Safe Injection Sites - Vancouver

The Constitutional Obligation of the City of Vancouver to Support Safe Injection Facilities


From 1999 to 2002 I (Perry Bulwer) was a law student at the University of British Columbia in Vancouver, Canada. I was also involved with various community-based advocacy groups supporting the rights of drug addicts and sex-trade workers. The paper that follows this intro and news updates was a collaborative effort in response to government inaction in the face of a publicly declared health crisis. It was subsequently published on the website of Pivot Legal, and listed in the Legislative Library of British Columbia, however it is no longer available online. I have made it available here for researchers and activists in other jurisdictions. Pivot was at the time a new legal advocacy organization serving Vancouver's most marginalized citizens. Pivot and its lawyers have since received several awards for outstanding community service.

This paper, the two related papers on Safe Injection Facilities on this website, as well as similar research were used by Pivot and other activists in the fight to force government action. In September 2003 North America's first legal supervised injection site, INSITE, began operating in Vancouver as a scientific pilot research project. The evidence to date shows that such a facility saves lives by preventing overdose deaths and the spread of communicable diseases. However, the Conservative government under Stephen Harper has questioned the effectiveness of the service and has threatened to withdraw funding. In April 2008, the operaters of INSITE launched a constitutional case to test the federal government's power to close the facility. In May 2008, a letter leaked to the CBC revealed that doctors at the University of British Columbia's Department of Medicine last year unanimously urged Prime Minister Stephen Harper to keep INSITE open.

On May 27, 2008 the B.C. Supreme Court struck down as unconstitutional sections of the Controlled Drugs and Substances Act. It gave Ottawa until June 30, 2009 to fix the law and bring it inline with the constitutional principle of fundamental justice. The court also granted INSITE an immediate exemption, allowing it to remain open. Ottawa must now update its laws to ensure provinces are free to provide health care services to addicts.

Government opposition to effective harm reduction measures is nothing new, as this article explores. On October 8, 2008 Pivot filed a complaint with the federal auditor general alleging that the RCMP secretly commissioned research in hopes of discrediting INSITE. Consequently, the RCMP announced an internal review of Pivot's allegations. This article, Vancouver's Radical Approach to Drugs, provides an updated overview of Vancouver's harm reduction approach to illicit drug use. And here is atranscript of a radio interview with Dr. Gabor Maté, a physician at INSITE, on the biological and socio-economic roots of addiction.


See related legal arguments in the following two articles on this blog:

SAFE INJECTION FACILITIES: COMPELLING GOVERNMENT TO ACT 




INTERNATIONAL LAW AND THE RIGHT TO THE HIGHEST ATTAINABLE STANDARD OF HEALTH CARE: Using Safe Injection Facilities to Control and Prevent Epidemics

http://perry-bulwer.blogspot.com/p/safe-injection-sites-international.html


FOR RELATED, ONGOING, UP-DATED MEDIA REPORTS ON THIS ISSUE SEE THE COMMENTS SECTION AFTER THE ARTICLE AT:  http://perry-bulwer.blogspot.ca/p/safe-injection-sites-bc.html


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DRAFT SUBMISSION TO VANCOUVER CITY COUNCIL
The Constitutional Obligation of the City of Vancouver to Support Safe Injection Facilities
DATE: May 2, 2002
AUTHORS: Perry Bulwer1 Craig Jones2 and John Richardson3
1 LL.B., University of British Columbia (expected 2002)
2 LL.B., University of British Columbia, 1998; LL.M., Harvard Law School (expected June 2002); of the Bar of British Columbia; Adjunct Professor of Law, U.B.C.
3 LL.B., University of Victoria, 1999, of the Bar of British Columbia
SUMMARY AND CONTENTS:
1. Drug addiction is a disability and drug addicts are protected from discrimination by Human Rights Codes and the Charter
2. Discrimination is the failure to provide reasonable accomodation for the disabilities of drug addicts
3. Providing reasonable accommodation for drug addicts means taking steps to provide alternative access to necessary medical services
4. Safe injection facilities are a necessary medical service for drug addicts
5. The failure to provide safe injection facilities for drug addicts is an unjustifiable violation of Human Rights Codes and the Charter
6. The City of Vancouver is bound by the Charter and must exercise its powers in conformity with the Charter
Conclusion: The Charter of Rights and Freedoms may require the City of Vancouver to support safe injection facilities within the scope of its power and jurisdiction
1. Drug addiction is a disability, and drug addicts are protected from discrimination by Human Rights Codes and the Charter
Both heroin and cocaine dependence are classified as psychiatric disorders under the authoritative diagnostic manual, DSM-IV, which sets out the characteristics of opioid and heroin addiction as follows:4
Opioid/heroin Abuse
A destructive pattern of opioid/heroin use, leading to significant social, occupational, or medical impairment. Must have three (or more) of the following, occurring when the opioid/heroin use was at its worst:
1. Opioid/heroin tolerance: Either need for markedly increased amounts of opioid/heroin to achieve intoxication, or markedly diminished effect with continued use of the same amount of opioid/heroin.
2. Opioid/heroin withdrawal symptoms: Either (a) or (b).
(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged opioid/heroin use:
  • sweating or rapid pulse
  • increased hand tremor
  • insomnia
  • nausea or vomiting
  • physical agitation
  • anxiety
  • transient visual, tactile, or auditory hallucinations or illusions
  • grand mal seizures
(b) Opioid/heroin is taken to relieve or avoid withdrawal symptoms
3. Greater use of opioid/heroin than intended: opioid/heroin was often taken in larger amounts or over a longer period than was intended
4. Unsuccessful efforts to cut down or control opioid/heroin use: Persistent desire or unsuccessful efforts to cut down or control opioid/heroin use
5. Great deal of time spent in using opioid/heroin, or recovering from hangovers
6. Opioid/heroin caused reduction in social, occupational or recreational activities: Important social, occupational, or recreational activities given up or reduced because of opioid/heroin use.
7. Continued using opioid/heroin despite knowing it caused significant problems: Continued opioid/heroin use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by nicotine
Associated Features

Learning Problem, Psychosis, Euphoric Mood, Depressed Mood: Somatic or Sexual Dysfunction, Hyperactivity, Addiction, Sexually Deviant Behavior, Odd or Eccentric or Suspicious Personality, Dramatic or Erratic or Antisocial Personality
Human rights instruments in Canada protect disabled persons from discrimination based on disability. Canadian courts have found that drug addiction constitutes a mental disability, and drug addicts are protected from discriminatory practices by government and by private persons such as employers and landlords.
Canadian Human Rights Act
The Canadian Human Rights Act clearly defines substance addiction as a disability:
"disability" means any previous or existing mental or physical disability and includes disfigurement and previous or existing dependence on alcohol or a drug.5
In Toronto Dominion Bank v. Canadian Human Rights Commission the majority of the court held that the protected disability of "drug dependence" included addiction to illegal drugs. Robertson, J.A. stated:

In my view, it would be contrary to the Supreme Court's approach to the interpretation of human rights legislation to construe section 25 of the Act narrowly by reading in the word "legal" so as to modify the phrase "dependence on [legal] drugs": see Robichaud v. Canada, [1987] 2 S.C.R. 84 at 89, 40 D.L.R. (4th) 577. Surely, it is accepted that dependence on illegal substances is just as, if not more, common than dependence on legal drugs. The comments made before the Standing Committee by then Minister of Justice, Mark MacGuigan, were based on an analysis of the American approach which developed in the context of that country's "war on drugs" policy of the 1980's. Our legislation is not influenced by the same politics. In any event, to my mind it would be impractical to protect only those dependent on so-called "legal" drugs as some of those might be obtained or used in an "illegal" fashion.6

Provincial Human Rights Codes
The Ontario Human Rights Code states:
Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour: ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, same-sex partnership status,family status or disability.7
The British Columbia Human Rights Code is similar to that of Ontario, prohibiting discrimination on the basis of:
...race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex or sexual orientation of that person or class of persons.8
In Entrop v. Imperial Oil Ltd., the Ontario Court of Appeal accepted that drug and alcohol addiction, although not specifically enumerated in the Ontario Human Rights Code, constituted a disability and a prohibited ground of discrimination:
The Board found, on uncontradicted expert evidence: that drug abuse and alcohol abuse -- together substance abuse -- are each a handicap. Each is "an illness or disease creating physical disability or mental impairment and interfering with physical, psychological and social functioning." Drug dependence and alcohol dependence, also separately found by the Board to be handicaps, are severe forms of substance abuse. Therefore; on the findings of the Board, which are not disputed on this appeal, substance abusers are handicapped and entitled to the protection of the Code.9
Outside of the provincial and national human rights codes, illegal drug addiction has been recognized as a disability in proceedings around criminal sentencing. In R. v. Nguyen, Ryan J.A. quoted with approval a description of illegal drug addicts as the "...sub-class of people who, by falling prey to heroin addiction, become effectively disabled from functioning as useful; self-supporting, productive members of society".10
The Charter of Rights and Freedoms
Section 15(1) of the Canadian Charter of Rights and Freedoms states:
Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.11
Canadian courts have not yet been asked to rule on the issue of whether drug addiction constitutes a prohibited ground of discrimination under the Charter. However, the outcome is likely to be the same as that in Human Rights cases, given the similarities in language and the uniformity of principles of interpretation. In Andrews v. Law Society of British Columbia, the Supreme Court of Canada considered the application of equality principles developed in human rights cases to cases invoking the Charter. McIntyre J. said for the court:

In general, it may be said that the principles which have been applied under the Human Rights Acts are equally applicable in considering questions of discrimination under s. 15(1).12

2. Discrimination is the failure to provide reasonable accommodation for the disabilities of drug addicts
In Law v. Canada (Minister of Employment and Immigration), lacobucci J. articulated what was, in his view, the proper approach to analyzing a claim of discrimination under section 15:

First, does the impugned law (a) draw a formal distinction between the claimant and others on the basis of one or more personal characteristics, or (b) fail to take into account the claimant's already disadvantaged position within Canadian society resulting in substantively different treatment between the claimant and others on the basis of one or more personal characteristics? If so, there is differential treatment for the purpose of s.15(1 ). Second, was the claimant subject to differential treatment on the basis of one or more of the enumerated or analogous grounds? And third, does the differential treatment discriminate in a substantive sense, bringing into play the purpose of s.15(1 ) of the Charter in remedying such ills as prejudice, stereotyping and historical disadvantage? The second and third inquiries are concerned with whether the differential treatment constitutes discrimination in the substantive sense intended by s.15(1).13
The Supreme Court of Canada applied that approach in a subsequent case involving a claim of discrimination based on temporary disability. In Granovsky v. Canada, Binnie J. expanded on what constitutes discrimination:

The "purposive" interpretation of s.15 puts the focus squarely on the third aspect of disabilities, namely on the state's response to an individual's physical or mental impairment. If the state's response were, intentionally or through effects produced by oversight, to stigmatize the underlying physical or mental impairment, or to attribute functional limitations to the appellant that his underlying physical or mental impairment did not warrant, or to fail to recognize the added burdens which persons with temporary disabilities may encounter in achieving self-fulfillment, or otherwise to misuse the impairment or its consequences in a discriminatory fashion that engages the purpose of s.15, an infringement of equality rights would be established.14
Binnie J. emphasized the state's obligation under section 15(1) to actively address disability:
The true focus of the s.15(1) disability analysis is not on the impairment as such, nor even any associated functional limitations, but is on the problematic response of the state to either or both of these circumstances. It is the state action that stigmatizes the impairment, or which attributes false or exaggerated importance to the functional limitations (if any), or which fails to take into account the "large remedialcomponent" (Andrews v. Law Society of B.C.,[1989] 1 S.C.R. 143, at p.171) or "ameliorative purpose" of s.15(1) (Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at para 66; Law v. Canada, [1999] 1 S.C.R. 497, at para 72; Eldridge v. British Columbia (A.G.), [1997] 3 S.C.R. 624, at para 65) that creates the legally relevant human rights dimension to what might otherwise be a straightforward biomedical condition. [emphasis added]15
The effect of the "ameliorate purpose" and "remedial component" of section 15(1) is that government must make reasonable accommodation for disabled persons, and the adverse effects suffered by disabled persons as a result of a failure to do so amounts to discrimination. Sopinka J. for the Supreme Court of Canada, in Eaton v. County Board of Education, stated:

