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Category "Drugs"

11Jul

Illicit drug deaths down this year in B.C., says coroner

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1May

Daphne Bramham: Alcohol, not opioids, is Canada’s biggest drug problem

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Alcohol is so much a part of our culture that 80 per cent of Canadians drink. But each year, nearly 15,000 people die from alcohol related harms.


Canadian governments are addicted to the revenue from alcohol


DALE DE LA REY / AFP/Getty Images

With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.

Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.

While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.

The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.

The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.

Over the past decades, the researchers found an erosion of effective policies and regulations.

“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”

British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.

Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.

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Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.

Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.

Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.

Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.

One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.

Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.

Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”

It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.

Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”

Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.

What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.

The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.

In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.

Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.

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Twitter: @bramham_daphne


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24Apr

Daphne Bramham: Decriminalization alone won’t end B.C.’s overdose crisis

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A man injects drugs in Vancouver’s Downtown Eastside, Wednesday, Feb. 6, 2019. Despite significant efforts to combat overdose deaths in British Columbia, the provincial coroner says illicit drug overdose deaths increased to 1,489, just over the 2017 death total.


JONATHAN HAYWARD / THE CANADIAN PRESS

The problem with the provincial health officer’s special report recommending decriminalization of all illicit drug users  is that Dr. Bonnie Henry chose to make that her only recommendation.

Three years after a public health emergency was declared because of an epidemic of deaths from illicit opioids, B.C. still has no comprehensive addictions strategy.

It has a stunning lack of treatment services, no universal access to services, no simple pathway to what few services there are, no provincial standards or regulation of privately operated treatment and recovery homes services.

Government ministries such as health, mental health and addictions services, social development and housing remain siloed and the root causes of addiction remain largely unaddressed.

While there has been substantial investment in harm-reduction measures including overdose prevention sites, free naloxone kits (to reverse an opioid overdose), low-barrier shelters and poverty reduction, the needs are greater.

Overdose deaths have only hit a plateau – not dropped. Every day, four people British Columbians die.

Yet, Henry is adamant that decriminalization is the most important next step.

“It’s about a focus and an intent,” she said. “Instead of police focusing on requirement of the Criminal Code, it builds off-ramps to connect with services. And, that in itself, ensures those systems are built.”

The majority of those who have died of overdoses were young men using alone at home. Without fear of being arrested and with the stigma of addiction being reduced, the expectation is that addicts or recreational users would be more likely to go to a supervised injection site, use with a friend (with a naloxone kit at the ready) or call for help if they overdose.

Henry calls decriminalization “a necessary next step to stop the death toll from rising and to make harm-reduction services more readily available.”

But it’s a question whether those recreational users would do that, because many addicts say that they use alone for a variety of reasons — not least of which is that they don’t want to share their drugs or they don’t want anyone to know what they do when they’re high.

The report recommended two options for British Columbia to work around the Criminal Code provisions.

Solicitor General Mike Farnworth firmly and quickly said no to both. But he noted there are pilot projects in Vancouver, Abbotsford and Vernon where rather than charging for possession, police are linking users with services. An evaluation of those will be completed in the fall and, depending on the results, they may be expended to other communities.

Henry makes no secret of the fact that her ultimate goals for Canada are full legalization and regulation of all drugs to ensure that there is a safe supply. If that were to happen, Canada would be the first in the world to do that.

Portugal is mentioned frequently in the report and by Henry. Possession for personal use was decriminalized more than 20 years ago. But it was done only as part of a comprehensive, drug strategy.

Police still arrest anyone found with illicit drugs. They are taken to a police station where the drugs are weighed. If the amount is above the maximum limit set for personal use, they are charged and go through the criminal justice system.

If the amount is below the limit, tickets are issued and users told to appear at the Commission for the Dissuasion of Drug Use within 24 hours. There, they meet with a social worker or counsellor before going before a three-person tribunal, which recommends a plan for treatment.

People don’t have to comply. But if they are arrested again, the commission can impose community service, require that they seek treatment, impose fines and even confiscate people’s property to pay those fines.

