Drug Addiction

Canada’s Drug Disaster Has a Answer. Politicians Do not Like It. – International Coverage


Sometimes it can be difficult to calculate the human impact of political decisions. Research takes time. Understanding the data and associated noise is a tedious process, and even years of research can lead to covered, verified, and suppressed conclusions if you come to a clear conclusion.

That is why the conclusion of a current study was so striking. It turned out that a trio of measures to combat the opioid overdose epidemic in the Canadian province of British Columbia alone saved an estimated 3,030 lives between April 2016 and December 2017.

The results, published in June in the Addiction journal, are clear confirmation of the provincial government's policies most affected by the epidemic: promoting access to the overdose-reversing drug naloxone, expanding access to naloxone-monitored use or injection sites and access to therapy known as opioid agonist therapy.

The clear evidence of their success took place in a federal election in Canada and spurred those affected on the ongoing crisis to push for more.

The Mayor of Vancouver, Kennedy Stewart, has urged party leaders vying for seats in parliament to take and advocate measures that would allow groups to get safer opioids and distribute them to users in the hope to push contaminated drugs off the streets.

Despite the continuing deaths, the election has hardly focused on the crisis.

Conservative party leader Andrew Scheer, who runs a head-to-head poll with incumbent Prime Minister Justin Trudeau of the Liberal Party, has even spoken out against all forms of harm reduction for opioid users. He abused the Mayor of Vancouver, rejected the proposal, and even promised to withdraw the harm-reduction programs that saved lives. "The government should focus on liberating people from dangerous and harmful narcotics, not on living a life of addiction," Scheer told foreign policy last week.

His position reflects that of President Donald Trump, who is supported by the belief that police and anti-drug campaigns can resolve the crisis.

Foreign Policy traveled to Vancouver to meet with activists and researchers on the front lines of the crisis. They say what is being done will slow the crisis down, but it will not end it. Resetting these guidelines will only make the disaster worse. The solution, they say, stares us in the face – the only thing that stands in the way is the political opposition.

Researchers, healthcare professionals and drug users have reached a bold consensus: the end of the opioid epidemic requires the decriminalization of the drugs responsible for it.

A take-away naloxone kit that temporarily reduces the effects of overdose with opioids. Carlos Osorio / Toronto Star via Getty Images

Ann Livingston has been at the center of the struggle for justice for Vancouver drug users for 20 years. While drug use has long been the order of the day, downtown Eastside was hit by a number of overdose deaths in the early 1990s. It wasn't an increase in consumption, but a new supply of extremely powerful heroin that seemed to be causing death. Over 200 people died from overdoses each year, a 12-fold increase since the late 1980s. The impact of the deaths was compounded by an explosion of HIV and hepatitis C transmission.

However, the governments at that time acted only slowly. They focused on abstinence-based programs and found that overdose deaths would end if they could only discourage drug use.

Livingston’s radical idea was to hit drug users wherever they were and to forego the rules and regulations.

"If you ask for permission and bureaucratic approval, you will never get anything," she told foreign policy.

Livingston, a single mother, tried to offer services to drug users without the city's permission. But without support, these services never got going completely. In 1998 she founded the Vancouver Area Network of Drug Users (VANDU) in a neighborhood park.

As can be read in the VANDU manifesto, the movement fights for nothing less than "the right to procure, prepare and take drugs based on our own personal choices and to get drunk on drugs without criminalization or unwanted interference by other people or organizations as long as our drug use doesn't directly harm other people. "

It served as a vehicle for what Livingston had tried to solo and for what drug users considered necessary. In the years that followed, they established safe injection sites in tents, trailers, and empty buildings so that users could safely consume their medication with clean needles and help with overdoses. Everyone will eventually be shut down by the city or province.

The crisis of the 1990s subsided. Overdoses subsided and eventually decreased. Livingston and VANDU continued to stir and finally the policy makers came by slowly.

In 2003, the Vancouver health agency, with the support of the provincial and federal governments, launched a safe injection site, Insite. It had 12 well-lit, monitored injection areas for users.