The principles that not every distinction on a prohibited ground will constitute discrimination and that, in general, distinctions based on presumed rather than actual characteristics are the hallmarks of discrimination have particular significance when applied to physical and mental disability. Avoidance of discrimination on this ground will frequently require distinctions to be made taking into account the actual personal characteristics of disabled persons. InAndrews v. Law Society of British Columbia, [1989] 1 S.C.R. 143, at p. 169, McIntyre J. stated that the "accommodation of differences . . . is the true essence of equality''. This emphasizes that the purpose of s. 15(1) of the Charter is not only to prevent discrimination by the attribution of stereotypical characteristics to individuals, but also to ameliorate the position of groups within Canadian society who have suffered disadvantage by exclusion from mainstream society as has been the case with disabled persons.
Whether it is the impossibility of success at a written test for a blind person, or the need for ramp access to a library, the discrimination does not lie on the attribution of untrue characteristics to the disabled individual. The blind person cannot see and the person in a wheelchair needs a ramp. Rather, it is the failure to make reasonable accommodation, to fine-tune society so that its structures and assumptions do not result in the relegation and banishment of disabled persons from participation, which results in discrimination against them. The discrimination inquiry which uses 'the attribution of stereotypical characteristics' reasoning as commonly understood is simply inappropriate here. It may be seen rather as a case of reverse stereotyping which, by not allowing for the condition of a disabled individual, ignores his or her disability and forces the individual to sink or swim within the mainstream environment. It is recognition of the actual characteristics, and reasonable accommodation of these characteristics which is the central purpose of s. 15(1) in relation to disability.16
An example of accommodating disabled persons in relation to the provision of a service is in Chipperfield v. British Columbia (Ministry of Social Services).17 In that case the Ministry of Social Services had a duty to provide a transportation subsidy to persons receiving social assistance who have disabilities which prevent them from using public transit.
3. Providing reasonable accommodation for drug addicts means taking steps to provide alternative access to necessary medical services
Accommodation means changing a rule or a practice, making adjustments or making alternative arrangements to remove discriminatory effects on an individual or a group. Safe injection facilities ("SIFs") would be an alternative arrangement allowing drug users to access essential health services that, due to their disability, they have been unable to access through traditional channels.
Section 3 of the Canada Health Act 18 describes the primary objective of Canadian health care policy as protecting, promoting and restoring the physical and mental well-being of residents of Canada and facilitating reasonable access to health services without financial or other barriers. Pursuant to section 5 of that Act, the federal government makes cash contributions towards the funding of B.C.'s health care system. Those cash contributions are contingent on provincial compliance with the criteria described in sections 8 to 12 of the Act respecting (a) public administration; (b) comprehensiveness; (c) universality; (d) portability; and (e) accessibility.
The preamble to the Medicare Protection Act states that the people and government of British Columbia believe that medicare is one of the defining features of Canadian nationhood, and "wish to confirm and entrench universality, comprehensiveness, accessibility, portability and public administration as the guiding principles of the health care system ... and are committed to the preservation of these principles in perpetuity."19 The preamble also emphasizes the fundamental value that an individual's access to necessary medical care must be based solely on need and not the individual's ability to pay. Section 2 of the Act states:
The purpose of this Act is to preserve a publicly managed and fiscally sustainable health care system for British Columbia in which access to necessary medical care is based on need and not an individual's ability to pay.
The requirement that government provide access to necessary medical services in a manner that accommodates disability creates positive obligations. In Eldridge v. British Columbia (Attorney General),20the Court ordered the British Columbia government to fund deaf interpretation services, where appropriate, to ensure that the deaf claimants had equal access to health care. Because of their physical disability, deaf persons were unable to communicate with their doctors and thus unable to receive universally available health benefits. The Court held that the government had violated s. 15(1) by failing to recognize the added burdens faced by deaf persons in accessing the core medical services provided to every other user. That failure to accommodate deaf persons constituted adverse effects discrimination. The government was required to provide interpreters for that purpose.
In Auton (Guardian ad litem of) v. British Columbia, the Court applied Eldridge in the case of funding for alternative medical treatment for autistic children. Alan J. found that
[t]he petitioners are the victims of the government's failure to accommodate
them by failing to provide treatment to ameliorate their mental disability. That failure constitutes direct discrimination. Further, the petitioner's disadvantaged position stems from the government's failure to provide effective health treatment to them, not from the fact that their autistic condition is characterized, in part, by an inability to communicate effectively or at all.21
In Auton the court again found that government had a positive obligation under the Charter to provide a necessary medical service. However, this decision went further than Eldridge, and is particularly relevant in the case of safe injection facilities for two reasons:
a) The court found that government was required to fund an entirely different system of treatment as opposed to merely providing access to an existing system.
b) The court rejected arguments that the schedule created by British Columbia's Medical Services Committee was an all-inclusive list of ''necessary medical services. It found that the term "medically necessary" was broader in scope, encompassing "whatever cures or ameliorates illness," and determined, based on the expert evidence, that government was in violation of the Charter by failing to provide Lovaas Autism Treatment for autistic children. In particular, the court found that it was not restricted in making this finding by an absence of broadly accepted or established scientific information.
4. Safe injection facilities are a necessary medical service for drug addicts
There are presently over 40 SIFs operating in various European countries, including Germany, Switzerland and the Netherlands. Other countries planning or in the process of setting up SIFs include Spain and Australia. There are three primary goals of SIFs: to prevent the spread of drug-related disease by providing sanitary conditions and clean equipment for injection drug use; to prevent overdose deaths by providing supervision of drug injections by medically trained staff who can immediately intervene when problems occur- and the reintegration of drug users within mainstream society by providing a gateway through which injection drug users can access the health care system.22

Evidence suggests that those goals are being met in places where SIFs are operating. In Germany and Switzerland, large reductions in overdose deaths were reported in areas served by SIFs. As well, HIV/AIDS prevalence rates in drug users showed significant declines where SIFs were part of a comprehensive harm reduction strategy. Furthermore, various research data indicate that SIFs are an effective way of contacting the most marginalized drug users and connecting them to a wide array of health services they wouldn't otherwise access.23 A comprehensive review of the literature reveals that SIFs are significantly reducing disease, hospitalization and death in those cities that have them. Moreover, they "have contributed to a stabilization of or improvement in general health and social functioning of clients" as a result of, among other things, the improved access to health services for addicts.24
Safe injection facilities are a medically necessary accommodation for providing drug users access to medical services because:
a) Unsupervised intravenous drug use is dangerous to life and health, through risk of overdose, transmission of disease; and direct physical effects such as vein collapse and abscesses. Providing injection supervision has been shown to ameliorate the deleterious health effects of drug addiction.
b) Supervised injection facilities provide a gateway for drug addicts to access non-emergency medical treatment, such as addiction counseling, rehabilitation, and treatment. It has been shown that, due to the nature of their addiction, drug addicts as a group do not obtain significant benefit through traditional delivery of such services. Government is obligated to accommodate this characteristic of addiction disability by taking special steps to provide access to services through alternative avenues such as safe injection sites.

5. The failure to provide safe injection facilities for drug addicts is an unjustifiable violation of Human Rights Codes and the Charter
Neither the Human Rights Codes nor the Charter afford persons failing within a protected category an unrestricted right to access any government service which might alleviate the effects of their disability. Once a claimant establishes a prima facie case of discrimination, the burden shifts to the government is to justify the discrimination, and policy considerations such as budgets may be introduced along with arguments pointing to the intent of the legislation and the purpose of the discriminatory provisions.
Justification under Human Rights Codes
In a recent decision considering justification in the context of the British Columbia Human Rights Code,British Columbia (Public Service Employees Relations Comm.) v. B.C.G.E.U.25. also known as Meiorin, the Supreme Court of Canada clarified the law regarding the duty to accommodate. That case, which concerned the occupational requirements for female firefighters, eliminated the distinction between direct discrimination and adverse effect discrimination. Moreover, it required an employer, when arguing that the discrimination created by a particular occupational requirement was justified, to prove that:
(1) the standard had been adopted for a purpose rationally connected to the performance of the job;

(2) the particular standard had been adopted in an honest and good faith belief that it was necessary to the fulfillment of that legitimate work-related purpose, have been fulfilled; and

(3) it is impossible to accommodate individual employees sharing the characteristics of the claimant without imposing undue hardship upon the employer.
In British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights),26 also known as Grismer, the Supreme Court of Canada reaffirmed the test in Meiorin and applied it, and in particular part three of the test, to the provision of government services. In Grismer, the issue was vision testing for a driver's licence, and the refusal of the Superintendent of Motor Vehicles to take special steps to evaluate the performance of a visually impaired person who desired to be tested wearing specially-designed prism glasses. The Court held that the Superintendent of Motor Vehicles discriminated by refusing licenses to people with the particular optical disorder suffered by the claimant, and that it had failed to demonstrate that it would suffer undue hardship if required to test persons individually.
Once it is established that a lack of safe injection facilities constitutes a violation of the provincial Human Rights Codes or the Canada Human Rights Act, the government could argue that to create safe injection sites would result an undue hardship due to budgetary constraints or the increased risk of safety to neighbouring residents from potential increases to drug user populations in the area.
An argument of undue hardship is unlikely to succeed against safe injection facilities. In evaluating safety risks, the court will weigh outcomes, and arguably the demonstrated harm-reducing effects of safe injection facilities will outweigh speculation of safety risks to neighbourhoods. There is no evidence that safe injection facilities create community safety risks; in fact, overseas experience suggests that the opposite is the case.27 Nor are budgetary factors likely to result in a finding of undue hardship; the costs of maintenance for safe injection facilities are low compared with other addiction treatment services. Moreover, general economic analysis favours harm reduction measures. A 1994 study commissioned by the U.S. office of National Drug Control Policy found that treatment is 10 times more cost effective than interdiction in reducing the use of cocaine in the United States. The same study found that every additional dollar invested in substance abuse treatment saves taxpayers $7.46 in societal costs and that additional domestic law enforcement efforts cost 15 times as much as treatment to achieve the same reduction in societal costs".28

Justification under the Charter
In , the claimants appealed to section 15(1) of the Charter in seeking medically recommended treatments that would ameliorate their condition of infertility and promote, if not attain, equality with the fertile. Chipman J.A., for the majority, stated at p. 654-5:
The government has failed to ameliorate the position of the infertile compared with fertile people. They are unequally treated because they are denied a medically recommended treatment appropriate for them.29
However, although the majority of the Court concluded that the government's failure to fund in vitro fertilization violated the petitioners' s.15 rights, it found that the policy was justified under s. 1. Section 1 states:
The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.30
The question of what constitutes a "reasonable limit" that is "demonstrably justified in a free and democratic society" has formed perhaps the largest component of judicial consideration of the Charter to date.
Contextual Analysis

In Edmonton Journal v. Alta.,31 Wilson J spoke of the importance of a placing a particular right or freedom within its factual and social context when undertaking a section 1 analysis, and placing a value on the right. In R. v. Keegstra,32 Dickson C.J. referred to that judgment:
It is important not to lose sight of factual circumstances in undertaking a s.1 analysis, for these shape a court's view of both the right or freedom at stake and the limit proposed by the state; neither can be surveyed in the abstract. As Wilson J. said in Edmonton Journal, supra, referring to what she termed the "contextual approach" to Charter interpretation (at pp. 1355-56):
... a particular right or freedom may have a different value depending on the context. It may be, for example, that freedom of expression has greater value in a political context than it does in the context of disclosure of the details of a matrimonial dispute. The contextual approach attempts to bring into sharp relief the aspect of the right or freedom which is truly at stake in the case as well as the relevant aspects of any values in competition with it. It seems to be more sensitive to the reality of the dilemma posed by the particular facts and therefore more conducive to finding a fair and just compromise between the two competing values under s. 1.
Though Wilson J. was speaking with reference to the task of balancing enumerated rights and freedoms, I see no reason why her view should not apply to all values associated with a free and democratic society. Clearly, the proper judicial perspective under s. 1 must be derived from an awareness of the synergetic relation between two elements: the values underlying the Charter and the circumstances of the particular case.
A contextual analysis of the arguments for and against safe injection sites in Vancouver will require consideration of the health situation amongst drug users in the city, particularly in the Downtown Eastside. In 1997, the National Task Force on HIV, AIDS and Injection Drug Use declared that "Canada is in the midst of a public health crisis concerning HIV, AIDS and injection drug use..., The number of new HIV infections among injection drug users is increasing rapidly, with Vancouver now having the highest reported rate in North America".33 In that same year the Vancouver/Richmond Health Board declared a public health emergency in response to the emergence of an HIV/AIDS epidemic, as well as the high rate of fatal overdoses among intravenous drug users (''IDUs"), centred primarily, but not exclusively, in the Downtown Eastside.34 Recent estimates put the HIV prevalence rate among IDUs in Vancouver between 23 and 28 percent, and IDUs account for 38 percent of new HIV infections.35 It is estimated that 85 percent of IDUs in Vancouver are infected with Hepatitis C.36 Tuberculosis, Hepatitis A & B, and syphilis also occur at epidemic rates among Vancouver IDUs. Tuberculosis, for example, had a 38 percent prevalence rate among Vancouver IDUs in 1998.37 Included with this epidemic of diseases among IDUs is an epidemic of fatal drug overdoses. From 1996 to 2000, there was an annual average of 312 overdose deaths in the Vancouver region.38
The fact that the context of drug addiction in the Vancouver area reduces to litany of critical health concerns is particularly important in a section 1 Charter analysis. In considering context, the Court must be informed by the values that underlie the Charter. One of the foremost of these is the right to life and health, and is set out in section 7:
Everyone has the right to life, liberty and security of the person and the
right not to be deprived thereof except in accordance with the principles of fundamental justice.39
In the Charter hierarchy of values that can be used to frame the context of drug addiction, illegal drug use, and safe injection sites, security of the person outweighs the two major competing values that are held up in arguments against such facilities: economic values and the values underlying criminal prohibitions.
Economic rights, such as the right to conduct a prosperous business in the neighbourhood of the Downtown Eastside, are not protected by the Charter, and economic values are not included among the Charter values. Economic values do receive consideration in a later stage of the section 1 analysis, but they are not weighed during the "contextual analysis."
In R. v. Morgentaler, Beetz J. clearly outlined the supremacy of security of the person over criminal law in cases involving access to health care:
If a rule of criminal law precludes a person from obtaining appropriate medical treatment when his or her life or health is in danger, then the state has intervened and this intervention constitutes a violation of that man's or that woman's security of the person. "Security of the person" must include a right of access to medical treatment for a condition representing a danger to life or health without fear of criminal sanction if an act of Parliament forces a person whose life or health is in danger to choose between, on the one hand, the commission of a crime to obtain effective and timely medical treatment and, on the other hand: inadequate treatment or no treatment at all, the right to security of the person has been violated. 40
In Rodriguez v. British Columbia (.A.G.),41 Sopinka J., speaking for the majority said:
There is no question, then, that personal autonomy, at least with respect to the right to make choices concerning one's own body, control over one's physical and psychological integrity, and basic human dignity are encompassed within security of the person, at least to the extent of freedom from criminal prohibitions which interfere with these.42
Section 7 is strong enough to permit medical treatment with illegal drugs. In R. v. Parker,43 a case involving the use of a prohibited substance, marijuana, for medical purposes, Rosenburg J.A., relied on the decisions in Morgentaler and Rodriguez, concluded:
...that deprivation by means of a criminal sanction of access to medication reasonably required for the treatment of a medical condition that threatens life or health constitutes a deprivation of the security of the person.... Depriving a patient of medication in such circumstances, through a criminal sanction, also constitutes a serious interference with both physical and psychological integrity.
It is not a difficult to conclude from R. v. Parker and its preceding case law that denying a confirmed drug addict with access to a medical facility where drugs - even illegal drugs - could be safely injected constitutes a violation of the security of their person under section 7 the Charter. In this manner, section 7 could stand as an independent cause of action against the failure of government actors to establish safe injection facilities.

