This past Tuesday, July 28th, over 200 organizations around the world commemorated World Hepatitis Day by hosting events and campaigns, doing public outreach, and raising awareness about the often misunderstood viruses. Over 400 million people (or 1 in 12 people worldwide) currently live with viral hepatitis, and 1.4 million people per year die from these illnesses. The word “Hepatitis” means “inflammation of the liver.” Non-viral forms of Hepatitis can result from exposure to chemicals or other toxic substances, heavy alcohol consumption, consumption of chemical drugs (prescription, over the counter, or otherwise), or autoimmune conditions which target the liver. Viral forms of Hepatitis however, which is the focus of WHD, result from viral infection of the liver. Viral forms of Hepatitis include Hepatitis A, B, C, D, and E. Each of these infections differs in terms of symptoms and transmission risks. While Hepatitis A, D, and E viruses (HAV, HDV, and HEV) are self-limited diseases (meaning that they resolve eventually on their own, with or without treatment) Hepatitis B and C (HBV and HCV) can become chronic and on-going infections in many patients. HBV and HCV are disproportionately common among populations who use intravenous drugs. Using intravenous drugs alone does not increase chances of contracting blood-borne infections, but unsafe drug use and sharing injection equipment does. While both HBV and HCV are treatable, intravenous drug users who contract both HIV and HCV face increased chances of mortality. In a 2000-2009 study of 32,703 people living with HIV in Europe and North America, coinfection with HCV was linked to a 2.65-fold likelihood of death and a 10.89-fold likelihood of liver-related death. People living with HBV and HCV in low- and middle-income countries also suffer disproportionately compared to their counterparts in wealthier nations and are less likely to be able to access treatment. As has been the case with HIV/AIDS, mass-scale treatment and subsequent decreases in transmission could be achieved if drug companies removed their patents and allowed manufacturers worldwide to market generic versions of the medications. There is no vaccine for HCV, so treatment as well as prevention through education and harm reduction are currently the only viable avenues to tackling the illness. Solvadi, a new HCV drug which has been hailed as more effective than previous ones with a success rate of 86-90 per cent, costs $1000 US for a single pill, which amounts to $84, 000 for an entire three-month course of treatment. This means that the treatments is unaffordable to poor and middle-income people even in highly developed countries. Governments and insurers in the US and Europe only offer subsidies to people with the most advanced symptoms, leaving others to become steadily sicker as they wait for treatment. Gilead, the manufacturer of Solvadi, offers some subsidies to low- and middle-income countries, but the the drugs are still unaffordable for many national budgets and individual patients alike. Toronto celebrated WHD by hosting an event at the Central Toronto Community Health Center, which consisted of a free barbeque, info tables, harm reduction supplies, on-the-spot testing services, and live music by local artist DJ Vrak. The event was a collaboration between the three Community Health Centers in Toronto, including CTCHC, South Riverdale, and Sherbourne.
Rob, a long-time harm reduction activist in Toronto, expressed how good it was to see how far the harm reduction movement has come in the past few decades, and how many more programs exist for HCV-positive people than did 20 years ago. Around 500 people showed up to the event. “Some people came for the food, and ended up leaving with harm reduction supplies or using the on-the-spot testing service,” Rob said. He added that there is still much progress to be made in terms of HCV justice, including making access to new medications as low-barrier as possible and not restricting prescriptions to only those with advanced symptoms. “I really like the turnout, and it’s great to see people from so many different organizations here,” said Celeste, who is part of the HCV group at CTCHC. Some of the organizations present included COUNTERfit, CATIE, and Black CAP. Another attendee, who asked not to be identified, said that she was disappointed that more people with lived experience of HCV hadn’t been involved in setting up the event. “It was something that was talked about, but never really followed through with,” she said, adding that while she was pleased with how many community members showed up, she felt that the event should have prioritized HCV-positive people at an organizational level.
The facts are in: Ontario is officially suffering from an epidemic of opioid overdose deaths, and has been for at least the past 15 years. According to the Prescription for Life report, which was released by the Municipal Drug Strategy Co-ordinator’s Network of Ontario in June of this year, over 5, 000 opioid-related deaths have been recorded in Ontario since 2000– the equivalent of one death every 14 hours.The majority of these deaths were accidental, and and many could have been prevented through improved access to life-saving Naloxone as well as implementing supervised injection sites.
