It does become sort of just commonplace — not to me. Not to all our members at Moms Stop the Harm and all the people who have lost a loved one."

    The data released Tuesday said 146 people died in June, down from 197 in May — a decrease of more than 26 per cent. The number of deaths was also down 17 per cent from the same month last year.

    The data showed fatalities across all age groups has decreased, though nearly 75 per cent of those who died were between 30 and 59 years old. Nearly 80 per cent of those who died were men.

    continued below

    ReplyDelete
  174. Sixteen of the people who have died this year were under the age of 19. Another 140 were between 19 and 29 years old, the report said.

    "It's an enormous and persistent issue that we see come up repeatedly — in fact, daily — in my office," said Jennifer Charlesworth, B.C.'s representative for children and youth.

    "The stats are consistently alarming."

    Charlesworth said some children survived being poisoned by toxic drugs, but suffered "questionable impact to their well-being" and lasting trauma. She said others end up in government care after losing their parents or guardians as a result of the drug supply.

    Lapointe has repeated the need for a safer drug supply, as many advocates, academics and health experts have been doing since the health emergency declaration in 2016.

    "We are recognizing drug use as a symptom and realizing that punishment and stigmatizing only causes further harm," Lapointe said at a news conference Tuesday.

    "Encouraging compassionate treatment and support is the only way to move British Columbians out of harm's way and out of this public health crisis."

    According to preliminary post-mortem toxicology tests, the illicit drug supply remains extremely volatile. Fentanyl has been found in higher and higher concentrations, according to the coroners' service.

    Etizolam was detected in 39 per cent of expedited testing between July 2020 and June 2022. An analogue of benzodiazepine, etizolam is a strong sedative whose effects cannot be reversed by naloxone, which challenges first responders trying to save lives.

    The coroner noted the rate of deaths in the Northern Health region rose in June, despite dropping in every other health authority.

    Most people continue to die indoors, the report said.

    No deaths have been reported at supervised consumption or drug overdose prevention sites. There is no indication that prescribed safe supply contributes to overdose deaths, it added.

    The coroner said 2,224 people died as a result of illicit drugs in 2021, making it the deadliest year to date. In the first half of 2022, 1,065 people have lost their lives.

    https://www.cbc.ca/news/canada/british-columbia/bc-overdose-deaths-june-2022-fatalities-decreasing-coroner-says-1.6552558

    ReplyDelete
  175. Remembering Peer Advocate Paige Phillips, Who Lost Her Life to Toxic Drugs

    by Moira Wyton August 25, 2022 The Tyee

    Paige Phillips is being remembered as a fierce friend, loving mother and “tiny fighter” for the rights of drug users, single mothers and marginalized people in British Columbia.

    Phillips died last Sunday of a toxic drug poisoning in Victoria. The BC Coroners Service is investigating. The 32-year-old was a mother to two young daughters with her partner, Jack Phillips.

    More than 10,000 people have been killed by the toxic drug crisis in British Columbia since it was declared a public health emergency in 2016.

    “Paige was charming and fierce, and she always went down swinging,” said Fred Cameron, who met Phillips while the two were research assistants at the University of Victoria, and later worked with her at SOLID, a peer outreach organization for others with substance-use disorder that provides harm reduction education and employment supports in Victoria. (Jack Phillips asked Cameron to speak to The Tyee in his stead.)

    “She spoke up on behalf and gave voice and strength and a place to talk to people who didn’t have it,” Cameron said.

    Friend and peer advocate Guy Felicella said Phillips’ death is a reminder that no one, even the most informed community members and activists, are safe from the increasingly poisoned and unpredictable drug supply.

    “I’m just so angry at the illicit supply,” said Felicella. “It doesn’t know how to stop taking people. And it sadly takes away your friends, your family, your community, and it’s causing generational trauma.”

    In an interview with Postmedia, Jack Phillips said his partner would likely still be alive if there was a safer drug supply available, as experts and advocates have repeatedly called on for years.

    The young couple met on the East Coast and moved to Victoria together, founding SOLID in 2007. Paige Phillips also studied business at Camosun College.

    SOLID has facilitated employment for nearly 3,500 drug users since it was founded, and expanded to offer emergency housing supports at the start of the pandemic.

    Paige’s compassion and deep sense of justice guided her work as an advocate, friends and colleagues told The Tyee. She had had a hard life and always made an effort to break those cycles by being kind to others.

    Phillips seemed to have a “biological clock” that told her when and where to find people in downtown Victoria who may need her help, Felicella said.

    He recalls Phillips giving someone her last $5 because they needed it more. “She worked hard to get people housed,” he added.

    That included speaking up for single mothers who used drugs, who fear asking for help or sharing they are struggling because it can mean they’d lose their children, said Cameron. (Child apprehension is a key risk factor for drug poisonings in B.C.)

    And when health-care staff wouldn’t listen to Phillips or other peers about the end-of-life wishes of a dying friend who was unhoused, she sought to change that through the Equity in Palliative Approaches to Care collective.

    continued below

    ReplyDelete
  176. Equity in Palliative Approaches to Care collective lead researcher and nursing professor Kelli Stajduhar remembers Paige, in tears, recalling how frustrating and dehumanizing it had been to not be able to help her friend. By the time the collective next met, Phillips had condensed 50 pages of advanced care planning documents from the province’s website into a six-page version.

    “And she said, ‘I think we can do this with people who use drugs and people who are marginalized in the community,’” said Stajduhar.

    “The thing I love about Paige is she was never afraid to say and speak her wisdom,” she added.

    A version of that six-page document Phillips drafted is now used in shelters and transitional houses across Victoria to ensure dignified deaths and end-of-life instructions are followed for the most vulnerable. Phillips also went on to help secure funding for a mobile palliative care team operating for vulnerable people in Victoria.

    As a result, Stajduhar said, hundreds more people have and will have their end-of-life wishes respected. “Paige was, in some ways, the glue in our community that helped us move the palliative care work forward.”

    Phillips made connections in the community for years at the Harbour supervised consumption site, SOLID programming and as a research partner at UVic.

    She was also a board member at the BC-Yukon Association of Drug War Survivors. Last November, she helped her half-brother, Scott Heffernan, enter recovery for substance use, he told Postmedia.

    And she was instrumental to establishing the burgeoning prescribed safe supply programs saving lives in Victoria, said Felicella.

    Colleagues say Phillips’ death is the result of an insufficient response to the crisis, and one which relies on peer workers who may be struggling themselves to help those also in dire need of support.

    It’s traumatic, “soul-crushing” work, said Hawkfeather Peterson, an advocate for drug user rights and friend of Phillips in an email. “Our leaders end up statistics for the exact thing they fought so hard to save others from.”

