Letter to a friend, because paid writers never waste words even when no one's paying

Image: Pixabay, johnhain

Letter to a friend today as we talked about how to get our heads around what has to come next in the toxic drug crisis:

I have been thinking so very long and hard about the toxic drug crisis lately, and have come to that point where the conclusion I've arrived at is challenging yet necessary. I hit that in my Peers Victoria years when I realized that the real way to support sex workers was to end stigma, and the only way you could end stigma was to normalize the activity.

So here we are on this one, and we all know the most obvious strategy with the quickest results: make sure everybody gets a safe supply of the drug they use. Normalize drug use. It's a strange one because in SO many ways and overwhelmingly, drug use is normalized. But this ridiculous "street drug" business - the drugs we don't want people to have, for no particular reason other than because we said so - is seen as an aberrant use.

In fact, as the demographics of the people dying have shown us, the people who are dying are "every person," in a sense. (Not really, of course - they skew male, young and blue-collar, but you know what I mean.) Drugs are used commonly, as it turns out, including the drugs we don't want people to have. I guess it hurts to know that, after a gazillion years of useless prohibition, but here we are. And we have to wake up to that if we're ever going to get a grip on the crisis.

I mean, let's consider this hoo-hah over "diversion," as you noted in your message. So what happened there was that a few people on safe supply are alleged to have sold their prescription drugs in order to get money for the kind of drug they actually wanted. (This can happen because the drug that works best for a particular person is not necessarily provided through the safe-supply system.) 

So in other words, safe drugs - at least in the sense of certified purity - entered the unsafe supply chain. How is that a bad thing when you've got 16,000 people dead and not even a whiff of a real plan up your sleeve?

Another revelation from my sex work days: You don't have to like the thing that is happening, you just have to want it to be safer, and less "in your face" for the community. I think we've been positioned to believe that safe supply means being pro-drug use, when it's actually just a pragmatic response to stop the dying. Other things absolutely have to come right after that, because really, we ALL need more understanding from a young age about drugs, and not from the police. But first, we need to get a handle on the drug supply.

Here's a thing to think about: Victoria has drug-checking through a really cool UVic initiative, and the government has (so far) been ok with checking small quantities of people's street supply. BUT they frown on checking the supply of an actual seller, because that could be interpreted as being helpful to drug "traffickers." 

In terms of stopping people from dying, a quickly effective strategy would be to expand drug-checking so that someone selling to 100 people, say, actually knows something about what is being sold. What about a big drug-checking initiative of suppliers' drugs, with immunity? Wouldn't that be a positive thing?

But you see the problem - first, you have to get over the fact that people buy drugs (and sex, going back to the sex work comparison). And that we all buy drugs, in fact, and count on them for all kinds of things we're deeply grateful for. And that this is exactly the same thing, except that the people who are dying are buying weird concoctions of unknown potency and dosage from some dude who's cooking them up in Kitimat, while the rest of us use drugs that have been deemed socially acceptable.

The crisis is a pretty obvious problem of potency, purity and dosage at the drug end of things. At the addiction end of things, it's more complicated, definitely, but there's very little about the current system that helps the person with addiction. So that needs to get sorted too.

 Interesting fact: 300,000 British Columbians with substance disorders, 623 publicly funded treatment beds, and 259 detox beds. Plus just the muckiest way through treatment that anyone could imagine, and horribly expensive with no known or followed-up-on outcomes. I don't have to tell you that.

Wow, I should use this as a blog post, lol. It does not take me much to get ranting these days. But the parallels with sex work are striking. People hate that people use drugs that we've declared illegal. But hey, tough shit, man. Nothing else we do matters if the drug supply isn't safe.

Stigma deepens. People suffer and die. Just another day in BC

A hundred years from now, our descendants will feel sick to their stomachs when they read about how we treated people who used drugs in ways we didn't approve of. It will be like the revelations of priest-pedophiles and residential schools were for my own generation – one of those things that an evolved person struggles to come to terms with.

”Our governments did that?” they will ask. “And the people just put up with it?” Yes, Grasshopper, because even though almost everyone used drugs in that era, governments could get elected by singling out and causing to suffer anyone no longer able to hide the signs of their drug use, most especially if they were poor and sick.

