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Retiring Chief Coroner Lisa Lapointe on Staring Death in the Face

Every loss from toxic drugs provides an opportunity to advance meaningful change, she says.

Michelle Gamage 31 Jan 2024The Tyee

Michelle Gamage is The Tyee’s health reporter. This reporting beat is made possible by the Local Journalism Initiative.

After 13 years in the role, B.C.’s Chief Coroner Lisa Lapointe is retiring.

Her final day in office is Feb. 18, marking 30 years in public service.

A lot has happened over the course of Lapointe’s tenure. Fentanyl arrived in B.C. in 2012. The unregulated toxic drug supply became the leading cause of death for people ages 10 to 59, killing more people than suicides, homicides, accidents and natural diseases combined. Deaths of people experiencing homelessness have also been on the rise.

While it might seem like a bleak job, Lapointe says she’s held on to the understanding that every death provides an opportunity to advance meaningful change.

To understand how Lapointe has held on to that glimmer of hope, The Tyee sat down with her to discuss the role of stigma in the toxic unregulated drug overdose crisis, the need for nuance in public messaging, how she’d like to change the treatment industry and why she’s not mad, just disappointed, with the politicization of drug use.

The interview has been edited for length and clarity.

The Tyee: Let’s start with stigma. How much is it driving the overdose crisis and what can we do about it?

Lisa Lapointe: It’s a challenge because we’re looking at shifting away from the historic law enforcement approach.

The challenge is helping the public understand, when for so many years the messaging that came from all levels of government was really stigmatizing — that was the goal. We thought that if we shamed people and vilified drug users that it would be a deterrent.

Now we know shaming people and punishing them has not been effective.

Stigma plays a huge role. Our goal is to shift the messaging to say this is a health issue and a health crisis. We’re shifting decades of messaging and public perception to one that is more compassionate, health focused and recognizing people are often in pain and their substance use is a way of coping with that pain.

There are 225,000 people in B.C. who use unregulated substances, including recreationally. We’re not talking about criminals.

Where do you see the unregulated toxic drug crisis in five years?

Unless governments at all levels, with public support, really shifts towards this health-focused approach — and I recognize this is difficult, there’s a lot of fear — but unless there’s a fundamental systems shift in how we respond then, frankly, in five years we’ll see another 10,000 deaths.

Provincial responses have been well intentioned. But you have 225,000 people at risk of overdose because they use unregulated drugs in B.C.

Unless we see a significantly different approach and recognize that maybe we need to begin to review the Controlled Drugs and Substances Act and the intention of the legislation and have really meaningful, honest conversations about what we’re trying to achieve and what are the necessary tools for that then, you know, a few beds here and there aren’t going to address the crisis in a substantial way.

At all levels of government there are gaps in the response to the crisis. But there are also people on the frontlines and community groups doing phenomenal work and trying to support people, even if they don’t get a lot of community support. I’d like to acknowledge their work too.

It seems like discussion around how to respond to the toxic drug crisis gets stuck because people either argue with logic (evidence-based harm reduction) or emotions (drug use is bad so let’s get people sober). Are we missing out because you can’t use logic to argue with emotions and vice versa?

It’s really important that every level of government does a better job at communicating with the public. Again, we’re pushing back against the narrative that’s been around for decades in terms of the war on drugs and the war on people who use drugs. Shifting that perspective to one of a public health crisis is monumental.

We need to do a better job of explaining what these approaches are. Sometimes when people talk about safer supply it gets distorted for political purposes and people say it’s “giving drugs to drug addicts.” People need to understand what “safer supply” actually means is that people are at risk of dying and so long as they’re connected to the illicit drug trade they will continue to die. They can’t recover if they’re dead. The current model just supports organized crime, which is making massive profits off the back of our most vulnerable people.

The issue gets painted as either we support people into treatment or we give them safer supply and ensure they’re dependent on drugs for the rest of their lives. Neither of those is accurate.

Safer supply is an approach that recognizes people use drugs for different reasons. It’s about saying people are in different places in their life. It’s about saying what is the best way to respond that will save the most lives.

The nuances are hard. It’s particularly challenging when people try to polarize the issue for their own political gain.

Speaking of politics, are you worried about the future of harm reduction services like safer supply, decriminalization or, for example in Saskatchewan, where recent policy changes mean people will now have a much harder time accessing pipes and clean needles?

History has shown us the old approach of punitive measures was ineffective. That’s what got us into this crisis in B.C. This is the eighth year of the crisis. The crisis in our province and across the country is an illicit fentanyl crisis. It’s the toxicity of the drugs that people are taking. So to abandon harm reduction will most certainly result in more deaths. And yes, I find that absolutely terrifying.

Let’s talk about the treatment industry. Why doesn’t your office report how many people died while in treatment or who were recently in treatment?

It’s pretty rare that someone dies in a treatment facility. Reporting on death shortly after being in treatment is really tough because there’s no provincial registry that a coroner can look at to see if someone has just been in a treatment facility or is connected to a treatment service.

We know if someone has been prescribed opioid agonist treatment because there’s a provincial registry of prescribed medications. We can ask friends and family but the reliability we get back is hit and miss because the people we speak to might not know everything.