    A GoFundMe to support counselling for Phillips’ daughters and their future education and needs organized by Peterson has raised more than $10,000 of its $25,000 goal.

    “It can feel like we are fodder being willfully sacrificed so that governments can claim they are trying to [stop] overdose deaths,” said Peterson. “Stable peers tend to relapse, end up in extreme crisis, with no real help.”

    Felicella and his wife became fast friends with the Phillips, who visited the Lower Mainland often with their children.

    The parents would take the five young kids between them to the park, the mall and the playground. It was healing for Felicella and Phillips to give their children the childhood experiences they hadn’t had.

    She had told him she was struggling in recent months, Felicella recalls. “A lot of the time we are good at helping others and not really good at helping ourselves. The work overshadows the other things.”

    Her calm and quiet perseverance defined her life and now her legacy, he said. Felicella hopes her daughters can one day take comfort knowing their mother changed so much for the better before her life was cut short.

    “They’ll always think, ‘She was a person you could always count on, would always be there and would always fight.’”

    https://thetyee.ca/News/2022/08/25/Remembering-Peer-Advocate-Paige-Phillips/

    ReplyDelete
  177. 4 years after son's death, a Vancouver mother marks overdose awareness day

    by Josh Grant · CBC News August 31, 2022

    Sharene Shuster wears a golden, heart-shaped locket around her neck with a fingerprint engraved on it.

    Inside are some of the ashes of her oldest son, Jordan Hunter Carhoun, who died in 2018 at the age of 25, after smoking what he thought was heroin but turned out to be fentanyl.

    Shortly after Jordan died, Shuster learned about international overdose awareness day. She brought a picture of him to an event in downtown Vancouver where she was introduced to Moms Stop the Harm, a network of mothers and families who have been directly affected by the toxic drug crisis.

    On Wednesday, a few weeks after the fourth anniversary of Jordan's death, she's marking overdose awareness day with that same group of mothers who are equally committed to ending the drug crisis.

    "This has been going on since 2016 and it's just heartbreaking," Shuster said in an interview with CBC.

    "We need a safe supply. We need to stop this."

    Jordan Carhoun was born deaf and received a cochlear implant when he was two years old. He quickly learned to sign, read lips and eventually speak while he was growing up.

    Shuster says he was an honour roll student who learned French and Japanese in school. He was popular, outgoing and happy; he loved animals and sports.

    But toward the end of high school, his mother says things got difficult for him.

    "Jordan was different," she said. "When the girls came in, he got teased and that's when the depression started."

    Shuster says a friend introduced Jordan to heroin and he quickly became addicted. But it wasn't until months later, when his girlfriend Jasmine caught him smoking the drug, that the family found out.

    Shuster says he was "so embarrassed" and told his family he wanted help to get off the drug.

    She remembers calling rehabilitation centres and being told the wait list was four to five months long. The family was lucky enough to know someone working at Together We Can, an addiction treatment centre, and Jordan was quickly admitted through their connections.

    "He was on a road to recovery. He had gone to rehab, he was doing amazing," Shuster said. Then Jordan learned that two of his friends that he'd met at rehab had died — and he relapsed.

    "He went out and what he thought he was purchasing was heroin," she said.

    continued below

    ReplyDelete
  178. Jordans autopsy report showed he had ingested 100 per cent pure fentanyl.

    "He didn't have a chance."

    Shuster points to Jordan as an example of the toxic drug crisis being pervasive across British Columbia and not confined to Vancouver's Downtown East Side.

    The family lived in Vancouver's west side and Jordan attended private school through to Grade 12.

    So many of the people who are dying are teenagers and young adults, struggling with mental health problems and using on their own, Shuster said.

    The day he died, Jordan was found by his girlfriend, slumped over the bathtub in the basement apartment the two shared at his parents' house.

    Shuster believes he, and countless other young people who have died since 2016, used drugs as a coping mechanism.

    "They're not there to get high and to party," said Shuster. "They're self-medicating to ease the pain and escape."

    On Wednesday, Shuster and other mothers, fathers, family members and friends will be wearing purple and gathering to honour the loved ones they've lost.

    B.C. Place, Rogers Stadium, Science World, Burrard Street Bridge, City Hall and other locations around the city will shine purple lights as part of overdose awareness day.

    "And also all along Robson Street there's ribbons tied all over the place with our kids names," she said.

    On the ribbon for Jordan, Shuster will provide details about her son: "Telling people: He was 25. He was an electrician. He had a live-in partner. He had siblings, friends, family."

    Across Metro Vancouver there will be several events offering training in first aid and handing out naloxone kits — a drug used to temporarily counteract opioids. There will be rallies calling for safe supply, organizations handing out testing kits and tested drugs as well as candlelight vigils remembering those who have died.

    "Our goal is just to raise awareness, stop the stigma and save lives," said Shuster.

    "Every minute, every hour, I think of my son."

    https://www.cbc.ca/news/canada/british-columbia/overdose-awareness-day-vancouver-1.6567644

    ReplyDelete
  179. B.C. compassion club hands out hard drugs in bid to save lives, despite Health Canada rejection

    by Amy Smart · The Canadian Press · August 31, 2022

    Organizers of a Vancouver compassion club say they will continue to distribute tested cocaine, heroin and methamphetamine despite a rejection from Health Canada, calling it the only way to save lives in the face of a toxic drug supply.

    Eris Nyx, co-founder of the Drug User Liberation Front (DULF) — a collective of advocacy groups working to ensure a safe supply of drugs — said regulating the illicit supply is the answer to stopping drug toxicity deaths, which have topped 10,000 in British Columbia since the province declared a public health emergency more than six years ago.

    "These people are our friends, our community members, people we love, people we care about very deeply and we're losing them every day. And the driving cause of these deaths is the deregulated and unpredictable illicit drug market,'' Nyx said Wednesday.

    Nyx spoke at a news conference marking International Overdose Awareness Day, saying the groups are also seeking a judicial review of the Health Canada decision, on the basis that it didn't consider charter rights to life and equality.

    DULF and the Vancouver Area Network of Drug Users requested the temporary Criminal Code exemption from Health Canada to operate a compassion club model for hard drugs last year. It was rejected July 29.

    Nonetheless, Nyx said the Cocaine, Heroin and Methamphetamine Compassion Club and Fulfilment Centre has operated for one month, distributing 201 grams of drugs with no overdoses or deaths.

    The group is pursuing a "do-it-yourself" model of community regulation that Nyx said could be scaled up across the province with approval.

    "What we have is a problem of regulation. What we have is a failure of the regime of prohibition. And that failure does not make it a criminal issue or a medical issue, that failure makes it a political issue,'' Nyx said.