That’s not the kind of decriminalization Henry is recommending. Instead, the onus here would be on police officers – not trained addictions specialists, psychologists or social workers — to connect users with services.

Part of the reason for the difference is that Portugal’s goal wasn’t legalization or keeping addicts alive until they chose to go treatment. Its focus was and is on getting addicts into treatment and recovery so they could resume their place in society.

Harm reduction is only a small part of the Portuguese plan. Its first supervised injection site has only recently opened. But there is free and easy access to methadone (which dampens heroin addicts’ craving for the drug) and free needles to stop the spread of infection.

These harm reduction measures are deemed to temporary bridges to abstinence for all but older, hardcore, long-term heroin users rather than long-term solutions. Of course, fentanyl and carfentanil have yet to be found in its illicit drug supply.

Its treatment services as extensive and include everything from outpatient treatment to three years’ residency in a therapeutic community during which time the users’ families are provided with income supplements.

Nothing in this decriminalization report moves British Columbia anywhere close to that kind of comprehensive system. And until we get there, it’s hard to imagine that this overdose crisis ending anytime soon.

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Twitter: @bramham_daphne


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22Apr

BC Interior warning on ‘trippy’ drug linked to ‘zombie’ outbreak in US

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KAMLOOPS — The B.C. Interior Health authority is warning street-drug users of a synthetic cannabinoid that has been linked to a so-called “zombie” outbreak in New York.

Chief medical health officer Dr. Trevor Corneil says tests at a Kamloops overdose-prevention site found the powerful drug mixed with heroin, fentanyl and caffeine.

The authority warns that users can look like they have overdosed on opioids, but they won’t respond to naloxone and they can experience “speedy” or “trippy” symptoms with possible hallucinations.

A 2017 article in the New England Journal of Medicine says the drug caused a mass intoxication of 33 people in New York City in July 2016 and was described in the media as a “zombie” outbreak because of the appearance of those who took the drug.

The journal article says the drug was developed by Pfizer in 2009 and it is a strong depressant, which accounts for the “zombie-like” behaviour reported in New York.

Corneil says they don’t like to use the zombie term because it can give people the wrong impression and what is important is they exercise caution when new substances come on the black market.


Dr. Trevor Corneil of B.C. Interior Health.

Corneil says they aren’t aware of any deaths where the cannabinoid is the only substance.

“Often overdose deaths are caused by a mix of different substance together and we’re not seeing any increase in overdose deaths related to this substance, relative to the impact of fentanyl, which is the major toxin we have in our drug supply right now.”

Corneil says the discovery of the drug is a good example of the level of sophistication that both harm-reduction workers and users have been able to access in the province.

“This is the problem with criminalization, in that it takes away any of the safeguards that the system puts in place to ensure that people get the product they think they’re buying and it hasn’t been mixed with something else.”

He says workers are seeing that users are becoming more aware that they need to have their illicit drugs tested and when they learn what’s in their drugs, they make better decisions.

The testing machines at safe consumption sites look at a large database of drugs, which Corneil says is used for both research and by police.

“Many of them are unusual and rare and we’re finding that manufacturers and suppliers are trying different new substances all the time … trying to make a buck off people who are quite marginalized by the criminalized setting around them.”

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3Apr

National chronic pain task force a first step: federal health minister

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‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


CHAD HIPOLITO / CANADIAN PRESS files

The federal health minister is forming a national task force to provide input on how to better prevent, treat and manage chronic pain, which affects one in five Canadians and is often addressed with opioids.

Ginette Petitpas Taylor said in an interview Wednesday the task force will provide information on barriers that may prevent people suffering with persistent pain from receiving the treatment they need.

“This is the first step in addressing the issue of chronic pain in this country,” she said, adding the eight members will consult with governments and advocacy groups around the country and provide an initial report in June, followed by two more over the next couple of years.

Petitpas Taylor made the announcement in Toronto at the 40th annual scientific meeting of the Canadian Pain Society, which has long called for a national pain strategy, especially as the opioid crisis has exacerbated the stigma around prescribing and use of the pain killers.

