Credit to Author: Daphne Bramham| Date: Fri, 29 Nov 2019 23:22:53 +0000
Now that the federal election is over, it’s time for a serious discussion about how to deal with Canada’s opioid overdose crisis.
This is a wicked problem — complex and multi-layered with no simple solutions.
But debates about how to address it are muddied with emotive words and euphemism. It hasn’t helped that the issue was weaponized during the campaign — particularly in ethnic communities — by the deliberate misuse of the words decriminalization and legalization.
Decriminalization would mean drugs would still be illegal, but people found with small amounts would not go to jail. If Canada were to follow Portugal’s model, people found in possession of illicit drugs would go to a panel of experts who would determine what services — if any — that person needs to quit using.
Legalization is what happened with alcohol, nicotine and more recently, cannabis.
In a report released earlier this year, the Canadian Association of People who Use Drugs made the case for full legalization of all mind-altering recreational drugs including fentanyl, heroin, cocaine, ecstasy and LSD.
It bears noting that no country has legalized drugs like fentanyl, heroin, cocaine, ecstasy or LSD as CAPUD proposes.
Confounding the conversation is that the overdose crisis caused by fentanyl-laced street drugs is being reframed as a supply problem. Increasingly, you’ll read and hear that it referred to as a “poisoning” crisis resulting from the “contamination” of the illicit supply.
Debates about fixing the supply take the focus off treating addictions — another wicked problem that’s almost invariably rooted in pain, whether it’s physical, psychological or economic.
And, if you think people are not highly aware of semantics, consider a footnote in a June report to Vancouver council on the overdose crisis that indicated staff discussed whether it should be “safer supply” or “safe supply.”
“One can never make a drug perfectly safe: people can overdose from alcohol, not following a prescription, or from taking non-prescription drugs like marijuana or even aspirin,” it said. But it went on to say that staff went with safe, not safer, “given the intent is for a regulated, poison-free supply.”
To be clear, fentanyl is already a regulated drug. So is heroin. So is morphine and a whole long list of other drugs. They are deemed so dangerous that require a doctor’s prescription and must be dispensed by a registered pharmacist. But as city staff acknowledged in the footnote, even prescription drugs are safe only when taken as directed.
The overwhelming majority of fentanyl that’s already killed too many Canadians hasn’t come from pharmacies.
So what do people advocating for a safe supply really mean?
Vancouver is already providing financial support for the BCCDC’s “low-barrier, hydromorphone dispersal pilot project.”
It involves trained staff dispensing pharmaceutical grade opioids at an existing overdose prevention site, and is intended as a pathway to treatment and recovery.
The B.C. Centre on Substance Use is running a drug-checking program for dealers and users at five locations in Metro Vancouver. To detect fentanyl, there are test strips as well as a portable Fourier-Transform Infrared Spectrometer that “sees” the various elements.
But the BCCSU is also advocating for heroin compassion clubs. At free-standing, low-barrier, member-only co-operatives, health care providers (although not necessarily physicians) would sell or possibly even give away diacetylmorphine.
Previously, the B.C. Centre on Disease Control had proposed dispensing heroin from vending machines.
While regulated sale of heroin might prevent deaths, there’s no evidence that it would meet the BCCSU’s heady goal of disrupting organized crime.
Last month, the Canadian Association of Chiefs of Police reported that despite cannabis legalization, a “vibrant” black market remains and Statistics Canada found 40 per cent of Canadians continue still buy from illegal sources.
The BCCSU’s compassion club recommendation led to the resignation of Marshall Smith, chaired of its recovery committee.
He was replaced by Carson McPherson. A recovering addict and head of one of Canada’s largest addictions treatment centres, McPherson argues for a more informed and nuanced debate around safe supply.
“If the intention is to keep someone alive in order to improve their quality of life as part of a continuum of care, a recovery pathway, it makes sense,” McPherson said in an interview.
“But to provide an incredibly powerful drug without that isn’t health care, it’s sick care … If an addict has an endless supply, the odds of getting into recovery are almost nil.”
There’s no end in sight to this health emergency. After nearly four years, things are worse than they’ve ever been in the epicentre of the Canadian crisis, Vancouver’s Downtown Eastside. A walk through there is like a trip through Dante’s nine circles of hell.
But just as land-use decisions and pipelines are no longer the sole purview of those most directly affected, drug policy can’t be left only to experts, grieving families and present and former users.
In Portugal, it took several years of public discussion before the government had forged a consensus to focus on treatment and recovery with decriminalization as a pathway to get addicts the help they needed.
That consensus held against the onslaught of outsiders’ threats of financial and sanctions and held through changes in government.
Canada might chose something similar to Portugal or create something unique. Regardless, it will require broad support among Canadians willing to grant the social licence to make it work.
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