    Health Canada could not immediately be reached for comment, but a statement commemorating Overdose Awareness Day said the government is investing in safe supply programs, supervised consumption sites and drug checking technologies.

    Last year was the worst year on record for opioid-related overdoses in Canada, with about 21 people dying every day, said Health Minister Jean-Yves Duclos and Carolyn Bennett, minister of mental health and addictions, in the joint statement.

    British Columbia is set to become the first province in Canada to decriminalize the possession of small amounts of hard drugs in January, after receiving a federal exemption in May.

    It means those 18 and over will not face criminal penalties for possessing a total of 2.5 grams of opioids, cocaine, methamphetamine and MDMA, also known as ecstasy.

    However, speakers at the virtual news conference Wednesday said the amount is insignificant, and means those who work to distribute safe supply will still be criminalized.

    "Imagine if alcohol prohibition had continued and the entire illicit alcohol supply was unpredictable to the point that if you open a bottle or a can of alcohol and drank from it, it could kill you,'' Nyx said.

    "The government's response, the equivalent response, would be that you can go to your doctor and be prescribed three light beers. That is a non-sense scenario. We need to change the way we approach this crisis.''

    Fred Cameron, of SOLID Outreach Society in Victoria, said the skyrocketing deaths since the 1990s show the problem is with the supply.

    "What's different about then and now — there was not better abstinence supports or better consumption services. The dope was not poisonous,'' he said.

    "There's one major issue that's causing all of this and we're addressing everything but, as a system.''

    continued below

    ReplyDelete
  180. People will always use drugs, he said, so the priority should be ensuring the drugs are as safe as possible.

    The news conference was one of many events across B.C. and Canada acknowledging Overdose Awareness Day. Metro Vancouver landmarks were set to be lit up in purple to mark the day, while lost lives were to be memorialized at Holland Park in Surrey, about an hour's drive southeast of Vancouver.

    Sheila Malcolmson, B.C.'s minister of mental health and addictions, issued a statement, saying it was a day to mourn with the families and friends who have lost loved ones.

    "That loss is shared by peer workers, paramedics, firefighters, police officers and all those on the front lines of this terrible crisis,'' the statement said.

    Increasing toxicity is outpacing the addition of overdose prevention services, despite an unprecedented number of new treatment and harm-reduction services, it said.

    The B.C. Civil Liberties Association called for the full decriminalization of all drug possession for personal use, as well as the sharing or selling of drugs for subsistence, to support personal drug use costs or to provide a safe supply.

    The Union of B.C. Indian Chiefs noted that First Nations people were 5.4 times more likely to fatally overdose than others and said the crisis is a symptom of unaddressed, long-term problems.

    "We call for safe and affordable housing, mental and physical health systems free from racism and discrimination, accessible socio-economic services to support people in crisis, and a full spectrum of culturally appropriate substance-use services to meet the needs of all people who use drugs,'' Grand Chief Stewart Phillip said in a statement.

    https://www.cbc.ca/news/canada/british-columbia/compassion-club-hands-out-hard-drugs-1.6568839

    ReplyDelete
  181. Brother of overdose victim plans to open brick-and-mortar store selling hard drugs in Vancouver

    by Josh Grant · CBC News · January 11, 2023

    As the possession of small amounts of hard drugs is set to be decriminalized in B.C. at the end of the month, one man says he wants to take safe supply to another level.

    A three-year pilot project approved by Health Canada will decriminalize the possession of up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA in the province starting Jan. 31 for British Columbians age 18 and older.

    Jerry Martin, 51, says he plans to open a brick-and-mortar store in Vancouver's Downtown Eastside to sell heroin, cocaine, methamphetamine, and other substances he says will be tested and be safer for consumption than drugs bought on the street.

    Even if the province says it's not legal.

    After spending 15 years on the street and getting sober from hard drugs, Martin says he feels he has a duty to help end the stigma around drug users and people on the Downtown Eastside, especially since his brother died of an overdose a couple of months ago.

    He says every day a store like the one he envisions is not open is another day people are dying, or are in danger.

    According to the latest data from the B.C. Coroners Service, 14,000 people have died since the province declared a public health emergency over the opioid and toxic drug crisis in 2016.

    "Opioids and dying from those sort of things, it's a major part of the crisis but that's not the only part," he said.

    He adds that "predators" on the Downtown Eastside often take advantage of people using and purchasing hard drugs.

    "Getting robbed, getting sold something that isn't what it should be — fear and violence is the number one."

    By having the drugs tested, Martin not only hopes to prevent overdoses and deaths, but also offer a safe place for people struggling with addiction.

    He says his plan is to sell only to adults and offer 2.5 grams at a time.

    Every purchase will also come with a bit of education: Martin says he'll warn customers about the dangers of using drugs, and direct them toward neighbourhood resources that can help them get clean, give them a place to spend the night, or offer something to eat.

    But B.C.'s Ministry of Mental Health and Addictions says the decriminalization of people who use drugs is not the same as legalization.

    "Mr. Martin's project is not within the scope of decriminalization," the ministry said in an email statement. "The selling (or trafficking) of controlled substances remains illegal."

    The ministry says police will maintain the ability to enforce laws pertaining to drug trafficking after Jan. 31.

    Dana Larsen, a cannabis and drug policy reform activist, says he thinks Martin's idea will catch on.

    "I think it's a good idea," Larsen told Radio-Canada. "To try to create the safe drug supply it seems everyone agrees we need, but it's not being created by government or anyone else."

    In 2019, Larsen founded Get Your Drugs Tested, a free testing site on East Hastings Street. Martin says he hopes to get the drugs for his future store tested at Larsen's site.

    Larsen says he anticipates a number of similar projects to pop up across the city in the next year.

    He adds that on the streets, heroin has almost been completely replaced by fentanyl.

    "These things should be getting tested beforehand," Larsen said.

    "They should be labelled, and people should know what they're getting beforehand, like with any other substance."

    While his business model has been mapped out, Martin is still looking for a commercial rental space, he says.

    Though he isn't sure when he'll be able to open — and though he also fully expects police to arrest him and close down the shop once he does — he's adamant he'll follow through on his plan.

    "It's just helping people," he said.

    "I don't feel like I'm me unless I'm doing that."

    https://www.cbc.ca/news/canada/british-columbia/jerry-martin-hard-drug-store-vancouver-1.6711271

    ReplyDelete
  182. What you need to know about the decriminalization of possessing illicit drugs in B.C.

    by Akshay Kulkarni · CBC News · January 30, 2023

    Starting Tuesday, it is no longer a criminal offence to possess small amounts of certain illicit drugs in B.C. for people aged 18 or above.

