My name is Ben Goerner. I am a 64 year old retired Mental Health and Substance Use Clinician. I also have lived experience with substance use. My career spanned almost 33 years working in contracted non profit agencies, for profit agencies and a health authority. I have worked in multiple levels of support and treatment. I worked with at risk youth for 15 years through outreach and direct youth treatment. I have worked with adults for the remainder of my time in treatment environments as well as spent the last 10 years of my work with people who struggled without shelter, with mental health and substance health issues.
I provide this brief from a researched and personal point of view. This comes from my training and my lived experience with substance use health. My hope is that my anecdotal narrative will help provide real context on mistakes and successes in the progress of the response to the unregulated drug poisoning crisis. My main objective is to help our government to understand the urgency of the need for a safer supply of regulated substances in our communities. I also wish to shed light on the importance of properly regulated treatment programming that includes and embraces harm reduction as a crucial part of the journey of recovery from substance health issues. Continuing to provide the status quo in services does not address the needs of the unregulated drug poisoning crisis.
History and context of the unregulated drug poisoning crisis as a Mental Health and Substance Use Clinician in the Central Okanagan in BC Canada.
I first observed the beginning of the surge in opiates in clinical work around 2009 when I took on the methadone program off the side of my desk at Mental Health and Substance Use (MHSU) with Interior Health. Prior to this, I was providing treatment counselling and groups with a variety of clients experiencing issues related to substance use and substance use disorder.
Taking on a kind of gate keeping position for the methadone program in 2009, I noticed there was a huge wait list, up to 6 months for some. Due to high case volumes, our health authority created admission barriers that included onerous bio-psychosocial assessments completed by a clinician, usually me, before a medical doctor’s assessment could be completed. Once the doctor’s assessment was completed, a substance use counsellor would be assigned and would contact the client for a first appointment. Once assigned a counsellor, a doctor could then follow up with actual medical services. Admission to this methadone program only had this one entrance in the central okanagan for the first year I was involved. It was difficult to navigate to say the least.
When comparing our program to others in Canada at that time, I found that too many places had onerous wait lists, and complicated admission criteria, some wait lists being up to one year before admission to the program.
Our program quickly developed though. The authority added a practical nurse to the admission team (now two of us) to complete comprehensive assessments including medical information. The mandate for a substance use disorder (SUD) counsellor was removed and offered as voluntary. Wait times decreased by about half averaging to about a 3 month wait time. Admission still had to be through the front door of the MHSU facility. For instance if someone were waiting for methadone in hospital, they could not be admitted to the program unless they literally walked through the doors of MHSU. Fortunately, a couple of doctors worked alongside me to circumvent and triage some of the more urgent cases despite health authority policies at the time.
As the opioid epidemic increased, policies began to change. Outreach became a necessity and at first, only I was assigned to do outreach alongside daily treatment groups. Eventually, more of us were assigned to deal with the more marginalized population and those on opiate agonist therapy. Eventually the wait list for methadone decreased to about 6 weeks.
By 2016 Suboxone became covered under BC’s pharmacare program. It had been brought in as the first preferred response in BC opiate agonist treatment policy. The local detox reorganized from a “social” detox to a medical withdrawal management model. Suboxone was the go to therapy for opiates at the facility. Those on methadone were not admitted to the facility for detoxification unless they were willing and appropriate to switch to suboxone. At this time we were beginning to notice a sharp increase in overdose deaths.
Revisioning detox as a medical withdrawal management process certainly addressed much of the concern around opioid withdrawal and was an attempt to decrease overdose deaths. What it discarded was the social necessity that people needed to have time to recover. For instance, someone withdrawing from crystal meth or cocaine did not have priority at that facility as on their own, neither pose a potential health threat during withdrawal. However, even a short abstinence from opioids, resulting in a decrease in tolerance, and given the high relapse rates, the risk of overdose deaths remained very high post program. Hence the first line of defence being suboxone.
