Don't buy the snake oil

ChatBox AI image created by me

I generally stay out of the fray when it comes to commentary on politicking, so much of which is about as reliable as a snake-oil pitch.

But having caught Pierre Poilievre’s promise of addiction treatment for 50,000 Canadians, paid out of the money that will be saved when safe-supply programs are cut, I just can’t let that blatantly misleading statement stand unchallenged.

First, let’s start with safe supply. That’s the term used for when people are able to swap out their completely unregulated opioid-based street drugs for a prescription opioid from a health professional. It’s the most obvious immediate strategy to stop a toxic drug crisis that has killed 50,000+ Canadians – more than a quarter of them in BC - in the decade since the anesthetic fentanyl began dominating the street drug market.

That Poilievre actually thinks there’s enough money in the country’s teeny-weeny safe-supply response to pay for a major expansion of treatment beds and the cost of putting people into them for three, four or more times through – totally predictable with a relapsing health condition – well, that’s the first glaring sign that this promise is pure snake oil.

Here in BC, we have an estimated 100,000-125,000 people with opioid use disorder. A mere 4,600 of them are on the safe-supply program that BC launched at the start of the pandemic. That’s four per cent of the people who could actually benefit from safe supply.

Elsewhere in Canada, 10 other cities launched pilot safer-supply programs during the pandemic, nine of them in Ontario and one in Fredericton, NB. Federal funding ran out for most of them already.

In the few short years since, the mercurial public mood has shifted toward a view of safe supply as having “failed,” even though it actually barely got a start. So good luck grabbing all that big money invested in safe supply into treatment, Mr. Poilievre.

What really gets me with stuff like this is that a politician's comments are rarely challenged by reporters, leaving the public to assume that there really is some massive government investment in safe supply that can be transferred over to treatment.

I figure that whichever party ends up elected at the end of this month, we’ll get a few more treatment beds. That’s a good thing, because we really need them, along with government funding to support people accessing those beds without having to come up with tens of thousands of dollars multiple times to buy their way into a largely private system of care.

But any new beds will barely make a dint on the actual issues that are troubling the public - one of which is an unregulated drug supply managed in the shadows by international drug cartels that is killing their children, grandchildren, employees, partners, siblings and neighbours; and the other being a multi-faceted crisis of poverty, homelessness and mental illness manifesting ever more ferociously on the streets of our communities.

Substance use is definitely layered into that latter problem. But the main driver of the tragedy unfolding on our streets is poverty, mental illness and a housing crisis. Until we deal with those underlying causes, we’re going to be living with the soul-searing visibility of enormous suffering no matter how many treatment beds come into play.

Safe supply is an easy scapegoat for politicians, I suspect because we’ve been convinced over many decades to view the kind of drugs that end up on our streets as evil. BC’s tiny safe supply program was dealt a very hard blow recently when Premier David Eby got fussed about the supply being diverted into the illicit market, and withdrew people’s right to take their prescription drugs in the privacy of their own home.

Picture how that would go for whatever prescription drugs you might be taking, if suddenly you had to visit your local pharmacy twice a day, within their operating hours, to take your heart drugs, for instance, or use your asthma puffer.

Your job, your family time, your recreation activities – all of that would have to fit around getting yourself to the pharmacy twice a day, every day, to swallow your pills or inject your insulin in front of a health professional. How long would it take any of us to be looking for alternatives on the black market to spare us such misery?

Yes, diversion happens. An issue with safe supply is that it decrees what drugs you can swap onto, and fentanyl isn’t one of them. So some people on safe supply sell whatever drug they’ve been given to get the money for the fentanyl that they actually want.

You can look at that as a failure, I suppose. But toxic substances laced with unknown quantities of fentanyl and fentanyl analogs are now the No. 1 cause of death for British Columbians ages 10 to 59, exacting a massive impact on our collective productivity that is second only to cancer. What could possibly be a bigger failure than that?

So now let’s consider treatment as a “cure” for that failure, as Poilievre wants us to do.

First, the obvious: Many of the people dead in the toxic drug crisis weren’t in need of treatment. They were just average people using drugs for fun – not aberrant behaviour in a country where three-quarters of us consume alcohol regularly. They died because a toxic drug supply doesn’t differentiate between whether you’re a first-time user or an “addict.”