    It's part of a three-year pilot by the federal government, which granted B.C. an exemption from the Controlled Drugs and Substances Act (CDSA) on May 31, 2022.

    While advocates for drug users say decriminalization alone won't stop thousands of people dying from a tainted drug supply, others say it is a step in the right direction when it comes to how drug users are treated.

    Here's what you need to know about B.C.'s drug decriminalization pilot.

    Which drugs are included in the pilot?

    Under the exemption, up to 2.5 grams of the following four drug types can be legally possessed:

    Cocaine (crack and powder).
    Methamphetamine.
    MDMA.
    Opioids (including heroin, fentanyl and morphine).

    Fentanyl and its analogues were detected in nearly 86 per cent of drug toxicity deaths from 2019 until 2022, according to the latest report from the B.C. Coroners Service.

    How long will the pilot last?

    The exemption pilot is set to last for three years until Jan. 31, 2026, unless it is revoked or replaced before then.

    A Health Canada spokesperson said the federal government will monitor the pilot throughout its duration to gauge its effectiveness.

    On Monday, Carolyn Bennett, the federal minister of mental health and addictions, said the government plans to collect data on health, criminal justice interactions, public safety and other indicators throughout the next three years. That information will eventually be available to the public through an online dashboard updated quarterly, she said.
    Does this mean those drugs can be sold legally?

    No. Anyone caught selling drugs or trafficking them will still face criminal penalties in B.C.

    Trafficking illegal drugs or possessing them for the sake of trafficking (not for personal use) could land a person in prison.

    What is still criminal when it comes to drug use?

    Possessing illegal drugs at schools, child-care facilities, and airports remains illegal.

    Multiple municipalities, including Vancouver, have bylaws that prohibit drug use at city facilities and private areas like malls or cafes.

    "However, adults removed from private establishments would not be subject to federal criminal charges for their personal possession of up to 2.5 grams of the illegal drugs listed in the exemption," the B.C. ministry of mental health and addictions said.

    continued below

    ReplyDelete
  183. How will the police enforce the threshold?

    According to officials, police have been provided with infographics and photos illustrating what 2.5 grams of the decriminalized drugs might look like.

    To determine which drugs are in someone's possession, officers are being instructed to simply ask the drug user what they believe the substance to be.

    The province has developed a training process for police that many departments, including the RCMP and Vancouver Police Department, have made mandatory for all officers.

    The government says police will not seize any drugs they find on an adult.

    "Instead, they will be offered information about health and social supports, including local treatment and recovery services, if requested," the government said in a statement.
    Why 2.5 grams?

    When the province first applied for an exemption under the Controlled Drugs and Substances Act in November 2021, it sought a threshold of 4.5 grams.

    The federal government lowered the threshold to 2.5 grams when they granted the exemption, citing feedback from law enforcement officials across B.C.

    Addictions Minister Carolyn Bennett said the threshold was a "starting point" that can be adjusted as needed.

    However, drug users have said both thresholds were far too low, given how most people consume substances.

    How did we get here?

    When B.C. first applied for the exemption in 2021, it was five years after a public health emergency was declared due to the spike in fatal overdoses resulting from a poisoned drug supply.

    More than 10,000 B.C. residents have died since the emergency was declared in 2016.

    Politicians and advocates have argued that decriminalizing drug use would remove the stigma associated with it and treat the crisis as a health issue rather than a criminal one.

    However, others — including B.C. Chief Coroner Lisa Lapointe — have said that decriminalization won't do much to stop people from dying and that only an accessible, safe supply of drugs would do so.

    See the charts and links embedded in this article at:
    https://www.cbc.ca/news/canada/british-columbia/what-you-need-to-know-drugs-british-columbia-1.6727814

    ReplyDelete
  184. 7 years into crisis, politicians still struggle to see drug users as people, Dr. Bonnie Henry says

    by Bethany Lindsay · CBC News · March 07, 2023

    As nearly seven people continue to die each day from B.C.'s poisoned drug supply, Provincial Health Officer Dr. Bonnie Henry says politicians are still grappling with the concept that drug users deserve to be treated like people.

    In a wide-ranging interview with CBC News, Henry described the toxic drug crisis as "the most challenging issue that I've ever dealt with in public health."

    One of the biggest issues when it comes to public policy, she said, is getting elected officials to shift their thinking after a century of prohibition and criminalization of drug users.

    "It has been really difficult for politicians to wrap their heads around," Henry said. "These are people."

    In the almost seven years since a public health emergency was declared in B.C. over illicit drug deaths, the provincial health officer says minds are beginning to change about how to approach the problem, but "slowly, too slowly."

    "We're recognizing that people who use drugs are people first," she said. "They're our friends, our family, they're our colleagues, they're our neighbours."

    Her words echo those of Chief Coroner Lisa Lapointe, who has said it's been a struggle to move public policy away from an ideology that suggests the only way to help drug users is to "harm them as much as we can."

    Vince Tao, a community organizer for the Vancouver Area Network of Drugs Users (VANDU), said it's not just politicians who have trouble seeing drug users as human; it's also academics, researchers, police and the media.

    "She's not wrong, but I would say, with all due respect, that's her job, right?" he said of Henry's comments. "Her job is to make sure that her colleagues, her cohort, understands the severity of the crisis at hand."

    Tao believes real change requires more than just viewing drug users as human. He said it also requires allowing them and other marginalized people to have power and a voice in how decisions are made.

    Henry spoke with CBC News to mark three years of the COVID-19 pandemic, another public health emergency that has led to an ever-increasing number of deaths from toxic drugs.

    On Tuesday, Lapointe's office released the latest numbers on the drug crisis, revealing that 211 people were killed by illicit drugs in January. The death rate that month was 47 people per 100,000, more than double what it was in April 2016, when the public health emergency was declared.

    continued below

    ReplyDelete
  185. Henry said it was distressing to watch as more people began using alone because of public health restrictions related to the pandemic. Other measures also caused the illicit drug supply to become increasingly dangerous.

    "Because of international trade being interrupted and people making large batches on their own at home, there's no quality assurance to any of it, so things got dramatically worse," Henry said.

    That includes a major spike in the deaths among men aged 30 to 59, many of whom had jobs and were using at home, without the knowledge of their families.

    But Henry said the pandemic also created some opportunities. Public health officials had to work closely with elected officials on how to deal with COVID-19, which resulted in more trust and openness to new ideas.

    As an example, she pointed to a three-year pilot project decriminalizing personal possession of very small amounts of some drugs in B.C.

    When Henry released a report in 2019 calling for similar measures, "it was dismissed by government," she said.