She said she committed to exploring the creation of a national pain task force after a discussion with patients, clinicians and researchers at a symposium in Toronto last year, when she heard people living with pain often feel their condition is misunderstood and services are inconsistent.

“We have to recognize that Canada’s a big country and we certainly know there’s inconsistent services in provinces and territories so I have to really have a good understanding of what’s available and what’s happening out there,” Petitpas Taylor said.


Ginette Petitpas Taylor, Minister of Health, stands during Question Period in the House of Commons on Parliament Hill in Ottawa on Thursday, Sept. 21, 2017.

Sean Kilpatrick /

The Canadian Press

Advocates for pain patients presented the former Conservative government with a plan in 2012, but Petitpas Taylor said it’s too early to say whether such a plan will be introduced.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, said he’s concerned the task force’s work will go nowhere if there’s a change in government in October.

“I’m looking for signs from the government that they’re taking this seriously and it’s not just something to state during an election campaign,” he said. “There has to be definite action.”

Koster, who will have surgery on his left knee next month following an operation on the other one last year, said he can no longer afford to pay $100 a week for acupuncture to deal with daily pain after he voluntarily reduced his opioids over concerns about any long-term consequences.

“People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,” he said from Victoria.

He said it’s crucial for the task force to identify non-drug costs for patients and provinces for services such as physiotherapy, occupational therapy and acupuncture as part of any strategy it may come up with in its final report.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.


Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.

CHAD HIPOLITO /

CANADIAN PRESS files

Serena Patterson, a 60-year-old psychologist in Comox, has lived with pain associated with fibromyalgia for over half her life and also developed migraines that prevented her from continuing her teaching job at a college.

She said a three-year task force seems excessive, especially because advocacy groups have enough information on health-care gaps and patients wait too long to see specialists.

“I think we know that people are dying in an opioid epidemic and chronic pain patients are high on that list,” Patterson said.

“I would hope that this three years would be building, not more research. What needs to be built is a network of multidisciplinary team programs that are accessible, that are in rural areas as well as urban areas, that provide not only medical support but psychological as well as social support to help people be full participants in their life and in their community.”

Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, said hundreds of organizations, patients, clinicians and researchers came together in providing the federal government with the strategy in 2012. There was no action at the time but he said the opioid epidemic has now made that unavoidable.

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20Mar

Jail drugs: Ex-prisoner says no addiction help as life outside loomed

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VANCOUVER — Memories of vomiting, diarrhea and unrelenting stomach pain as he withdrew from opioids in prison had Rob MacDonald repeatedly asking for addiction treatment before he left a maximum-security facility but despite dozens of formal complaints, he says he didn’t get any help.

“I was thinking, ‘Wow, I can’t believe I’m going out onto the street with this addiction,”‘ MacDonald said recently, a week after being released on supervision from the Atlantic Institution in Renous, N.B., his fourth facility in over a decade behind bars.

MacDonald, 41, said he feared his 15-year opioid addiction would cause him to returned to crime while using illicit drugs on the outside so he tried desperately to get treatment from the federal prison service.

“I put 150 requests in, probably 70 complaints, for a 15-month period, trying to tell them, ‘Put me on it. I need it before I get out. I want to get help, I don’t want to go back into the community in a high-risk situation, I don’t want to re-offend,’ ” he said from Halifax, where he lives in a halfway house.

He said he complained to the warden and then appealed to the commissioner of the Correctional Service of Canada. One of his complaints to the commissioner was upheld but he said he was placed on a wait list because there was a limit on the number of inmates receiving treatment.

When he was incarcerated at Agassiz’s Kent Institution between 2017 and 2019 for drug-related offences and robbery, MacDonald said debilitating withdrawal symptoms had him seeking potentially deadly fentanyl-laced drugs that were smuggled into the prison.

“At least eight guys died in the 17, 18 months I was at Kent,” he said.

The Correctional Service linked MacDonald to a clinic in Halifax upon his release nearly two weeks ago and he is now prescribed the opioid substitute Suboxone. But he said he should have received the medication in prison as part of the agency’s treatment program, which also includes methadone, so he could focus on finding a construction job to get his life back on track.