In any logical world, offering prescribed drugs as a substitute for toxic street drugs would be a good thing. Now that dying of an overdose is the No. 1 cause of death in BC for anyone ages 10 to 59, substituting non-toxic drugs is pretty much the best strategy we’ve got to stop the deaths.

But today’s announcement from government, which follows on the heels of a big media fuss about legal opioids being “diverted” into street sales, cuts the legs out from under BC’s own prescribed-alternatives program. The 4,000 people on the program will no longer be able to bring home their prescriptions like any normal person, they will now have to go to wherever the health professionals are, in whatever hours those professionals work, and take their prescribed drugs in front of them.

The news release is loaded with hot words like “predators” and “bad actors” to make a reader think we’re fighting evil with this bold move. But sweep away all the noise and what you’ve basically got is government intensifying the stigma around drug use and making life even harder for people who don’t need any more of a hard time.

The cynical move, so blatantly political, will almost certainly push many people back to the deadly street supply. Some will die. The rest will just have their complicated lives made even more complicated. I hope David Eby feels that weight on his soul forever, and may it be all the more crushing because he’s a man who actually knows he’s doing the wrong thing.

Picture what this edict would look like in your own life. You like to come home after work and have a couple glasses of wine. Nope – you want that wine, you’re going down to the drug store to drink it fast in front of the pharmacist, while whoever is in line waiting for their own prescriptions watches. “Oh, what a shame,” they’ll whisper.

You like a cannabis gummy just before bedtime? Get on those bunny slippers and head on down to the clinic to eat it in front of the nurse, if anyone’s even open that late. If they’re not, you’ll be eating it at 6 p.m., and tough luck if what you really need it for is bedtime.

And yeah, you’ll be doing that every night.

Got high blood pressure? Keep the car warm or a bus pass in your pocket for those twice-daily visits to take your drugs where a health professional can see you do it. Have a job with odd hours? Get ready to figure out a work plan that lets you get to the pharmacy however many times a day, every day.

Ah, but those are the “good” drugs, I can hear you saying. (Not really, because the only people who have read this far already think like me.)

Sure, but they’re the good drugs only because we say they are. There’s no actual science connected to which drugs are legal and which ones aren’t. Every “illicit” drug has its story in our country’s history, but none of it is about careful science establishing which drugs harm us the most and making those ones illegal.

Somehow, people have come to believe that the visible suffering we’re all witnessing in our communities is about drug use. They hate talking about drug use and are very sure it looks nothing like the six bottles of wine they drank over the week.

In fact, the sad state of our streets is about a social safety net left to crumble over the last 30 years and a housing crisis. Harmful drug use is a symptom, not the underlying problem. And the toxic drug crisis isn't even about harmful drug use, it's about unregulated drugs of unknown potency, egalitarian in their deadliness whether you're a first-time user, an injured construction worker, or an "addict."

No difference. People are going to read the government’s cruel news release about deepening the humiliation for people trying to get well, and they’re going to think that something decisive is happening to stop the misery. 

Not at all. Something decisive is happening to increase the misery. David Eby is tightening the screws. The prescribed-alternatives program offered the tiniest ray of hope that government was beginning to grasp that one of the more obvious solution to toxic drugs is to switch to drugs that aren’t toxic. The light has gone out at Hope Farm tonight.

“We are committed to saving lives and getting the people who are suffering from addiction the treatment they need,” says Health Minister Josie Osborne in the news release.

Oh, please. That line doesn’t stand up 21,000 deaths later, most of them under the watch of the current government. Why do we let them get away with it? Why is the media just so damn useless, recording the empty words of whoever saying whatever, as if they see no role for themselves in digging deeper to solve a problem that can never be solved this way?

David Eby and his government will be on the wrong side of history one day. Another generation will tear their MLA names off plaques and schools, and be baffled that people with such a mindset could have ever been left to run government and cause such harm.

But that’s little comfort to the people being shamed and harmed now. David Eby would rather see them take poison on the streets than risk losing a political base who he imagines admires him for his decisive stand. Shame on YOU, David Eby.

***  

If you haven't discovered Garth Mullins' podcast Crackdown yet, make that a priority. 

