Drug users and their allies are gathering in Vancouver’s Oppenheimer Park at noon today to call for an end to the overdose epidemic that killed 1,038 British Columbians in the last 12 months.
The Vancouver rally is one of seven across Canada where participants are calling on the federal government to decriminalize drug possession and work towards legalizing and regulating illicit drugs. Drug users are also calling on the government to include them in making decisions that impact their lives.
“We’re disrupting a narrative about ourselves,” organizers with the Canadian Association of People Who Use Drugs wrote in a website post about the rally. “There’s a common public misconception that we are unable to make decisions for ourselves. Truth being we are excluded from even participating in policy decisions that determine our fates.”
The day of action follows many recent steps taken by drug user communities and harm reduction advocates to share knowledge, increase frontline supports and cope with the grief of losing loved ones as fentanyl helps fuel an overdose crisis.
On Sunday night, a weekly Fentanyl Grief and Loss Support Group met for the first time at the Downtown Eastside Neighbourhood House. Last week, more than 100 frontline workers and public health and human rights activists met in Vancouver for a two-day summit on providing additional safer consumption services to curb the overdose epidemic. Federal Health Minister Dr. Jane Philpott and Vancouver Mayor Gregor Robertson met on Friday and toured a Vancouver clinic that provides pharmaceutical-grade heroin and injectable opioids to patients under a supervised program.
And a community of substance users released a patient-centred, patient-authored guide to opioid substitution therapy through the Centre for Addictions Research of BC.
Harm reduction advocate Garth Mullins helped write the report. “I’ve gone to so many memorials and funerals for those dead of overdose, who couldn’t get help and couldn’t get support,” he said in a statement. “The medical system made them feel like outsiders.
“Too much is done in the name of helping drug users without giving any room to the actual voices of that experience,” he said. “The handbook is just a start. One day those most affected by government and drug policy and legislation should have a hand in writing it.”
No overnight solutions
A major piece of that legislation is now before the Canadian Senate. Bill C-37 would amend the Harper-era Controlled Drugs and Substances Act and remove legal barriers to opening safer consumptions sites like Vancouver’s Insite supervised injection facility.
Reached by phone after the bill passed third reading in the House of Commons last week, Philpott said she was glad to see the bill moving closer to passing, but remains grimly aware of how much still needs to be done.
“I would simply hope that everyone would realize that this is absolutely among the very top priorities in my portfolio right now. It’s something I think about every single day,” she said. “But I don’t want to be naive about the fact that a crisis of this proportion is not going to be fixed overnight, sadly.”
The crisis is rooted in trauma and mental illness, she said. “It takes time to heal all of those things. It takes time to get the treatment necessary for everybody that needs to get that treatment.”
Asked how she responds to calls from advocates to legalize and regulate illicit drugs, Philpott did not respond with direct support for legalization and regulation. But she said there needs to be a broad range of treatment options.
Philpott has often spoken in support of treatments like supervised injectable opioid treatment therapies. In Canada, a small group of people in Vancouver are able to access these treatments — which include provision of injectable pharmaceutical-grade heroin (diacetylmorphine) or the analgesic sold under the brand name Dilaudid (hydromorphone) — but the therapies are not currently available elsewhere in Canada.
“I think there needs to be access to a broad range of treatment options,” she said.
But Philpott said there are “several barriers” to expanding opioid substitution therapies using Suboxone or Dilaudid and even more challenges in allowing wider use of injectable diacetylmorphine, which can only be used with a special federal exemption through Health Canada.
She added that many doctors don’t yet feel comfortable prescribing opioid substitutes. “Prescribers need to, in some cases, have medical education or updating of their skill set and their scope of practice to be able to feel comfortable with using these options,” she said.
Philpott is convening a federal roundtable to consider national guidelines in this area and work with medical educators to develop programs on opioid substitution therapy, with regulatory bodies for physicians to help them understand that these treatments need to be available to patients and with provincial health authorities to open more facilities and clinics for administering the therapies.
“We need to see broader access to programs that will, under the direction of a physician, allow people to be able to get treatment in a safe way and to be able to make sure that they know what their options are for being able to eventually decrease that dependency on opioids,” she said.
Philpott points to evidence from Switzerland, where a wide range of treatment options include programs providing prescription heroin to users. Opioid overdoses in the country are now very rare, she said. “We need to look at the best practices internationally.”
Philpott says she is not declaring a federal health emergency over the overdose crisis, despite calls to do so from B.C.’s health minister and harm reduction advocates.
The emergencies act, she says, is based on the War Measures Act and has not been used for any public health emergency at the federal level.