'At least eight guys died in the 17, 18 months I was at Kent,' Rob MacDonald says of the Agassiz maximum security penitentiary.


‘At least eight guys died in the 17, 18 months I was at Kent,’ Rob MacDonald says of the Agassiz maximum security penitentiary.

Darren Calabrese /

THE CANADIAN PRESS

Ivan Zinger, Canada’s ombudsman for offenders, said the Correctional Service has failed to provide adequate addiction treatment, programs and staff at a time when more drugs are contaminated with fentanyl.

“I think when you’re dealing with a large inmate population that has such a long history of substance abuse you should be providing an awful lot more treatment and programming in addition to opioid substitution therapy,” said Zinger, who called for the reallocation of funding to provide those services.

“It’s unclear to me why the budget has remained the same and decreased in the past when clearly the number of incidents is increasing,” he said of overdoses that caused 41 deaths between 2010 and 2018.

Zinger said programs such as counselling are provided just before offenders are released instead of throughout their incarceration.

“That’s a problem when you have a highly addicted inmate population that has a lot of time on their hands and are in sometimes difficult conditions of confinement. They will find ways to bring in drugs.”

The Correctional Service said in a statement that 66 per cent more prisoners have accessed treatment in the last two years, but a jump of 115 per cent has been recorded in the Pacific region, where the opioid crisis is most acute.

It did not respond to requests for information on whether its budget will be increased to meet the demand for more treatment.

Kent Elson, a lawyer for an offender at Joyceville Institution in Kingston, Ont., said the Correctional Service did not accommodate his client’s disability of addiction so he filed a complaint with the Canadian Human Rights Commission last November.

Rob MacDonald, who was released last week on supervision from the Atlantic Institution maximum security facility in New Brunswick after a 10-year stint in four facilities including Kent Institution in Agassiz.


Rob MacDonald, who was released last week on supervision from the Atlantic Institution maximum security facility in New Brunswick after a 10-year stint in four facilities including Kent Institution in Agassiz.

Darren Calabrese /

THE CANADIAN PRESS

Elson said his 50-year-old client, who is serving a four-year sentence, had been on methadone but alleges the medication was withheld without explanation for five days when he was transferred from another facility in November 2017.

“He needed medical help and he got forced, cold-turkey withdrawal in a feces-smeared segregation cell and cruel mistreatment from guards. And it was so unbearable that he tried to kill himself three times,” Elson said from Toronto.

While Correctional Service guidelines state a doctor is required to interview offenders before they are involuntarily tapered or cut off from methadone or Suboxone, Elson said his client was not seen by a physician.

“This whole experience was incredibly traumatic and he ended up with PTSD,” he said.

“The impact on him was terrible but everybody wins if prisoners get the right treatment. Suffering from PTSD is not going to make them easier to integrate back into society.”

The Correctional Service did not respond to a request for comment on the human rights complaint filed by Elson or another from the Prisoners’ Legal Services. The B.C. group’s complaint was filed in June 2018 on behalf of offenders who accused the Correctional Service of discriminating against them.

Nicole Kief, an advocate for the group, said about 100 inmates reported three main concerns: long wait lists for treatment, being cut off Suboxone after false accusations of diverting it and not receiving addiction counselling.

“Of the people that I’ve talked to there has been a real sense of urgency, with people calling me and saying, ‘I’m worried about dying,”‘ she said.

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6Mar

Psilocybin touted as magical relief from death anxiety

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Windsor, Ont., police display a large quantity of drugs on Jan. 13, 2012, that were seized in the area, including psilocybin (magic mushrooms) shown here.


Dan Janisse / The Windsor Star

The active ingredient in magic mushrooms may soon be used to help people with a terminal illness come to terms with death.

A counsellor in Victoria is part of a team that wants to use the psychedelic substance psilocybin to treat a condition called end-of-life distress when someone suffers from a combination of anxiety, depression and demoralization.

Bruce Tobin said that there are about 3,000 people with a terminal illness across the country whose end-of-life-distress is so severe that traditional treatments have been unable to alleviate it.