“In February 2012, a reformulated tamper-deterrent form of long-acting oxycodone, OxyNEO, was introduced as an initiative to address concerns related to the misuse of the previous controlled-release oxycodone product, OxyContinOne”. (Canadian Institute for Health Information)
The Guideline for opioid therapy and chronic non-cancer pain was implemented in 2017.
Critiquing the guidelines, “Kelly Eby, director of communications and government relations at the College of Physicians and Surgeons of Alberta, suggested that more punitive approaches might discourage doctors from prescribing opioids when necessary. If patients are “cut off, or their subscription is reduced dramatically, they’re going to go elsewhere, and that means to the street.” (Glauser Wendy 2017)
I find it more than coincidental that overdose deaths began to rise even more after 2012. The toxicity of the deregulated drug market also began to increase after the alteration of oxycontin.
The trend to use stronger substances became noticeable, to me anyway, through my experience as the methadone gatekeeper in Kelowna starting in 2009.
Of the characteristics of the crisis I noticed was the move of prescribing doctors to wean their patients from any opiate prescriptions. I was told this was mandated from the college of physicians and surgeons in response to the overprescribing of oxycontin. This was happening prior to the guidelines being implemented in 2017. I knew that Kelly Eby had it right before he had even stated it.
All of this became even more evident as I took on outreach in the community. Clients were desperately “drug seeking” after being weaned, usually quite quickly, off of their opiate therapies. Many were desperately seeking opiate agonists. When faced with such unrealistic wait times for opiate agonists and other forms of treatment, far too many people sought the black market for any illicit opiates that were available.
I noticed as well, that people who were not considered “addicts” by definition by the methadone administration at the time were also beginning to try and access opiate agonist therapies for pain management. Admission was refused for these folks, many of whom were struggling with pain from physical trauma and many who were aging and elderly.
The college of physicians and surgeons and the pharmaceutical college seemed to be actively contributing to the onset of the overdose crisis through mismanagement of the mandate to wean people off of their opiate prescriptions. It seemed that doctors were moving far too quickly and without real medical knowledge of the withdrawal process. People came to me to try and have me advocate further prescriptions from their doctors to manage pain and now increasing brutal withdrawal symptoms. People would tend to ask their friends and families to provide them with prescription medications. That was usually short lived and people would then access an illicit street supply. At this point these people were now considered “addicts” with opiate use disorder and were bestowed the stigma that always accompanies the term “addict”.
Stigma and misinformation turned families against their loved ones and alienated people who used substances and developed a SUD. People did not understand addiction nor did they know what to do about it. The only information available was based on beliefs, propaganda and strategies that are now dating more than 80 years old.
Medical professionals were quick to refer to them as “drug seeking” and turning them away from any medical help.
The street supply quickly became more toxic as the producers and distributors responded to the epidemic. We know the rest. We have a deadly cocktail of illicit street drugs out there that are profit driven. This because the whole opioid epidemic was completely mishandled by the public and most importantly by trusted institutions that were driven by stigma created over a century of criminalization bolstered by propaganda and sensationalist misinformation.
Number of overdose/poisoning calls since proclamation in BC in 2016
According to the BC Emergency health services data update from January 2022, the number of overdose/poisoning calls in BC fell by 5% in 2022 from the previous year. Before that decrease, there were consistent increases since 2016 with the largest being 2016 itself with a 57% increase since 2015. The next highest increase was 2021 with 31% and 2017 following up with 22% from the previous year. From 2004 to 2015 calls fluctuated from 10,000 to 15,000 per year. So from the average, approximately 8,550 more calls were sent out in 2016. That means there is likely up to 23,000 overdose poisoning calls per year.
Out of those calls that were reported, and likely out of the overdose events that weren’t reported BC has experienced a loss of 13,536 souls up to October 2023, to unregulated drug deaths since the declaration of a state of emergency in 2016 from BC Public Health.
The widely accepted story of this loss is that the majority who died from overdose/poisoning were likely addicted, street entrenched, marginalized people. The social story is out there that this is completely about mental health and addiction and is being linked to crime and homelessness. The accepted story is about the opioid epidemic. However, the numbers are telling a different story.