Since 2018 we’ve been asking for regulations around reporting so that anytime someone accessed a treatment or recovery service we’d know about it.

One of my concerns is if someone has not used opioids for a period of time — in as little as three days or as long as 30, 60 or 90 days in treatment or much more — they have a lower tolerance so if they use an opioid substance again they’re at a much higher risk of death.

I fear that some of the abstinence-based programs are actually contributing to the death rate. We don’t know if this is true, though, and this is where data would be so helpful.

Just this week I heard Jennifer Whiteside, minister of mental health and addictions, say they’re looking into a registry. It’s really unfortunate that it wasn’t initiated in 2016 or any of the years following.

What other regulations would you like to see introduced for the treatment industry?

What we’re lacking as a province and across the country is an evidence-based approach for treatment for those seeking treatment for recovery of dependency on drugs.

Many of the for-profit and not-for-profit treatment facilities are abstinence focused. We don’t know what methods they’re using or — because we don’t have regulations around reporting — how effective they are. Are people dependent on stimulants? Methamphetamine? Cocaine? Or is it an opioid dependency?

There are all of these different approaches and we need to standardize evidence-based guidelines around what is the most effective.

Families are paying significant amounts of money for some of these private programs. They want what is best for their loved one but really they just have to hope for the best and hope that the promises made by the service are going to actually work.

Let’s talk about the issue of diversion. Why do you think we’re hearing stories of hydromorphone being diverted and used by teenagers when your office is not seeing evidence that supports those claims? Does that mean kids are using drugs and not dying? Could that ever be considered a positive thing?

Diversion has always existed in the prescribed medication world.

We know that 86 per cent of Dilaudid [the prescribed version of hydromorphone] in B.C. is prescribed for pain control, for example for people post-surgery or with chronic severe pain, and 14 per cent has been prescribed under the safer supply program.

Dilaudid has always been available in the Downtown Eastside so it’s nothing new. We don’t know whether people are accessing diverted Dilaudid that was prescribed for analgesic purposes or for safer supply purposes.

We do know youth aren’t dying as a result of Dilaudid use and we know from the best data that’s available, which lags, that there hasn’t been an increase in opioid dependency amongst youth. So the indicators we have show it’s not a significant problem.

That being said, we always need to be aware that diversion is a possibility and we don’t want anyone to become dependent on an opioid. It’s not a healthy thing if you don’t need it for long-term pain.

So focusing on education for youth, really helping people understand what the risks are and providing supports if people are using drugs to deal with their own pain, whether physical or emotional, is helpful.

Using any medication that wasn’t prescribed to you can be dangerous.

But let’s also address this other myth where if youth didn’t have access to diverted Dilaudid then they wouldn’t do drugs. We know that youth also use drugs from the illicit supply, which is highly toxic and even more unpredictable.

It’s not a choice between diverted versus the illicit supply. It’s about providing the support, help and education so children aren’t using drugs in the first place.

But a regulated dose of Dilaudid is definitely going to be safer than anything that is purchased off the black market.

Again, we always want to caution that any drug used in a way that it wasn’t prescribed can be dangerous. Anyone can go to a drugstore and buy enough substances that, if used inappropriately, could cause serious harm and death. There is no safe drug but drugs are safer if they’re controlled, prescribed or from a regulated source.

On the day you announced 2023 was the deadliest year of the overdose crisis yet, the BC NDP asked the court for permission to appeal the injunction granted to the Harm Reduction Nurses Association to pause the implementation of Bill 34, which adds more restrictions about where people can use drugs in public. On the day you released the third death review panel, Minister Whiteside shot down your proposal to use a non-prescribed safer supply model. Do you think the timings were coincidental?

It probably reflects on the credibility of the data and that the public does hear the information we’re sharing. There’s public concern about the number of deaths communities are experiencing. In a backhand way I think it’s recognition that when the Coroners Service issues something, people are listening to it and we have the public confidence and trust in the information we share.

So if the government wants to provide a contrary message or a different message — or what they think might be a more reassuring message — then it would make sense to time it with the information we’re putting out. It’s tragic and really identifying that, in the eighth year of this crisis, we haven’t made any progress in terms of addressing the underlying needs and some of the challenges that people in our communities are experiencing.

How do you feel when you hear politicians like Pierre Poilievre and Kevin Falcon using stigmatizing language about people who use drugs or misrepresent the overdose crisis?

It makes me very sad. When I hear anyone in a leadership role vilifying members of our community, almost hate mongering, I think it’s really disappointing. It shows a real deficiency in leadership.

We know people who use drugs are people just like us. They’re not bad people, they’re not villains. Oftentimes they are experiencing trauma and pain and turning to substance use as a means of coping with the place that they find themselves.

To me leadership is recognizing that when members of our community are hurting or in dangerous situations, we reach out to help. Kindness goes a lot further than vindictiveness and anger. As a Coroners Service, we know the people who are dying. We hear from their families. We hear their history and know they are just human beings, some who have struggled and suffered in their lives.

To vilify people who use drugs is beyond the pale.  [Tyee]

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