The Oakes Test
Once the factual context is established through reference to the Charter values, the government must establish that the decision or legislation that resulted from the discrimination constitutes a limit on equality rights that is reasonable and demonstrably justified in a free and democratic society. In R. v. Oakes 44 Dickson C.J. set out what has become the standard test. It has four parts:
1. The law or decision must pursue an objective that is sufficiently important to justify limiting the Charter right;
2. The law or decision must be rationally connected to the objective;
3. The law or decision must impair the right no more than is necessary to accomplish the objective; and
4. The law or decision must not have a disproportionately severe effect on the persons to whom it applies.
A government decision which has been shown to violate the Charter must satisfy each arm of the Oakes test. Without going into detail here, substantial arguments can be marshaled against any attempt to justify the failure of government to establish safe injection facilities under this test. In the case of Eldridge v. British Columbia,45 the court engaged in only the most superficial of section 1 analyses once it had been determined that the failure to provide translation services for deaf persons compromised their access to health care. In that case La Forest J. did not go through the steps of the Oakes test. Instead, he found that the decision not to fund medical interpretation services for the deaf did not constitute a minimum impairment of their section 15(1) right. Having decided that, it was not necessary to go through the elements of the Oakes test. At paragraph 94 he stated:
...I am of the view that the failure to fund sign language interpretation is not a "minimal impairment" of the s. 15(1) rights of deaf persons to equal benefit of the law without discrimination on the basis of their physical disability. The evidence clearly demonstrates that, as a class, deaf persons receive medical services that are inferior to those received by the hearing population. Given the central place of good health in the quality of life of all persons in our society, the provision of substandard medical services to the deaf necessarily diminishes the overall quality of their lives. The government has simply not demonstrated that this unpropitious state of affairs must be tolerated in order to achieve the objective of limiting health care expenditures. Stated differently, the government has not made a "reasonable accommodation'' of the appellants' disability. In the language of this Courts' human rights jurisprudence, it has not accommodated the appellants' needs to the point of 'undue hardship"....
The force behind this argument comes from the importance of the right to security of the person. It is perhaps the most deeply rooted Charter value, and it is rare that a violation of the principles of fundamental justice will be upheld as a ''reasonable limit prescribed by law as can be demonstrably justified in a free and democratic society". The government could argue that its decision not to set-up safe injection facilities was prescribed by law; that the objective of the policy was pressing and substantial (for example, budgetary concerns), that the decision was rationally connected to the objectives and that it constituted a minimal impairment of section 7. However, despite, these arguments, the facts of the situation framed in the context of Charter values make it likely that a court would find that the deleterious effects of the decision, namely that the denial of necessary medical treatment to control epidemics of disease and overdoses;
outweigh any salutary effects such as budgetary savings.
In summary, it is uncertain that government would be able to justify the failure to establish safe injection sites under either Human Rights Codes or the Charter; however, there are persuasive arguments available that support a constitutional mandate for such facilities.

6. The City of Vancouver is bound by the Charter, and must exercise its powers in conformity with the Charter
The City of Vancouver is bound by the Charter, and required to observe its obligations and restrictions within the bounds of its power and jurisdiction: in the same manner as the provincial and federal governments. In Godbout v. Longueuil (City), LaForest J. stated:
While this Court has never before expressly endorsed that proposition: we have done so inferentially, inasmuch as we have already applied the Charter to municipal by-laws without specifically engaging in an analysis of the application issue; see Ramsden v. Peterborough (City), [1993] 2 S.C.R. 1084. Moreover., the view that municipalities are subject to the Charter is not only sound, but also wholly consistent with the case law I have been discussing. Indeed, municipalities -- though institutionally distinct from the provincial governments that create them -- cannot but be described as "governmental entities". I base this finding on a number of considerations.
First, municipal councils are democratically elected by members of the general public and are accountable to their constituents in a manner analogous to that in which Parliament and the provincial legislatures are accountable to the electorates they represent. To my mind, this itself is a highly significant (although perhaps not a decisive) indicium of "government" in the requisite sense. Secondly, municipalities possess a general taxing power that, for the purposes of determining whether they can rightfully be described as "government", is indistinguishable from the taxing powers of Parliament or the provinces. Thirdly, and importantly, municipalities are empowered to make laws, to administer them and to enforce them within a defined territorial jurisdiction. Thus, while I expressed no specific opinion inMcKinney as to whether municipalities are, in fact, subject to the Charter, I nevertheless had this to say, at p. 270 of that case:
... I agree with the Court of Appeal that, if the Charter covers municipalities, it is because municipalities perform a quintessentially governmental function. They enact coercive laws binding on the public generally, for which offenders may be punished.... [Emphasis added.]
Finally, and most significantly, municipalities derive their existence and law-making authority from the provinces; that is, they exercise powers conferred on them by provincial legislatures, powers and functions which they would otherwise have to perform themselves. Since the Canadian Charter clearly applies to the provincial legislatures and governments, it must, in my view, also apply to entities upon which they confer governmental powers within their authority. Otherwise, provinces could (in the manner outlined earlier) simply avoid the application of the Charter by devolving powers on municipal bodies.46
The City of Vancouver is not the governmental body with primary jurisdiction over the establishment and maintenance of safe injection facilities, However, it is a government body with the power to impede or facilitate SIFs, and as a government bound by the Charter it is required to facilitate and support them to the limits of its jurisdiction.
Conclusion: The Charter of Rights and Freedoms may require City of Vancouver to support safe injection facilities within the scope of its power and jurisdiction.
When voting on the question of safe injection facilities, the City Council is acting pursuant to its statutory authority under the Vancouver Charter and other Acts. There is no doubt that such decisions must be consistent with the Charter of Rights and Freedoms, and indeed with 'quasi-constitutional' sources of authority such as the B.C. Human Rights Code.
This submission has briefly made the case that governments may have a constitutional imperative to act towards making safe injection facilities a reality.47 If this is the case, then decisions of the City must be consistent with that obligation. It is our respectful submission that the current resolution before Council is consistent with the constitution, and that obstruction or interference with the provision of appropriate medical services to this vulnerable segment of the population would not be. We therefore urge support for a pilot safe injection project in Vancouver without further delay.
ENDNOTES:
4 Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), published by the American Psychiatric Association. Washington D .C., 1994ss. 304 (opiod dependency) and 304.2 (cocaine dependency)
Canadian Human Rights Act, R.S.C. 1985. C. H-6, s.25
Toronto Dominion Bank v. Canadian Human Rights Commission (1998), 163 D.L.R. (4th) 193 (FCA) at paras. 15,16
Ontario Human Rights Code, R S.O. 1990, c. H.19, s.1
British Columbia Human Rights Code, R.S.B.C. 1996, c. 210, ss. 7-11,13,14
Entrop v. Imperial Oil, Ltd., [2000] O.J. 2689 (Ont. CA), 50 O.R. (3d) 18, at para 89
10 R. v. Nguyen (1995), 56 B.C.C.A. 290, at para 13, citing Oliver J. in R. v. Ping Li (unreported, November 19, 1993) Vancouver Registry No. CC930521
11 The Constitution Act, 1982, The Canadian Charter of Rights & Freedoms
12 Andrews v. Law Society of British Columbia [1989] 1 S.C.R. 143
13 Law v. Canada (Minister of Employment and Immigration), [1999] 1 S.C.R. 497 at para. 39
14 Granovsky v. Canada (Minister of Employment and Immigration), [2000] 1 S.C.R. 703, at para. 80
15 Ibid., para. 26
16 Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at paras. 66, 67, emphasis added
17 Chipperfield v. British Columbia (Ministry of Social Services) (No.3) (1998), 33 C.H.R.R D/340 (B.C.H.RT.)
18 Canada Health Act, R.S.C. 1985, Chap. C-6
19 Medicare Protection Act, R.S.B.C. 1996, c. 286
20 Eldridge v. British Columbia (Attorney General), [1997] 3 S.C.R. 624
21 Auton (Guardian ad litem of) v. British Columbia (A.G.) (2000), 78 B.C.L.R. (3d) 55 at para. 132
22 Thomas Kerr, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver Harm Reduction
Action Society, 2000)
23 Thomas Kerr, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver Harm Reduction Action Society, 2000); Drug Policy Alliance, Research Summary: Safe Injection Rooms, (1999) online: http://www.soros.org; Drug Policy Alliance, Research Brief: Safer Injection Rooms, (1999) online: http://www.soros.org (last visited: April 28, 2002)
24 Kate Nolan et al., "Drug Consumption Facilities in Europe and the Establishment of Supervised Injecting Centres in Australia", (2000) 19 Drug and Alcohol Review, 337 at 338-340
25 British Columbia (Public Service Employees Relations Comm.) v. B.C.G.E.U., [1999] 3 S.C.R. 3
26 British Columbia (Superintendent of Motor- vehicles) v. British Columbia (Council of Human Rights), [1999] 3 S.C.R. 868
27 R. Broadhead et al "Safer Injection Rooms in Public Policy and Health Initiatives" Journal of Drug Issues(forthcoming)
28 Drug Policy Alliance, online: http//www.soros.org (last visited April 27, 2002)
29 Cameron v. Attorney General of Nova Scotia (1999), 177 D.L.R. (4th) 611 (N.S.C.A.)
30 The Constitution Act, 1982, The Canadian Charter of Rights & Freedoms
31 Edmonton Journal v. Alta, [1989] 2 S.C.R. 1326
32 R. v. Keegstra, [1990] 3 S.C.R. 697
33 Canadian National Task Force on HIV, AIDS and Injection Drug Use: A National Action Plan (1997)", at 3-4, online: www.cfdp.ca/hivaids.html
34 Penny Parry, "Something to Eat, A Place to Sleep and Someone Who Gives a Damn". HIV/AIDS and Injection Drug Use in the DTES, Final project report to the DTES Community, Minister of Health and V/RHB, 1997
35 Supra note 33; Fischer, B., Rehn, J., Blitz-Miller, T., (2000). "Injection Drug Use and Preventive Measures: A Comparrison of Canadian and Western European Jurisdictions over Time", Canadian Medical Association Journal, 162(12), 1709-1713.
36 Canada Communicable Disease Report, "Hepatitis C - Prevention and Control: A Public Health Consensus". Vol. 2552 (Supplement, June 1990; online: www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/99vol25/25s2/index.html
37 Thomas Kerr, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver: Harm Reduction Action Society, 2000) at 3 [citing the Vancouver Injection Drug Users Study (VIDUS), 1998 report]
38 Selected Vital Statistics and Health Status Indicators, 1996-2000: Drug induced deaths by age and gender. Victoria: British Columbia Vital Statistics Agency
39 Canadian Charter of Rights and Freedoms, Constitution Act, 1982, s.7
40 R v. Morgentaler, [1988] 1 S.C.R. 30 at para 90
41 Rodriguez v. British Columbia (A.G.), [1993] 3 S.C.R. 519 at 587-8
42 Ibid.
43 R. v. Parker, [2000] O.J. No 2787 (Ont. CA) at para. 97
44 R. v. Oakes, [1956] 1 S.C.R. 103
45 Eldridge v. British Columbia, [1997] 3 S.C.R. 624
46 Godbout v. Longueuil (City), [1997] 3 S.C.R. 844; [1997] S.C.J. No. 95 (three concurring judgments)
47 For more discussion of the constitutional, civil and international law issues, see generally Craig Jones, "Fixing to Sue: is There a Legal Duty to Establish Safe Injection Facilities in British Columbia?" (2002)U.B.C. Law Review (forthcoming), and Perry Bulwer, "International Law and the Right to the Highest Attainable Standard of Health Care: Using Safe Injection Facilities to Control and Prevent Epidemics" and "Safe Injection Sites: Compelling the Government to Act", both available online at www.perrybulwer.com

29 comments:

  1. The news reports on this page are a continuation of previous news reports in the comment section of this page on this blog:

    Safe Injection Sites - British Columbia

    "SAFE INJECTION FACILITIES: COMPELLING GOVERNMENT TO ACT" https://perry-bulwer.blogspot.com/p/safe-injection-sites-bc.html

    ReplyDelete
  2. How Prescription Heroin Is Saving Lives

    Safer supply has become a political wedge issue. But at one clinic, it’s providing patients ‘immediate relief.’

    by Michelle Gamage, The Tyee September 12, 2023

    Crosstown Clinic patient Michel has used opiates for 30 years. His addiction to heroin, he says, drove him to use “alternative methods to get money, like criminal activity.”