Then there’s also this tricky truth: Treatment for any chronic, relapsing condition is a long, hard slog. Whether it’s Type II diabetes, hypertension, or this thing we call addiction, 40-60 per cent of people will relapse after treatment. They will need many passes through treatment to reach a state of recovery, and some will never get there. Getting to where we need to be in terms of quick access to treatment is going to be expensive, just as it is for any other long-term health care interventions.

People using opioids are particularly vulnerable to dying during a relapse, as their tolerance falls significantly after a period of abstinence. Add in that little ongoing problem of a toxic drug supply - any hope of accessing safe supply during a relapse having evaporated under Poilievre’s plan - and it’s clear that expanding treatment alone will not get us out of this crisis.

And one more tricky truth: Treatment for this thing we call addiction is almost completely owned by the private sector – and increasingly, by multinational corporations and private-equity firms interested in consolidating many small community treatment centres into one big entity that will attract investors. (As is happening with veterinary services, lab services, mental health services, employment training, etc.)

Treatment for substance use problems is outside of the Canada Health Act. Private treatment centres are free to set their own rates and their own methods. If they report on their effectiveness at all, the data collection stops the moment a person leaves the centre. A person could relapse within hours of “graduating” and still be counted as a success.

The lack of transparency and absence of meaningful data collection leaves us with scarce knowledge to prove or disprove the effectiveness of any treatment approach. Nobody can actually say what’s working, or what happens once someone leaves a treatment facility in a state of abstinence and walks out into the big world where all their troubles await.

We simply don’t know how many times people relapse, because we don’t measure or track. We don’t know how long an individual stays abstinent after a round of treatment. There are no national standards for treatment. No followup.

So yes, let’s talk treatment. It’s a pillar of any health-care approach, as is access to regulated medications. But please don’t buy the snake oil.

One more walk down the road to failure

Sunil Kargwal, Pixabay

Thank you to long-time community organizer Ann Livingston for pointing me to this 17-year-old blog post that takes us back to 1950s Vancouver to remind us that there's nothing new about the strategies being talked about now to improve health care for people who use substances - or the political tactics used to block those efforts.

The Community Chest and Council, the forerunner to the United Way, struck a Narcotics Committee in 1952 to examine the problem. The Committee recommended a comprehensive drug strategy that included rehab centres, educational campaigns, and stiffer penalties for traffickers. But what really stirred debate was its proposal for clinics that would provide maintenance-level doses of heroin to addicts.

The drug clinic scheme was intended to “maintain a constant check on the number of addicts in any community. It would also protect the life of the addict and support him as a useful member of society. This existence would hasten his rehabilitation, or at least reduce the amount of his addiction since many of the stresses in the addict’s life would be reduced.” What’s regarded today as the novel philosophy of harm reduction was simple pragmatism in 1952.

Both the Province and Sun newspapers printed the Community Chest’s report along with gushing editorials endorsing its recommendations. The Sun noted that Vancouver alone had four times as many addicts as all of Britain, leaving “little doubt that the European system of cheap drugs and medical treatment is infinitely superior to our faltering system of straight police suppression.” The editor agreed that the Community Chest’s plan would eliminate the illegal drug trade by “destroying its root – the fabulous underworld profit in drugs.”

The Community Chest anticipated resistance to the drug clinics, predicting they would be “violently opposed by those who profit from drug trafficking and one should expect opposition and interference from such criminals.” Stiff opposition did kill the clinic plan, but it came from the government rather than criminals.

Soon enough, the government of the day was promoting involuntary care. What is now Matsqui Institution was in fact purpose-built in 1966 for the forced treatment of men and women using heroin. But they built it so it could be repurposed as a prison just in case - a good move, as it turns out, because the forced-treatment project was deemed a failure a mere three years later and Matsqui became just another jail. 

The John Howard Society also reported “a radical upswing in addict deaths in BC” since Matsqui opened. [The JHS's] Mervyn Davis explained that it was probably “the result of increasing police pressure on the drug market, which usually results in inferior drugs and a wider variety of potentially dangerous drugs – such as barbiturates – being used as a substitute for heroin.”

 But hey, 20 times is the charm, right? With more than 17,000 dead just since BC declared a state of emergency almost nine years ago and such a long, long history of abject failure on this issue, you'd think we might be ready for something new. Nope. We're pulling back even farther, leaving politicians, police and hysterical media pundits to continue calling the shots on a massive public health crisis. 