Our governments are protectionists for the drug cartels

Image by Manfred Steger, Pixabay

John Horgan, David Eby and Justin Trudeau are responsible for the unnecessary deaths of 21,000 people in BC in the last eight years. John Rustad and Pierre Poilievre will continue the trend if given the chance.

So there you go, a rare all-party agreement. If I were a conspiracy type, I’d be looking for drug cartel money dressed up as some fancy campaign for a fentanyl czar, because you couldn’t make life much better for a cartel than to be handling the issue of street drugs the way our political leaders do.

A person could spend a long time trying to find anything that makes sense about how we are managing a drug supply grown toxic from a complete absence of regulatory oversight. Believe me, I have. But then I was on a dog walk today in the sunshine and my mind was clear, and I saw the obvious – that our governments are protectionists for the drug cartels.

Oh, they do a good job of hiding it. They shake their fist at “evil predators,” and they definitely throw a ton of money at police enforcement as a distraction. But peek under the surface and all that’s really evident is support for protecting the profits and the market share of the street-drug industry.

A person can’t even really use the term “drugs” anymore to mean anything beyond a substance used by a sad, sick person living unhoused, all because our politicians have fed us such a load of hooey for so long even while everything they were doing was making business better for the cartels.

Most of us take drugs; the only real difference between “us” and those sad, sick people we mistakenly think this “drug” issue is all about is who the seller is. It’s not even about legal versus illegal, because the same drug that is legal in the hands of one seller is illegal in someone else’s hands. (Sex work is very similar that way.)

So how come we’re constantly worked up about “drugs,” then? Because it's the dominant political discourse. Politicians across parties appear to want us to buy our alcohol and cannabis from government, our prescription drugs from Big Pharma, and the rest of our drugs from the cartels. 

That’s the only logical conclusion I can come to after a lifetime of watching politicians worry loudly about drug use even while their actions always protected the cartel market share.

I suppose I should say I’m being a bit of a smartass here, to make it clear that that our governments actually being in the pocket of the drug cartels is a ridiculous idea. But is it? How else to explain the relentless commitment to enforcement all these years despite the very obvious and over-and-over-again proof of failure of that one-dimensional strategy?

Here’s an interesting fact when thinking about the odds that enforcement can stop the flow of drugs from unregulated sellers: The equivalent of three million 20-foot containers from all over the world come in and out of the Port of Vancouver in a typical year. Ninety-six per cent of them go uninspected.

Next time you hear a politician crowing about some minor fentanyl seizure at the border, think about that. They’ve probably got a drug lord on speed dial thanking them right after the news conference for their continued effort in helping maintain his market share.

If I were a cartel kingpin, I couldn’t imagine a better business strategy than supporting the election of a candidate trumpeting an enforcement approach.

It’s a hopeless strategy that never worked from virtually the first moment we bet the farm on it all those decades ago, and now is practically comical in its proven toothlessness. Yet still it persists, across political party, ideology, “woke” and comatose.

When the thought about cartel protectionism hit me this morning, it was like when I read a column a couple months ago that advised a view of Trump as a con man. Suddenly it all made sense. A person can spend a lot of time thinking why why why in times like these, but then a new perspective comes out of the ether and finally, it’s clear.

Tragically, all of our current political representatives appear to have been corrupted by the drug cartels, and remain committed to helping them maintain their market share. I can’t think of a single politician in power right now, or vying to be, who takes a different line.

That's a crime, or ought to be. Five or six people dying every day in British Columbia, and not a single politician to stand up for them. Got to hand it to the cartel PR types for one heck of a successful backroom campaign.

Next time some politician puts out a fake-weepy news release lamenting all the deaths and promising more money for enforcement, read it for what it is and chalk one up for the cartels. Their market share is safe.

BC's toxic drug crisis: Facts, figures and a video that will break your heart

I'm fresh from MC'ing a great opening event today for Peers Victoria's speaker series on the toxic drug crisis, and wanting to share some facts on the crisis here that I gathered as part of my work helping to organize the series. It really is so critically important that we shake off this paralyzed shock state we seem to be in, and do something. 

