So many things have happened since British Columbia declared a public health state of emergency regarding the “overdose crisis”. So much has been done without a doubt, but nothing anywhere near the target of stopping the deaths.
The best we have done is created a MASH like culture of triage through indispensable harm reduction strategies. We have opened up a few more “treatment beds” But overall, a difference of “opinion” has been created that has created a gaping yaw between two concepts that really should never have been separate in the first place; harm reduction and recovery.
I hope that this article will help clarify the need for recovery based and harm reduction based policies to be seen as one and not two separate approaches. Saving lives is crucial to helping people. Dead people do not seek help after all.
Safer supply or what we are now calling regulated supply of substances has become viewed as the first step in dealing with the number of deaths that are happening. This is because of the increasing toxicity of the unregulated supply of substances that is the only option for many people. Many experts in many health and justice related fields as well as the peers with lived and living experience are beginning to see the sense in regulating unregulated substances. Regulation is now being recognized in a growing community as a way to save lives; Not only with people who are struggling with addiction, but also with people like you and I who like to feel pleasure on occasion.
Don’t roll your eyes or shake your head in disgust!
Almost all of us have at least experimented. And usually at a very young age. We might like to enhance our experience at a concert or a party. Catch a buzz, even get wasted once in a while to let off a little steam, have a little fun. There are plenty of reasons people use substances that do not involve addiction. There are plenty of reasons that frankly are none of our business. And there are a majority of us that do so without experiencing any of the negative consequences that some experience – at least not until now.
The unregulated supply upon which we must obtain that little bit of risky fun has now become huge risky business. In fact according to the BC coroners report, consistently the majority of people who are dying of “accidental overdose” are not people suffering from addiction living on the street. They are people in sales positions, businesses, and a majority in construction and blue collar industries. Most seem to have housing. And the majority are young to middle age men. Interesting.
And yet, our belief that “it won’t happen to me, it only happens to addicts” (people who struggle with addiction) still prevails. Our tendency to use substances for entertainment and fun has now turned deadly but because of our belief systems, we don’t see it.
There are specific risk factors that, when in place, can contribute to the development of addiction as we understand it. A minority of us have those risk factors. According to most research over time, between 10-20% of us who use a substance somewhat regularly will develop an addiction.
Those of us who do develop an addiction will have experienced one or more of the following, childhood trauma, chronic trauma, family history of addiction, mental health issues, brain injury, developmental issues, undeveloped social skills, are among some of the more prominent risk factors that have been found to contribute to addiction.
The main reason my “clients” (ahem) people who have struggled with issues pertaining to substance use, have told me about why they use and developed a problem, was to medicate for either/or physical and emotional pain. That would be the number one reason given during my career as a counsellor.
Many people were simply forced to see me for the simple reason that they were caught using something and had no other real adverse effects from substance use. They were just caught. Or some had minor problems that were easily addressed through therapy and even just simple problem solving.
So we know that the majority of people who are dying from overdose due to toxic unregulated drug poisoning are people who are not necessarily addicted. We know that about one fifth of the people who use substances actually become addicted. And yet our general point of view about an answer to the unregulated drug crisis is to increase access to treatment for addiction.
Hold on, rewind a bit. Our first responses to this was to get harm reduction strategies in place. Suboxone became available through pharmacare in 2015 and became the preferred first response as an opiate agonist for people who struggled with addiction. Advocacy for naloxone to be available to everyone was successful and is virtually free and available to anyone in BC.
The first supervised injection site in North America was established in 2003 and the onerous policies to further establish sites were simplified in 2017. But not without a fight that held up the changes for about a year. A year that was increasingly deadly.
Supervised consumption sites are now spread across Canada, but not without public controversy. Controversy that is founded in outdated and dangerous views about addiction and enabling. Supervised Consumption Sites (SCS’s) have saved thousands of lives by intervening in overdoses at safe locations by peers and trained health and social professionals. I watched this happen in real time the last five years of my career.
Life saving apps, life saving policy changes at housing and shelter facilities have also contributed to saving lives. Even medically supervised injections and prescriptions of opiate replacement therapies changed lives as well.
Detox facilities became medically oriented to opiate agonist and opiate replacement therapies. Even a small number of treatment centers were becoming medical assisted freindly moving away from the abstinent only approaches.
Over the last 7 years, hundreds of beds have been funded for treatment. Yet wait times and abstinence policies have not changed in most facilities.
And still the numbers are climbing. Those who were experiencing addiction and on the street had been provided with all sorts of harm reduction and treatment options. What are we missing here?
The increasing record breaking number of deaths that are occuring have spawned an aggressive campaign for more recovery, abstinence based resources and calling for the end of support for harm reduction programs. In other words, more of the same. Harm reduction has even been falsely identified as the cause of this crisis by many in the recovery community.