    "Having built that relationship of trust through the pandemic enabled us to have a conversation and to go back and say, look, read this again, let's think about this," she said.

    That the province went on to apply for an exemption from federal drug laws, and that some version of decriminalization was approved is "a massive step forward" in Henry's mind.

    "They call it a pilot program. I cannot see us going back from this," she said. "What we need to do is ensure that it is implemented, that we take the criminal justice system out of people's lives."

    She said she's spoken to mothers who are afraid to ask for help with addiction because they're scared of being labelled as criminals and losing their children. Henry hopes decriminalization will take away some of those fears.

    But B.C. still has a long way to go in terms of policies to stop the flood of drug deaths, she added.

    That includes expanding access to prescribed safer supply, which is still reaching only a small percentage of drug users and is not available in many communities.

    It also includes reforming the treatment and recovery system, which is not subject to provincial regulation ensuring facilities are using evidence-based methods and employing qualified staff.

    "We have no system," Henry said. "There's never been a system to understand who's in there, how well they do, how often people relapse."

    In the end, though, the drug crisis isn't just about drugs in Henry's mind. It's about overlapping, systemic issues including B.C.'s fragmented mental health-care system, homelessness and incomes that don't cover the cost of living in this province.

    "It is more than just one thing," she said.

    https://www.cbc.ca/news/canada/british-columbia/bc-bonnie-henry-toxic-drug-crisis-1.6771279

    ReplyDelete
  186. Vancouver club will continue to distribute hard drugs in bid to save lives, despite Health Canada rejection

    Drug User Liberation Front says regulating illicit supply will prevent further deaths

    by Amy Smart · The Canadian Press · Aug 31, 2023

    Organizers of a Vancouver compassion club say they will continue to distribute tested cocaine, heroin and methamphetamine despite a rejection from Health Canada, calling it the only way to save lives in the face of a toxic drug supply.

    Eris Nyx, co-founder of the Drug User Liberation Front (DULF) — a collective of advocacy groups working to ensure a safe supply of drugs — said regulating the illicit supply is the answer to stopping drug toxicity deaths, which have topped 10,000 in British Columbia since the province declared a public health emergency more than six years ago.

    "These people are our friends, our community members, people we love, people we care about very deeply and we're losing them every day. And the driving cause of these deaths is the deregulated and unpredictable illicit drug market,'' Nyx said Wednesday.

    Nyx spoke at a news conference marking International Overdose Awareness Day, saying the groups are also seeking a judicial review of the Health Canada decision, on the basis that it didn't consider charter rights to life and equality.

    DULF and the Vancouver Area Network of Drug Users requested the temporary Criminal Code exemption from Health Canada to operate a compassion club model for hard drugs last year. It was rejected July 29.

    Nonetheless, Nyx said the Cocaine, Heroin and Methamphetamine Compassion Club and Fulfilment Centre has operated for one month, distributing 201 grams of drugs with no overdoses or deaths.

    The group is pursuing a "do-it-yourself" model of community regulation that Nyx said could be scaled up across the province with approval.

    "What we have is a problem of regulation. What we have is a failure of the regime of prohibition. And that failure does not make it a criminal issue or a medical issue, that failure makes it a political issue,'' Nyx said.

    Health Canada could not immediately be reached for comment, but a statement commemorating Overdose Awareness Day said the government is investing in safe supply programs, supervised consumption sites and drug checking technologies.

    Last year was the worst year on record for opioid-related overdoses in Canada, with about 21 people dying every day, said Health Minister Jean-Yves Duclos and Carolyn Bennett, minister of mental health and addictions, in the joint statement.

    continued below

    ReplyDelete
  187. British Columbia is set to become the first province in Canada to decriminalize the possession of small amounts of hard drugs in January, after receiving a federal exemption in May.

    It means those 18 and over will not face criminal penalties for possessing a total of 2.5 grams of opioids, cocaine, methamphetamine and MDMA, also known as ecstasy.

    However, speakers at the virtual news conference Wednesday said the amount is insignificant, and means those who work to distribute safe supply will still be criminalized.

    "Imagine if alcohol prohibition had continued and the entire illicit alcohol supply was unpredictable to the point that if you open a bottle or a can of alcohol and drank from it, it could kill you,'' Nyx said.

    "The government's response, the equivalent response, would be that you can go to your doctor and be prescribed three light beers. That is a non-sense scenario. We need to change the way we approach this crisis.''

    Fred Cameron, of SOLID Outreach Society in Victoria, said the skyrocketing deaths since the 1990s show the problem is with the supply.

    "What's different about then and now — there was not better abstinence supports or better consumption services. The dope was not poisonous,'' he said.

    "There's one major issue that's causing all of this and we're addressing everything but, as a system.''

    People will always use drugs, he said, so the priority should be ensuring the drugs are as safe as possible.

    The news conference was one of many events across B.C. and Canada acknowledging Overdose Awareness Day. Metro Vancouver landmarks were set to be lit up in purple to mark the day, while lost lives were to be memorialized at Holland Park in Surrey, about an hour's drive southeast of Vancouver.

    Sheila Malcolmson, B.C.'s minister of mental health and addictions, issued a statement, saying it was a day to mourn with the families and friends who have lost loved ones.

    "That loss is shared by peer workers, paramedics, firefighters, police officers and all those on the front lines of this terrible crisis,'' the statement said.

    Increasing toxicity is outpacing the addition of overdose prevention services, despite an unprecedented number of new treatment and harm-reduction services, it said.

    The B.C. Civil Liberties Association called for the full decriminalization of all drug possession for personal use, as well as the sharing or selling of drugs for subsistence, to support personal drug use costs or to provide a safe supply.

    The Union of B.C. Indian Chiefs noted that First Nations people were 5.4 times more likely to fatally overdose than others and said the crisis is a symptom of unaddressed, long-term problems.

    "We call for safe and affordable housing, mental and physical health systems free from racism and discrimination, accessible socio-economic services to support people in crisis, and a full spectrum of culturally appropriate substance-use services to meet the needs of all people who use drugs,'' Grand Chief Stewart Phillip said in a statement.

    https://www.cbc.ca/news/canada/british-columbia/compassion-club-hands-out-hard-drugs-1.6568839

    ReplyDelete
  188. Toxic drugs killing First Nations residents in B.C. at nearly 6 times the rate of overall population: report

    373 First Nations people died from illicit toxic drugs in B.C. in 2022: Toxic Drug Data report

    by Angela Sterritt · CBC News · Apr 21, 2023

    First Nations people are disproportionately represented in toxic drug poisoning deaths in British Columbia, according to new data from the First Nations Health Authority.