While these numbers are staggering on their own, drug users are too often portrayed as statistics, whose deaths are either forgotten or only recorded as evidence of our broken drug policy system. Every year on June 17th, the COUNTERfit harm reduction program at the South Riverdale Community Health Centre holds a day of remembrance, mourning, and celebration, in honour of the lives and legacies of drug users and activists who fought against the war on drugs who have died in East Toronto. The Toronto Drug Users’ Memorial, a flame-shaped brass statue which stands in the courtyard beside the South Riverdale Community Health Centre, was created as a visual reminder of those lost. The statue was created by activist and street artist Rocky Dobey, and is etched with images of birds in flight, vines, and the COUNTERfit logo. On one side it bears a plaque with the names of 58 East Toronto residents who have died since 1997. “We remember them as neighbours, colleagues, community leaders, friends, sons, daughters, moms, dads, artists, grandmothers and grandfathers, and as people who created much beauty in our lives,” the memorial’s home page states.
This year’s memorial service was held inside the SRCHC on account of rain, although the weather did not deter a large crowd of community members and SRCHC staff from attending and showing their support. People gathered in a meeting room festooned with bouquets of fresh flowers, white candles, and collages of people who have passed away. Speakers took turns sharing stories, poems, and goodbyes dedicated to people they had known and cared for. Afterwards, food was served and live music was performed, with the audience singing along to Amazing Grace, Leonard Cohen’s Hallelujah, and Bob Marley’s One Love. The event was full of laughter, tears, hugs, memories, and most of all a feeling of openness, support, and hope for the future.
Losing a loved one (or anyone in your social circle) is never an easy experience. Drug-related deaths, like other causes of mortality that are commonly accidental, can come as a severe shock and leave the deceased’s loved ones without a sense of closure. Drug-related deaths are also often caused by factors that would not be at play if supervised consumption sites were normalized in Canada and drugs were decriminalized and destigmatized. The needless and unjust nature of drug related deaths can add another layer of grief to the devastation people already feel at having lost a loved one.
“Just this past week, we had a service user here pass away,” said Paul Vaughan, a harm reduction worker with COUNTERfit who read some of his poetry during the service. Vaughan explained that the woman, who fatally overdosed, hadn’t known about Naloxone. “Even after all the education, all the outreach that we do, there are still too many people who don’t know about it,” he said, expressing his frustration regarding how many obstacles there are to ensuring proper harm reduction under a policy system that does not prioritize Naloxone access or other life-saving services such as supervised consumption sites.
“Drugs are not going to go away,” he said. “we need to have harm reduction instead of just waging a war on drugs. Drug users have to fight for their freedom every day, and we need to commemorate their fight. We have to remember, because if we forget then it will happen again.”
Patricia Grayston, who said it was her first time attending the memorial, expressed feeling emotionally overwhelmed by the intensity of the event. “I’m a writer, and I can’t even find the words,” she said. “I’ve never had an addiction problem, and I feel really blessed, because it’s not easy. These days there’s just no way of knowing what you’re getting when you buy something. A person could do drugs for the first time and die, because you don’t know what’s in there anymore.”
In a world where people who use illicit drugs are often stereotyped as lacking in moral worth, not contributing to society, and being self-destructive and unlovable, the Toronto Drug User’s Memorial presents a much needed counter-narrative. The event gives friends and family members of the deceased an environment where they can honour the legacy of their loved ones, and remember them as they were: complex, dynamic, valuable people who left a lasting positive impact on their communities, despite the hardships and oppression that they often faced. “After seeing a person being criminalized, being harmed so much by the system, it can mean so much to their family to come here and see that in their own community, they were loved and revered,” said one speaker. “Just because someone is using drugs or alcohol, that doesn’t mean that they don’t deserve love,” said Grayson. “And I think you can feel so much love and support, here. It reminds us to never stop trying.”
On June 11th 2015, Canada’s Supreme Court ruled in favour of legalizing medical cannabis in all forms. The ruling was unanimous, meaning that all seven judges on the panel agreed with this decision. Previously, laws allowed medical cannabis patients to legally access dried cannabis only, while excluding all other forms such as extracts and derivatives like tinctures and edibles. This ruling was effective immediately, and expanded the definition of “medical marijuana” to include all forms of the substance, rather than limiting it to the dried plant. The SCC found the previous restriction to be arbitrary, potentially harmful to patients’ health, and therefore not in line with the rights to life, liberty, and security of person as outlined in Canada’s charter. This ruling rendered sections 4 and 5 of the Controlled Drug and Substances Acts (which prohibit the possession and selling of non-dried forms of cannabis) to be null and void.
