COMPASSION AND CLEAN DRUGS

BC’s Chief Coroner, Lisa Lapointe, came out in defence of “safe supply.” Safe supply being the tack recently adopted by the province to offer non-tainted drugs (cocaine, hydromorphone, fentanyl, and meth) to users, in our unending journey to curb overdose deaths. The coroner told CityNews that “the pushback against safer supply isn’t backed up by the science. 'There’s a small group of individuals who are using this as a political weapon ... I think it’s reprehensible that this is a medical crisis that people are trying to politicize." Lapointe also went on CKNW radio to explain how people using drugs openly in public parks is, according to her, a "rumour". She offered her perception that "whether people are actually using in parks, I don't know... it's certainly a rumour... a lot of fear being spread."

WHAT CITY DOES SHE LIVE IN?

Well, I have all kinds of questions. The first: What is she smoking? I had two grandparents and a parent born and raised in East Van. And I haven’t just frequented the area but lived on Main Street and Commercial Drive for years. I am well acclimated to the region, the public health crisis epicentre that the Downtown Eastside has become, as well as the more recent evolution of the culture and circumstances there. But for the last three years I lived on the edge of Chinatown in Victoria. Just as in Vancouver, here I've spent some part every day walking my neighbourhood, its neighbouring districts, and many of the city’s parks. And, also like Vancouver, I can find you needles and syringes, glass and metal pipes, and charred tinfoil on nearly every street corner, patch of grass, or cluster of trees and bushes in town; and this with city and private clean-up crews pouring through these same haunts (smack in the middle of the tourist district) every single day. And I can find you more than the occasional fellow hiding behind a dumpster, planter box, electrical panel, or parked car, slumped over and fiddling with his score. There are whole groups of folks (in the motel parking lot next door, on the lawn in front of the church or hardware store down the road, or perched on the dugout benches or bleachers at the baseball field down the way) getting what they need. Prior to my time in Victoria’s Chinatown, I lived two blocks from the largest city park, Beacon Hill, where things are no different. And the situation is just the same where I live today, near another popular suburban Victoria park, where going for a stroll or walking the dog means being alert to the novel, 21st century inevitability of unwanted encounters with a proliferation of user-related wastes (whether those be liquid, solid, plastic, metal, or glass.) So, it’s just inconceivable to me that anyone could be so out of touch – never mind blind all the most visible aspects of all of this. And then declaring your ignorance from such a high vantage and so publicly and prolifically boggles the mind. But that's not the only mind boggling bit.

TORTURE AS COMPASSION

The second question I have concerns Lapointe's spiritual beliefs and how those relate to her definitions of compassion, safe, and harm. If she’s a devout believer in the afterlife then all of this makes sense: the here and now is but a fleeting instance serving only as a waiting area for the accrual of sufficient credits permitting admission into the eternity that is Heaven. And in that universe, the only real harm is failing to reach that desired end and the only truly substantive safety; and, as a result, the only real compassion is helping others achieve the same. Within such a framework, then, you can do nothing more than cause the continual immiseration of the most vulnerable among us through the relentless degradation of their material well-being and their mental and physical health and with little concern you’ve done anything wrong — just as the best-known and most celebrated believers have for millennia and we still see popping up all the time. (This is what those opposed to assisted suicide and abortion are all about: brutal Christ-like suffering as life’s gift and obligation.) If Lapointe is operating on such a premise, I have all kinds of problems with that. And if she orients herself in any other way and subscribes to any other definitions, well, then she has all her work ahead of her explaining her baffling position. Of course, she doesn’t actually spell out her thinking. She only talks about how people on “safe supply” aren’t overdosing — or, at least, and this is quite the caveat, that when they do die they are also found with other drugs and/or alcohol in their system. (Which rings in my ear a lot like "They didn’t die from COVID but with COVID." How many of these people were able to spot bullshit from Covid deniers and then turned around and immediately used the same logic themselves? Hmm, where have we seen this before?) Lapointe appears to wish to tally every pill or injection taken that doesn’t itself alone kill someone as a life saved by handouts of government-approved stimulants, depressants, and pain meds. Or, perhaps, similarly, she thinks every death directly caused by tainted drugs is evidence that said life would have been saved if only they'd had easier access to "safe" government drugs. But, very obviously, that is lunacy (refined, concentrated, pure, government-issued, pharmacy-distributed lunacy.)

If a user consumes “clean drugs” from the “safe supply” even once and still has their life tangibly degraded (in any manner and on any front) by their government-maintained addiction, I couldn’t in good conscience score that as a win for the system. To me that is demonstration of nothing other than people (political leaders, public administrators, coroners, doctors, pharmacists, police officers, medics, social workers, activists, and fellow users, and anyone who has made contact with someone unquestionably addicted) lacking even a modicum of compassion while operating a system of harm that doesn’t merely promote but delivers highly unsafe drugs to folks demonstrating they’re unable to help themselves. How could it be otherwise? Continued capture by the cold, grinding machinery of addiction (and kept there by a for-profit illicit and pharmaceutical engine, partly fuelled by taxpayers) is not a radical form of empathy or some sort of benevolent charity. When someone has no friends or family looking out for them, it is society’s job to step into that role. All of these social actors collectively failing to have an intervention (when they would take the opposite path and immediately have their loved one forcibly institutionalized and on a strict abstinence and counselling regimen) is a derogation of duty not enlightened ahimsa. How could it be otherwise? If you've identified a serious problem and a community in dire need then why spend millions perpetuating the problem rather than solving it? The "clean drugs for addicts" shtick sounds a lot like "clean highway overpasses for the homeless." That’s psychotic.