    First Nations members represented 16.4 per cent of toxic drug deaths in B.C. in 2022, despite making up only 3.3 percent of the province's population, according to the FNHA's Toxic Drug Data report.

    It shows that 373 First Nations people lost their lives to drug toxicity last year, meaning First Nations people are dying from toxic drugs at 5.9 times the rate of the general population.

    At a news conference in Vancouver on Friday, FNHA acting chief medical officer Dr. Nel Wieman described 2022 as "the most devastating year for First Nations people."

    "We've lost too many loved ones to the toxic drug supply," Wieman said.

    The report comes on the heels of preliminary data released by the B.C. Coroners Service that showed almost 600 people in B.C. died in the first three months of 2023 because of the toxic drug supply.

    At least 11,807 lives have been claimed by toxic drugs since a public health emergency was declared over the issue seven years ago.

    Wieman said more than a third of the First Nations victims in 2022 — 36.5 per cent — were women, meaning First Nations women are dying at 11.2 times the rate of female B.C. residents as a whole. Less than a quarter of all toxic-drug deaths in B.C. in the first three months of 2023 were women.

    But men, at 63.5 per cent, still make up most of the toxic-drug deaths among First Nations.

    One of those taken was Darius Smallboy, a 23-year-old Cree youth living in Vancouver.

    "My son had such a loving and caring spirit," said Rex Smallboy, who is originally from Maskwacis, Alta.

    Darius left behind three sisters, a mom and a community in East Vancouver that thought the world of him, according to several online posts in his memory. He was a powwow drummer, a singer and a young man known for his big heart.

    "[He] showed me that you could be strong and still be taken away," Smallboy said through tears, while talking to CBC before the news conference.

    During a trip home from a visit with his maternal family when he was 21, Darius slipped on some ice and broke his collarbone.

    "And that's when everything changed," said Smallboy. After his surgery, he became addicted to painkillers.

    Smallboy said he was unaware of how deeply entrenched his son was in substance use, even though he noticed small changes over the years.

    "As a parent, I was in denial. I didn't want to see my son in that light. And his death, he showed me this is the ugly truth."

    Now Smallboy wants to open up conversations about addiction among Indigenous people, men in particular, and make them feel safe to express emotions like grief.

    "That whole side of colonialism taught us how to be tough and not express our feelings and not to have needs," he said.

    continued below

    ReplyDelete
  189. The FNHA says intergenerational trauma from surviving "the residential school system and other racist federal government and provincial government policies, including the Sixties Scoop, are for many a deeply rooted cause of harmful substance use."

    "My son showed me that the most beautiful person is not safe. It is a part of being hurt," said Smallboy.

    During the news conference, Wieman said the drug-poisoning crisis is the worst it has ever been.

    "We have to treat this as it is — a public health emergency," she said.

    "It's sad, and it actually makes me angry," said Chris Livingstone, interim executive director of the Aboriginal Front Door Society, a safe place for Indigenous people in Vancouver's Downtown Eastside.

    Livingstone started the Western Aboriginal Harm Reduction Society in 2002 when he says he was living on the street and a drug user.

    "As an Indigenous person and someone that is down here, I can recognize the disconnection," said Livingstone, who is Nisga'a from Laxgalts'ap.

    "You're disconnected from your family and your culture. There's no access to housing, and the supports out there are not enough to help people make changes in their lives," he said.

    He also says in the bigger picture, policy changes are still needed to address the crisis.

    "There's a certain amount of drugs making their way into this country, so there should be a way for us to find out where they are coming from and stop that part of it," Livingstone said.

    "Even before that, doctors, nurses and health-care professionals need to get a real safe supply to the people."

    He says people in the Downtown Eastside access safe supply through the Rapid Access Addiction Clinic at St. Paul's Hospital. But he says he doesn't know anyone who has succeeded in addressing their addiction through the program.

    He thinks the program needs to be expanded to serve a diversity of needs. He also believes that Indigenous people could benefit from land-based programs to help them reconnect with their culture, people and land.

    https://www.cbc.ca/news/canada/british-columbia/first-nations-overrepresented-toxic-drug-deaths-1.6817428

    ReplyDelete
  190. Vancouver police arrest man operating drug dispensary in Downtown Eastside

    by Eva Uguen-Csenge · CBC News · May 04, 202

    Vancouver police officers have arrested a man a day after he began operating an illicit drug dispensary in the Downtown Eastside.

    According to a police statement, the 51-year-old man has been arrested for drug trafficking after he started selling cocaine, crack, methamphetamine and heroin out of a mobile trailer parked near the intersection of Main and Cordova streets.

    The VPD said it could not name the individual as no charges have been laid.

    Wednesday, CBC News spoke with Jerry Martin about the launch of his mobile drug store.

    Martin told On the Coast host Gloria Macarenko that he planned to sell illicit drugs in small quantities, up to a maximum of 2.5 grams.

    "Providing a safe, clean supply is going to hopefully stop a lot of the overdoses and a lot of the injuries and stop girls from having to do certain things just to get their drugs," he said.

    Earlier this year, a three-year pilot project approved by Health Canada decriminalized the possession of up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA for British Columbians age 18 and older.

    Police spokesperson Const. Tania Visintin stated in a statement that the VPD supports harm reduction services and decriminalization.

    "However, we remain committed in our position that drug trafficking will continue to be the subject of enforcement."

    Police say they seized two vehicles, body armour, and Canadian currency as part of the ongoing investigation.

    They say the man who was arrested has been released from custody pending his next court appearance on the condition he stay away from the Downtown Eastside.

    Martin told CBC News that he was prepared to be arrested once the store opened. In fact, he said one of his goals, if arrested, was to launch a constitutional challenge arguing for a legal safe supply of drugs.

    "They've called for a clean, safe supply, the police and the government," he said. "So I'm hoping that they just let me do what they need to do. I mean, they should have done this themselves."

    In an email, the City of Vancouver's chief licence inspector said the municipality will not issue business licences for the sale of illicit drugs such as heroin, cocaine, and methamphetamine.

    "Should the City be made aware of a retailer selling any of these substances or products containing them, they would be subject to enforcement for operating without a valid development permit and/or business licence, which may include orders, fines and/or prosecution," wrote Sarah Hicks.

    https://www.cbc.ca/news/canada/british-columbia/drug-dispensary-arrest-1.6832669
    Dozens of people lined up at the entrance to the mobile drug store parked at Main and Cordova to buy drugs Wednesday afternoon.

    ReplyDelete
  191. Supervised inhalation sites take surprising forms in B.C. amid challenges setting them up

    by Kate Partridge · CBC News · April 28, 2023

    A glass enclosure that looks like a bus stop. A repurposed ice-fishing tent in a car park.