There is no debate here. My hope is that I’ve already provided enough information to indicate that we have missed the target altogether. It is neither the fault of harm reduction nor abstinent based programs that the death toll is increasing. I hope that we can see that harm reduction is actually saving lives as are many treatment programs. Both are absolutely necessary at this point. It is absolutely necessary for both to recognize that they are all part of the same process. And that harm reduction serves, or can serve a population that do not access the facilities and programs currently in place.
I’ll start at the street level again to demonstrate one of the biggest reasons that people are avoiding services that provide life saving solutions for substance use. There is an organization in Vancouver under the name of the Drug Users Liberation Front or DULF. Making a very long story short, the members of that group were successful in creating a means to provide a safer more regulated supply to people who did not have access to the medical supplies provided. They took the success of the medical model and brought it to the street level so to speak. They received funding and proceeded to produce a year long study that was successful in demonstrating the actual impact of a regulated supply. A compassion club was opened.
In October of 2023, police raided the facility arresting the founding members. They were accused of using public funds to obtain substances from the dark web for testing and then re selling tested safer substances. According to the resulting study produced from these “illegal” activities, there were no overdoses or deaths associated with the safer supply.
According to the BC coroners reports, there were no indications that any deaths were caused by a regulated safer supply.
Yet here we are arresting the brave souls that had to work beyond an ill informed and seemingly broken system to prove what none of us want to hear apparently; that a regulated safer supply of substances will save hundreds of thousands of lives.
This speaks volumes about how we as a society view anyone who uses substances and especially anyone who develops problems from it. For over a hundred years and even more, we have vilified, demonized, moralized, criminalized, over-medicalized, substance use to the point that we would rather see people die than become addicted or use any substances. It is this stigma that is one of the main reasons people do not access any services related to mental health and substance use health issues.
The fact is that people have used substances for eons and will continue to do so. Most of you reading this use substances! Many of you may even have problems associated with your use but you won’t talk about it or seek help because you know full well what will happen to you if you do. You risk banishment, punishment, betrayal, isolation and possible criminalization. You could lose your family and friends. Why? Because that’s what we do with people who use drugs and have the audacity and lack of moral will to become addicted to them. How’s that working so far?
There has never been anything historically that has ever stopped substance use. So why not revalue our beliefs and view people as people. And provide the help where it is needed and stop contributing to the problem through our morally laden policies and judgments.
No it won’t address addiction. But we seem to prioritize the potential for addiction over the potential for death.
I have witnessed hundreds of overdoses over the last few years from people who have attended detox, short and long term treatment programs, recovery houses and programs. A few have even died while attending these facilities. In short, anyone who knows anything about addiction knows that relapse is an expected part of the recovery process. Even the best preparations can’t guarantee that relapse won’t occur. Where does the supply come from when relapse occurs…?
And, there is enough evidence out there that the toxicity of the supply is killing people who normally and historically would not have been in danger from overdose and who do not necessarily suffer from addiction. Where does the supply come from just to have a little fun or experiment…?
How much more evidence do we need? Here is the answer: Regulate all illegal substances and put the production and distribution in the hands of certified and regulated agencies. Everyone will have the option of obtaining a safer supply then. And yes, let’s bolster our treatment programs for those who need it. But not the same old same old 80 year old outdated abstinent only programs that are currently in place. Ensure that along with the tried and true methods of the past, yes they exist, there are the researched and evidence based methods of the present included. And ensure that the “industry” changes as more research develops.
In the meantime, (eye roll time again if you like), those of us who enjoy to get high once in a while, enjoy a buzz or even want to forget about life for a moment or two will not be automatically sentenced to death for the want of pleasure.
Resources:
Mate, G., M.D. (2012) “In the Realm of Hungry Ghosts; Close Encounters with Addiction”. Vintage Canada.
Alexander, B.K. (2008). “The Globalization of Addiction; A Study in the Poverty of the Spirit” Oxford University Press.
Hari, J. (2015). “Chasing the Scream; The First and Last Days of the War On Drugs”. Bloomsbury U.S.A. New York.
Fisher, Carl Eric; “The Urge: Our History of Addiction”, 2022, Allen Lane, Canada.
https://canada.constructconnect.com/joc/news/ohs/2017/09/opioid-crisis-looms-over-men-in-the-trades-1027095w
https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports
Dulf compassion club preliminary findings
https://www.cbc.ca/news/canada/british-columbia/oat-coverage-british-columbia-1.6876365
https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Life-in-Recovery-from-Addiction-Report-2017-en.pdf
https://www.catie.ca/prevention-in-focus/harm-reduction-in-action-supervised-consumption-services-and-overdose
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966500/