Samuel Plamondon with input from Caleb Chepesiuk
One hundred years ago to this very day an assassination was carried out in Sarajevo, an event that would trigger a war larger and more egregious than any the world had seen before it. A different kind of war, one that would last far longer and eventually affect many more nations, was just months from beginning in earnest.
On December 17, 1914, the United States Congress passed the Harrison Narcotics Tax Act. Ostensibly a law made to regulate and collect revenue on the sales of opium and coca products, a sly interpretation of one of its clauses was used as justification to arrest any physician who prescribed morphine or heroin as a maintenance drug for someone with an opioid addiction. The medical community immediately recognized the damage that a policy like this had the potential to cause:
“The really serious results of this legislation…will only appear gradually and will not always be recognized as such. These will be the failures of promising careers, the disrupting of happy families, the commission of crimes which will never be traced to their real cause, and the influx into hospitals to the mentally disordered of many who would otherwise live socially competent lives.”
– Editorial in the New York Medical Journal, May 15, 1915
One hundred years on, similar policies have been established all throughout the world and these “serious results” have damaged the lives of many more people than anyone could have imagined.
However, just as it was a century ago, there are many today who believe that using criminal law to control and punish drug users causes more harm than good. This belief is exemplified by the global “Support. Don’t Punish.” campaign. The United Nations Office on Drugs and Crime has billed June 26 the International Day against Drug Abuse and Illicit Trafficking, and so the annual Global Day of Action as part of the “Support. Don’t Punish.” campaign, organized by International Drug Policy Consortium, is intended as a counterpoint to the punitive approach propagandized by the UNODC. During the campaign, activists from close to 100 cities in 50 countries staged protests and artistic exhibitions with the purpose of educating the public about the importance of drug policy reform. Examples of specific policies that were called for during the campaign include the opening of supervised injection sites, the decriminalization of drug possession, and the provision of naloxone over-the-counter to opioid users.
Canada was represented in the “Support. Don’t Punish.” campaign by Participatory Research in Ottawa: Understanding Drugs (PROUD), a group of drug users and their allies who run and publish sociological research on the topic of local drug users. Tara Heighton of PROUD explains the group’s action for SDP:
“When brainstorming for PROUD’s summer forum, we knew that the Second Global Day of Action for Support Don’t Punish was coming up on June 26. The forums are events where we share data collected during the PROUD study in 2013, where people who either inject drugs and/or smoke crack were asked questions on a number of topics. Because of the team’s lived experience, along with the early results of the data collected, the team knows that the heightened risks drug users face cannot be ignored. Our forum was centered on criminalization and the experiences of people who use drugs in Ottawa, and it seemed a natural fit to connect this with the struggles people who use drugs face around the world. We organized a short panel for the forum, featuring three speakers: Frank Welsh, from the Canadian Public Health Association, to talk about their recent report on how Canada’s war on drugs is failing and the need for new policy options; Kelly Florence, a PROUD researcher, to speak about PROUD research findings on the law and criminalization; and Ricki, a community member, to speak to her personal experiences with having her addiction criminalized. The speakers were all very engaging and provided three different lenses of how drug use is criminalized in Ottawa, which sparked a great question and answer period.
PROUD puts up posters around Ottawa neighbourhoods on June 26, as part of “Support. Don’t Punish.”
We blended in elements of Support Don’t Punish so that we could help build awareness for this important cause, and show solidarity with the thousands of people around the world taking action. With this in mind we set up a table with an information board about the day, and provided lots of blank Support Don’t Punish posters for the forum attendees to write their own messages on. Messages included things like “Unite as one!”, “Stop Criminalization” and “Provide treatment options.” To support the global day of action on June 26 we will putting up these posters in our neighbourhoods in order to raise awareness, and encouraging people across Ottawa to do the same in their neighbourhoods. With this small action we hope to show our connectedness to people across the globe who are demanding that the repression of people who use drugs be replaced with true care and support.”
To find out more about the events that took place for “Support. Don’t Punish,” check out the official website, where you can see local actions listed by city.
Apathy and Overdose Forum
“The people using and abusing opioids (and dying as a result) are not all stereotypical ‘junkies’ shooting up in alleys. They are also grandmothers who take too many painkillers, labourers who get addicted after treatment for a back injury, teenagers who raid their parents’ medicine cabinet, kids who mistake pills for candy and recreational users who can be anyone from Bay Street brokers to squeegee kids.” (Andre Picard, Globe and Mail healthcare correspondent)
Did you know that more people die from accidental overdose than motor vehicle accidents in Toronto?
This is just one fact that sparked the Apathy and Overdose Forum on June 18th in downtown Toronto. The topic of the evening was quite timely, particularly after the CBC coverage on the rise of opiate use. Tonight’s forum was called “Apathy and Overdose,” focusing on accidental drug overdose, and was broken down into two speakers and one panel with individuals who had experience in some way with overdose.