    While they might look trivial in the face of a mounting toxic drug crisis, these consumption sites designed for smoking substances are saving lives, overdose prevention workers say — and are doing so despite the financial and bureaucratic challenges setting them up.

    Almost 5,000 people have died from toxic drugs in British Columbia in the past two years alone, according to the provincial coroners' service.

    At least half of them were smoking the substances that killed them — and that proportion is growing, says Jordan Stewart, executive director of the Pounds Project.

    The overdose prevention service in Prince George, B.C., currently offers supervised injection services, and Stewart says it now has support for an outdoor space that includes a small shed dedicated to smoking. When established, it will be the first official supervised inhalation site in the city in two years.

    Stewart says there are many reasons people prefer inhaling drugs. There is less risk of infection compared to injecting, it's easier to conceal and use and quicker to prepare.

    "Unfortunately, the overdose risk remains exactly the same," she said.

    But health officials, as well as advocates, say it's taking too long for supervised inhalation sites to be set up in response to that reality and that they remain few and far between in many parts of the province.

    Dr. Jong Kim, chief medical health officer for Northern Health, says that's due in part to the initial strategy in dealing with the crisis when a public health emergency was declared in 2016.

    "At the beginning, one of the main focuses was ensuring naloxone was more broadly available ... not necessarily safe consumption, but harm reduction," Kim said.

    Yet, as far back as 2017, smoking was the mode of consuming substances that most often led to death, according to the B.C. Coroners Service.

    In a written response, the Ministry of Mental Health and Addictions says it knows there's "more to do, and won't stop working until all British Columbians can access the supports they need and deserve."

    In the meantime, some service providers are getting creative.

    Behind the Cowichan Valley Wellness and Recovery Centre, a boxy brown building at the edge of downtown Duncan, B.C., is a structure that could be mistaken for an out-of-place bus stop.

    In reality, it's a purpose-built smoking room designed for supervised consumption.

    While not fully indoors, the room has four walls and a powerful ventilation system.

    Jessica Huston, Island Health operations manager for substance use services, says it sucks the smoke from the space through pipes that extend well above the roof of the multiple-storey building, keeping users, workers, and their neighbours safe from any incidental contact.

    Huston says the centre sees 350 to 450 people a week in the space. Staff monitor people through the glass and administer Naloxone if they are in medical distress. They estimate they reverse an average of three to five overdoses a week.

    continued below

    ReplyDelete
  192. The recovery centre is operated by Island Health and receives funding for some services through Health Canada.

    But Huston says it's a struggle to expand its services and pay additional staff with its current budget, which is made up of a patchwork of funding sources from the health authority and grants from various organizations. The services are only available for limited hours as a result.

    In Fort St. John in the north of the province, an insulated tent marketed to ice fishers pops up in various parking lots as a makeshift supervised consumption site.

    It's part of Northern Health's mobile overdose prevention service (OPS).

    Rakel Kling, medical health officer for Northern Health, calls it an "alternative option" to an indoor site — and, she admits, an imperfect one.

    "With so much snow and cold, it's really hard to ensure appropriate services in an outdoor space … it can put people at risk of cold injuries," said Kling.

    Daytime temperatures in the Peace Region frequently plummet to –30 C in the winter months, and frostbite can occur within minutes.

    A Northern Health-operated van that provided additional support was destroyed by fire last fall and has yet to be replaced.

    But the authority says it has continued to provide services, and Kling says Northern Health is now working on establishing a full indoor site in Fort St. John, having chosen a central location that's close to other services.

    However, it's not the first time the health authority has been in this position. A previous plan for an indoor inhalation OPS went nowhere after the landlord pulled the permitting application without warning, delaying the opening by years.

    There's hope that the Pounds Project site will offer a similar service again in Prince George after the city shut down an outdoor area behind a building shared by multiple agencies providing harm reduction and overdose prevention in 2021, citing fire safety concerns.

    There hasn't been a sanctioned supervised inhalation service in the city since.

    Stewart says the RCMP, fire department, city bylaw services and the property's landlord are all on board with the plan for the new space and shed. Construction is set to begin this summer.

    "This time around, we really did our best to be super thorough in planning and brought as many involved parties to the table as we could to make sure we got off on the right foot," Stewart said.

    In the absence of a designated space, she said, people often congregate on the sidewalks outside the Pounds Project and knock on the window when they need staff to respond to an overdose.

    Stewart said the cost of setting up an indoor service is prohibitively expensive for non-profits like the Pounds Project, but the smoking shed is a step forward.

    "Having a designated space where [there are] benches and picnic tables and flowers and staff to say hi to… is preferable to having to sit on a sidewalk," she said.

    https://www.cbc.ca/news/canada/british-columbia/smoking-substances-solutions-toxic-drug-crisis-1.6823856

    ReplyDelete
  193. Thousands of Canadian drug users dying as government red tape limits help, advocates say

    by Jonathon Gatehouse, Kimberly Ivany, Marnie Luke · CBC News · July 13, 2023

    The historic core of Cobourg, Ont., brims with small-town charm. There are stately buildings, quaint shops and old-fashioned iron lampposts decorated with hanging flower baskets. The local business authority even coined a hashtag, "#8BlocksofAwesome."

    But on Friday nights, just steps off the postcard main street, another side of life comes into view. Volunteers are setting up camp chairs and folding tables in an alleyway and laying out supplies, including alcohol swabs, plastic pipes and naloxone kits to be used in case of overdoses. All for an unsanctioned, pop-up safe site for local drug users, specifically geared to people who inhale rather than inject.

    "It just seemed that there was more and more need, and more and more people dying," said Ashley Smoke, one of the organizers. "There's just so many people that are struggling and no one to help."

    Cobourg, home to 20,000 on the shore of Lake Ontario east of Toronto, has had a dozen fatal overdoses over the past 18 months. The nearest official safe consumption site is in Peterborough, almost 60 kilometres away. And like all government-funded harm reduction facilities in Ontario — and most of the rest of the country — it doesn't permit drug smoking, just injection, oral and nasal use.

    Smoke said the cost of not having supervised spaces for those who inhale drugs can be seen in Canada's near-record overdose numbers.

    "The consequences have been death. A lot of people have lost their lives. There's just so much loss and grief," they said.

    In 2022, more than 7,300 Canadians died of apparent opioid overdoses, with 87 per cent of those deaths occurring in British Columbia, Alberta and Ontario.

    Overdose prevention has become a pillar of government efforts to combat the opioid epidemic, with a growing, national network of safe consumption sites approved by the federal government and funded by the provinces and territories.

