Volunteers prepare a tent at a pop-up safe-injection site at Moss Park in downtown Toronto on Sept. 13, 2017.Fred Lum/the Globe and Mail
Benjamin Perrin is a law professor at the University of British Columbia and author of the new book Overdose: Heartbreak and Hope in Canada’s Opioid Crisis.
Canada is in the midst of two simultaneous public health emergencies, but only one of them is capturing headlines and the attention of politicians and policy makers. The response to the COVID-19 pandemic is rightly extensive, intense and based on the best available medical advice to save lives.
The opposite is true of the continuing neglected opioid crisis, which has been exacerbated during COVID-19 as many critical public health interventions for people who use drugs (such as supervised drug-use sites) have been restricted and people have isolated themselves. Vancouver and Toronto have witnessed spikes in overdose deaths in recent months. British Columbia just recorded its highest-ever loss of life from illicit drug overdoses in May – a 93-per-cent increase from the same month last year. And on a single recent day – June 26 – paramedics in B.C. responded to a record 131 overdoses.
While 167 people have died in B.C. from COVID-19 from January to May, 2020, 554 people died of illicit drug overdoses in the province during the same period. Inaction is continuing to cost lives.
Eight years ago, I was then-Prime Minister Stephen Harper’s top criminal justice adviser. His “tough on crime” drug policies were already entrenched. I blindly accepted party dogma that illegal drugs brought crime and devastation, so they had to be suppressed. I now deeply regret that I didn’t question those policies. Today, I’m calling for the decriminalization of people who use drugs, along with other vital measures to respond to the continuing opioid crisis. It’s a sensible and necessary step that has been recommended by a growing chorus of experts and even this week by the Canadian Association of Chiefs of Police.
After leaving politics, as I drove to and from work at the University of British Columbia, I kept hearing stories of people dying from drug overdoses. A public health emergency was declared in the province. Fatalities across Canada grew to a staggering 14,000 deaths between 2016 and 2019 – one person dead every two hours. The status quo was failing. I felt a moral and ethical obligation to find out why. I had to have an open mind, setting politics aside. I also had to open my heart – it started with a prayer, asking God to give me a heart of compassion for those who were dying.
Investigating the opioid crisis
My first inclination was to consider whether the police needed more resources or legal tools. But senior police officials that I spoke with conceded we can’t prosecute our way out of the opioid crisis. Most people they encounter using drugs are just trying to cope with pain and trauma they’ve suffered, have substance-use disorders, and aren’t making any real choice to use drugs. This makes criminalizing people who use drugs pointless at best and cruel at worst. The police said we should consider other options and be investing in treatment on demand, not more policing.
What about cracking down on supply? Border officials suggested trying to interdict illicit fentanyl – the opioid blamed for this crisis – is like looking for a needle in a haystack. Nearly two million pieces of mail come through Vancouver from China every month. Due to its potency, it has been found in items as small as greeting cards. Plus, fentanyl, a synthetic drug, could be made in Canada with college-level chemistry knowledge and basic equipment and supplies.
While the global “war on drugs” has seized increasing quantities of illicit drugs, it has failed to eradicate or disrupt supply to curb drug availability and use. Studies show, paradoxically, as seizures increased, street drugs became less costly and more potent. How can that be?
This phenomenon of unintended consequences has been dubbed the “Iron Law of Prohibition” by Richard Cowan, a Republican turned drug activist, who observed in 1986: “The more intense the law enforcement, the more potent the drugs become.” Under prohibition, suppliers and drug users have strong incentives to minimize the bulk of contraband in order to minimize the risk of detection, thereby encouraging more potent substances. It’s been seen before during alcohol prohibition in the United States. Fentanyl is 30 to 50 times more potent than heroin and 50 to 100 times more potent than morphine. Seize more heroin, we get more fentanyl – and even more potent carfentanyl.
So much for “cracking down” on supply. What about demand?
Our antiquated drug laws predate any modern understanding of substance-use disorders. Public health and addictions experts explain opioid use disorder is a chronic, relapsing condition. A compulsive disorder, it consists of a strong desire to stop or cut back, but an inability to do so despite the risks and consequences.
How do people develop substance-use disorders? A combination of trauma, genetics, psycho-social, mental-health disorders, intergenerational trauma, early drug use and peer influence. Studies show someone with moderate childhood trauma is seven to 10 times more likely to have an illicit drug use problem. Fentanyl was invented as a powerful painkiller. Many people who use illicit drugs are self-medicating trauma and pain – physical, emotional, psychological, intergenerational.