In 2006, a new conservative government took power in Ottawa. The new prime minister vowed: "We as the government will not use taxpayers' money to finance drug use." Instead, he prioritized "enforcement, prevention, and treatment." And he tried to stay true to his word, shut down insite. Insite brought him to court.

The matter reached the Canadian Supreme Court, which issued a landmark ruling in 2011, noting that "Insite has been shown to save lives with no apparent negative impact on Canada’s public safety and health objectives" and must remain open Open dozens of such centers across the country.

Ottawa pretended to comply with the judgment, but made the rules so strict that opening new locations was next to impossible.

In these years of foot dragging, a new drug came onto the street: fentanyl, an incredibly powerful pain reliever that is said to be orders of magnitude stronger than morphine. Overdose deaths were again recorded in Vancouver. The government remained unmoved.

At the time of Trudeau's election in 2015, the epidemic was growing, partly because of a promise to legalize marijuana. Trudeau's liberal government set about opening the safe injection sites his predecessor had fought against.

Finally, new locations were opened in 2017. At that time, 4,100 people died from an overdose in Canada, 67 percent were attributed to fentanyl or its analogues.

Ottawa finally continued the workable strategies that activists like Livingston had identified 20 years ago. However, these safe injection sites should never be a solution, just a way to stop death. The study published in Addiction estimates that 230 lives have been saved thanks to safe injection sites in British Columbia.

As we spoke, Livingston hooked her index finger and grabbed the inside of her cheek and pulled her head back. "It's capture and release," she said. Someone can come to the construction site, shoot up and return to the city. There is little support, follow-up or attention for the drugs that cause the epidemic.

Safe injection sites are a "bandage over a gaping chest wound," said Garth Mullins, a punk musician who became a broadcaster and activist, and the host of Crackdown, a podcast devoted to reporting on the crisis. The first episode begins with a distortion of the guitar over a woman's voice: "I'm sorry we can't take this anymore," she says, straining her voice. "If we have to go home to our churches and they are fucking dead!" She spits out the last two words when the drums begin and the show begins.

Even today, just a few blocks from Insite, people are shooting at the sidewalk. On a Thursday morning this summer, two paramedics knelt over someone and reversed an apparent overdose.

They were probably armed with the same drugs in a black bag attached to Mullins' belt. There is a bright red cross on it, the telltale sign of a naloxone kit. These kits usually contain two nasal sprays containing the opioid-blocking agent naloxone, which can be used to effectively reverse an overdose. Ottawa provided the drug over the counter in 2016. A year later, British Columbia and Alberta allowed the kits to be sold everywhere – in other provinces, they still have to be dispensed by pharmacies. In recent years, pharmacies have started giving the kits free of charge.

The study published in Addiction found that approximately 1,580 lives were saved with these naloxone take-away kits.

Addicts inject themselves on May 3, 2011 in a regulated injection center in Vancouver. Laurent Vu The / AFP / Getty Images

The third strategy investigated in the addiction study was opioid agonist treatment, in which drug users were given replacement opioids in the hope of finally stopping them. The study found that this therapy saved 590 lives in 19 months.

But trying to make consumers aware of new drugs has its pitfalls. The classic example of this treatment is methadone, which can be a difficult form of treatment due to state overregulation, among other things.

The first episode of Mullins Crackdown podcast features Chereece Keewatin, an indigenous woman who was on the editorial team for the podcast. "This whole lifestyle is not what I signed up for," she says with a hacking cough. Keewatin had consumed methadone and kicked heroin for a decade. In 2014, the state government abruptly switched methadone consumers to a new drug, methadose, without much consultation. Keewatin and many others hated the switch. They went into intense retreat. Many turned back to heroin, shaken by what is known as a "dopesick".

The second episode begins with the news that Keewatin has died.

Keewatin was not the only one. While drugs like methadone can initially be effective, long-term follow-up has shown that many users drop out of treatment, often due to strict government regulations. Alternatives to methadone, such as Slow release morphine pills are promising but have some of the same disadvantages.