While opioids such as fentanyl and carfentanyl are certainly major players as we have read above, stimulants, benzodiazepines, Etizolam and now xylazine have also been major contributors to the toxic cocktails being distributed. The additives are providing more bang for the buck for the black market. They are also increasing the prevalence of substance dependence and substance use disorder with those people who struggle on that level. Diacetylmorphine or heroin is hardly even a concern anymore as more and more product is being tainted heavily with fentanyl and other additives. Any ingredient other than opioids make life saving naloxone ineffective in reversing overdoses.
“Oxies” and “Dillies” are not the main drugs of choice for many now. The lies from big pharma about oxycontin and the mismanagement by the college of physicians and surgeons, the medical community and law enforcement have stoked the perfect fire. The “opioid” crisis has evolved into the fatal unregulated supply of illicit drug crisis. The dependence developed from oxies has transformed into the dependence on fentanyl. Fentanyl has now eclipsed any other opioid.
It’s not personal, it’s just business:
I am reminded of conversations I have had with ex dealers who were reaching out for help through counselling. Anecdotally, what I heard reinforces the reality of the business model being used to hold on to people who use substances. Basically the stories from the dealers point of view went something like this: (paraphrased)
“We put a little fentanyl in the cocaine/methamphetamine/dilaudid and so on. The person’s experience is generally very good and they return for more. After the third or fourth score, we sell a pure form of the drug of choice without the additive. It does not have the same effect [and minor withdrawal symptoms begin to form] and they come back sometimes sick. We then charge more for a dose with fentanyl and or benzo’s etc. The person then becomes more dependent and pays more for stronger doses. Occasionally we will leave out the extra ingredient just to reinforce the dependence. Next thing you know we’re selling fentanyl which is easier to manage and seemingly cheaper for the person using. The dependence developed guarantees a long term customer”.
This narrative or business strategy is a mirror of a process described by B.F. Skinner in the 1950’s labelled Variable Ratio Conditioning. It is a psychological structure or set of strategies using unpredictable rationing of rewards to reinforce behaviour. It’s used in business to “hook” clients, consumers, etc into being interested through random rewards. Add on the chemical “hooks” of certain substances and addiction becomes even more reinforced.
Cocaine – cocaine w/fentanyl; cocaine – cocaine with more fentanyl; – fentanyl; – fentanyl with benzodiazepine; …. and so on.
Why is it that most people who are struggling with addiction to substances are now so dependent on fentanyl? Why is fentanyl now the drug of choice for so many? Because of the business model used by the black market to keep their customers coming.
So we can clearly see that the black market business model is at the root of the increasing toxicity of illicit unregulated substances. This was described as the “iron law of prohibition” which asserts that the stronger the criminal sanctions, the more toxic substances become. This was noticed during the prohibition of alcohol as deadly cocktails were brewed at that time causing the equivalent of today’s overdose crisis.
So not only addiction and substance dependence play a role in the deregulated drug poisoning crisis. There is a reason major institutions, agencies, advocates and those with lived and living experience include the word poisoning. Because that is exactly what is happening. And it is the poisoning of the illicit supply of unregulated drugs that is actually causing overdoses and deaths. Addiction is certainly one of the drivers. And yet, that is all politicians and, not without suspicion, the treatment industry are making noise about. As I have said, the numbers tell a different story as do the tales from the street and the black market do.
The Impact of a toxic poisoned supply of illicit unregulated substances.
From the BC Coroners reports:
Profiles: 13,536 lost souls in BC from 2016 to October of 2023 so far.
The age groups most represented in the unregulated drug death count ranged from 19 to 60 accounting for a total of 11,775 lost souls between 2016 and October of 2023. A breakdown from that time period sheds a bit more light on this.
There were 2,204 lost between 19 and 29; 3,355 lost aged 30 to 39; 3,044 lost aged 40-49; and 3,172 aged 50-59 were lost.