But first, watch this video of people lost to the toxic drug crisis. (Thank you to Moms Stop the Harm for the use of families' photos.) It takes 18 minutes to watch all 300 of the beautiful faces here pass by. If we made a video of everyone who has died in BC since a state of emergency was declared in 2016, it would take 16 hours to play. 

And here's a good fact sheet/backgrounder for a hot-button issue like this one, where everybody's going off about this "fact" or that to the point that nobody knows what's actually going on. These are some well-sourced, categorized facts to bring clarity, gathered with care for our series. When people say idiot remarks about the crisis, pull out this fact sheet and set them straight. 

Hope to see you Feb. 26, 3-6 p.m. for the second event in the series, and March 26 2-5 p.m. for the third and final event. More details to come soon on both of those - watch for them here. 

Fact Sheet, January 2025

The situation

·       An emergency over toxic drug deaths was declared in BC in April 2016. Overdose deaths had been slowly on their way up for many years prior to this, but the steep rise from 2016 on would be unprecedented.

·      The primary cause of increased deaths is the growing toxicity and unpredictability of the street supply of opioids, or “down,” the vast majority of which (94.4 per cent) contains the synthetic opioid fentanyl or a fentanyl analog[1]. As noted in 2022 by now-retired BC Chief Coroner Lisa Lapointe, the current drug policy framework of prohibition is the main driver of the illegal, unregulated and toxic street supply.

·         Prior to 2012, BC’s knowledge of illicit drug use in the province was limited to data from Vancouver and Victoria, which accounted for about 15% of BC’s total population at that time. Little data and many gaps in knowledge remain as to the historic impact of illicit drug use in suburban, rural, and northern populations.

A national crisis

• The toxic drug crisis affects people in every province, with 49,145 opioid toxicity deaths occurring in Canada between January 2016 – June 2024
• 84 per cent of those deaths were in BC, Alberta and Ontario

Faces of the crisis

• ·         70 per cent of people dying are ages 30-59, almost three-quarters of them male
• ·         BUT – overdose deaths among females are increasing year over year. The 2024 rate of 21 deaths per 100,000 is 60 per cent higher than in 2020.
• ·         Female death rates in the North and on Vancouver Island are higher than the provincial average - 46 per 100,000 in the North, 26 per 100,000 on the Island
• ·         A 2022 coroner’s review found that 35 per cent of those who died were employed at the time of their death, with over half of them working in the trades, transport or as equipment operators.
• ·         In 2024, 82 per cent of fatal drug poisonings were either from smoking drugs (68 per cent) or snorting them (14 per cent). Injecting accounted for just 12 per cent of overdose deaths.

 

Impact on Indigenous people

• ·         First Nations people die of opioid toxicity deaths at 6.1 times the rate of non-Indigenous people in BC (2023)
• ·         First Nations women die at 11.7 times the rate of non-Indigenous women, and account for 38.9 per cent of First Nations drug deaths. First Nations men die at 4.8 times the rate of non-Indigenous men (2023)
• ·         First Nations people make up 3.4 per cent of the BC population, but 17.8 per cent of its toxic drug deaths
• ·         The COVID pandemic and the toxic drug crisis combined resulted in the average life span of an Indigenous person in BC dropping by six years between 2017-2021

 

Dual crises: Toxic drugs and housing

• ·         Most toxic drug deaths occur in private residences (48 per cent in 2024) or shelters, hotels and other indoor locations (32 per cent).
• ·         People experiencing homelessness account for 12 per cent of toxic drug deaths, even while making up a scant 0.5 per cent of the BC population. Someone living unhoused in BC is 24 times more likely to die of a toxic drug overdose than someone who is housed.

                                                                                                          .

Survivors risk brain injury                

• ·         A BC study that followed 2,433 patients admitted to hospital between 2006 and 2015 found that at least three per cent of those admitted for accidental opioid overdose had also suffered a brain injury due to oxygen deprivation during the overdose.
• ·         Extrapolated across the roughly 21,000 people in a typical year who BC paramedics revive after a fatal poisoning, that means a minimum 640 people a year are incurring a lifelong brain injury due to the toxic drug supply.
• ·         People with a history of overdose were 38 times more likely to have a diagnosed brain injury compared to a random sample of other British Columbians in a BC study from 2015-17.