“We are being very restrictive about the clients we are seeking to treat,” he said. “We’re only seeking to treat those for whom all other treatments have failed. There is now growing scientific evidence that this is likely to be effective for them.”

On Tuesday, Tobin was part of an application to Health Canada seeking a Section 56 exemption to the Controlled Drugs and Substances Act. The exemption allows researchers, including physicians, veterinarians and others affiliated with universities and private industry, to use a controlled substance. Psilocybin is a controlled drug under Schedule III of the act.

Tobin is a registered clinical counsellor who practises psychotherapy. He leads a clinical team that includes two doctors, two psychologists, two registered clinical counsellors and a nurse/pastoral counsellor. All have received specialized training in psychedelic medicine.

Tobin said he wants to see psilocybin used to treat patients who “have nothing left to lose and who are in abject pain.” He said his team would use pharmaceutical grade psilocybin, not ‘magic mushrooms’ whose active ingredient is psilocybin.

“The effects from the synthetic psilocybin, as far as I know, are indistinguishable from the effects of organic mushrooms,” he said by phone from a town south of La Paz in Baja, Mexico. “There are certainly perceptual, cognitive and emotional changes that a person experiences while under the effects of psilocybin. It is precisely those changes that result in a kind of re-evaluation of their life situation.

“They gain new insights and perspectives on their life and its meaning and their relationships. It helps them reframe their understanding of their impending death and leads, in a vast majority of cases, to a much deeper acceptance of death as a part of life and an understanding that even though they’re dying that basically, everything is OK.”

Recent studies, he said, have shown that treatment with psilocybin produces large decreases in depression and anxiety, along with increases in quality of life, life meaning and optimism.

In one study, a six-month followup after treatment showed that about 80 per cent continued to show clinically significant decreases in depressed mood and anxiety.

He said psilocybin would be used in association with psychotherapy that includes screening, assessment, preparation and followup.

Tobin said if Health Canada denies the application, then his team is prepared to challenge the decision in court using the same kind of Charter arguments used for medical cannabis.

In 35 years of treating anxiety and depression, Tobin said he’s seen little improvement in the effectiveness of medications despite all the billions of dollars spent on developing them.

“Psilocybin promises to be a game-changer,” he said in a news release. “Medicines such as this may well soon revolutionize not only palliative and hospice care, but psychotherapy and psychiatry in general.”

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28Feb

Daphne Bramham: First Nations’ solution to a modern, medical crisis

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Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”


Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /

PNG

“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.


The Crosstown Clinic in downtown Vancouver.

JONATHAN HAYWARD /

THE CANADIAN PRESS

“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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Twitter: @bramham_daphne


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21Feb

Daphne Bramham: B.C. group’s call for legally regulated heroin sales is unfounded

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Desperate times call for desperate and often unfounded measures. And, that’s exactly what a new report from the B.C. Centre on Substance Use is proposing in response to the unabating opioid overdose crisis.

It wants government to immediately clear the way for “heroin compassion clubs.” These would be free-standing co-op stores staffed by health care providers selling untainted heroin — diacetylmorphine — to members at the same price or less than street heroin. It would be free to members who can’t afford it, even though the report acknowledges that the risk of street resale of prescription opioids is greatest when the drugs are free.

And that would all be possible, the report says, because of things like volume discounts and “other economies of scale.”

“It would be precisely measured and dispensed in known quantities and at relatively safe doses,” says the report that was released Thursday. The emphasis has been added.

The heroin would be in powdered form, rather than an injectable liquid, just like it is on the street except this would be untainted heroin, not heroin cut with caffeine to prevent overdoses or any other additives to bulk up the product.

Members would be able to buy a couple of days’ supply and take it home with them.

Membership would be low-barrier, a term that’s not defined in the report.

Applicants would be screened by staff members who are “health care providers,” although not necessarily addictions physicians.

The co-op’s board members would be people with “lived experience” — a.k.a. users and former addicts.

Evan Wood, the head of the B.C. Centre on Substance Abuse, says the proposal is unprecedented so there is no evidence that it would reduce overdose deaths or disrupt organized crime’s role in fentanyl, money laundering or housing affordability, which is what’s advertised on the report’s cover.