An important point here is that the numbers of deaths between age 30-60 doubled over the pandemic years. This is important because there was a universal closure and thus lack of access to harm reduction and recovery based services especially for marginalized groups. It demonstrates that prior to the pandemic, some numbers were beginning to decline such as in 2019 before the shut down of the pandemic where numbers doubled. Harm Reduction and other services were obviously and most definitely needed and having an effect before the shutdown of the pandemic.
Of particular interest is the sex of the people who died. Overall men represented high 70’s to low 80’s in percentage while women represented consistently between 18- 24% of those who died from toxic drug poisoning. In 2023 so far 1,573 men and 466 women have died preventable deaths from toxic drug poisoning.
Of those who fell victim to the toxic drug poisoning in BC, 47.8% died in their private residence. That’s 974 people who died in 2023 who were likely in a family or a friend’s home. There were 566 or 27.8% of people who died in other residences including single occupancy rooms, shelters, or social/supportive housing. Those that died outside represented 19.2% or 392 people. Very small numbers below a percentage point died in public buildings or washrooms, medical facilities or while incarcerated.
There was no evidence that safer supply contributed to any of these deaths. Further, there was no evidence to suggest that youth were dying from the diversion of safer supply.
The numbers here provide crucial clues as to who is actually falling victim to the overdose/poisoning crisis. They suggest that people in the prime of their lives, many in the working class, in their own homes or homes of friends, far outnumber those that are struggling with issues such as homelessness.
Despite the numbers, the narrative maintains that this is just about addiction, homelessness and crime!
In other words people that would be normally considered “stable” in our judgmental society are actually the ones most affected by the overdose/poisoning crisis. That men far outnumber women suggests to me a possible male culture that provides a perfect storm for seeking out relief from whatever that culture imposes on men. I found this concept blatantly inescapable as I heard the stories of thousands of men over the years.
These numbers could also be suggesting the success of harm reduction in action. Most harm reduction programs and strategies are provided on the street level as opposed to in home, in office, on the job site. Deaths decreased somewhat as resources began to get established; at least until the pandemic hit. This despite the propaganda that harm reduction is contributing to addiction thus contributing to the deaths. Quite the opposite is true when you study the numbers.
Unfortunately the stigma around mental health and addiction being linked with the most destitute and vulnerable members of society presents a very real barrier for the men and women who have the fortune of housing and employment in society. No one wants to be “that addict”. Not only does public opinion play into that but so do institutional policies regarding substance use health.
The treatment of people who have been black listed as “drug seeking” and/or have presented at hospitals for lack of any other resources has been nothing short of disgusting, horrendous and rife with bigotry and disdain. Fair and just treatment for anyone with substance use issues in the health system has been the exception, not the norm in my experience.
I make these assumptions as witness to, and from the many many people I have spoken with in confidence about their lifestyles. Everyone from lawyers, CEO’s, celebrities, stay at home moms, youth, grandparents; Blue collar and sales people who seem to represent the majority of men and women who struggle with substance use issues. All of these living experience stories, including my own, makes it easier to see that we are facing challenges far beyond an “opioid” crisis.
Number of deaths from unregulated drugs at a Safe Consumption Site or Overdose Prevention Sites:
There has been one known death ever that occurred in 2022 at an Overdose Prevention Site (OPS) in Canada. There have been no other deaths reported anywhere in the world or at any time.
From my experience I will highlight the indescribable value that OPS’s have had in our communities.
In 2017 Kelowna and Kamloops received their first mobile safe consumption sites. This was not the ideal model proposed, but a political and community compromise had been reached based on the current stigmatizing views of substance use at the time. There was huge resistance to a stationary site for a variety of reasons not the least of which included the “not in my backyard” attitude shared by too many community and thus political members.
Regardless of and despite the resistance, the mobile site made a huge impact on the number of lives saved from overdose. Prior to its inception, overdoses were happening multiple times per day outside of the clinic I was working in. More lives were saved as naloxone became more accepted and widespread. But even that faced huge resistance from law enforcement and bi law enforcement who initially refused to carry naloxone. That changed with pressure from front line workers, clinicians like myself and our health authorities as they began to listen to the experiences of those facing the crisis head on. Finally our OPS was in place in the winter of 2017 and situated behind our clinic in our parking lot.