    Six years ago, exhausted by the lifestyle he was leading, Michel joined Crosstown as a patient and began accessing prescription injectable heroin.

    “It worked from day one,” he says. “There was immediate relief from the daily grind all addicts go through — it felt like freedom.”

    Providence Health Authority’s Crosstown Clinic in Vancouver’s Downtown Eastside offers a range of treatments for opioid use disorder, including opioid agonist therapy, medical care and wraparound services with social workers and counsellors.

    British Columbia first declared a public health emergency due to toxic drugs in 2016. Since then, the drug supply has only increased in potency and unpredictability, with fentanyl, carfentil and benzodiazepines — which can increase the risk of overdose and complicate the reversal of overdoses — showing up more and more frequently. Toxic drugs have killed over 12,700 British Columbians since 2016, making unregulated drug toxicity the leading cause of death in the province for people aged 10 to 59.

    While the province has been ramping up harm reduction initiatives, such as distributing naloxone kits and permitting safer supply, it has not been able to keep up with the toxicity of drugs bought on the illicit market, leading to a rise in toxic drug deaths year after year.

    Observed injected opioid agonist treatment is currently available daily at the Crosstown Clinic in Vancouver, as well as in the U.K., Netherlands, Denmark, Germany and Switzerland.

    The British Columbia Centre on Substance Use defines opioid agonist treatment as prescription opioids that reduce opioid-related harms, reduce how often a person uses opioids sourced illicitly, and that improve their mental health, social functioning and quality of life. In B.C., OAT includes opioids taken orally, such as Suboxone (buprenorphine/naloxone), methadone (which can be sold under the names Methadose or Metaldol D), and Kadian (slow-release oral morphine).

    OAT is different from safer supply, which is a harm reduction practice where clinicians prescribe pharmaceutical drugs in order to reduce a patient’s need to rely on the illicit market. Safer supply can include diacetylmorphine, Dilaudid (oral hydromorphone) and M-Eslon (sustained-release oral morphine). For people who are not interested in OAT, or who are still at high risk of overdose even while on OAT, safer supply reduces their risk of overdose, death and other harms, according to the BCCSU.

    While offering patients injectable diacetylmorphine and hydromorphone is considered standard injectable opioid agonist treatment in many countries, it’s still considered an “emerging treatment” in Canada.

    Safer supply has recently become a bit of a political wedge issue. Conservative Party of Canada Leader Pierre Poilievre, for example, has been critical of programs that offer pharmaceutical alternatives to street drugs, which include OAT and safer supply programs. He says federal money would be better spent on getting people into recovery.

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  3. Poilievre has also raised concerns that safer supply is being resold by patients. In a previous article, The Tyee spoke with experts who said diversion happens when the potency of safer supply doesn’t match the potency or combination of illicit drugs a person is used to taking. Diversion is not creating more overdose deaths, they added.

    Meanwhile, advocates say that B.C. and Canada should be increasing access to safer supply. In June, the BC Centre for Disease Control told The Tyee that only around 5,000 patients — about 5 per cent of people who have been diagnosed with opioid use disorder in B.C. — have accessed safer supply so far.

    Dr. Scott MacDonald, Crosstown Clinic’s lead physician, says people have complex reasons for using drugs and benefit from a variety of treatment options, including a range of medications to reduce their risk of illicit street drug use and wraparound services like those provided at Crosstown. Abstinence and recovery just do not work for everyone, he says.

    Studies demonstrate efficacy

    Crosstown Clinic researchers launched the North American Opioid Medication Initiative, or NAOMI, in 2005. This groundbreaking study found supervised prescription injectable heroin was a safe and effective treatment for people with chronic heroin addiction who had not benefited from previous treatments.

    This was a harm reduction tool that had been used in the United Kingdom for nearly a century at the time, MacDonald says. The United Kingdom offered patients powdered heroin, sterile water and syringes, he says. Crosstown provides liquid heroin in a syringe, which gives it a shelf life that will quickly lose potency throughout the day and requires the medication to be stored in a dark, cool place.

    Crosstown launched a second clinical study, the Study to Assess Longer-term Opioid Medication Effectiveness, or SALOME, with results published in 2015. This study found that both injectable heroin and hydromorphone were effective opioid-addiction treatments.

    Crosstown then set up a permanent brick and mortar clinic and started offering injectable heroin and hydromorphone to its patients.

    This wasn’t a program that was available to just anyone — patients had to have a history of injecting opioids and have tried opioid agonist therapy before, MacDonald says. Injectable opioid agonist treatment is still considered an off-label treatment in Canada and the distribution of diacetylmorphine is carefully controlled by Health Canada.

    Patients had to come to the clinic to access the dose and inject the dose while supervised by clinic staff.

    Crosstown’s studies and programs show that offering injectable opioids as part of safer supply reduces mortality; keeps people in life-saving harm reduction programs longer; reduces street drug use; reduces local property and violent crime by 80 per cent; increases patient life expectancy by several years and reduces overall public spending by cutting costs associated with policing and public health, MacDonald says.

    He adds that OAT and safer supply programs need to offer a “full continuum of care,” including a range of opioids to meet individual patient needs, to be effective. Because injectable opioids are short-acting, patients may also take longer-lasting oral opioids like methadone, morphine (which last 24 hours), or buprenorphine, (buprenorphine/naloxone is also known as Suboxone, with the buprenorphine lasting 36 to 46 hours) or a slow-release fentanyl patch.

    A “small but significant” amount of people who use drugs will qualify or benefit from using injectable opioid agonist therapy, or iOAT, MacDonald says, adding that it isn’t necessary for all clinics across the province to offer this program.

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  4. But there are a couple of ways MacDonald says he would like to scale up the iOAT program. First, he’d like to see it offered in more clinics across B.C. and Canada. With a laboratory in Montreal now making heroin, there’s enough of a domestic supply to expand iOAT programs, he says.

    Second, he’d like to expand the clinic’s “carry” program, where patients can visit Crosstown once a day for supervised iOAT and then take two doses home to take later in the day.

    The carry program began during the COVID-19 pandemic to allow patients to continue accessing harm reduction services while also isolating as much as possible from the virus.

    Research published this spring found the carry program improved patient’s quality of life because it freed up time in their day, allowed them to find jobs and gave patients more autonomy.

    Just 11 patients are currently allowed to carry.

    Donnie Cinnamon is one of these 11. Cinnamon told The Tyee he has taken opioids for the last 30-odd years but has been on pharmaceutical safer supply for the last 14 years.

    Cinnamon says safer supply programs have helped the Downtown Eastside. “People are not dying as much and are doing better,” he says.

    But the illicit drug supply is still toxic. Cinnamon says he carries several naloxone kits with him at all times and notes 10 Crosstown patients have passed away in the last four years when they used illicit drugs.

    MacDonald says safer supply programs work to reduce how much patients access the illicit market but can’t prevent them from doing so.

    Cinnamon says he likes the carry program but wishes he could get several days’ worth of iOAT so he could travel and visit his mother, who is 104.

    Because carry patients still need to visit the clinic once per day it’s not possible, he says. “I could go on morphine and go and visit her but then I’d get those pins and needles in my limbs from the morphine and I really don’t like that,” Cinnamon adds.

    Michel, who has asked to join the carry program but has not yet been approved, says he wouldn’t want to be able to access any more than a single day’s worth of iOAT. He can get up to three supervised iOATs per day but says he can usually only access one or two doses due to scheduling.

    “This clinic offers stability,” Michel says. “That’s why it works for me. But I’d like just a little less stability. How can you do anything else when you have to come here three times a day? You can’t go on a vacation or trip. But you manage.”

    On recovery ‘versus’ safer supply

    When asked about Conservative opposition to OAT and iOAT programs, with politicians like Poilievre and Vancouver Mayor Ken Sim calling for treatment above all else, MacDonald, Cinnamon and Michel portrayed such stances as simplistic.

    “Abstinence is a lofty ideal. The reality is that people have needs — all you have to do is look outside and you see needs not being met,” Michel says. “I went into recovery once. It didn’t work for me.”

    “You can’t force treatment. It doesn’t work,” Cinnamon adds. “They tried that years ago when they threw people into the big house. The person who wants to quit is the person who is already going to detox.”

    MacDonald says there’s stigma behind the belief that recovery or abstinence is the best outcome.

    “Sometimes I may wish that for my patients, but it just doesn’t work for everybody,” he says.

    “You leave people behind when you don’t meet them where they’re at. Then all they’re left with is the illicit supply, which increases their risk of death.”

    See the photos and links embedded in this article at:
    https://thetyee.ca/News/2023/09/12/Prescription-Heroin-Saving-Lives/

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  5. Insite Is Turning 20

    North America’s first legal supervised consumption site has welcomed four million people and reversed 17,000 overdoses.

    by Michelle Gamage, The Tyee September 15, 2023

    Over the last two decades, Insite, located in Vancouver’s Downtown Eastside, has welcomed four million people through its doors and three million into its supervised injection room, said Dr. Mark Lysyshyn, deputy chief medical health officer of Vancouver Coastal Health.

    Insite held an early morning media scrum on Thursday to talk about the supervised consumption site’s impact on the community. Later in the day the community hosted a street party in the DTES in the early afternoon to celebrate.

    Insite has reversed 17,000 overdoses and referred a similar number of patients to treatment programs, like Onsite, located upstairs to the overdose prevention site, or other programs around the Lower Mainland, Lysyshyn said.

    The site opened its doors on Sept. 21, 2003, in an effort to reduce the spread of blood-borne pathogens like HIV and hepatitis C, said Susan Alexman, director of programs at PHS. “Unfortunately we’ve now moved into a toxic fentanyl crisis and we’re working really hard to ensure people are not dying from this crisis as well.”

    The illicit drug supply in British Columbia has been getting increasingly potent over the past decade with opioids like heroin being replaced by stronger opioids like fentanyl, and recently with fentanyl analogues and other synthetic opioids like nitazenes.

    Drugs purchased through the illicit market also increasingly contain other substances like benzodiazepines, which can complicate an overdose. When people buy illicit drugs they do not have a guarantee of the drug’s potency, purity or what is in the substance, so even an experienced drug user can accidentally overdose.

    Harm reduction initiatives like naloxone kits can temporarily reverse an opioid overdose but the illicit drug supply continues to increase in toxicity which is making harm reduction initiatives like naloxone less effective.

    That’s why Michael Vonn, CEO of PHS Community Services Society said the “end goal” of harm reduction is safer supply, whether prescribed by a clinician or accessed another way.

    Insite has a history of leading the harm reduction charge, both on the ground and in the courts, said Monique Pongracic-Speier, a lawyer with Ethos Law Group.

    Insite initially opened thanks to a collaboration with people in the community, the PHS, Vancouver Coastal Health, the City of Vancouver, the Vancouver Police Department and provincial and federal governments, she said. Legally, it was allowed to exist because of a federal exemption from the Controlled Drugs and Substances Act, which meant people could come with their drugs and staff could work without fear of arrest.

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  6. In 2008, under a federal government run by then-prime minister Stephen Harper, Insite was told the exemption would not be renewed, which put “Insite’s very existence into jeopardy,” Pongracic-Speier said.

    This launched two lawsuits challenging the Controlled Drugs and Substances Act, which both argued the law overstepped provincial rights to oversee health care — arguing Insite was health care in action — and a person’s right to life, liberty and security of the person.

    Mark Underhill, a lawyer with Arvay Finlay, took a moment to acknowledge the work done by lawyer Joe Arvay in the legal battle. Underhill gave a shoutout to a Tyee article, “Joe Arvay Changed Your Life,” for its summary of Arvay’s accomplishments. Arvay passed away three years ago.

    The cases won, but were appealed all the way to the Supreme Court of Canada.

    Pongracic-Speier said she was standing in Insite’s supervised injection room at 6:30 a.m. on Sept. 30, 2011, when the Supreme Court released its decision that ending Insite’s exemption would be unconstitutional. The court went on to order the federal minister of health to grant the exemption.

    This decision was important for many reasons, she said.

    First, it allowed Insite to keep its doors open then and celebrate its 20th anniversary today.

    “We know that saved lives by preventing fatal overdoses and deaths from drug poisonings and by reducing disease transmission and infection from needle sharing and high-risk injection practices,” Pongracic-Speier said.

    But the legal battle also helped shift the public discussion about drugs from crime to health care and helped demystify and explain harm reduction, she said.

    This has helped push for further harm reduction services.

    During the legal battle Insite was the only lawfully operating supervised consumption site in Canada. Today there are 40 overdose prevention sites in B.C. — with four of them having legal exemptions, Lysyshyn said.

    Guy Felicella, a peer clinical advisor with the BC Centre on Substance Use, shared his personal story about his history of drug use and recovery.