Perhaps the most striking number in the addiction study is not the number of lives saved, but the number of those lost. During the same period, the newspaper estimated that 3,030 lives had been saved, and it was found that more than 2,000 people were lost to the opioid crisis in British Columbia alone.

"If one of the questions is why it doesn't work, it's the wrong answer," said Donald MacPherson, director of the Canadian Drug Policy Coalition and associate professor at Simon Fraser University. He has been at the forefront of the drug problem since the 1980s and has worked with Livingston and others to accelerate harm reduction efforts. His research has been instrumental in the Supreme Court on Insite case.

The government does not treat this as an emergency, he said.

"We could open 30 more [overdose prevention sites] and they will save some lives. However, we cannot rely on the cartels to change their offer," said MacPherson. "The sad thing is that the government has given up the opportunity to take a large amount of drugs out of organized crime and replace them. "

When Canada has slowed down from the start, the United States is still in the stable.

In a New York Times published in August 2018, then Deputy Attorney General Rod Rosenstein played all of the old hits and called for better treatment and criminal prosecution instead of mitigation approaches.

“Americans struggling with addiction need to be treated and have less access to lethal drugs. You don't need a taxpayer-sponsored port to shoot in the air, ”he wrote.

The Trump administration has steadily increased the spectrum of criminal prosecution for those who open or oversee safe injection sites and even filed a lawsuit against Safehouse who wanted to open a Philadelphia site. Nevertheless, Safehouse is making progress.

There are few locations in the United States. A website is only operated secretly by invitation: Nevertheless, the website, which is operated in an unknown location, has invited researchers to observe what is happening. Their research showed that hundreds of people benefited from the job and dozens of overdoses were reversed thanks to on-site naloxone.

Even naloxone access in the United States is patchy. It was not until January that the Food and Drug Administration decided to allow the drug to be sold over-the-counter. A recent report by the Centers for Disease Control found that access to naloxone is patchy, especially in communities most affected by the opioid crisis. The cost of the drug has also limited its intake.

Life expectancy in Canada no longer rose due to the crisis, and even fell in the United States.

The number of deaths from overdoses in the United States increased dramatically year on year, reaching more than 70,000 deaths in 2017. New data suggest that the number decreased slightly in 2018, but remains astonishingly high.

In Canada, 2018 was the worst year in existence with almost 4,500 overdose deaths. The per capita rate of opioid overdoses is similar in both countries.

Sarah Blyth, coordinator of the pop-up injection site, is holding a naloxone kit for treating overdoses in Vancouver's downtown Eastside on January 30, 2018. John Lehmann / For the Washington Post via Getty Images

Nothing significant has changed in drug use and addiction between the 1990s and today. What is different is the drugs.

Governments have said they want to stop the flow of deadly drugs like fentanyl and the like, but this often means that drug bans and policing have been tightened. Yet studies from British Columbia and other countries suggest that these busts not only do not significantly affect consumption, but can also lower prices as competing drug dealers try to fill a void.

Jane Philpott was appointed Trudeau Minister of Health in 2015. She made it a priority not to try to interrupt the supply of one or the other drug, but to introduce a reliable and safe supply to the drug users who wanted to use it.

In 2017, Philpott launched a program that doctors can use to prescribe heroin to patients nationwide. Instead of treating the overdose, ending the addiction, or pushing consumers for a new drug, the government would allow consumers to continue using the drug of their choice, but ensure that it doesn't contain any dangerous additives like fentanyl.

Philpott had heroin imported from a supplier in Switzerland, a country that has been pursuing an approach to damage reduction for decades.

"I will not say that it was all easy," Philpott told Foreign Policy in May, recalling how much resistance there was in her own government. "The further you push, the more anxious the political staff becomes."

Philpott is open about their position. She was removed from the health portfolio before she left the cabinet on principle – she is now running against her former party and Trudeau as an independent party.

"I was hoping to move things forward in an evidence-based manner," she said. Philpott explicitly cited the "fantastic" international models of Switzerland and Portugal, which in 2001 completely decriminalized all drugs and had generally positive health and social incomes.