The law monitored but would not move on government property nor could complaints be operationalized into anything other than proper security. And there were myriad complaints, mostly by professionals such as lawyers and bankers whose offices were nearby.
The number of people recorded using the site topped 100 a week and multiplied almost exponentially. No one died at this site and all unregulated drug poisoning overdoses were stopped. The site was working. It was saving hundreds of lives; even as the numbers of overdoses continued to skyrocket, lives were at least not being lost at this site.
And being located behind our clinic, the services most needed were a step away from the mobile unit. Referrals were made and many followed through with connections to other resources including treatment, housing, and other necessities. My case load grew, once again, without assistance. Thankfully the team there was diverse and well skilled.
So we were having success with the mobile unit. Lives were being saved, people were getting resources they needed including the most important at this level, harm reduction. Again, I can’t say this enough; without this type of harm reduction, the numbers of deaths from overdose due to poisoning would have been exponentially higher. However, there was a large number of people we were not reaching.
The people we were not reaching were folks I have spoken of earlier. They are understandably cautious and/or too traumatized from stigmatizing events, activities and attitudes that have proved to be barriers to resources.
I have nothing but the utmost respect for the courage that it took for people to come through the door to my office and then later to the clinic I was stationed in. The absolute fear, humility, shame, guilt, timidness, apprehension, all of it, was thick on every single person. The relief in the air once a person began to feel safe and welcome was like lifting a rock off of our chests.
I could also relate to the first time I had to reach out for help with my own substance use and mental health issues. Not only is the experience rife with shame and humiliation, it is an embarrassment as we walk by other people who are likely there for the very same reasons. It is a lonely and stark experience.
But as I said, once a sense of safety, comfort and respect is established, the experience can become a warm learning opportunity for growth. Any level of self determined growth.
Treatment, harm reduction and recovery
When we talk about treatment, the general understanding is that it is about going to a residential rehab facility to abstain from substances and hopefully somehow come out abstinent and ready to function in the world. What is not generally known is that there are many different types of “treatment” programs and avenues. What also needs to be known is that “treatment” is not a panacea for substance use disorder. It is a step. And it is an ongoing evolving process that transforms into a journey of recovery and thriving in life. That doesn’t happen overnight or in one month, or even one year for anyone. It happens throughout our lifetimes.
Yet treatment is being touted as the silver bullet to the unregulated toxic drug poisoning crisis. It is being separated from the effective harm reduction approaches that have saved thousands of lives so far. This division is tragically dangerous and if followed through, and harm reduction remains separate and divided from the answer, then thousands more lives will be lost.
Self help such as AA and NA or SMART Recovery are good examples of ongoing community based support systems. Many health authorities offer “outpatient” types of day programs from weekly to daily groups along with individual counselling. All of these have their value in society and for the people that are struggling through issues related to substance use health. The most important thing to remember from my experience in facilitating treatment is that there is no “one size fits all” approach.
Many people will benefit from faith based programs from attending church groups to the 12 step based self help groups and programs offered in residential and outpatient circles. Many will not. Many others will benefit from psychological approaches such as cognitive or dialectical behaviour therapies; Narrative, Brief Solution therapies as well as other psychosocial approaches. Many will not. There are other strategies attached to various programs such as Eye Movement Desensitization and Reprocessing (EMDR) to help treat trauma. They work for some but not all. Many programs are trauma informed so as to address trauma sensitivity in individuals. More traditional and faith based programs are not trauma informed. Despite all of these approaches, there are still those who don’t really fit neatly into any one place.
What I’m getting at is that it seems we’re throwing money at “treatment beds” without really understanding what treatment is, how it works, how it doesn’t work, with the expectation of impacting what we are labelling the opioid crisis. What we really should be calling this is the unregulated toxic drug poisoning crisis.