For people who live with chronic and severe nausea, pain, seizures, and other health issues commonly relieved by cannabis, being able to leave the house, run errands, work, socialize, and attend public events is often contingent on being able to consume medication when and where they need to. Using cannabis as a medicine has historically left patients feeling stigmatized, is often associated with criminality, and is not generally practical in enclosed indoor areas such as workplaces, classrooms, and restaurants. Where chronic illness and disability often comes with its own stigma and social isolation, the restriction to consuming cannabis by smoking created further barriers, such as limiting social events and interaction in places where medicating could come with unwanted attention or misunderstanding. These issues also spill into other areas of a medical cannabis patient’s life, such as housing. For people on short-term leases, landlords can use the smell of cannabis smoke as grounds for eviction, even if the tenant has a prescription. If a tenant chooses to appeal the eviction (something which requires substantial time and energy) they may already have lost their lease by the time the case is heard.
According to Sarah,* a long-time cannabis patient and advocate who lives with a severe seizure disorder, smoking also presents a problem because the smell lingers on hair and clothing. “The smell marks me and gives people in a professional setting information that is not their business,” Sarah said. Extracts, in comparison, are discreet. Sarah said that tinctures are her preferred medium, since they are not only portable but also easy to consume at any time and can be made without sugar, calories, or additives.
Many people who use medical cannabis also feel that smoking the dried plant is an inefficient or undesirable way of getting relief from their symptoms. In an interview with CBC, Owen Smith (the case’s appellant) pointed out that it is unheard of for patients to be required to smoke any other medication, since it is generally agreed upon that smoking is a harsh way of consuming any substance. Other ways of consuming cannabis can offer higher bioavailability, and/or produce a more slow-acting result- which, for many patients, can mean the difference between a good night’s sleep and being woken up intermittently by pain or other symptoms.
The ruling may also make a considerable economic difference for many patients. Aside from the fact that medical cannabis does not have a Drug Identification Number, and thus excludes patients from receiving coverage, smoking dried cannabis is very costly compared to other forms of the medicine. For patients like Sarah, who need high doses for effective management of symptoms (her prescription often runs up to half a pound per month, and she can experience frequent seizures if she consumes less) relief can often be unaffordable. In the U.S., there have been efforts at a municipal level to subsidize medical cannabis due to the fact people with disabilities are often low-income, although a similar model has not yet been attempted in Canada, aside from various compassionate pricing programs offered by Licensed Producers which arguably still don’t meet the economic needs of patients.
On some levels, the ruling has created substantial change– patients who chose to place their well being above the irrational previous laws no longer have to fear criminalization for their teas and cookies. In other ways, however, it has not yet had a substantial impact on the day-to-day lives of cannabis patients. According to Ania Bula, a writer and activist who uses cannabis to treat Crohn’s Disease and other health issues, concentrates and other newly-legal cannabis products must now be made accessible through Licensed Producers before many patients can access them. “In practice it hasn’t changed much yet, not until we also allow dispensaries, and other distribution methods to make the concentrates accessible.” Although Health Canada released a statement yesterday issuing a section 56 exemption so Licensed Producers can now provide a legal route of access to oils and fresh cannabis, there are stringent restrictions on the concentration of THC LPs can use, as well as the exclusion of hash and other derivatives important to patients. Many advocates claim that Health Canada is, once again, doing as little as possible to accommodate the court’s decision.
Cannabis is still technically not an approved drug or medicine in Canada, and compassion centers and dispensaries remain illegal. Bula, after a visit to Colorado, has seen what these developments could mean for Canada in the future, including the introduction of THC patches (which are especially valuable for Bula and other people with digestive disorders), and e-juices that make vaporizing cannabis (rather than smoking) easier.