Watch this segment on moral panic from the Peers Victoria speaker series on the toxic drug crisis that just wrapped this week. There's the conversation we need to be having. 

 

Could the stories of the dead shake us out of this moral panic?

Pixabay: Erika Wittlieb

This is a callout to people who know someone who has died in the toxic drug crisis in the last decade. I've got an idea. I'll need your help. 

Nobody can look at the faces in this Moms Stop the Harm video of lost loved ones without questioning what's going on, with more than 17,000 people dead in BC since 2016 and us seemingly powerless to act. (We aren't, but I've already written about that, so more on that later.)

That emotional connection is exactly what's needed to shake off this ennui around a four-alarm public health crisis. We seem to have parceled the toxic drug crisis into the part of our brains where we hold faint understanding of something that we don't think affects us. But it does affect us, in so many ways. 

Normally I'm all about the stats and evidence, but as the fantastic panel on moral panic pointed out at the Feb. 26 event in Peers Victoria's speaker series, we've got stacks of evidence on this issue and quite a lot of stats, at least at the death end of things. So the question becomes how you get past moral panic to actually implement the evidence-based strategies that will substantially ease the crisis. 

I think it's through the heart. Not in a Sally Struthers way - teary-eyed, sobby, pleading (sorry, Sally, loved you in Man on the Inside) - but in that way that almost instantly shakes off some of that "this is not my problem" way of thinking. I don't know what it is, but it's like the blinders come off and you finally see. For me, it was Stephen Lewis, of all things, pointing his finger out to the audience that I was in one spring day in 2004 and saying, "What are YOU doing?"

I've seen it happen a multitude of times for other people, where someone sees or experiences something out there in the realm of suffering that hits them where they live, and they get it. You can't predict when they'll have it or what's the magic sight that will open their eyes, because everybody is different, but it's a beautiful thing to see. (Tony Joe, I saw you have one.) Here's harm reduction and recovery advocate Guy Felicella talking about his father-in-law's moment. 

It can often be a long way to action from that point. But there will be zero action until a person at least has that moment. That's an important strategic reality to ponder for anyone pushing for social change, especially when an issue is stigmatized.

So let's help get them to that moment, I say. Let's bring the faces and stories of people killed in the toxic drug crisis into the world. Moms Stop the Harm's video has 300 faces, but there are thousands upon thousands more. I think there would be much power in a Humans of New York style of story-telling (an image and 150 words max) for all these people we have lost to an entirely preventable crisis.

What I'd ask for is an image, and the answer to this question: What did the world lose when this person died? I'd like their age and at least their first name, and two names are even better, because being out there with your full self, while hard, is a rejection of stigma.

The tools are in our hands, and free. Instagram would be great. Facebook has potential, though my personal sense is that the algorithm doesn't like things about toxic drugs. On the other hand, it DOES love things about people. 

Podcasts are a possibility, to bring out the voices that will reveal the enormous grief hanging over this province solely because of this preventable crisis. It would be very brave to consider X, but we could warm up on the friendlier BlueSky initially. 

We'll need some kind of consent form, of course. It's a proposal that people will need to think all the way through before participating. Some thought is needed as to who can consent to the use of an image and story. I'm imagining that things will go wrong, because they always do, and I'll tell you right now that the haters are going to hate. You're going to have to be like little Ruby Bridges in 1960 Louisiana, bravely entering the first integrated school while the white protestors hurled vile insults. 

But if you are one of the many frustrated families and supporters who can't bear the lack of action on this issue one minute more, then maybe you're OK with that. 

This thing I'm thinking about is meant to memorialize and honour those who have died, and hopefully stab people in the heart until we get action. But the use of drugs that our society believes are "evil"  is also possibly the most stigmatized social issue of our times, so it isn't an easy choice to step up. 

If you're reading this and are one of the lucky ones who doesn't know anyone who has died in the toxic drug crisis, I'd ask that you ask around and then share this with someone you know whose name comes up. Because there's definitely going to be someone in your circle. 

If you do know someone, write to me at jodypatersonmobile@gmail.com and tell me what you'd want to know before going ahead with something like this. I'm just seeing us spinning our wheels while people die, and it feels way past time to take things up a notch. 

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.

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