“If I felt that invoking that act would give me a tool that I don’t already have, of course I would use it,” Philpott says. “We don’t need to declare a public health emergency to act with the greatest of urgency.”
Stalled action after ‘10 years of darkness’
As Bill C-37 moves through Parliament, people continue to die of overdoses every day. Senator Larry Campbell is the senate sponsor for the bill and former B.C. chief coroner, former Vancouver mayor, Da Vinci’s Inquest muse and longtime harm reduction advocate. He was instrumental in opening the Insite safe-injection facility in 2003.
Campbell worked on the Downtown Eastside overdose epidemic of the 1990s. It’s worse today, he says.
“It’s way, way more dangerous right now,” he said. “In the ’90s, we were in the 300 to 400 death range and we were pulling our hair out. But we knew the reasons. We knew there was a bulk of heroin. We knew it was cheap. But this one here, it goes to a whole different level from the point of view of availability, cost of production, ease of importing, that there’s no comparison... it hasn’t even hit the east yet.”
Campbell says he doesn’t know how to get in front of the crisis, particularly after what he refers to as “10 years in darkness” under the Conservative government of Stephen Harper, whose policies prohibited the expansion of safer injection sites across the country.
Legalization and regulation, he says, is the next step.
“Nobody’s suggesting that you do opioid treatment by giving out these opioids and then letting people leave to go use them.. it has to be under controlled circumstances. But we know from the NAOMI trials and lots of other trials, that this actually works to get people into treatment, to change their lifestyle,” Campbell says.
“If you don’t believe in saving lives, then you must believe in saving money. And this would do both.”
The week in new funding
On Friday morning in Victoria, the provincial government announced that it would invest $5 million to support the overdose response in B.C. as part of the 2017 provincial budget.
The announcement coincided with Philpott’s announcement that the federal government would allocate $10 million to help B.C. to address the overdose crisis, in addition to a $65-million investment over five years for federal programs responding to overdoses.
On Feb. 15 the Vancouver Mayor’s Task Force on Mental Health and Addictions announced it will support programs to combat the stigma around drug use, mental health education programs for children, Indigenous wellness programs and frontline peer work for dealing with overdose deaths. The task force is allocating nearly $1 million in funding for these programs, which consists of approximately $450,000 from the city and $550,000 from partners.
The new provincial government funding will improve mental and emotional supports for frontline workers; expand rapid access to opioid substitution treatment; support harm reduction measures; expand law enforcement efforts on fentanyl and carfentanil; and enhance support for the BC Coroners Service.
That funding doesn’t include promises of funding for supervised injectable therapies that doctors like PHS Community Services Society medical director Dr. Christy Sutherland say could save lives.
Dr. Hedy Fry, longtime Liberal MP for Vancouver Centre and and former parliamentary secretary for the minister of health, was the chief architect of the 2000 Vancouver Agreement, which coordinated efforts between all levels of government to improve the health of neighbourhoods like the Downtown Eastside, which was then in the grip of a overdose and HIV epidemic. She travelled to Switzerland in 1995 to learn about its harm-reduction approach to opioid addiction, including injectable therapies.
But Fry says we lack the strong evidence base needed to implement supervised injectable opioid therapies like those used in Vancouver’s NAOMI and SALOME clinical trials. The Conservative government blocked the needed research, she said. Public awareness of injectable therapies and new harm reduction techniques will be key to their acceptance by Canadians, she said.
Coordinated efforts still lacking
Provincial health officer Dr. Perry Kendall notes supervised injectable opioid therapies are “politically quite contentious.”
“There are a number of barriers — political, fiscal, and just in terms of training and access that I think would need to be overcome... I’m sure they’ll come,” he said. “But I think that any intervention takes a while to be accepted.”
In the meantime, the province has made progress on encouraging doctors to prescribe Suboxone, a tablet formulation of buprenorphine and naloxone that rapidly relieves opioid withdrawal symptoms. “That’s where the focus is,” Kendall says, “because that’s become a lot easier now to prescribe and access.”
Kendall says many efforts towards solutions are now under way, but they’re not coordinated. He also notes that those hardest hit by the overdose epidemic often have childhood histories of abuse, neglect, and undiagnosed mental illnesses.
“Our priorities are somewhat strange,” he says. “I live in Victoria and we have a serious issue of homelessness here. We’re going to invest a billion dollars in a sewage treatment plant. Which will offer little, if any, environmental benefit, to be frank. And I think of how much infrastructure could be built around affordable housing for that much money.
“And I shake my head.”
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