Zurn, a harm reduction advocate who is currently in recovery, stated similar concerns to Bula. “Manufacturing of synthetics and extracts needs a regulation system,” he said “conditions like seizure disorders require exact doses, people shouldn’t really be making these things at home. If companies could actually do what they need to do, it would be easier to get products with exact dosage.” Zurn is currently part of a residential treatment program which took him off his prescription for Cannabidiol (CBD), which was the only medicine he found to effectively treat his Post Traumatic Stress Disorder. “They don’t allow CBD in treatment, but they put me on even more pharmaceuticals,” he said, adding that the pharmaceutical medications he has been prescribed are less effective for him and have more side effects than CBD. In order to achieve full accessibility, it is important to continue dismantling the stigma that surrounds cannabis. Cannabis is still heavily associated with it’s criminal designation, and this means that many doctors are less likely to view it in a neutral light. “Cannabis is a plant that has a lot of potential,” Zurn said. “In Canada, we’re not using healing plants to their full potential, even though other countries are, and the results are clearly positive.”
In a stunning article from the CBC yesterday, those of us that work in harm reduction and drug policy dropped our jaws in utter excitement at the prospect that Evolve Music Festival in Nova Scotia was offering testing kits to partygoers. This was a big move, and one that we hoped would make people who are going to use drugs pause and consider their use. Sadly, less than a day later, the CBC reported that Evolve was going to lose its insurance due to this. The feeling of elation we experienced disappeared, and we were left momentarily silent at the fall of a music festival trying to do the right thing.
First, we should talk about reagent testing kits. A reagent drug testing kit does not tell you your drugs are safe, or even that the drug you are taking is the one that you bought. If anything a kit can only tell you if there are other substances in a powder, it can never verify that your substance indeed is 100% pure. Even if it could tell you purity, there are still risks associated with each and every substance, not to mention that they carry a high level of social stigma and at this current point in time are illegal. This is something that every harm reduction organization emphasizes emphatically and something that the people I have known who use drugs also know through personal experience. When PMMA was being distributed in British Columbia back in 2012, had those 5 people known that they were consuming PMMA, and that it carried a high likelihood of leading to their deaths, there’s a strong likelihood they would have chosen not to take it.
The troubling thing about a decision like this is that it sets a precedent, and a terrifying one at that.
These last few weeks have not been good for harm reduction. The Bunk Police, an organization that does drug checking in The United States, had all of their equipment confiscated by Bonnaroo for offering checking. Dancesafe was kicked out of Electric Forest, even when they complied with every one of Electric Forest’s requests. As someone who has been working to establish a nightlife organization in Vancouver for the past year, only to be told by promoters that they are afraid to lose their insurance, it says to them that they should not have us at their events.
The irony here is that harm reduction saves lives. Harm reduction is not just test kits, it is having lifesaving information available, it is keeping paramedics on staff. Could you imagine if we lived in a world where at music festivals paramedics were not available? Event goers stand out in the sun for hours on end. Even if they are not consuming drugs (even alcohol!) they still can run the risk of getting heatstroke, or being dehydrated. Yet when those people pass out, no one would question whether or not having health professionals on site would lead to a safer populace at a music event. No one actively desires heatstroke, but it happens, and when it does you want someone to deal with it immediately. Sending people to the hospital is not good for an insurance company either.
Mind you, test kits are in themselves not enough. A testing kit without any knowledge of how it works and what the other substances are is not going to make you much safer. Only a holistic approach to harm reduction will minimize risk. Not consuming substances is still always going to be the safest option (that includes you, alcohol!), yet, people still are consuming these substances. It is time to have a conversation about how best to protect our loved ones, and community. Evolve is only responding to a problem with the only tool they have.
Why are they being punished?
Last night Evolve responded to all of the support from the community stating that they may have an insurance provider after all!
Today Evolve confirmed that the show indeed will go on. Unfortunately, while Evolve found an insurer, testing kits have been dropped from the program. Deep sadness here, as this is still a loss for health promotion and the safety of the guests! While it confirms the need for this important harm reduction service at festivals, ultimately testing services will not be available at the festival this weekend due to insurance difficulties. Still, here are some twitter highlights from a very emotional day:
Alex Betsos is an undergraduate in sociology and anthropology at Simon Fraser University. He is the Personnel Liaison for Canadian Students for Sensible Drug Policy, and the Volunteer Coordinator for Karmik, a west coast based harm reduction initiative.
In today’s world, should it really be a radical notion that drug users deserve the same health rights as people who do not use? When it comes to drug use, prejudice and emotion often trump undeniably beneficial, evidence-based policy. Contrary to the “tough on crime” ideology of the Harper government, stigmatizing and imprisoning drug users is not for the good of individuals or society. With the passage of Bill C-2, which received royal assent on June 22nd, Canada has opened the door to the unnecessary suffering and death of people who are often already severely marginalized.