    Felicella travels to schools to talk to kids about substance use and is often featured in the news as a go-to expert to weigh in on news stories about drugs and harm reduction.

    On Thursday he spoke about the 4,000 times he used Insite during his decade of using drugs. He told The Tyee how staff would let him hang out late and only send him out the door when they closed up shop and headed home at 3 a.m.

    Felicella said he overdosed six times during a nine-month period, with the final overdose happening at Insite on Feb. 18, 2013. When staff revived him, Felicella said he was moved by how the nurse who brought him back was crying.

    “I don’t remember going down but I remember waking up and seeing the nurse visibly emotional, telling me ‘I care about you, Guy.’ I burst into tears. There were many moments that led to that moment where I told her, ‘I don’t want to do this anymore.’”

    He had been down for seven minutes, meaning he came close to being Insite’s first fatality, he said.

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  7. To this day no one has overdosed and died at Insite.

    Felicella said he hadn’t wanted to go to the hospital so staff let him hang out at Insite. From there he moved to Onsite, the upstairs treatment centre, before being moved to a treatment centre in Surrey.

    “The life I have today would not exist if this facility didn’t exist,” he said. “I can’t stress how vital and important this is not only to myself but so many people who are on similar paths and journeys. This facility not only saves lives but it builds a connection with a community. That connection empowers people to change their own circumstances.”

    As Felicella often says, you can’t help someone if they’re dead.

    Insite has the largest database on overdoses in the world because people come in and tell staff what drug they’re planning on using, Lysyshyn said.

    When someone overdoses on fentanyl their chest goes rigid and their arms can flail around, he said. Staff at Insite were documenting this when fentanyl first appeared in B.C., which helped gain the attention of anesthesiologists, who work with fentanyl and were aware of the overdose signs, he added.

    When fentanyl stared showing up in B.C. the risk of overdose for all drugs increased 10 times because it could be mixed into any substance, Lysyshyn said.

    Alexman, director of programs at PHS, said Insite has always opened its doors to everyone and welcomed people into a dry, warm, safe space and offered harm reduction supplies like clean needles, condoms and pipes. People can give their name or use a pseudonym.

    Staff are friendly and willing to listen, she added. During these visits people can chat with staff and volunteers, which creates opportunities to connect people with services, like health care if they’re complaining about an infected leg, or housing if they say they don’t have anywhere to sleep.

    Felicella said these “non judgemental supports” made him always feel welcomed and loved.

    “Most importantly, I’ve always felt that they care,” Felicella said.

    Harm reduction, safer supply and supervised injection services are under political scrutiny right now, with Conservative party Leader Pierre Poilievre saying he wants to focus on treatment above all else and cut funding for harm reduction services.

    But the Insite team said they’ve weathered Conservative scrutiny in the past.

    “We let the evidence speak for itself,” PHS’s Vonn said.

    Insite, Vonn said, is “trying to keep the politics out of what we do. Because simply the facts tell the story. We don’t need to have a gloss of partisanship on something that is so fundamentally a human rights and health-care issue.”

    see the photos and links embedded in this article at:
    https://thetyee.ca/News/2023/09/15/Insite-Turning-20/

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  8. B.C. drug users group says new consumption rules stigmatizing them further

    Vancouver Island Free Daily by Jane Skrypnek Oct. 4, 2023

    A group of Vancouver-area drug users and community members say the provincial government’s decision to limit where illicit substances can be consumed is stigmatizing and endangering their lives.

    B.C. announced new restrictions on its three-year decriminalization pilot project last month.

    While people who use drugs can still carry up to 2.5 cumulative grams of opioids on them, they can no longer do so within 15 metres of any play structure in a playground, spray or wading pool, nor skate park. That’s in addition to the limitations that came with the start of decriminalization on Jan. 31, which prohibit illegal drugs for youth under 18, on school grounds, at licensed child-care facilities and at airports.

    The province also said last month that it will be introducing further legislation soon to further regulate public drug use.

    Vince Tao, a community organizer with the Vancouver Area Network of Drug Users (VANDU), said these new moves came without any consultation with people who use drugs or, apparently, any evidence. In July, Mental Health and Addictions Minister Jennifer Whiteside said they had seen nothing to suggest decriminalization has led to an increase in the consumption of illicit drugs in public spaces.

    READ ALSO: No evidence decriminalization has led to increase in public drug use: B.C. addictions minister
    https://www.vicnews.com/news/update-no-evidence-decriminalization-has-led-to-increase-in-public-drug-use-bc-addictions-minister-662765

    READ ALSO: B.C. excludes playgrounds, rec areas from drug decriminalization trial
    https://www.todayinbc.com/news/b-c-excludes-playgrounds-rec-areas-from-drug-decriminalization-trial/

    Why then, the VANDU members asked at a gathering on Wednesday (Oct. 4), is the province limiting where they can consume, in the name of public safety.

    Tao said the result of policies and language that treat drug users as a risk to children and families is stigmatization and increased deaths – the very things the provincial government said it was tackling with decriminalization.

    “It’s only been eight months and the BC NDP is already backtracking on its own commitment to the safety of drug users and the safety of our communities here.”

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  9. VANDU board member Martin Steward said increased restrictions on outdoor drug consumption would be one thing if there were enough overdose prevention sites and safe indoor spaces for people, but that isn’t the case. In fact, Tao added, they’ve been watching safe consumption sites closing across the country.

    READ ALSO: Overdoses from smoking toxic drugs outpace B.C. prevention sites
    https://www.todayinbc.com/news/overdoses-from-smoking-toxic-drugs-outpace-b-c-prevention-sites/

    He said the restrictions are especially frustrating for drug users when they see the consumption of other substances, such as alcohol, being normalized for some people.

    “There is a deep hypocrisy in these public consumption laws. We see our very own mayor, Ken Sim, chugging a beer at the front of a festival. Meanwhile, he’s banning the use of illicit drugs just for our community who’s already over-policed, stigmatized and profiled for being poor, for looking poor.”

    Sim is one of a number of municipal leaders who, along with provincial opposition party BC United, have been pushing for limitations on decriminalization since it was implemented. He and the mayors of Victoria and Courtenay issued statements in favour of the new restrictions, after they were announced. Leaders in Campbell River and North Cowichan have pushed for local bylaws banning public consumption altogether. And BC United Leader Kevin Falcon has said he would end decriminalization if elected.

    On Wednesday, VANDU publicly released its Users’ Code, showing the 16 protocols their members follow to ensure the safety of their neighbourhood.

    Among them is a rule to call out when there are kids nearby as a signal for everyone to put their drugs away, for instance. People are also told to keep sidewalks clear for elders and people with disabilities, be discrete when consuming drugs and always carry Narcan. They agree not to turn someone onto drugs for the first time, not to steal from neighbours and to alert people about a toxic supply.

    “The government refuses to accept that drug users are family too,” Lorna Bird, VANDU’s longest living member, said.

    So far this year, at least 1,645 people have died from the toxic drug supply in B.C., representing the leading cause of death for people aged 10 to 59. In fact, more people in that age category die from toxic drugs than all homicide, suicide, accident and natural disease deaths combined.

    At least 12,929 British Columbians have died since B.C. declared a public health emergency in April 2016.

    READ ALSO: 174 people died from toxic drug supply in August, B.C. coroner finds
    https://www.todayinbc.com/news/174-people-died-from-toxic-drug-supply-in-august-b-c-coroner-finds/

    https://www.vancouverislandfreedaily.com/news/b-c-drug-users-group-says-new-consumption-rules-stigmatizing-them-further/

    ReplyDelete
  10. Rally Supports Vancouver Compassion Club Providing Tested Drugs

    DULF denied its day in court as Crown prosecutors assess their case.

    by Michelle Gamage, The Tyee January 17, 2024

    Around 400 people gathered at the Vancouver courthouse Tuesday to support Eris Nyx and Jeremy Kalicum, co-founders of the Drug User Liberation Front. The pair were scheduled to make their first court appearance after their October arrests.

    But they didn’t end up getting their day in court. Instead, the matters were struck from the court list to give the Crown more time to review whether there is a substantial likelihood of conviction and whether the public interest requires a prosecution, said Stephanie Dickson, a lawyer with Pender Litigation and counsel, along with Tim Dickson, for Nyx and Kalicum.

    Nyx and Kalicum were arrested by police for suspected trafficking of controlled substances and for possession with the intent to traffic controlled substances. They have not yet been charged.

    If charges are approved, Dickson said, they plan to challenge the constitutionality of the prohibitions in the Controlled Drugs and Substances Act. It’s also possible that the pair won’t be charged because DULF was working to save lives, she added.

    Dickson said a new court date will likely be set in the coming weeks.

    DULF had been running a compassion club supplying tested drugs for just over a year when Vancouver police raided the club as well as the homes of Nyx and Kalicum.

    The pair had been buying unregulated cocaine, meth and heroin off the internet, rigorously testing the substances and selling them at cost to compassion club members in clearly marked bags that listed the substance alongside any cuts and buffing agents.

    The idea was to give the club’s 42 compassion club members access to a clean, regular supply of drugs in order to protect them from the toxicity of B.C.’s current unregulated street drug supply.

    After one year of operation, DULF reported that its compassion club members had experienced fewer overdoses, fewer negative interactions with police, fewer hospitalizations and less drug-related violence. No members had died of overdose.

    DULF had also been funded by Vancouver Coastal Health to run an overdose prevention site where club members could access overdose prevention and drug checking. This funding was ended Oct. 31 last year. Both Vancouver Coastal Health and DULF previously told The Tyee that the funds from VCH had not been used to buy drugs. DULF said it used donations to buy drugs.

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  11. In British Columbia the toxic drug crisis is the leading cause of death for people aged 10 to 59 and, according to the BC Coroners Service, has killed around seven people per day in the province over the last year. Since a public health emergency was declared in April 2016, more than 13,000 people have died after using unregulated drugs.

    The current drug supply is highly potent and has several substances in it, which can increase a person’s risk of overdose when they are unable to know what they are taking or how strong the substance is.

    At the Vancouver rally people called for Canada to end its war on drugs and to legalize and regulate all substances so people who use drugs can access a regulated supply.

    Drug advocates are not the only ones calling for existing drug policy to change.

    Shortly after Nyx and Kalicum were arrested, the BC Coroners Service published its third Death Review Panel, which called for the province to introduce a non-medical model for safer supply that would give people who use drugs access to alternatives to the unregulated drug market.

    Many people interpreted this to mean testing and distribution through compassion clubs, like the one DULF was running.

    On the same day the Death Review Panel was published, Minister of Mental Health and Addictions Jennifer Whiteside responded with a letter saying the province would not consider a non-medical model for safer supply.

    The Tyee asked the Ministry of Mental Health and Addictions to respond to these calls for legalization and regulation of substances to save lives.

    In an emailed statement, a spokesperson for the ministry said the legalization of drugs such as those DULF sold fell under the jurisdiction of the federal government.

    The provincial government, the statement continued, “is working urgently to build an integrated and comprehensive system of mental health and addictions care from the ground up, to ensure people can access effective care when and where they need it and to separate people from the toxic drug supply. This means expanding access to care including prevention, harm reduction, treatment and recovery services, carefully based on evidence and best practice.”

    Rallies around the world

    There were five different rallies held around the world on Tuesday in support of Nyx and Kalicum, with people gathering in Vancouver, Nelson, Calgary, Dublin and London.

    In London around 20 people gathered around the Canadian Embassy and chanted “Safe supply saves lives,” and “VPD, shame on you.”

    “We often look to our North American comrades, including DULF, for inspiration and direction in the global harm reduction movement,” London co-organizers Shayla S. Schlossenberg, drug service co-ordinator at Release, and André Belchior Gomes, communications lead at Release, told The Tyee in an emailed statement. Release is an independent charity that helps educate the public and professionals about drug use and drug laws in the United Kingdom.

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  12. Schlossenberg and Belchior Gomes added that 4,907 people died of drug-related causes in England and Wales in 2023, the worst year for fatalities in those countries to date. England and Wales have a combined population of 59.6 million, according to a 2021 census.

    Canada, by comparison, has a population of 40.8 million and had 3,970 deaths in just the first six months of 2023, according to a December 2023 update from the Public Health Agency of Canada. Most of those deaths happened in B.C., Alberta and Ontario.

    In Dublin, six people gathered in support of DULF, Lynn Jefferys told The Tyee in an email. Jefferys is an organizer with Dublin Overdose Prevention and Education and operations manager of the European Network of People Who Use Drugs.

    The Dublin rally was organized to “highlight the global importance of [DULF’s] direct action in the face of state silence,” Jefferys wrote. Ireland has had clusters of overdoses over the last year, linked to nitazenes, a synthetic opioid.

    “In Ireland we stand on the cusp of a toxic drug supply crisis,” Jefferys added, noting that naloxone, which can reverse an overdose and is available for free at all pharmacies in B.C., is available only through prescription in Ireland. Ireland does not report annual overdose deaths, Jefferys added.

    “The DULF case and the legal precedent it may result in is very much in the interest of people who use drugs and activists in Europe whose main goal, like DULF, is to save lives,” Jefferys said. “We stand in solidarity with Jeremy and Eris.”

    Tuesday’s rallies were designed to raise awareness that the charges against DULF are “ridiculous” and that “they were engaged in an activity that was saving lives and acting in a way that the government should act to get people access to a regulated supply,” Leslie McBain told The Tyee. McBain is co-founder of Moms Stop the Harm, a network of Canadian families whose loved ones have died from drug-related harms or struggle with substance use.