“To be fair, we are in an unprecedented situation with fentanyl and the prescription opioids overdose crisis,” Wood said. “We are in uncharted waters.”

The two main goals are keeping users alive and disrupting the evils of organized crime.

These are ambitious albeit inappropriate goals for an organization whose mandate is to “develop, help implement, and evaluate evidence-based approaches to substance use and addiction.”

Using heroin to treat users isn’t new. But every other trial or program has a treatment component whether they’re at Vancouver’s Crosstown Clinic, the PHS Community Services or in European countries.

In Europe, heroin is prescribed with the goal of stabilizing users to a point where they can get jobs, form relationships or switch to other (cheaper) opioid replacement therapies such as methadone or Suboxone. (The annual cost per patient in European prescription-heroin programs ranges from $19,000 in Switzerland to $30,000 in the Netherlands.)

But there’s nothing like this in Canada.

“I’m not aware of the existence of ‘heroin clubs’ anywhere else,” Jann Schumacher from the Swiss-based Ticino, an organization of addictions specialists, said in an email. “In Switzerland the heroin assisted therapy is strongly regulated and always under medical control.

“Our Swiss model (heroin assisted treatment) has strong evidence as a harm reduction method, in getting people into treatment and stabilizing their lives, and in reducing the illegal market.”

To qualify, Swiss patients must have at least two years of opioid dependence and at least two failed tries using other addictions treatment methods. They are only allowed to the drug in pill form and take it with them after being in the program for six months and only if it’s necessary to hold down a job.

Drug-related crime in Switzerland has decreased 90 per cent. But compassion clubs would have no effect on drug-related crimes because members would still have to find some way to buy the heroin.

As for disrupting organized crime, the report suggests that compassion clubs would be competing for sales, influencing both the demand and market for heroin.

“The establishment of a regulated and controlled supply of fentanyl-unadulterated heroin may increase demand for street heroin among persons who use street opioids and force organized crime groups to return to the provision of heroin as part of the illicit drug market,” the report says.

And since violence is criminals’ usual response to unwelcome competition, it seems likely that they will attempt to terrorize compassion clubs out of business.

What makes this proposal all the more absurd is that it is aimed only at British Columbia. Surely, low-barrier access to pure heroin would be a magnet to every opioid user across the continent, let alone Canada.

British Columbia is already the epicentre of the overdose crisis just as it was ground zero for the cannabis legalization movement that began with compassion clubs dispensing so-called “medical marijuana,” which led to an explosion in unlicensed and unregulated pot shops.

It’s also where Canada’s harm-reduction model was birthed with free needles, supervised injection sites and readily available naloxone. But it was supposed to be part of a four-pronged strategy just as Switzerland’s is — a strategy that includes access to treatment and recovery as well as education aimed at dissuading drug use.

But since 2017, the $608 million spent by the B.C. government has gone almost exclusively to harm reduction. Yet, the number of overdose deaths is still rising.

It’s clearly not working and Canadians can’t help noticing now that 9,000 are dead including more than 4,000 in British Columbia. According to an Angus Reid poll released last week, 85 per cent of Canadians want mandatory treatment for opioid addiction. Forget legalization or free drugs, decriminalization was favoured by only 48 per cent.

Although the B.C. Centre on Substance Abuse is proposing a radical and untried solution, Wood dismissed mandatory treatment as an option because it’s unsupported by evidence.

As for decriminalization, Wood said, “The problem with it is that you still leave control of the market to organized crime. The user is not criminalized, but they still have to go to the black market.”

Yet, 20 years’ worth of evidence from Portugal show that paired with assertively promoting treatment and recovery, providing universal access to those programs and enforcing drug trafficking laws, decriminalization works.

There, it not only effectively brought an end to Portugal’s heroin overdose crisis, addiction and usage rates for all drugs including cigarettes and alcohol are now among the lowest in Europe.

[email protected]

Twitter: @bramham_daphne

 


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20Feb

Report coming Thursday to outline proposal for regulated heroin sales

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