Bill C-2, which is ironically named the “Respect for Communities Act,” amends Section 56 of the Controlled Drugs and Substances Act to add 27 new criteria to opening or maintaining Supervised Injection Sites (SIS). SIS are places where injection drug users (IDUs) can consume illegal drugs in an indoor environment in the presence of nurses who provide medical and social support and supervision. These services provide clean needles, discard used needles, allow nurses to intervene in overdoses, and give individuals (who may otherwise be difficult to reach because of homelessness or other factors) access to rehabilitation, counseling, condoms, and a variety of other services that are essential to any person’s well being and dignity. SIS are founded on an ideology of harm reduction; instead of idealistic thinking and moral condemnation, harm reduction offers pragmatic and compassionate resources to people who use.
Bill C-2 gives an unreasonable amount of power to uninformed or biased groups to object to new SIS being opened. Certain community groups and police associations may have vested interests in keeping the status quo of absolute prohibition, and their opinions and ideologies should not be placed above empirical evidence when it comes to dictating public health policy. One of the new amendments irrationally does not allow anyone with a criminal record to be work at an SIS. This ignores the fact that those who have been to prison on drug-related convictions and achieved sobriety frequently make the best addiction counselors. This amendment takes community-based support away from people who use, replacing harm reduction workers who have lived experience of marginalization with individuals who may be less sympathetic or relatable.
The history of SIS both in Western Europe and in Canada has shown that these services are undeniably beneficial, life-saving, and cost-effective. Supervised injection sites have existed in Western Europe since the late 1980s, with over 90 locations currently operating in the region. There is a wide body of research proving that SIS are positive for drug users and society in general. In 1999, Portugal decriminalized possession, and implemented SIS and other harm reduction policies. Ten years later, a national study showed that there were less people using drugs, less crime associated with drugs, more people in treatment, and a decreased transmission of bloodborne diseases.
During the 1990s, Vancouver’s Downtown Eastside community had HIV transmission rates similar to those of Sub-Saharan Africa. As a response, ground level advocacy groups pushed for the adoption of a SIS. In 2003, Insite was founded and the social and scientific research produced as part of its mandate has been overwhelmingly positive. While Bill C-2 implies that SIS increase local crime, thorough comparative research shows it causes either no change or a decrease in crime.
Regardless of the concrete evidence in favour of Insite, the Harper administration attempted to close it in 2011 with Bill C-65. The Supreme Court of Canada ruled that the right to health and safety should come before adherence to strict criminalization. The ruling cited section 7 of the Charter of Rights and Freedoms, which gives all individuals the right to life, liberty, and security of person.These life-saving services are a fundamental human right, as outlined by Canada’s charter. Bill C-2 stands in blatant opposition to the 2011 ruling, the droves of scientific evidence supporting SIS, and the very nature of our Charter rights.
Toronto, Ottawa, and Montreal, are cities with high concentrations of injection drug users that would benefit greatly from SIS. It is highly probable that the creation of SIS in all major Canadian cities would save countless lives and millions of dollars of taxpayer money per year. It is estimated that an SIS in Montreal could prevent over 11 new HIV cases a year. When Insite seeks renewal of its exemption status in 2016, it may not meet the new unreasonable criteria and is at risk of being shut down.
Supervised injection sites have international approval from the UN’s Declaration on HIV Prevention, as well as the World Health Organization. Associations of nurses, social workers, public health professionals, researchers, lawyers, and officials at all levels of government have also openly supported these services. The opposition to harm reduction services often comes from individuals and groups with political agendas guided by opinions grounded in rigid morality, and who have no practical experience with the issues.
A survey of 1407 Ontarians concluded that 60 percent of the province’s adult population is in favor of adopting SIS. Public opinion is a fundamental component of how policy and legislation should be adopted, in democracies. Creating obstacles for new and existing supervised injection sites to be able to operate is not only against concrete evidence and public opinion, it will have real world fatal consequences. Denying these services will allow preventable deaths and the spread of disease. It will cost taxpayers millions of dollars. When there is a clear life saving policy, preventing its adoption is unjust and inhumane. The Canadian public must consider this legislation as hostile to our values and fight to challenge Bill C-2. We must call for the end to harmful criminal enforcement of irrational drug laws. Treating drug use as a physical and mental health concern instead of criminal is demonstrably the best way to prevent drug-related harm.