What worries me is the appearance that many politicians I have spoken with, particularly on the conservative side of the issue, are referencing faith based treatment facilities. Likely because it has been faith based 12 step approaches that have been used the most in the last 80 or so years. My experience, being a part of the “fellowship” so AA, is that each support approach claims to be the answer. It seems that the information that is being used to develop policy is restricted to these particular approaches with the expectation that they will provide the answer to the overdose deaths we are experiencing. I urgently hope that is not true.
My experience in dealing with all levels and forms of treatment reinforces the fact that there is no one size fits all approach. That treatment is far more complex than we think it is, and most importantly, that harm reduction itself is part of the recovery process. There is no one answer! But there are things we can do to eliminate the toxicity of the current deregulated supply of drugs that are causing the overdose deaths. In doing so, we can increase the likelihood of treatment for those that need it. That is something concrete that we can do!
The research on success and failure of treatment programs as they are understood in the general public is all over the place. There is no real standardized way of defining or measuring success. Some programs measure program retention, others measure abstinence immediately after attendance. This is important as it directly relates to the recovery process that people experience.
The Canadian Centre for Addictions describes success in rehab as a culmination of many different factors. They argue that there is no set structure that determines what success is and how it is obtained. Based on this description, they state that their research has determined that 51.2% of people achieved stable recovery without experiencing a single relapse. That’s wonderful if it is true. But most programs do not gather data beyond the one year mark and many, like our health authorities only gathered data up to the 6 month mark, when and if responses are returned. Most programs and studies only measure treatment retention and call program completion a success, which it most certainly is. But does the general public know that longer term abstinence as a measure of success falls short of the actual progress a person can make while receiving help?
This brings us to relapse rates. If we follow the numbers from CCA, then 48.8% of people relapsed at some point after their program. This is consistent with numbers from the American Addiction Centers website which reports that about 40- 60 % of people relapse after discharge from a rehab. Close to 91% of people relapse after discharge from short term detox facilities and from rehab. These numbers have been consistent with information and my personal experience throughout the last 30 plus years.
It was a rarity to see one of my clients remain abstinent for any length of time after their first and very often, after multiple attempts at residential treatment and/or outpatient treatment programs and/or participation in self help programs such as 12 step. A constant complaint of my clients was the unstable revolving door activity happening with NA meetings.
The CCA talks about barriers to treatment. They talk about perceptions of others, not knowing where to access resources, lack of social support. Almost half of the respondents in their study reported perceived stigma and discrimination during their active addiction. Of course, the biggest barrier being long wait times. In short, stigma and waiting are the biggest barriers to treatment. This is certainly consistent with my own experience with the system.
I can tell you from my experience that onerous referral policies, packages, and unrealistic expectations of abstinence before admission to rehab contributed to those long wait times.
In the meantime:
So in the meantime where do people get their drugs of choice? For those waiting for treatment for Alcohol Use Disorder, their supply comes from regulated market sources. People will use their alcohol in safe consumption sites in restaurants and local bars and pubs. They know where they are and what they are getting. They may be unhealthy on various levels, but they will not die from an unregulated product nor from an overdose in a safe consumption site such as a bar. People will be there to respond.
But what if the drugs of choice are stimulants like cocaine, amphetamines or methamphetamines, analgesics such as opioids or tranquilizers such as benzodiazepines?
Where do they get their supply and where can they use it safely? Where does that supply come from? How do they know what they’re getting?
While addiction certainly is shown to play a role in the unregulated drug overdose poisoning crisis, it is not the primary cause. Addiction can explain the compulsion, drive and lack of control of use and even some deaths, but it can’t account for the overwhelming numbers of people who are falling to the unregulated supply. Addiction should not be the main focus of this crisis!
When a person has to wait weeks or months to access opiate agonist therapies; when a person has to wait weeks to months to access withdrawal management, residential or outpatient treatment; when a person has to wait weeks to months to years for affordable housing; when a person has been cut off their prescription of opiate agonists or even the small amount of medical safer supply; where does that person get their supply of their drug of choice?