 

Societal Costs

• ·         Death from toxic drugs is the No. 1 killer in BC for age groups 10-59
• ·         The toxic drug crisis costs Canada $7.1 billion annually – $1.6 billion in BC. Almost three quarters of that cost is due to lost productivity because of the young age of people – average age 44 - at time of death.
• ·         The number of deaths from the toxic drug crisis is so significant that in 2021, it caused a decrease in average lifespan in BC.
• ·         The peak of paramedic-attended overdoses in a single month in BC since the declaration of the 2016 emergency was September 2021, when paramedics were called to almost 2,600 overdoses in a single month.
• ·         But 2023 set the record for worst year to date, with BC paramedics responding to a record-high 42,172 overdose/poisoning incidents that year - a 25 per cent increase over 2022.

 

Health approach favoured, but spending is on enforcement

• ·         Public support in BC for harm reduction strategies has been very high for almost 15 years, with a strong majority support for harm reduction services and the distribution of safer-use equipment.
• ·         This majority support isn’t reflected at the political level, however. While 50 per cent of people in BC favour a public health approach to address substance use issues and just 4 per cent favour police enforcement, 58 per cent ($433 million) of the spending in the Canada Drugs and Substances Strategy goes to enforcement.

 

Grief and suffering

• ·         In 2014, 26 per cent of respondents surveyed at BC harm reduction sites reported witnessing an opioid overdose in the past 6 months. In 2023, 88 per cent had witnessed an overdose in the past 6 months
• ·         In 2018, 19 per cent of drug users surveyed at BC harm reduction facilities had experienced an overdose themselves. In 2023, 50 per cent had.
• ·         Between 30-40 per cent of the 6,000 members of the Ambulance Paramedics of BC have an active mental health claim, many of them related to compassion fatigue and PTSD related to the unregulated drug crisis.

A few facts on fentanyl

• ·         Created in Europe in the late 1950s as a surgical anesthetic, 50 to 100 times stronger than morphine
• ·         Now one of the most popular pharmaceutical opioids in the world
• ·         Whether diverted from legal markets or produced in home labs, it’s popular among drug suppliers because it’s potent in small amounts, odorless, and easier to produce/transport
• ·         Emerged in B.C. drug supply 2009-12. Overdose deaths in BC related to fentanyl increased dramatically at that point.
• ·         By 2016, fentanyl was being found in 42 per cent of toxicology tests following an overdose. In 2023, fentanyl or a fentanyl analog was present in 85 per cent of those tests.
• ·         Fentanyl is often combined with another pharmaceutical, benzodiazepine, to lengthen duration of effects. It has rendered heroin virtually obsolete in B.C.

 

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Sources: BC Coroners report 2022; Health Canada; BC Centre for Disease Control; First Nations Health Authority; Ministry of Mental Health and Addiction; Substance Drug-Checking; Canadian Centre on Substance Use and Addiction; Harm Reduction Journal; BC Emergency Health Services; Population Survey of Canadian Adults, University of Alberta

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[1] Based on drug sample testing

Lessons from the UnitedHealthcare murder: Yes, CEOs, that's blood on your hands

Pixabay: Valentime AI

I was in Philadelphia visiting family last month when UnitedHealthcare CEO Brian Thompson was shot dead on a Manhattan street in a carefully planned execution. The instant roar of approval that united an otherwise starkly divided America in the days and weeks that followed has been a notable reminder that people are feeling a little done these days.

Like everyone who has written about Thompson’s murder, I want to stress that in no way do I condone street executions. I’m sorry that he got killed, and that a young man whose own path seemed quite promising felt compelled to take such drastic action.

At the same time, I’m awed by the powerful rage that the shooting brought out in people, and the major conversations it is sparking. (I, too, burn with fury at what the CEO class has gotten away with, though I’d like to think I’d never settle it with a gun.) The killing lit a fire under the issue of health-care claim denials in a way that a thousand of the most heart-breaking tales of life shattered by a claim denied could never do.

When terrible things are happening to ill people with no hope of seeing justice done, how can anyone be surprised when a CEO at one of the most prolific claim-denying companies ends up killed?