GOING OFF BOOK

The third question I have relates to drug legalization and our system of harm minimization. Whenever I hear about any of this, folks reference the European Four Pillars model and the best practices followed by Portugal, who has effectively put an end its drug abuse problem. Okay. So, what part of the Portugal model, that world-leading rational approach, has British Columbia adopted?

Portugal, really the only place anyone ever uses as an example of policies that have worked, has never legalized drugs of any kind. It’s not legal to produce, distribute, sell, buy, or use drugs in Portugal. (So walking down the street and turning the corner to find an entire community crashed out, bodies filling the doorways and corners, people laying across the sidewalk and in street, syringes still in their arms, in filth and full of wounds and infections eating their flesh — as happens in neighbourhoods all over Vancouver and Victoria — is, weirdly, not a thing.) The only thing the Portuguese have done is decriminalize and attempt to destigmatize drug addiction. That means folks in possession or using drugs don’t face a judge or go to prison and there are no other criminal penalties, and the social costs are minimized. But none of that means there’s an absence of state coercion or severe consequences. Drug producers and pushers still receive criminal punishments. Users have a whole suite of non-criminal repercussions that may be worse than jail. Once they’ve encountered police or social services, as an alternative to a criminal court, users are put before a commission. That commission commonly has social workers and psychiatrists aggressively engaging users. Not only that, the commission also has powers to restrict user’s freedom of movement, limiting or even banning travel and preventing users from entering certain neighbourhoods or businesses if those places are seen to be a source of the problem. They can also restrict freedom of association by preventing users interacting with certain persons enabling their use of illegal substances. Commissions are even able to seize and sell their personal possessions if fines are not paid and end their access to social services and public funds. The carrot then offered to prevent these sticks from being applied is the user’s “voluntary” rehabilitation. So there simply is not an option for someone with a persistent problem to avoid coercion into a program of multi-layered drug-use cessation. And with their maintenance of drug illegality and construction of elaborate systems of coercion, Portugal brought no “harm reduction” strategies (above getting folks into counselling, rehab, and off drugs.) They had no safe injection sites, no needle exchanges, no “safe supply” program. In fact, Portugal has never even distributed naloxone anti-overdose kits outside a medical setting; and so, as you can imagine, handing out "safe snorting" kits to fourteen-year-olds in high schools is also not on the books. And what has all of this harm acceptance, coercion, and illegality done for Portugal? Well, as we all know, Portugal has been an example to the world of how to end your nation's drug problem.

In this same time period, British Columbia has done none of this and gone in what is effectively the opposite direction. Here it’s personal freedom and “harm-reduction” all day long. To start, we brought in needle exchanges back in 1989, in large part a response to the HIV/AIDS pandemic. That year there were just 67 drug overdose deaths recorded. After a boom of overdose deaths in the ‘90s, safe injection sites followed in 2003. But the numbers kept going up. Though there was a brief dip, the provincial government tells us there were 211 illicit drug overdose deaths in 2010; that after efforts by three levels of government to make this problem, along with our renowned homeless situation, go away in the years leading up to our very public appearance on the world stage with the hosting of the Olympics. Still, those already high numbers doubled. With a spike in deaths, many from toxic synthetic opioids, now up to 465 in 2015, the Provincial Public Health Officer declared a public health emergency and formed a Drug Death Investigation Team to better understand what was happening and why. The province followed along, forming a Joint Task Force on Overdose Response while also seeking new strategies to prevent deaths and resolve this unfolding catastrophe. By 2017 the number of deaths catapulted up more than three times to 1,494. As the numbers boomed, advocates and activists (and city hall) pushed harder for destigmatization as well as decriminalization and legalization of all drugs. These same folks began handing out tested, and thus deemed “safe”, batches of the most addictive substances known to humankind – and largely to vulnerable people living on the street due to their mental health and/or substance abuse issues. In 2020, Vancouver City Council passed a motion asking the federal government to decriminalize possession of all illicit drugs in the province. That same year the BC Coroners Service tells us 1,775 people died overdosing on those substances, another significant jump. Still, this move emboldened the destigmatize, decriminalize, and “safe supply” folks, including those in government, all of whom increased their operations. And in 2021, taxpayers put forward more than $22.6 million for what was called an "innovative new approach." Canada’s Minister of Mental Health and Addictions then granted a three-year exemption to the Controlled Drugs and Substances Act for BC, while the deaths of British Columbians continued in the wrong direction with a 32% jump, now putting the death toll at 2,340. Surely easier access to all our most potent addictive substances, and ramping that up to an industrial scale for a population of thousands, with pharmacies and stores offering these goods, will result in radically reduced harms. Surely! (Or maybe 2023 will break a new record for the number of deaths.)

So, after decades of this, one may start to ask where this set of policies and tools has gotten us and where it is likely to take us? Does Vancouver look more or less like Lisbon? To me, it looks like we have ten times the problem than when we started. Of course, clean drugs are not tainted and so aren’t causing tainted drug deaths, but more harm-reduction appears to strongly correlate with huge jumps in real, grievous harm and most certainly not anything anyone could interpret as a reduction. Just as our approach has gone in the opposite direction as Portugal, so too has the volume of drug overdose deaths. This cannot be denied. Will expunging data and analysis on the relationship between mental illness, addiction, and crime land us in a better place? Will doubling down, taking no responsibility, and, in fact, demanding that lives are being saved even as the death toll goes exponential, make all of this right? I have my doubts.