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  • Title: Overdose
  • Author: Benjamin Perrin
  • Genre: Non-Fiction
  • Publisher: Viking
  • Pages: 304

As Canada struggles to contain a frightening virus, it’s useful to be reminded that the country is facing another health emergency that has already claimed thousands of lives. Between January, 2016, and June, 2019, the opioid crisis killed 13,913 people. By 2018, it was killing one person every two hours.

Appalled by these numbers, Benjamin Perrin set out to discover why. A University of British Columbia law professor, he was once the leading adviser on criminal justice issues to prime minister Stephen Harper. Harper raised penalties for drug offences and tried to shut down the country’s first supervised drug-use site. Perrin saw no problem with that tough stand. “I figured it made sense,” he writes.

Had he been horribly mistaken? He dropped everything and embarked on a one-man, 100-day investigation of the opioid crisis. He pored over all the major reports. He interviewed more than 40 experts. He talked to police chiefs, doctors, border officials and activists. The result is this important book, the best yet on the crisis. It examines all the big questions: What are opioids and how did they become so popular? Why can’t police keep them off the streets? What can we do to stop the ongoing toll?

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The deadliest opioid is fentanyl, a synthetic drug 30 to 50 times more powerful than heroin. It was created in the 1950s by a Belgian doctor, Paul Janssen. Drug companies took his invention and made fentanyl patches, applied to the skin to control pain. Drug users learned how to extract fentanyl from the patches to get high.

Recognizing a good thing, drug dealers started peddling a powdered form, which they often acquire on the dark web from labs in China. They mix it with things such as salt or caffeine to bulk it up, then sell it. Poor mixing – some dealers have been known to use kitchen blenders – leads to deadly hot spots in the drugs. Those who get a bad batch quickly overdose, their breathing slowing to a stop.

Law enforcement is more or less helpless. Fentanyl often comes into Canada by mail and they can’t possibly check every letter from China – besides, police are prohibited from meddling with the mail. The risk of getting caught is very low, the profits sky-high.

Health authorities have been more successful. Supervised drug-use sites have proliferated since Harper’s failed attempt to shut down Insite, the pioneering Vancouver outfit. Drug users get to use in a supervised environment, with clean needles and other supplies on hand. Perrin says the staff at such sites have reversed thousands of overdoses.

Doctors are putting more users on the substitute drug Suboxone, which reduces cravings and prevents withdrawal. It allows many of them to live normal lives. Naloxone has helped, too. Often called the Lazarus drug, it resuscitates overdose victims. Many police officers, firefighters and paramedics now carry naloxone kits. Users often use it on companions who OD.

In British Columbia, ground zero of the crisis, the number of fatal overdoses dropped by a third in 2019 compared with 2018. That is progress, but the death toll remains staggering: 981 in B.C. last year, or about three deaths a day. Across the country, Perrin says, the loss of life is equivalent to having a fully loaded passenger jet crash every five or six weeks.

Adding up everything he learned during his investigation, Perrin comes to what for him is an unavoidable conclusion. He was “dead wrong” about drug policy. Using the criminal law to discourage drug use has been an abject failure, forcing many users to commit crimes to pay for their drugs and into the shadows to take them. If they use alone, they have a much higher chance of succumbing to an overdose. If they end up in jail, they face a high probability of overdosing when they get out.

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He writes: “It’s time to stop punishing those with substance use disorders and instead treat them with compassion. It’s time to stop fuelling the stigma that’s endangering people’s lives and instead help them deal with their pain and trauma. It’s time to stop deploying criminal law in ways that run counter to the best medical advice about opioid use disorder and how to treat it.”

Perrin believes that if authorities can’t stop the inflow of drugs and if harm-reduction measures can’t altogether stop the wave of deaths, the only sensible thing to do is decriminalize drugs, as Portugal has done with notable success.

That is not a radical conclusion – not any more. As Perrin found, many addiction doctors, medical officers of health, advocates for drug users and relatives of overdose victims think it should have happened yesterday. Perrin’s passionately argued, fact-based polemic adds weight to their argument.

That doesn’t mean they are going to persuade the government, at least in the near future. Both major federal parties are against decriminalization. Having recently legalized cannabis, Ottawa does not appear ready to take criminal penalties off heroin. But, in time, who knows? Not very long ago it would have seemed like madness to give needles to users and set up booths where they could inject their drugs in plain sight. Now there are dozens of supervised drug-use sites across the country.

Attitudes about drug use and drug users are changing. More people are coming to see what Perrin calls a clear moral wrong: “The injustice of unmercifully judging and punishing people who are using drugs in an attempt to get relief from the pain in their lives.” His book should help hasten that welcome change.

A Globe and Mail columnist, Marcus Gee has been writing a series of articles about the opioid crisis.

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