As opioid-related drug overdoses climb in B.C., firefighters are increasingly the first people to get the call to help. Here are the firefighters of Vancouver's Fire Hall No. 2 in action
The Globe and Mail (staff)
Criminal laws are chiefly to denounce, deter and rehabilitate. Given what we now know about substance-use disorders, how can we continue to heap condemnation on people who use drugs? Research shows drug criminalization doesn’t have any deterrent effect, but does increase risks to people who use drugs, suggesting it also violates the Charter. Likewise, rehabilitation of drug users is also not achieved through criminal sanctions.
Our prisons are costly holding facilities for people who use drugs: 70 per cent of federal inmates have substance-use disorders. A stunning 44 per cent of those who fatally overdosed in B.C. had been in custody and died within two years of being released – the greatest risk being two weeks after release.
Most people who fatally overdose in our communities were using alone because of the stigma of drug use, flowing in large part from its criminalization. No poster campaign will be effective when this remains so.
Solving the opioid crisis
We need a compassionate and evidence-based response. That means widespread naloxone availability (the “antidote” to an opioid overdose), more supervised drug-use sites, overdose prevention sites and drug testing services. People need greater access to evidence-based treatments (including suboxone and methadone). Abstinence-based programs or “detox” alone aren’t recommended as they increase the risk of fatal opioid overdoses – when people relapse, they have reduced tolerance.
Since street drugs are effectively poisoned, we need a low-barrier, regulated “safe supply” of drugs of known potency and contents for people with substance-use disorders under medical supervision. This has also been shown to reduce crime, is cost effective and helps people who use drugs stabilize. This is not legalization, which would instead allow anyone to freely obtain drugs. Illicit manufacturing, trafficking and importing would remain offences, but their enforcement isn’t a focus.
We also must invest in research and a holistic response along with greater support for Indigenous, front-line and peer-based organizations, as well as families. And, as I’ve argued, we must stop criminalizing people who use drugs in all their forms.
There is a financial cost to these measures, but inaction and the status quo cost more. The U.S. National Institute of Drug Abuse estimates that every $1 spent on addiction treatment saves the health care and criminal justice systems up to $12. We spend $5-billion a year on federal corrections alone, not to mention the continuing costs of the opioid crisis that have already increased public expenditures – and taxes – in many parts of Canada. There are sound fiscal reasons for a new approach to go along with humanitarian ones. But there are other potential obstacles: religion and politics.
Bringing faith into the conversation
Historically, drug prohibition included appeals to morality – drugs were an “an evil in Canada” that were “inconsistent with those principles of morality which ought to govern the conduct of a Christian nation.” Today, according to Statistics Canada, two-thirds of Canadians identify as Christians, including many politicians. If we’re to change our approach, we need to bring faith into the conversation.
While I was raised going to church and thought of myself as a Christian, I recently came to see that I was a hypocrite and unrepentant sinner – I was an “unsaved” or “cultural” Christian. I’ve since started following Jesus Christ and turned my life over to him. As part of walking my own Damascus road, I finally read the entire Bible for myself. It’s transformed how I see myself and others, including people who use drugs.
The Bible says that God loves every one of us beyond comprehension, even while we are far from him and despite everything we’ve done. It explains we don’t get right with Him by following a set of commands or by being “good.” It shows that we don’t experience lasting change because of laws telling us what to do, but because of God’s goodness, patience and kindness, and the Holy Spirit working in us. It reveals a Saviour, God with us, who spent much of his time on earth with social outcasts – not condemning them, but loving them. A Saviour who calls us to believe in him as we turn from our own sinful ways of living and toward a life of following him.
Through Jesus’s eyes, I began to see things differently. Jesus loves people who use drugs. He embraces them as he embraced the lepers of his time. He does not condemn them, just as he did not condemn the woman caught in adultery. He does not demand that they first change to become deserving of his love. He offers healing, hope, forgiveness and a new life to everyone. I hope that more Christians – and people like me who thought of themselves as one – will see people who use drugs through Jesus’s eyes. As a Christian, I believe everyone has fallen short of God’s standards and no one is worse than another. We all need his grace, mercy and forgiveness.
The need for political leadership
What else stands in the way? Prime Minister Justin Trudeau must do more. His unwillingness to move forward with decriminalizing people who use drugs smacks of politics interfering with policy. Imagine any other public health emergency where politics was a factor in responding to it. It would be a national scandal. Leaders would resign.
Conservative politicians bear much blame for demonizing people who use drugs – derisively calling them “junkies” and “addicts” – opposing life-saving measures such as supervised drug-use sites and “safe supply,” and fearmongering for votes about drug decriminalization. Politicians must know that their action and inaction is continuing to cost lives. History will judge them for it.
Our response as Canadians to the COVID-19 pandemic has shown what is possible when we put the best available medical advice into practice, and that we all have a role to play in saving lives. We need to marshal the same resolve and resources to address the deepening opioid crisis before thousands more die.
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