When a person is discharged early from a program or recovery house due to relapse; when a person relapses after detox after 7 days; when a person relapses 6 months after rehab; where does that person obtain their drug of choice?
When a person goes out with “the boys” after work and does a line of cocaine under peer pressure or for just personal pleasure; when a home maker is so burned out from career and/or caring for family and needs energy to complete their day; when a sales person has had a bad week and needs something more than a drink; when a youth goes to a party or a concert and wants to use something recreationally or experiment; where do these people get their supply?
These are all very real and verifiable life situations for the majority of Canadians.
Once upon a time, there wasn’t a whole lot of concern around relapse or experimentation aside from the lack of abstinence and the impact of using could have on the person’s life. We knew, and still know this is a part of the recovery process when one is struggling with substance use disorder.
It is also a form of rite of passage in our culture to drink, smoke or experiment, to take high risks.
The luxury of finding a supply of substances that won’t kill you is no more. And there is no program I know of in existence anywhere that is able to guarantee that a relapse will never happen or guarantee that a youth or any other person will not experiment with an unregulated substance.
The only place that people who use unregulated substances can obtain their substances is from unregulated, dangerous and careless, sources – The Only Source!
And 21 people a day are dying now in Canada. In BC, 6-7 are dying per day. How is this even okay?
Summary
We are facing more than an opioid/overdose/unregulated drug crisis. We are facing a complete systemic structure that has either maliciously or inadvertently created the perfect storm for the crisis we are facing with mental health and substance use in our country and society as a whole. This is more than about an individual with a disorder/disease/health issue. This is far more than about addiction to substances. Yet we keep pointing our fingers at the individual and refuse to look at what we have done as a whole to keep this system in place. But we can do something.
Yes we need more treatment programs. We need more programs that are flexible and less onerous with their admission criteria. We need programs that are flexible and prepared with viable strategies in how they deal with the very expected and real issue of relapse during recovery. Strategies such as detox or time out rooms for those who relapse while in treatment or recovery homes for instance would decrease the need for revolving door admissions and more importantly prevent deaths from early discharges. Early discharge is far too often a death sentence. Relapse after a rehab program is a death sentence. Relapse after any period of time of abstinence is a death sentence yet all to real and all too often.
We need more programs that embrace harm reduction as one of the most valuable tools so far in saving lives from the unregulated drug poisoning crisis. Programs that do embrace medical assisted therapies instead of stigmatizing them as “enabling”. The crisis is not just about addiction and treatment, it’s about lives lost to an unregulated supply of poisoned substances.
We need some way to protect youth who, despite our best intentions and efforts to stop them, will experiment with drugs. We need to help them understand harm reduction as well as prevention. “Just Say No” has been a dismal failure and has actually not had anything close to the impact that was intended. Youth know when we are lying to them and that program was replete with irrelevant inaccuracies. Prevention needs real life anecdotes that must include harm reduction safety measures, not RCMP doing the ineffective “scared straight” routines.
We need to change public opinion through education that is not sensationalist but rather balanced between factual and anecdotal from people with lived and living experience. A saying I try to live by is “nothing about us without us”. A valuable lesson I learned during my career. Peer inclusion is crucial in policy planning, and not just for obligatory appearances but for adopting that experience into programs and policies.
We need to review and change all institutional policies. Among the most important are policies in the medical field including the treatment industry, law enforcement and the justice system. How do we change them? By listening to more than the nay sayers or those who have special interests. We listen to everyone including those who are on the front lines of this war on drugs and especially listen to the victims and casualties themselves.
But we are dancing around the obvious answer. Addiction is part of the crisis, but it is not addiction that is causing the overdose deaths. There is very little we can do to eliminate addiction or substance use in general in our society. We can address it but as I hope you can see, it is complex and requires onerous huge long term changes in our attitudes, knowledge and roll out. But there is something we can do right now to almost eliminate the deaths due to overdose.