    “Every day and even as we speak, someone is dying in this province from the toxic supply,” said McBain, who lost her son, Jason, 10 years ago.

    “If my son was alive and still in a desperate situation but had access to a compassion club like DULF, then he could have stabilized,” she added. “That’s what people were able to do with DULF, they could stabilize and think about recovery.”

    DULF has been caught in the middle of a “moral panic,” said Vince Tao, a community organizer with the Vancouver Area Network of Drug Users.

    Tao said he hopes that the charges against DULF will be thrown out and that the support for DULF will grow into a global movement for safer supply.

    see the links and photos in this article at:

    https://thetyee.ca/News/2024/01/17/Rally-Supports-Vancouver-Compassion-Club/

    ReplyDelete
  13. No one should be surprised by this news. For decades, anti-prohibition activists, including me, having been fighting against the utterly failed war on people who use drugs. The blood of the untold thousands of people who have died because of immoral government laws and policies in on the hands of prohibition politicians and law-makers. It didn't have to be this way.

    B.C. sets grim record with 2,511 toxic drug deaths in 2023

    Toxic drug deaths in B.C. last year climbed to almost 7 per day

    CBC News · January 24, 2024

    The B.C. Coroners Service says there were more than 2,500 suspected illicit drug deaths in the province last year, the highest annual number recorded.

    In announcing the grim number, B.C.'s chief coroner Lisa Lapointe renewed her plea for an expansion of safer supply and a "systems change" that treats substance use as a health issue, not a criminal problem.

    "More people than ever are dying," said Lapointe in her final public address before retiring next month.

    "Each day, coroners across B.C. go into communities and retrieve the bodies of the dead. More than 2,500 families who lost a loved one this year didn't know they'd be among the statistics. How many more will join these statistics next year?"

    The 2,511 suspected illicit drug deaths recorded last year equates to an average of nearly seven per day, marking a five per cent increase compared with the previous high of 2,383 deaths recorded in 2022.

    According to the B.C. Coroners Service's 2023 data:

    --Of those who died, 77 per cent were male.
    --70 per cent were aged 30 to 59.
    --Fentanyl was detected in 85.3 per cent of toxic drug death investigations, followed by meth and amphetamines at 46.9 per cent, and benzodiazepines at 40.2 per cent.
    --Vancouver, Surrey, and Greater Victoria had the highest number of deaths.
    --Northern Health was the region with the highest rate of deaths at 67 per 100,000 people.
    --80 per cent of the unregulated drug deaths occurred inside.
    --Smoking was the most common form of consumption at 65 per cent, compared to injection and snorting, both at 14 per cent.
    --One death occurred at an overdose prevention site.

    On social media, B.C. United leader Kevin Falcon said the 2,511 deaths are an indictment of the B.C. NDP's policies, including the "reckless decriminalization" of small amounts of certain illicit drugs.

    Lapointe said Wednesday that "decriminalization is not responsible for these deaths, illicit fentanyl is."

    continued below

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  14. She said almost 14,000 people have died since the province declared toxic drugs a public health emergency in April 2016.

    An estimated 225,000 people in B.C. use unregulated drugs, according to Lapointe. Of those, 100,000 have an opioid disorder.

    "Given the unpredictability of illicit drugs, each of these 225,000 people is at risk of death," she said.

    Instead of "watching people die by the thousands," Lapointe restated her calls for a meaningful continuum of care, including expanded harm reduction services like safer supply in addition to evidence-based accessible treatment and recovery programs.

    "What if, instead of continuing to revert to policing and punishing in the guise of public safety, we focused instead on the underlying issues: that people use substances or become dependent on substances because of pain, trauma, physical or mental health challenges," she said.

    A recent coroners service death review panel report that recommended providing controlled drugs to people without prescriptions was rejected by B.C.'s mental health and addictions minister this past November.

    The report said about 5,000 people have access to provincially-regulated prescribed safer supply.

    Advocacy group Moms Stop the Harm said politicians need to stop playing politics with the toxic drug crisis and listen to experts.

    "The B.C. NDP, B.C. United and the B.C. Conservative parties have all demonstrated a shocking lack of understanding of substance use and addiction," said the group in an emailed statement.

    "Courageous and bold action must be taken, and instead politicians posture for their own gains."

    see the photos, charts and links embedded in this article at:

    https://www.cbc.ca/news/canada/british-columbia/b-c-sets-grim-record-with-2-511-toxic-drug-deaths-in-2023-1.7093528

    ReplyDelete
  15. More than 2,500 people died of toxic drugs in B.C. in 2023, driven by fentanyl

    By Elizabeth McSheffrey, Global News January 24, 2024

    More than 2,500 people died from unregulated, toxic drugs in B.C. last year, with fentanyl continuing to be a major driver.

    The powerful opioid has been detected in 86 per cent of deaths each year between 2017 and 2023, according to B.C. Chief Coroner Lisa Lapointe, who provided an update on the public health emergency on Wednesday.

    “Your child, brother, sister, mom dad friend or colleague did not deserve to die this way. Their death was preventable. Their loss — your loss — is our collective loss,” Lapointe said. “How many more families will join these statistics next year?”

    Since the crisis was declared in April 2016, she said 13,794 lives have been lost. The province’s experts estimate some 225,000 British Columbians are currently accessing the drugs through the illicit market, Lapointe added.

    Last year was the third in a row that more than 2,000 people died in B.C. from unregulated, toxic drugs. Seventy-seven per cent of them were men, and 70 per cent were between the ages of 30 and 59, according to the coroner’s office.

    The highest rates of death were in Vancouver in the area that includes the Downtown Eastside, along with Hope, Port Alberni and the Clayoquot area, Terrace, and Greater Campbell River.

    Eighty per cent of unregulated deaths took place indoors and 19 per cent occurred outside. A single death occurred at an overdose prevention site — the first one on record.

    For many months, unregulated drug toxicity has been the leading cause of death in B.C. for people between the ages of 10 and 59, surpassing murders, suicides, natural diseases and accidents.

    It takes an average of six to seven lives in the province each day.

    In December, her office’s expert death review panel vouched for expanded access to safer supply as the “fastest way to reduce deaths” amid the crisis. That panel said a prescription-free model is the most viable, scalable short-term option to save lives, as an estimated 225,000 British Columbians are currently at risk of drug injury or death.

    As it stands, prescribed safer supply is only accessed by about 5,000 people in B.C. each month. There continues to be “no indication” that prescribed safer supply is contributed to unregulated drug deaths.

    In 2023, the coroner’s office said hydromorphone — a prescribed alternative also known under the brand name Dilaudid — was only detected in three per cent of unregulated drug deaths that underwent expedited toxicology testing.

    Lapointe said that’s not statistically significant when considering what factors drive toxic drug deaths.

    Lapointe has been a fierce public advocate for safer supply in the province and echoed the panel’s concerns on Wednesday.

    “Prescribed safer supply is simply not able to address the scale of the public health emergency in which we find ourselves,” she said. “One million people in our province don’t have access to a family doctor, never mind the focused and specialized expertise needed to address a public health emergency of this magnitude.”

    British Columbia will continue to “count the dead” without an expanded supply model, Lapointe said.

    continued below

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  16. Mental Health and Addictions Minister Jennifer Whiteside has already rejected the suggestion of prescription-free substances. In her own Wednesday press conference, she said the province’s working to address the “spectrum of need,” including housing, treatment and recovery.

    “I want to assure British Columbians that my commitment to ending this crisis is unwavering,” Whiteside said.

    “We know that when someone makes the brave decision to seek help, they need to be met with access to the services that they need and they need care that is specific to their own unique needs. We do know that we are making a difference.”
    Click to play video: 'Some BC MLAs receive illicit drugs gift package'

    Whiteside referenced recent research published in the British Medical Journal that found people with an opioid-use disorder who were prescribed a day or more’s worth of opioids in B.C. were 61-per cent less likely to die the following week than those who did not.

    Pressed on her rejection of the coroner’s recommendation on adopting a prescription-free safer supply model, the minister referenced the study again. Work is underway to improve access to prescribed safer supply, she added.

    In its 2023 budget, the province committed $1 billion to addressing the crisis over the next three years. The province has pointed to new investments in addictions beds and recovery care, an expanded scope of practice for nurses, and the expansion of 24/7 substance-use and mental health supports as examples of its action to combat the crisis.
    Click to play video: 'B.C. premier sticking with drug decriminalization program'

    In a news release, Whiteside said the province has made “significant progress” last year in that regard.

    “We have opened hundreds of treatment and recovery beds. We are scaling up access to virtual care and outpatient care,” she said. “All of those measures are critical in our goal to ensure we can connect people to the care and support that they need.”

    British Columbia almost a year into its experiment with decriminalization, which allows adults to possess small amounts of certain drugs — opioids, crack, cocaine, methamphetamine and MDMA — for personal use.

    On Wednesday, BC United Leader Kevin Falcon called that pilot program “disastrous,” having “recklessly endangered lives,” in a post on social media.

    Whiteside accused Falcon of “spreading misinformation that will not help to save a single life in this crisis.”

    In the context of decriminalization, Lapointe said the use of the toxic drug crisis for “political fodder is extremely disappointing.”

    Lapointe is preparing to retire on Feb. 18 after many years of public service, making Wednesday her final public event. Asked if she had advice for her successor, she emphasized the importance of collaboration.

    “Those relationships across public health, across law enforcement, across the criminal justice system, across health authorities — critical,” Lapointe said. “We need to talk to each other. We cannot be polarized and we are not.”

    The chief coroner also pointed to the value of good data collection, so that when questions come up about the diversion of prescribed safer supply, for example, there’s a body of information to work with.

    In her Wednesday address, Whiteside thanked Lapointe for her years of service and support during some of the toughest health crises the province has ever faced.

    see the links, videos and photos embedded in this article at:

    https://globalnews.ca/news/10247747/toxic-drug-crisis-update-bc/

    ReplyDelete
  17. Eby underscores 'fundamental' disagreement with B.C. chief coroner on safe supply

    Last year saw a record 2,511 toxic drug deaths in B.C.

    The Canadian Press · January 26, 2024

    B.C. Premier David Eby has rebuffed the province's retiring chief coroner's swansong pleas for non-prescription safe supply of drugs, calling it a "fundamental issue'' of disagreement on how to curb the toxic drug crisis.

    "I do not believe that the distribution of incredibly toxic opioid drugs without the supervision of a medical professional in British Columbia is the way forward and the way out of the toxic drug crisis,'' Eby told a news conference.

    Eby said Thursday that he appreciated Lisa Lapointe for her "important and profoundly challenging work,'' a day after she used her final press conference to announce a record 2,511 people had died of suspected illicit drug poisoning last year.

    Lapointe had said that asking doctors to prescribe a safer supply of drugs would not address the crisis that has claimed almost 14,000 lives since the province declared a public health emergency in April 2016, noting that only about 5,000 people had access to prescribed safer supply.

    Eby said he believed the only way out of the crisis was to prevent people from using toxic street drugs and help them rebuild their lives, such as opening more detox spaces.

    "Our vision is that no person should have to wait for detox. No person should have to wait for treatment,'' said Eby.

    He said he was disturbed that a record number of people died in the province last year of illicit drug overdoses, saying he recognized that more needed to be done to stop it.

    But he said the addition of 180 publicly-funded treatment and recovery beds across the province was a step toward saving lives.

    Listen | Why B.C.'s chief coroner is angry at 'lackadaisical' response to toxic drugs crisis: www.cbc.ca/news/canada/british-columbia/eby-lapointe-drug-deaths-1.7095428

    The province said nearly 100 of these beds are already open and available to British Columbians in several communities while the rest are expected to be launched by summer.

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  18. Eby told the news conference that most of these were previously private beds, and only available to people who paid thousands of dollars, but now they are freely available to the public.

    He said the move would allow more people with addictions to access high-quality treatment "close to where they live, without worrying about how to pay for it.''

    The government says there are currently 3,596 publicly-funded adult and youth addiction treatment beds in B.C.
    No 'cookie-cutter' solution: minister

    Brenda Plant, executive director of Turning Point Recovery Society, said the new beds would help remove barriers for people who can't afford services and reduce wait times for them.

    "We are decreasing the burden on our health-care system by getting people into treatment sooner,'' she said.

    "We're also providing hope for families who live with the devastating impacts of having family members with addiction issues by getting their loved ones into treatment sooner.''

    Eby said the record death toll reported by Lapointe was "disturbing,'' underscoring the importance of the work they need to do to support people amid the public health crisis.

    "Our goal is ultimately to get to a system [in which] when somebody's ready for care, that high-quality care is ready for them when they are, and there is not a barrier of cost, of wait — that's what we're working toward.

    "We're not there yet, but we're going to continue that important work,'' said Eby.

    Mental Health and Addictions Minister Jennifer Whiteside said there was no "cookie-cutter'' approach to the crisis, and the delivery of these beds is one of many pathways to support people in need.

    Lapointe's views on the crisis echo a recent coroners service death review panel report that recommended providing controlled drugs to people without prescriptions.

    But the proposal was immediately rejected by the government in November, moments before Lapointe had an opportunity to present the conclusions at a press conference.

    Eby said Thursday that there was common ground, however.