The event was planned by Walter Cavalieri, the founder of the Canadian Harm Reduction Network, and a core group of others who made this forum possible. Dr. Philip Berger was the moderator for the evening– a physician, social justice activist and Medical Director of the Inner City Health Program at St. Michael’s Hospital.
The first presenter was Donald MacPherson, the founder of the Canadian Drug Policy Coalition. Donald worked with other like-minded Canadians to start CDPC to create a national voice for ending the war on drugs and moving a public health approach to drug policy forward. CDPC just recently released their policy brief on overdose, and copies were available for everyone who attended. We discussed some of the recommendations that address what can be done to save lives now. He explained it as an “advocacy document” that should be circulated to everyone – politicians, public, front line workers, etc. Some of the major points of the document included suggestions such as reducing barriers to calling 911 during a drug overdose event (i.e. Good Samaritan type legislation). This is so important because, as we learned, opioid overdose can be reversible though timely administration of naloxone coupled with emergency care. These kinds of strategies are important because they can be implemented with little cost, saving both lives and resources.
Dan Biggs was the second presenter of the night, all the way from Chicago and director of the Chicago Drug Recovery Alliance. A very charismatic guy, he started his talk by asking the audience who had been personally affected by overdose, where just over half the audience put their hand up. Then, he asked if anyone knew that naloxone was essentially the reverse for overdose – a “pure antidote to opioid poisoning,” and almost all the audience put their hands up. Lastly, he asked if anyone thought it should be made available everywhere – to which the entire audience raised their hands. “Alright we’re done here!” he joked.
All joking aside, Dan spoke to the 188 programs in the United States, since 1996, which have been dispensing naloxone kits. Dan showed us three variations of a naloxone kit. He showed us the first version (even demoing it – a recording which walks you through the steps) developed by a pharmaceutical company, costing over $500 for only one. The US government has not put any funding towards developing this initiative, so it can get quite costly to distribute something like this. He also showed up an intranasal naloxone device that mists into each nostril, a preferred method for police who are resistant to carrying the injection kit. The intranasal version costs only $42. Lastly, he showed us the “cheap guy from Chicago’s” version of the kit, costing less than $3 a kit. This version has the potential to really make an impact because it becomes much more affordable and thereby accessible. I’m always pulled in by simple and effective solution that could really save lives – I think sometimes it’s easy to get caught up in “fighting the entire system and its flaws” rather than reaching for smaller, but also important, solutions that can change things right now as the bigger initiative continues to develop. One person asked a question I had been wondering, “what if you inject naloxone into someone who doesn’t have opioids in their system?” Dan responded that this would actually have no effect, similar to injecting oneself with saline.
The second panel was really interesting because it focused on four people who have had first hand experience with accidental overdose. Peter Leslie, a former paramedic who now works in harm reduction, discussed some of the “miraculous” recoveries he had seen using naloxone. Another man spoke from a drop-in harm reduction shelter in Toronto, a pretty unique program in Canada. This started an interesting conversation about police and EMS’ response to overdose. One woman, Donna, shared an emotional story about the loss of her daughter due to an overdose. She spoke to the last time she saw her – underweight, broken bones, and barely recognizable. What was really captivating for me was her discussion about the discourses we draw on when discussing addiction and the barriers this creates to support and services. She had labeled her daughter as a ‘dirty junkie’ – and spoke to this type of thinking and labels that prevented her from trying to understand her daughter’s experience. Labels that she believed work to dehumanize her daughter, “destroying her at her very core.” She framed this as a lack of education and understanding, and shared this story in order to advocate, “doing better” in the future – by, for example, advocating for effective Good Samaritan policies and advocating for naloxone to be widely available.
Many people stayed for the networking period after the discussions, sparking some really interesting conversations. Overall, I am happy it was such a successful event, filling the seats, raising awareness and getting a dialogue started about overdose prevention in Toronto.
Wednesday June 18th 7pm
College Street United Church
454 College Street West, Toronto, Ontario
The Canadian Harm Reduction Network along with Jac’s Voice, the Canadian Drug Policy Coalition, Canadian HIV/AIDS Legal Network, John Howard Society Toronto, Patients Canada, and Canadian Students for Sensible Drug Policy, have organized a free public forum, titled “Apathy and Overdose.”
Dr. Philip Berger will act as the moderator for the forum. Guest speakers include Donald MacPherson (Executive Director of the Canadian Drug Policy Coalition, who also published Vancouver’s “Four Pillars Drug Strategy”), as well as Dan Bigg (Founder and Director of the Chicago Recovery Alliance).
There will also be a panel of people who have experience or witnessed an accidental overdose, and will speak to the impact on themselves, their families and the community more generally.
We are also looking for volunteers at the event, so if you can help, please leave us a post!
Please SHARE this event on your Facebook page and invite your friends and colleagues!
