This article was co-written by David Mendes. David is the national program coordinator for the Canadian Association of People who Use Drugs (CAPUD). He is an artist and activist who created and directed the shadow unit in "Illicit," the successful theatre production. He lives in Vancouver's Downtown East side.
As 2018 comes to an end like the lives of thousands of our family members, friends and co-workers, it seems there may be hope in the fight against the overdose epidemic. Canada's Chief Public Health Officer, Dr. Theresa Tam, has publicly stated that developing a "safer supply" of regulated opioid drugs is being actively reviewed with Canada's provincial and territorial governments.
What Dr. Tam is referring to leads us to something people who use drugs have been asking for for a long time — "safe supply." It means providing people using contaminated drugs with legal, pharmaceutical-grade alternatives that provide the euphoria that drug consumers seek when using heroin or fentanyl. It means providing people their substance of choice, giving a person back their autonomy and allowing them to use by their preferred method of administration. This eliminates the stigma and inherent dangers of being forced into the black market, and in many cases can produce a domino effect of personal growth and independence. This is an approach grounded firmly in the voices of people who use drugs that keeps their human rights of paramount interest.
This approach is not a treatment for people who use drugs, but a treatment for the toxicity of Canada's drug supply and a century of criminalization. This is harm reduction in its purest form, protection from the drug policy that is lowering life expectancy across Canada.
Safe supplymeans those in the position of making literal life and death decisions, politicians and bureaucrats alike, listen to what drug users need and act on it. It means not seeing us in dire need of rescue or receiving ineffectual treatment, but as humans being systemically poisoned to death at a rate of 11 each day.
Responsibility lies with provincial governments
If the government has any serious inclination of ending this overdose epidemic, they need to be willing to reduce barriers. "We're trying to work within a system that just is not flexible enough to allow people to access these drugs," says Dr. Mark Tyndall of the British Columbia Centre for Disease Control (BCCDC). The rigidity of this system hampers the ability of people to receive take home doses of their drug, which Dr. Tyndall states is a key to making safe supply accessible to the people who need it.
The responsibility lies with provincial governments and their regulatory Colleges of Physicians and Pharmacists to break these barriers down. Health care is the constitutional responsibility of the provincial governments, but even in the most impacted province, British Columbia, you can hardly feel a pulse. Overdose deaths in the province appear to be unchanged from last year's record-breaking total. Upcoming projects, like BCCDC's oral hydromorphone pilot project, will provide low-barrier access to hydromorphone and a glimmer of hope for people at high risk of overdose.
Decision makers at all levels of government need to understand the fundamental differences between safe supply and traditional treatments, like methadose, suboxone and more recently Kadian (which puts users at increased risk of endocarditis, a devastating heart valve infection when injected). Nonetheless, safe supply can work in conjunction with these treatments — the major difference being that opioid substitution treatment does not provide the euphoric effects that people who use drugs seek, and as a result people seek these drugs on the street. Safe supply offers them an alternative to the fentanyl implicated in overdose deaths across the country.
All drug users deserve safety
In the case of alcohol, Canadians already take safe supply for granted. They can get a drink at the bar and never worry that it will suddenly kill them.
If only we all could have that safety.
This wasn't always the case. It was only 85 years ago during the alcohol prohibition that bathtub gin was being made into methanol or wood alcohol, blinding and/or killing thousands of drinkers. The government realized that alcohol needed to be regulated by the provinces and distributed safely.
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This is why Dr. Tam's announcement is an important one. Canada has to move beyond drug prohibitions that have caused epidemics for over a century. We need to see some indication that Canada's members of Parliament truly understand what is happening, that they understand the drug supply is toxic in a systemic way, and that they are not callous enough to wait until death comes to someone they care about. It is very possible to end this epidemic and stop the dying. We need boldness from our politicians for it to happen.
If Canadians expect to see the death toll decline in any significant way, they need to open their eyes and understand that human lives cannot be taken for granted. If their MPs refuse to understand, Canadians must make them. They need to be vocal and engaged in every level of government, and show their support for the lives that can be saved through safe supply programs. This overdose epidemic is unyielding, but it can end. If there is anything positive that can come from such a heinous loss of life, it's an end to the War on Drugs.
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