    "The coroner, myself, Minister Whiteside, and all British Columbians have the same goal of ensuring that treatments are available for people when they need it and that the treatment that's available is of the highest possible quality,'' he said.

    www.cbc.ca/news/canada/british-columbia/eby-lapointe-drug-deaths-1.7095428

    ReplyDelete
  19. Backlash against drug decriminalization and safe supply 'terrifies' B.C.'s exiting chief coroner

    Lisa Lapointe says significant policy change at all levels of government is needed to save lives

    CBC News · February 01, 2024

    Since she became B.C.'s chief coroner in February 2011, Lisa Lapointe has seen a lot change.

    In 2016, the province declared a public health emergency over drug poisoning deaths. In 2023, B.C. decriminalized the possession of up to 2.5 grams of some illicit drugs for personal use.

    Changes have also been made to allow people who use drugs to be prescribed regulated alternatives to street drugs in what is termed safe supply.

    And yet, the number of people dying of toxic drug deaths continues to climb — a record high of 2,511 in 2023, for a total of more than 14,000 deaths since 2016.

    Through the years Lapointe has tracked each of those deaths, releasing regular, data-driven reports on the public health emergency.

    Through it all, she says, the evidence is clear that keeping people alive must be a priority. She says to do that, efforts at destigmatization, decriminalization and prescription must continue, despite the sense from some that these changes are doing more harm than good.

    In a year-end interview back in December, B.C. Conservative Party Leader John Rustad argued prescribed drugs are "not safe," and an emphasis should be put on arresting and prosecuting dealers. Similar sentiments have been expressed by members of the federal Conservatives.

    B.C.'s NDP government says it is committed to moving forward with a three-year decriminalization pilot project.

    Premier David Eby, meanwhile, said last week that he has a "fundamental" disagreement with Lapointe, who has called for non-prescription safe supply of drugs.

    The growing backlash in some corners "terrifies" Lapointe, who says toxicology reports make it clear that illicit drugs are responsible for the vast majority — roughly 85 per cent — of toxic drug deaths, not diverted safe supply.

    She says she is worried there is a move toward once again driving users into "back corners, basement suites [and] back alleys ... where people die alone."

    Lapointe spoke to CBC host Gloria Macarenko on CBC's The Early Edition.

    The following transcript has been edited for length and clarity.

    continued below

    ReplyDelete
  20. What are you reflecting most on right now?

    I'm certainly reflecting on the genesis of this crisis. In 2012 when we first saw illicit fentanyl show up in post-mortem toxicology results and had absolutely no idea that that would result in the devastation and the death that we've seen over the past seven-and-a-half years. The number of families that have been impacted.

    And I will leave knowing that as a coroner service, we have done our very best to bring forward information, to provide the data, the evidence, to support meaningful responses.

    But I also leave with a real sense of sadness knowing that unless we see some significant policy change at all levels of government, the death toll will continue to climb. And that makes me very sad and very worried.

    Why do you think David Eby is having such a hard time accepting the recommendation [of expanding safe supply]?

    I think it's very difficult for politicians [to encourage] something that, for the public, feels radical.

    It feels radical to give substances to people who are already suffering from the effects of those substances.

    But when we explain to people ... The idea behind the prescribed or non-prescribed model of safer supply is to keep [people] alive.

    Let's stop supporting the organized crime-driven illicit drug market, provide a safer supply to those at risk ... and then have, in the background, building that prevention, treatment, recovery [infrastructure] that currently just doesn't exist.

    Where is the data?

    The decriminalization pilot — while incredibly important — [it's] really difficult to get meaningful data at this stage.

    I think there are critics of decrim who say, 'Well look, it's been in place a year, the deaths didn't go down.'

    Well, decriminalization is one year into a three-year pilot after decades of criminalization and policies that have supported – sadly, unknowingly or without meaning to — the illicit drug trade.

    So where people say, 'Decrim's a failure,' we can't measure one year of decriminalization against decades of criminalization. That's where this problem started.

    And I don't think we can measure the success of decriminalization until we address the toxic supply because people are still dying every day because the supply is toxic.

    But politicians are attacking this whole process.

    It's funny how we want to revert back to what is familiar.

    Criminalization is what we did for decades. It wasn't effective, but somehow we feel like that's got to be the better way.

    It didn't work and that's where we need to have that separation of politics and medical evidence and look at what actually works.

    To abandon that, to go backwards to a system that was never effective, has led us to the crisis where we are today ... That's a knee-jerk reaction. It's an emotional reaction and it isn't driven by science.

    It's unfortunate.

    But we rely on the science, and then hopefully over time the public and the politicians will see that, and we will see that meaningful change.

    Because if we don't, and I'm going to be really honest, if we don't see wide-scale change, then next year the new chief coroner will be standing up and saying there were another 2,500 deaths.

    see the links, charts and photos embedded in this article at:

    https://www.cbc.ca/news/canada/british-columbia/safe-supply-backlash-chief-coroner-1.7101210

    ReplyDelete
  21. B.C. should expand safer-supply program despite drug diversion risks: provincial health officer

    Dr. Bonnie Henry says other drugs should be included in program, while acknowledging it carries societal risks

    by David P. Ball · CBC News · February 01, 2024

    A new report from Dr. Bonnie Henry has called on the B.C. government to broaden the availability and types of drugs that can be prescribed under the province's controversial safer-supply program.

    But the provincial health officer also acknowledged Thursday that the pioneering program carries some societal risks, and urged B.C. to create a scientific and clinical committee to address concerns and evidence arising from it.

    B.C. is the first province to have a safer-supply program, which allows medical prescribers to give substance users regulated versions of some opioids.

    "This policy, in its intent, is an important part of the spectrum of medical care we are providing — and need to continue to provide — for people who use drugs in the province," Henry told media Thursday on the release of her report, titled A Review of Prescribed Safer Supply Programs Across British Columbia.

    "The program does not go far enough in terms of the medical model to meet those needs … The medical model must be expanded."

    Henry said she was asked by the province last spring to scrutinize any risks and benefits of the initiative and to issue recommendations.

    Her report comes amid growing controversy around prescribed safer supply, which B.C. launched in March 2020.

    Last year, a record 2,511 British Columbians died as a result of unregulated drugs, the equivalent of nearly seven deaths a day. That represents a five per cent increase compared with the previous high of 2,383 deaths recorded in 2022.

    B.C.'s mental health and addictions minister said the provincial government will continue to offer a broad range of support for substance users — including treatment and recovery, harm reduction, housing and employment programs — not just prescribed safer supply.

    "This program is one part of a comprehensive approach to saving lives," Jennifer Whiteside told reporters following Henry's news conference. "We are going to continue to work all across that continuum … to keep people alive and connect them to the care they need.

    "Our focus now is to look at improving the current model that we have."

    Whiteside called prescribed safer supply an important step to helping people accessing opioid replacement therapy, as well as treatment services.

    Asked about concerns over the scarcity of definitive scientific evidence for safer supply, she said Henry's proposal for a scientific and clinical committee is "under consideration" by the province.

    Critics have expressed concerns that some of the regulated drugs may be making their way to unintended substance users without a prescription, known as diversion.

    "Emerging evidence indicates diversion of prescribed substance(s) is occurring and may be causing harms," Henry's report states.

    However, she said there is no evidence that more youth are being diagnosed with opioid use disorder since the province launched its prescribed supply program — in fact, she found the opposite.

    continued below

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  22. But she acknowledged that issues surrounding "diversion and diversion mitigation result in moral distress for some prescribers."

    "We need to understand that better," Henry said on Thursday. "Clearly, for the unmet needs, we need expanded access to medications that do meet people's needs, so you don't need to sell the drugs you have."

    She added that B.C. must ensure officials have a "better understanding of whether or how" youth are accessing prescribed opioids.

    Chris Dunham, who receives methadone treatment, told CBC News he often sold his previous prescription of hydromorphone (also known as Dilaudid) and diazepam (also known as Valium) on the streets because he found them ineffective.

    "To get other drugs [to] get high on, like fentanyl ... I sold them all the time," the 54-year-old said. "I think the heroin program is probably good but ... don't take it home so it can't be diverted.

    "All these dilaudids are going to the streets and addicting other people ... I don't want other people to have to go live the life I've lived."

    On the other side, substance users and some health providers have said it is too difficult to access the prescriptions for users at greatest risk of dying from toxic, illicit drugs.

    Henry therefore called on the province to expand its prescription program to include more commonly used forms of drugs including diacetylmorphine — or pharmaceutical heroin — and powdered fentanyl.

    For one patient who receives prescribed heroin in Vancouver's Downtown Eastside, the program has been a life-saver as she watched many of her peers die of overdoses (ODs).

    "Everyone was OD-ing and dying," Claudia West said. "I haven't touched street drugs since I joined the program ... It's been helping me keep clean from street drugs for over two years now.

    "It saved my life, because I was doing fentanyl."

    Currently most of the prescribed supply under the program has been hydromorphone in tablet form, said Dr. Alexis Crabtree, the B.C. Centre for Disease Control's medical lead of harm reduction and substance use services.

    "Hydromorphone tablets are not a substance that is working for everyone," she told reporters on Thursday.

    Additionally, she said, there's not yet strong enough research to definitively say prescribed safer supply is an effective "evidence-based intervention."

    But what little data there is suggests the program is worthwhile, if it can be expanded to more substances, she argued.

    "The research is largely positive regarding prescribed safer supply," said Crabtree, who is also a clinical instructor at UBC's School of Population and Public Health.

    On Jan. 24, Chief Coroner Lisa Lapointe renewed her plea for an expansion of safer supply and a "systems change" that treats substance use as a health issue, not a criminal problem.

    Following Lapointe's remarks, B.C. United leader Kevin Falcon said on social media that the grim death toll was an indictment of the B.C. NDP's policies, including the "reckless decriminalization" of small amounts of certain illicit drugs.

    According to the province, 4,265 people were prescribed an opioid alternative under the $184-million program in November 2023.

    see the links and photos embedded in this article at:

    https://www.cbc.ca/news/canada/british-columbia/bc-bonnie-henry-report-prescribed-safe-supply-1.7101874

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  23. Documentary: Drug User Liberation and the fight for safe supply

    This short documentary follows the late 2023 raids and arrests against the Drug User Liberation Front (DULF) and the Medicinal Mushroom Dispensary in Vancouver, Canada.

    Meet the brave activists creating a safer drug supply - leading and protecting their communities despite threats from politicians and attacks from the cops.

    https://youtu.be/TQAdd8-5ib4?feature=shared

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  24. What’s Behind the Right-Wing Backlash Against Harm Reduction?

    Ideology and money are driving a campaign against measures that could save lives.

    by Carlyn Zwarenstein, he Tyee August 2023

    To harm reductionists in the United States, Canada can sound like a bastion of progressive, evidence-based drug policies. Naloxone is available over-the-counter at pharmacies, sometimes for free; cannabis is legal everywhere and widely available; a growing number of safe supply programs provide opioids of known dosage and composition; safe consumption sites exist across the country.

    The harm reduction gains are real, even if programs don’t reach nearly enough people and far more remains to be done. Each has only been won through painstaking activism, often civil disobedience or legal challenges, by people who use drugs and their allies.

    But Canada’s gains also face — increasingly, perhaps — an organized, ideologically right-wing backlash. Opponents of harm reduction vigorously seek to link progressive drug policy with social strife, stoking moral panics that translate to votes and then to deaths, as life-saving interventions are weakened or eliminated altogether.

    Benjamin Perrin should know. A conservative from his early teens, he rose through party ranks to become advisor on public safety issues for former Conservative prime minister Stephen Harper in 2012, just as the toxic drug supply saw a dramatic surge in overdose deaths.

    He’s not the first person to become more progressive upon leaving their position of leadership or influence (the pro-decriminalization Global Commission on Drug Policy is full of former presidents who upheld prohibitionist or punitive policies while in office).

    But Perrin’s change of heart was a bit more like a transplant. After close personal encounters with the lived realities of intergenerational trauma, addiction, disability and mental health challenges, he “found freedom and peace in Jesus Christ,” according to his website. And he began to take an interest in the impact of poverty and other forms of marginalization on people he once saw as the problem.

    Perrin now speaks across the country about the need for compassionate, evidence-based policies, and wrote a progressive-minded, if not radical, book on the subject. But he doesn’t believe more evidence is likely to change people’s opinions.

    “Ideology is firmly in the driver’s seat,” he told me. In fact, it’s not an old-fashioned conservative ideology that he describes — although he draws links to the traditionally conservative idea that people should “pull themselves up by the bootstraps” — but moralism, what he calls “moral panic.”

    Most worrying, drug policy has joined other hot-button issues as the subject of massive misinformation campaigns, which Perrin describes as mob-like and fear-based.

    “Substance use has become enmeshed in right-wing narratives such as homelessness,” he said.

    This has played out most recently in relation to safe supply, in stories that illustrate complicated connections between anti-harm reduction rhetoric, people making money from unregulated addiction treatment and the right wing in Canada and beyond.

    In January, Last Door Recovery Society, a private, abstinence-only addiction treatment centre in Vancouver, provoked a national-level debate with an inflammatory press release alleging “diversion” of safe supply hydromorphone in the city.

    Although these allegations have been debunked, Conservative party Leader Pierre Poilievre seized on the issue. In doing so, he aped U.S. global warming apologist Michael Shellenberger’s argument in his 2021 book, San Fransicko: Why Progressives Ruin Cities that unhoused people and permissive drug policies are to blame for urban problems.