Anywhere you turn today, you will hear cries of a prescription-painkiller epidemic. These painkillers are part of a class of drugs known as opioids, of which heroin is also a member. The touting of an epidemic is not incorrect: opioid overdoses have been rising dramatically in the United States over the past several years. The situation is similar in Canada, which has the second-highest level of opioid consumption per capita in the world according to the International Narcotics Control Board. However, there are some major misconceptions surrounding opioid addiction and overdose that lead to both stigmatization and an increased likelihood of overdose death among the population that uses these drugs.
The majority of people who try opioids recreationally do not become addicted. According to the U.S. National Survey on Drug Use and Health in 2012, 5.6% of people who had ever tried prescription opioids recreationally were considered to have abused or been dependent on them within the past year. To put that in perspective, 8.3% of people who had ever tried alcohol were considered to have abused it or to have been dependent on it in the past year by the same measure. Even among chronic pain patients using opioids long-term, a minority show signs of addiction. In a Pennsylvania study, 21.7% of non-cancer chronic pain patients on long-term opioid therapy showed moderate symptoms of addiction, and 13.2% showed signs of serious addiction.
Opioids used responsibly are not particularly lethal. They have a therapeutic ratio (average lethal dose divided by average effective dose) that is favourable enough for them to be considered safe and even essential medicines by every pharmaceutical regulatory agency in the world. However, the climate of drug prohibition (the “War on Drugs”) has created a situation where the harm from these drugs has been maximized due to several factors.
Drug overdose deaths occur almost exclusively after the consumption of multiple drugs, primarily multiple depressants (depressants are “downers,” drugs that slow your breathing and heart rate and relax your mind). In Scotland in 2012, it was found that 97.6% of all people who died of a drug overdose had multiple drugs in their system at the time of death. By far the most common class of drugs found were benzodiazepines (72.1%). In the state of New South Wales in Australia, a study was done on all overdose deaths involving oxycodone over a decade. In every single case, multiple drugs were found in the systems of the deceased, and once again, benzodiazepines were the most common (68.6%). Alcohol is another drug that is often present in drug overdose deaths. Drinking even a small amount of alcohol significantly increases one’s likelihood of dying while taking an opioid.
This simple truth about combining depressants is of such enormous importance for the livelihood of drug users that it should be hammered into their skulls long before they have the chance to actually use drugs. However, with drug prohibition comes a clear narrative for drug education: abstinence is presented as the only option. Our drug education mimics the sex education we abandoned (for the most part) sometime in the last century.
While we used to learn:
“Sex is bad, don’t have sex!”
We now learn:
“Abstinence from sex is the safest option, but if you do end up having sex, you will be much more likely to avoid the greatest harms if you make sure to use a condom.”
Meanwhile, we still learn:
“Drugs are bad, don’t do drugs!”
While we should be learning:
“Abstinence from drugs is the safest option, but if you do end up taking drugs, you will be much more likely to avoid dying of an overdose if you make sure not to combine depressants.”
Drug prohibition also increases the frequency of overdose deaths by pushing users towards adulterated products. Heroin users have no way of confirming if the dope that they are getting on the street is pure heroin or a number of other formulations, which means that many heroin users, even if they think they are only using heroin, are automatically using multiple drugs within a mixture. There is evidence that quinine, a common cut in heroin, often contributes to overdose deaths.
Despite the dangers of combined-depressant overdoses, there is actually a drug that can reverse them almost invariably when they involve opioids: naloxone. Even though it costs cents to manufacture per dose, has no recreational-use potential, and isn’t under patent protection, naloxone is not available to most of the Canadian public. In most jurisdictions, a prescription is necessary to obtain it. Most people are not aware that this life-saving elixir exists, and this is another case of insufficient education. Throughout North America, there is currently a push to make naloxone more available to everyone, so that friends and family of opioid users could administer the drug in the case of an overdose. Edmonton became the first municipality to set up a take-home naloxone program in Canada in 2005, and has since been followed by Toronto and Ottawa, among others. On the provincial level, both British Columbia and Ontario have recently begun to officially support local take-home naloxone programs.
To be clear: I am not saying that it is a good idea to try opioids. Some people, especially (but not exclusively) those with a significant amount of chronic emotional pain, will find opioids so soothing that they will never stop using them once they have started. However, many people can and will use them responsibly. For those who do become addicted, there is no reason their use should be a death sentence.
If you are interested in this topic, I highly recommend this book by Consumer Reports. It was published in 1971, but the analyses and conclusions are not dated at all, and you might find it surprising how questions that were answered so long ago can still be so terribly misunderstood today:
The Consumers Union Report; Licit and Illicit Drugs
Edward M. Brecher and the Editors of Consumer Reports Magazine
Also, if you are in the Toronto area, you might be interested in attending an upcoming public forum, entitled Apathy and Overdose. The event will examine various topics related to drug overdose and will take place at 454 College Street West in Toronto on the 18th of June at 7 p.m.