Philpott's successor, Ginette Petitpas Taylor, continued to advance some of the priorities. Speaking to Ottawa foreign policy in June, she said it was her priority to expand Philpott's projects.

"We will cut red tape – by making some regulatory changes to ensure that we can address the issue of safe care and address the issue of drug replacement therapy." This is where we use our energy, ”she said.

While safe injection sites and naloxone only help users who have already purchased or used their medication, the supply problems are resolved by requiring users to have a safe supply of heroin or a legally required opioid. However, these programs remain small and require users to enter the healthcare system. So far, they have only used a few hundred users.

Thomas Kerr, a professor at the University of British Columbia, who has conducted a longstanding study of drug users in Vancouver, said that introducing safer and more reliable drugs is one way to stop the "poisoning epidemic" critical to the persecution of Overdosed and deceased.

Yet, in an editorial in the Journal of Epidemiology and Community Health, Kerr wrote: "Access to these newer therapies remains unacceptably low, and efforts are required to bring these programs to an adequate level."

MacPherson, Canadian Drug Policy Coalition, is more direct. He calls it "a total drop in the bucket".

A lack of access and distrust of the official system has prompted some users in Vancouver and elsewhere to set up so-called compassion clubs, in which users pool their resources to deliver heroin or other drugs in bulk from a more reliable or consistent place buy source. These approaches, like Livingston's early safe injection sites, are illegal and are strongly discouraged by the government.

However, researchers say that the approach is the only smart way.

A man lies unconscious in an alley in Vancouver's downtown Eastside after suffering an heroin overdose on August 3, 2003. The man recovered and walked away. Christopher Morris / Corbis via Getty Images

Despite Canada's liberal stance, decriminalization was no obstacle to this government. Whenever asked directly about decriminalizing drugs, Trudeau refused.

"I believe that decriminalizing drugs is a terrible idea that we will never consider," conservative leader Scheer told foreign policy campaigners last week. He reiterated that even after the investigation, which shows the effectiveness of these mitigation strategies, is repeated that "communities affected by these monitored injection sites should hear their voices and concerns".

In 2017, Trudeau was confronted by a front worker about the opioid crisis in a vice town hall. Her hands trembled when she told him, "It is a national disaster, you are not doing enough, the corpses are increasing." Decriminalization is the solution.

"I'm not there yet," he said, flanked by his deputy, who was in charge of legalizing marijuana, a former police chief in Toronto who had done his part in drug busts.

Trudeau, who was interviewed directly this week on the campaign path, said, "Our approach is based on harm reduction, safe consumption, and stigma measures that have proven effective." But he wiped away the idea of ​​decriminalizing drug use as we realized that "we know there is more to do and we are committed to doing it."

Philpott tried to force the Prime Minister to decriminalize drugs, but he didn't. "Decriminalization is not popular when asked about it," summarizes Philpott Trudeau's position.

Trudeau and his challenger in the Conservative Party are absolutely against decriminalization. But opinions are changing.

The British Columbia Chief Health Officer is in favor of this, as do a number of other public health officials.

The center-left New Democrats' party, Jagmeet Singh, has spoken out for the complete decriminalization of illegal drugs – for this campaign, his party platform is calling for the "end of criminalization and the stigma of Drug addiction. "

The ecologist Green Party also advocated decriminalization and committed the party on its platform to "ensure access to screened care".

While the Greens and the New Democrats are fighting for a distant third place in the elections, one or both could hold the balance of power in a minority parliament and put them in the position of kingmaker or junior partner in a coalition government.

The Economist magazine has long been a proponent of any legalization or decriminalization model, and Canadian paper The Globe and Mail recently came to the same conclusion.

The Pew Research Center found that only a quarter of Americans believe that drug drug persecution should be a priority, while a fixed majority support treatment instead. The pollster Angus Reid found that almost half of Canadians support the idea of ​​decriminalization.

In his tight office, MacPherson sounded tired.

Even though his research has shown exactly what needs to be done, progress at government level seems to have been a great success. He sighed and explained why.

"It is the fear and hatred of the criminalized drug user."