It’s no way to settle scores in a civil society. I really hope we don’t start murdering each other. But that’s not to deny the power of Luigi Mangione’s alleged bullets to open up an urgently needed public conversation in the U.S. on the brutal outcomes when people’s health is pitted against ruthless corporate profiteering.

The U.S. health care system is so profit-oriented that the first thing a typical American has to think about when they get sick or injured is how much it’s going to cost them. Polling by Gallup earlier this year found half of U.S. adults reporting it was difficult to afford health care costs.

One in four said they’d skipped or postponed needed health care in the previous 12 months because of the cost. Two-thirds said they went without care to escape the expense.

Until Thompson’s murder woke up the health insurance industry around just much they’re despised, one of United Healthcare’s competitors was busy setting new time limits in three states on how long a person could be under anesthesia before the insurance coverage would run out. (Anthem Blue Cross Blue Shield reversed that decision after Thompson’s death.)

A dozen years ago, my partner and I lived in Honduras for the better part of three years. Justice never got done officially in Honduras, which had a four per cent criminal conviction rate.

So it was rough justice in all directions at that time. People got killed in the street and at their homes for all kinds of reasons as citizens and gangs settled up debts, grudges and issues requiring vengence, rightly or wrongly. (But there was always a reason; Hondurans were completely baffled by the random gun violence going on in the US.) 

Honduras came to my mind immediately when I heard the news of Thompson’s death.

What CEOs feared in Honduras in our time there was kidnappings. Every now and then I’d imagine how it must have felt to be a CEO in Honduras, with your kids being driven to school by guys with guns and the constant threat of something scary happening to you or someone you loved. I’m sure it must feel deeply wrong for a person who considers themselves law-abiding to experience that.

But I really hope that the Manhattan killing prompts deep soul-searching among a class of business executives who have divorced themselves from the moral impact of their business decisions. If Thompson’s death impacts such decisions in the future because CEOs start worrying that they might get killed, that would not be a bad outcome.

There’s no arguing that corporations cause the rest of us harm routinely in the course of doing business. Our governments are helpless before them, compromised by their vast economic power and political donations, and not nearly smart enough to catch corporations out on all the ways they’ve figured out to maximize profits.

What does justice look like for people irreparably harmed by corporate actions? Right now, it looks like a CEO killed in cold blood and the lionizing of the young man charged with the murder.

The ongoing rage of the American people after the killing of Thompson has not abated. Expert after expert has weighed in with comments that are prefaced with their abhorrence of the murder, but follow with a big “…but on the other hand…” analysis contextualizing the public’s fury.

In a recent poll surveying 1,000 people in 50 states, a fifth said Thompson’s killer bore only a little or no responsibility at all for his death. Almost 70 per cent put the bulk of responsibility for the killing on the health-care insurance companies that deny claims.

But of course, Thompson wasn’t doing anything illegal when he ran his company hard on health-care claims. His shareholders and his big bosses might have loved him for it.

Yet millions of Americans have died, grown sicker or been bankrupted by the decisions of their health-care insurance providers. One study found that 36 per cent of the Americans surveyed had had at least one claim denied, and most of them had been denied multiple times.

What justice exists in such a system? Most companies would have an appeal process for individuals, but this 2023 ProPublica article says the appeal rate is one per cent. There’s court, but that’s money and time that few have. In truth, Americans have virtually no chance of justice against corporate decision-making around health care, yet their very lives are being ripped apart by the corporate direction being set by men like Thompson.

I could hear the hurt feelings in the voices of the CEOs quoted after Thompson’s death. Most sounded completely taken aback that people could hate them that much. It was as though their gilded life had shielded them from the harsh fact that yes, it WAS their fault that people were being killed, sickened and bankrupted by corporate policies and decisions under their direction.

That’s the takeaway that I hope lingers on in the reverberations that the murder has set off. CEOs need to internalize that when the corporation they run is routinely hurting people in order to create profit, they carry the burden of responsibility. The rule of law breaks down in societies where there is no hope of seeing justice done, and they should know that all eyes are ultimately going to be on them.

In one sense, Thompson was an innocent man that day he got murdered. But in another, he wasn’t. Let that be a cautionary tale to CEOs who still can’t see the connection between their executive actions and the mayhem on the ground.