    Yet even as this system expands, it's failing to meet the needs of drug users because it largely excludes inhalation — the most common method of consumption, advocates and experts say.

    "What the country is really lacking is the indoor inhalation sites," said Patrick McDougall, a Vancouver-based harm-reduction specialist who helps community groups across the country set up consumption sites.

    "There's not some safe and secure places for folks to be using right now, unlike what we have with injection."

    In B.C., there have been 3.87 million visits to safe sites since 2017, according to the Ministry of Mental Health and Addictions, with 25,000 overdoses and just one death. That compares to 2,342 fatal overdoses in homes and on the streets in 2022.

    Studies suggest that adding inhalation spaces would save additional lives.

    Only B.C. and Ontario keep statistics on the mode of consumption associated with drug deaths, but the trend towards smoking is both clear and longstanding.

    In British Columbia, inhalation overtook injections back in 2017, causing 56 per cent of drug deaths in 2021. Ontario's numbers flipped five years ago, with smoking accounting for 68 per cent of fatalities by late 2022.

    continued below

    ReplyDelete
  194. But there remain only five approved indoor inhalation sites across the country, versus almost 50 focused on injection .

    The reasons why appear to be mostly bureaucratic.

    "In my opinion, it's red tape," said McDougall. "And I think the consequence is what we're seeing now: six deaths a day in British Columbia, 20 deaths a day in Canada … several times what you might get from motor vehicle accidents and suicides and other forms of death combined."

    Health Canada will exempt inhalation sites from federal drug laws, demanding the same safeguards as for injection or other uses, a process that usually takes just a few weeks with community support. But things appear to bog down at the provincial level.
    $10,000 to build, 18 months to approve

    Ontario has one sanctioned smoking site, a small room that exclusively serves clients of Casey House, a specialized HIV hospital in Toronto. It was simple to build, said Joanne Simons, the hospital's CEO.

    "What we needed to install was just a really big fan that could blow the smoke out as quickly as possible," she said. The construction cost about $10,000 and was covered by hospital donors, as are the room's ongoing operating costs.

    However, even without taxpayer funds on the line, the approval process took 18 months.

    "The piece that seemed to be the barrier initially was around the Smoke Free Ontario Act because you can't smoke obviously within a public facility, especially a hospital," said Simons. "And that took some time to understand from the government's perspective whether they were going to allow us to have people use illicit drugs in this space."

    Now that such questions have been answered, Simons is hopeful that future approvals will be faster.

    But other significant bureaucratic hurdles remain, especially for safe sites that receive provincial funding.

    Kerri Kightley is the manager of consumption treatment services for a facility in Peterborough, Ont., a city of 135,000 people that experienced 59 overdose fatalities in 2022 and 38 more over the first six months of this year. Her safe site serves as many as 70 users a day, a number she estimates would at least triple if smoking were permitted.

    "There's been a dramatic shift away from injection use and towards inhalation use and the provincial government just hasn't caught up to that," said Kightley.

    Under the existing funding agreement with the province, Ontario safe sites must use their government money to support injection, oral and nasal drug use and nothing else. Even using the same supplies, space or staff to facilitate smoking might be a breach.

    "The requirements prevent us from using the provincial funds towards anything other than what we're approved for," said Kightley. "It's a bit complicated."

    CBC News made repeated requests for an interview with Sylvia Jones, Ontario's minister of health, but did not receive a reply from her office or the ministry.

    We also asked the Alberta government about its plans for supervised inhalation sites. The province's only smoking area, part of a facility in Lethbridge, closed in 2020, after a provincial audit found evidence of financial mismanagement.

    continued below

    ReplyDelete
  195. Dan Williams, Alberta's minister of mental health and addiction, provided a statement saying his focus is on treatment and holding criminals "accountable."

    "Our vision for Alberta is one where families have an opportunity to live in healthy communities that are free of illicit drug use and trafficking. Our vision is one where those suffering with addiction have immediate access to treatment," he wrote, pointing to plans for 11 new "recovery communities."

    British Columbia, which began a three-year trial this past winter decriminalizing possession of small amounts of opioids, cocaine and methamphetamine, has also rapidly expanded access to safe smoking, with one indoor facility and 16 indoor-outdoor hybrid sites in tents and other shelters now in operation.

    In April, the inhalation sites recorded more than 35,000 visits, according to the latest update from the Ministry of Mental Health and Addictions.

    But it's not clear how practical such hybrid sites might prove in parts of the country with harsher winters or whether the political climate is favourable to such innovations, with Conservative Leader Pierre Poilievre and his federal party on the attack over harm reduction strategies like safer drug supplies.
    Users told smoking is safer

    All this worries experts like Tara Gomes, a Toronto epidemiologist and principal investigator for the Ontario Drug Policy Research Network.

    Gomes and her colleagues have been tracking the switch to inhalation — a trend fuelled by multiple factors: pandemic isolation, the wear and tear on veins from injecting powerful opioids like fentanyl and public health advice that smoking reduces risk from an increasingly toxic supply.

    She draws a contrast between government response to the COVID-19 pandemic and the opioid crisis.

    "An ongoing concern of many of us who work in this space is just the ability to mobilize funds to be able to make changes to legislation if necessary to react to this emergency. We saw how quickly that could happen in the pandemic," said Gomes.

    "And unfortunately because of the stigma that exists around substance use, this doesn't often have the same level of urgency even though we're losing thousands of people across our country and thousands of people in Ontario every year from this."

    Back in Cobourg, reaction to the pop-up inhalation site has been decidedly mixed.

    When volunteers set up a tent to provide users with privacy, the town council responded by sending out bylaw officers and threatening fines of up to $50,000 for zoning infractions.

    Cobourg police, however, have made it clear that they support sanctioned harm-reduction approaches and will not arrest individuals for simple possession of illicit drugs alone. So far, the table-and-chairs setup has been left alone.

    John, a Friday night smoker whom CBC News is not fully identifying, said he is hopeful that some compromise can be found.

    "The people down here need something. They need somewhere safe to go," he said. Maybe just a trailer down by the beach, he suggested, a place for users to look out for each other.

    "Being out here with kids on the street and the police and everything is just too much," he said. "These people aren't safe out here. They don't have the help that they need."

    https://www.cbc.ca/news/canada/safe-inhalation-sites-canada-1.6903281

    ReplyDelete
  196. Comments on this page have reached the limit. More news reports on this issue are now being posted in the comments on this page of the this blog: Safe Injection Sites - Vancouver
    "The Constitutional Obligation of the City of Vancouver to Support Safe Injection Facilities" https://perry-bulwer.blogspot.com/p/safe-injection-sites-vancouver.html

    ReplyDelete