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  25. This draws liberally from the playbook of right-wing activist and journalist Aaron Gunn, whose incendiary documentary, Vancouver Is Dying, came out in October. The film takes direct aim at the federal government and politicians who have promoted harm reduction policies. It interviews cops, people with histories of addiction and victims of crime to advance the debatable view that crime in that city is out of control, and the baseless assertions that it results from harm reduction policies and is perpetuated by unhoused people who use drugs (but not by policies that result in homelessness).

    A frequent, nonsensical analogy made in the film — which has garnered millions of views — is that providing opioid safe supply is like encouraging people with alcohol use disorder to drink and drive.

    On the back of the Last Door tempest, a swarm of poorly informed articles flooded Canada’s mainstream right-wing media. In May, the National Post dedicated 10,000 words to an opinionated investigation of safe supply “diversion” that was deeply careless with the facts. On the further reaches of far-right media that have spread in recent years, the trifecta of violent crime/homeless encampments/harm reduction has become an almost constant bugaboo.

    Meanwhile, Alberta’s United Conservative Party has been vociferously opposed to safe consumption sites; defies the evidence by promoting abstinence-based treatment for opioid use disorder; and has thrown lives into chaos with its recent reduction of access to an existing safe supply program.

    April was Alberta’s worst month on record for overdose deaths. Yet in May, instead of rethinking her attacks on harm reduction, Premier Danielle Smith — selective in her libertarian opposition to government overreach — promised to legislate forced addiction treatment. She stated, without evidence, that this “will allow us to save the lives of addicts who are at risk of dying from an overdose and protect those who are at risk of being randomly attacked in our communities.”

    It’s not clear, however, that anti-harm reduction positioning reflects the views of the average Canadian.

    “I think that generally speaking, the Canadian public tends to be fairly supportive of harm reduction,” said Elaine Hyshka, an associate professor at the University of Alberta’s school of public health. “I think for most people it is becoming increasingly, like, common sense that in order to reduce the harms of substances in society, we need to take multiple different approaches. And one of those approaches is harm reduction.”

    In support of this, Hyshka cited her recent work on public opinion about safe supply. Even in Alberta and Saskatchewan, the relatively conservative provinces she polled, Canadian public opinion didn’t follow anti-harm reduction rhetoric: in Alberta in 2021, for example, a full 63.5 per cent of respondents were in favour of programs that replace illegal drugs with pharmaceutical alternatives for people who haven’t been able to stop using.

    “We found that the majority of people were supporting the idea of prescribing pharmaceutical alternatives or providing pharmaceutical-grade alternatives to illegal drugs for people who are dependent on the illegal drug supply,” Hyshka said.

    Nonetheless, Canada’s right-wing backlash to harm reduction is loud, determined and politically powerful. Perrin now looks at the movement a bit like someone who has escaped a cult — even as it goes further in a direction set by the government he served.

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  26. To understand the appeal of that cult to at least a significant proportion of Canadians, consider the “right-wing authoritarian personality,” as defined by Canadian-American social psychologist Robert Altemeyer. He describes a personality type submissive to authority, highly adherent to social conventions endorsed by authorities and quick to condemn, and aggressively punish, supposed enemies identified by assertive leaders. Typically these “enemies” are outsiders, or people perceived as morally degenerate.

    “One kind of theory is that Canadian drug policy is very dictated by these oscillating moments, of panic and then indifference,” Alex Betsos noted. A PhD student studying Canadian drug history at Rensselaer Polytechnic Institute, he’s also an international working group member for the harm reduction organization Youth RISE.

    Betsos pointed to the wave of limited but progressive initiatives that governments got behind for a couple of years, as a result of panic about surging overdose deaths around 2016. Over this period, increasing public understanding of the evidence supporting safe consumption sites and other harm reduction interventions was evident, as borne out in polls like Hyshka’s.

    Since then, though, many Canadians have returned to the indifference part of Betsos’ cycle, the COVID-19 pandemic having seized everyone’s attention (and severely worsened the overdose crisis).

    Perhaps this sense of comparative indifference created a vacuum into which right-wing advocates of prohibitionist, punitive drug policy could step, gathering up a mob of vocal followers to unleash a pattern of online, often transnational mobilizing, with right-wing media outlets stoking local and in-person outrage — seen around everything from safe consumption sites and immigration to the use of gas stoves.

    “Regardless of what crime statistics say, people’s feelings about the city and crime go up and down,” Garth Mullins told me. A longtime drug-user activist and member of the Vancouver Area Network of Drug Users and the British Columbia Association for People on Methadone, he also hosts and produces the award-winning drug-war podcast Crackdown.

    And then, when those feelings take a downward turn, he continued, “drug users or people without housing get the blame for it. And we’re seeing one of those cycles happening.”

    “You know, if people are feeling unsafe, then it starts with a genuine feeling,” Mullins said. “And then it pivots to blame new enemies. And that’s how right-wing and far-right propaganda often works.... When there’s a complicated situation, to find enemies you can point to — like Pierre Poilievre, you can just point to ‘Look, look here, these people on the street who are completely visible, that’s what’s causing the problem,’ instead of something like the price of food or the inequality in the system or the Controlled Drugs and Substances Act.”

    Betsos noted that attribution of “urban blight” and visible homelessness to failed progressive drug policy isn’t a new thing. But, he said, it wasn’t until recently that it gained new traction. “It’s taken a while to get off the ground, I think, and that’s maybe why we’ve been really caught off guard.”

    What seem like spontaneous reactions and inadequate education — and what harm reductionists have typically countered, in good faith, as such — are increasingly arising from the larger anti-progressive movement that specializes in disinformation and is eager to find a way to be partisan about everything.

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  27. “People can have views about things, but if they’re not organized, they haven’t found each other and co-ordinated their messaging and actions, [it’s] not very effective,” Mullins said. “But now, right-wing politicians and commentators in the media have all found each other, and they’re co-ordinating their action. And so they’re being very effective about it.”

    “This is all [rooted in] a sort of nationwide or continent-wide law-and-order backlash,” he added. “When it first came to my attention that this is a continent-wide thing that was gonna affect us was when that Shellenberger guy was getting ready to write his book.”

    When he saw how San Fransicko fuelled pundit and public outrage — by attributing public homelessness, similar to Vancouver’s, to compassionate drug policy — Mullins knew that this argument would have a lot of currency in Canada.

    Another line of thinking: At the bottom of this, it isn’t really a debate about the pros and cons of harm reduction at all. Some Canadian harm reductionists have begun looking into the links between would-be privatizers of Canada’s public health-care systems, right-wing influencers and movements across North America, and government or political party workers on the Canadian right who benefit financially from private addiction clinics and services.

    Bringing such connections to light clarifies narratives that benefit those for whom deaths and suffering among certain groups of people who use drugs are the cost of doing business. In this case, it’s not really views on harm reduction that are driving policy, but right-wing ideology acting as a justification of profiteering.

    Last Door — the residential addiction treatment facility that set off a storm in Canadian politics — is, as various harm reductionists have carefully traced, deeply enmeshed in a network of anti-harm reduction advocates who are also entrenched in U.S. right-wing movements. And, in contrast to publicly accountable harm reduction programs, unregulated treatment centres like Last Door take public funding but make private profits.

    Euan Thomson, executive director of Each + Every: Businesses for Harm Reduction, a coalition of small businesses promoting evidence-based responses to the overdose crisis, points out in his newsletter that Last Door’s director of community development is the chair of Recovery Capital Conference of Canada, which runs the influential and prohibitionist Alberta Recovery Conference.

    This annual conference, open to those who can pay $500 to attend, draws speakers from among the most outspoken North American opponents of harm reduction. These have included U.S. doctors Keith Humphreys and Anna Lembke; Julian Somers, a British Columbia psychiatrist known for his conflation of homelessness, addiction, drug use and crime; and Marshall Smith, chief of staff to Danielle Smith and an advisor to the United Conservative Party on addiction and recovery.

    Smith, who comes from B.C., experienced homelessness and addiction to methamphetamine and alcohol in the early 2000s. Shortly after receiving residential treatment himself, he became the director of a private treatment centre. Later, he was a senior staffer in an abstinence-based “therapeutic community.”

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  28. Since leaving B.C., he’s parlayed his combination of political influence and experience into a career as a driving force for the so-called "Alberta Model." U.S.-based pundit Sean Speer, a fan of Margaret Thatcher and Ronald Reagan’s “coherent and intellectually rooted policy agenda,” is another former Stephen Harper advisor who has praised the Alberta model.

    Thomson additionally flags a network of public and governmental organizations in Alberta that provide massive funding to Last Door — for example, a 2021 contract worth over $1.2 million to create a phone app. Another sponsor of the conference, Edgewood Health Network, was awarded tens of millions of public money by Alberta’s UCP government to open residential “therapeutic communities.”

    The inaugural ARC sponsor, meanwhile, was Our Collective Journey — a UCP-funded, Medicine Hat-based recovery coaching organization. Our Collective Journey is a member of North America Recovers, a transnational organization that has run ads in Washington, D.C., calling on President Joe Biden to shut down safe consumption sites.

    First established in Seattle just this year with the aim of also shutting down encampments of unhoused people, North America Recovers promotes abstinence-based treatment, with a distinctly right-wing philosophy that draws on ideas similar to San Fransicko.

    Like the UCP, North America Recovers advocates mandatory medication for mental health issues and forced treatment for addiction — including treatment known to increase the risk of death, relative to other options, for people with opioid use disorder.

    In this vision of the world, encampments should be razed and unhoused people forced into emergency shelters even at risk of disease, overdose or other harm. Human rights like safe shelter should be conditional on abstinence or compliance with mental health and addiction treatment. And drugs should remain illegal, even as the lucrative treatment industry lines its proponents’ pockets.

    During an earlier overdose crisis in the 1990s, drug-user activists who had argued for a range of solutions, including decriminalization — which might have prevented the later rise of illicit fentanyl — were forced to compromise on their demands. They wound up with a single safe consumption site in Vancouver.

    A single site was deeply inadequate given that prohibition was already worsening overdose risk in an illicit drug market centred in the Downtown Eastside. The site also bought into a medical model many drug-user activists would prefer to avoid. Yet it was better than nothing, and viewed as a first step. And so, despite these concessions, they later had to defend it, and other imperfect responses, from attacks by Stephen Harper’s Conservative government.

    “When Harper came to shut it down, we had to defend it,” Mullins recalled. “And there was a whole bunch of myths fabricated around the safe injection site as well. And we had to clarify those myths.”

    While Harper’s former advisor Perrin tries to convert Christians to the harm reduction cause, those in the harm reduction trenches and others see it as less about cajoling compassion and more about claiming rights.

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  29. Betsos, for example, argues that while harm reduction initiatives are falsely characterized as not working because they are too radical, in fact, the reason they don’t work as well as they could is that they don’t go far enough.

    “We’re always... trying not to step on toes,” he said, “and so we’re making all these compromises.”

    Hyshka believes the same. In her research, she’s found that while generic harm reduction rhetoric is often used by governments, there are still relatively few substantial harm reduction policies in any of the provinces or territories.

    “I actually think that in some cases, the fact that these programs have been implemented incrementally [is] providing critics an opportunity to say, well, we’ve tried that and it doesn’t work,” she said. “They have not been scaled to the size that they need to be.”

    Like Hyshka, Betsos points to the backlash against very restricted hydromorphone programs, which were developed in response to some evidence that some people can’t distinguish hydromorphone from heroin under certain conditions. Critics of such programs say sarcastically that you might as well give everyone heroin, or fentanyl. In fact, Betsos agrees.

    While hydromorphone, like methadone, works very well for those for whom it works, it was yet another compromise for drug-user activists and harm reductionists. It was simply easier to seek approval for hydromorphone than the less politically palatable diacetylmorphine, the pharmaceutical version of heroin.

    “We’ve been kind of stymied by the potential for conservative backlash,” Betsos said.

    Harm reductionists know that many people who use opioids now seek not heroin, but more potent, shorter-acting fentanyl. As a direct substitution, prescription fentanyl programs — some isolated examples are emerging — would be more likely to retain people and help them stabilize their lives.

    Perhaps, Betsos suggests, harm reduction advocates need to go not smaller in their demands, but bigger — lining up more squarely behind evidence and a holistic grasp of the dynamics in which people are suffering.

    “One point is [the potential of] meeting the political moment as a moment to open up possibilities,” he said.

    Mullins is focusing on building coalitions to make common cause with labour movements, civil rights groups and others against the right-wing momentum across North America. These efforts seek to bring drug-user voices into the conversation, and to educate the public — including his fellow VANDU members, whose lives are directly affected by the rhetoric — to see through right-wing talking points.

    At a recent VANDU meeting, Mullins played video clips from the House of Commons debate on Poilievre’s (eventually defeated) motion seeking to defund nationally funded harm reduction programs like safe supply.

    “Everyone is like, booing [Poilievre], but also kind of shocked to see our issues being lied about in the most powerful room in the country,” he said.

    It’s not easy countering the lies, though. “The problem is, we have to explain the system, and they have to just point to a scapegoat… so our job is a little harder,” Mullins explained. “That’s the great thing about the invisible hand of the market. It’s invisible… so those market forces that are making everybody’s lives so much more difficult are hard to just point to directly.”

    https://thetyee.ca/Opinion/2023/08/02/Behind-The-Right-Wing-Backlash/

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