It is the unregulated supply of drugs that is the only option for people who are using substances. So it is the unregulated supply of drugs that must be addressed first and foremost or at least in conjunction with the fortification of treatment programs. For the last century we’ve tried to arrest our way to a solution with tragic and fatal results. So now it is time to regulate a safer supply of substances. Using substances, even developing an addiction to substances should have never been a crime. And it certainly should never have become the death sentence it is now.
This crisis has formed under a society that has stigmatized, demonized and criminalized something that has always been a health issue with a social impact. Education with facts not propaganda; regulation of evidence based treatment which includes medically assisted therapy, harm reduction, social and community resources and support; and most importantly, the regulation of a safe supply under a decriminalized infrastructure so that no one needs to choose a poison to medicate their withdrawal or pain.
Instead of arresting community members for providing a compassion club style of safer supply, we should be supporting them. We can create the infrastructure to save lives as DULF has done here in BC. We even have the evidence! A compassion club infrastructure will save lives. For that to work we need decriminalization that does not have unrealistic caps and conditions and must allow the infrastructure for compassion clubs to work. These can work alongside medically prescribed programs to help provide a safe supply.
For the sake of grieving mothers and fathers, family and friends; for the sake of the first responders and front line workers; and most crucially for the sake of people who use substances; regulate all substances and make them that much safer so that people can live to grow through their experimentation or their substance use disorders.
Just focusing on addiction and treatment is an incomplete and frankly a stigma driven response to the unregulated toxic drug supply overdose crisis. Harm reduction including regulated safer supply must be included to help save lives while attempting to quell the tide of addiction in our society. We have to work together.
We can’t help dead people.
We can’t treat dead people.
Dead people don’t recover.
Resources
http://www.bcehs.ca/about/accountability/data/overdose-drug-poisoning-data
https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports
Scott HK, Jain A, Cogburn M. Behavior Modification. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29083709.
https://americanaddictioncenters.org/workforce-addiction/blue-collar
: McQuaid, R.J., Malik, A., Moussouni, K., Baydack, N., Stargardter, M., & Morrisey, M. (2017). Life in Recovery from Addiction in Canada. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction. © Canadian Centre on Substance Use and Addiction, 2017.
Rehab Success rates: https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics
Canadian Drug Policy Coalition: Case for Reform;
https://drugpolicy.ca/our-work/case-for-reform/#:~:text=Moreover%2C%20the%20%E2%80%9Ciron%20law%20of,more%20easily%20hidden%20and%20imported.
British Columba Centre on Substance Use, BC Ministry of Health, and BC Ministry of Mental Health and Addictions. A Guideline for the Clinical Management of Opioid Use Disorder. Published November 2023 Available at: https//:www.bccsu.ca/opioid-use-disorder/
Canadian Institute for Health Information. Opioid Prescribing in Canada: How Are Practices Changing?. Ottawa, ON: CIHI; 2019.
Medical-legal concerns over prescribing opioids on the rise
Wendy Glauser
CMAJ Oct 2017, 189 (40) E1270-E1271; DOI: 10.1503/cmaj.109-5500
Guideline for opioid therapy and chronic noncancer painJason W. Busse, Samantha Craigie, David N. Juurlink, D. Norman Buckley, Li Wang, Rachel J. Couban, Thomas Agoritsas, Elie A. Akl, Alonso Carrasco-Labra, Lynn Cooper, Chris Cull, Bruno R. da Costa, Joseph W. Frank, Gus Grant, Alfonso Iorio, Navindra Persaud, Sol Stern, Peter Tugwell, Per Olav Vandvik, Gordon H. Guyatt
CMAJ May 2017, 189 (18) E659-E666; DOI: 10.1503/cmaj.170363
Alcohol Prohibition Was a Failure
JULY 17, 1991 • POLICY ANALYSIS NO. 157
By Mark Thornton
Cato Institute.
‘Just say no’ didn’t actually protect students from drugs. Here’s what could; November 9 2023 NPR https://www.npr.org/2023/11/09/1211217460/fentanyl-drug-education-dare
https://www.dulf.ca/cc-preliminary-findings
Opioid Relapse Rates, Prevention and Recovery
https://drugabuse.com/opioids/relapse/