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Overdose crisis in Canada’s BC – From Criminal Justice to Health care

Dr. Neelam Batra Verma

Overdose crisis: Kylie Walker was just 18 years old when she overdosed along with five other teenagers but she was the one who died, in Victoria, British Columbia.

Carson Crimeni, was 14 years old when he was found by his grandfather on the pavement of a skate park and later died in hospital. As he lay on the ground in apparent distress, videos appeared of Carson’s last moments on social media making it obvious that he deliberately overdosed. His phone was found in a nearby garbage can.

A 16-year-old girl died in a posh Vancouver school, of likely fentanyl overdose. Despite being rushed to the hospital and timely treatment, she died six days later, leaving the students, her family, and the community still wondering what happened. Her family did not want to release her name.

Debbie Porter was 49 years old when she died of an overdose on Vancouver Island. She struggled with drugs and mental illness for most of her life.

Elyse Bailey was 21 when she was found in a stairwell on the Vancouver Downtown Eastside, of an apparent overdose. She was a hockey goalie and passionate about music.

Ryna Norris was 35 when he died of a suspected fentanyl overdose in an East Vancouver apartment while waiting for treatment for depression, anxiety, schizophrenia, and suicidal tendencies.

Jordan Hunter Carhoun was 25 years old when he died after smoking what he thought was heroin but turned out to be fentanyl.

And the story goes on. But you get the point that drugs are consuming bright young lives, age, social status, or education no matter what. It was always believed that most addicts belonged to poor uneducated families and mostly belonged to First Nations.

That myth is now broken.

Addiction beyond races, cultures

Addicts come from all walks of life – they are a school or college students; runaway kids, prostitutes, construction workers, engineers, the depressed, the struggler, the frustrated, the mentally or physically ill, the troubled teen or tween, from a broken or loving family, the loner, maverick or weirdo or conformist or just someone who recently had surgery and was prescribed these drugs for pain. But once treatment is over, their doctors may not prescribe them anymore and the patient will then turn to the drug trafficker to get their fix. Dates, when these deaths occurred, have deliberately been excluded as those do not matter. Those who lost their loved ones were family; for the government, they are rendered mere statistics.

Overdose crises in BC

Between 2016 and 2022, 23,000 Canadians died due to drug toxicity. Latest figures show that in 2022 as many as 2,272 people died of suspected drug toxicity in the Canadian province of British Columbia (BC) alone, which was slightly lower than the 2,306 records set in 2021, reported BC Coroner Service. Total drug overdose death in Canada in 2022 stood at 3,556 in the first six months of the same year, with BC taking the largest share. The first month of 2023 has already seen at least 45 deaths in BC, which means we are losing more than 6 people a day to drug overdose, which is nothing but unacceptable. Dr. Paxton Bach, an addiction medicine specialist in a news conference last week said, “To the families of the 45 individuals who have passed away in the last week alone … to their friends and their colleagues and their communities and loved ones: my heart goes out to you and I’m so sorry that we’re continuing to fail.” Failing we surely are. “I hope that we can sit with that grief and that outrage. I hope that every citizen of the province reflects on this report and feels that outrage and uses that to drive the advocacy that is needed to generate change.” Bach is also the co-medical director of the BC Centre of Substance use.

Legalizing quantities to control overdose crisis 

Paxton was speaking at the recently announced decriminalization initiative declaring small amounts of illegal drugs legal for those above 18 years in BC. The question is, will legalizing just 2.5 grams of certain drugs end the drug overdose crisis in the province? BC chief Coroner Lisa Lapointe admitted that this is only a “key first step” but “only one measure of many that are necessary to end this crisis.” She rightly believes that the goal should be to deter people from using drugs.

Public health emergency

A public health emergency was declared back in April 2016 in BC, the year, which saw 994 deaths due to the toxicity of illegal substances. It has taken more than six years to reach the threshold level of legalizing 2.5 grams of certain drugs for personal possession. This amount is almost half the amount requested by the province. For now, decriminalization is a three-year pilot project, which advocates have only described as half-measures.  Provincial minister of Mental Health and Addictions Jennifer Whiteside acknowledged “decriminalization of pilot alone will not fix the problem. We know there’s more to do and we won’t stop working until we turn the tide on this crisis.”

Exemption extended by Health Canada

So, what exactly is changing? Starting January 31, 2023, Health Canada granted an exemption to adults from the Controlled Drugs and Substances Act for possessing 2.5 grams of opioids like heroin, morphine, fentanyl, crack and powder cocaine, Methamphetamine, and Ecstasy. No criminal charges will be laid if an adult is found in possession of these and within limits and drugs will not be seized. Instead, they will be offered health and social services, including referrals to local treatment and recovery services.

Local governments have the last say

This exemption does not apply to youth and if found in possession of a combined total of 2.5 grams of illegal drugs or any number of illegal drugs not on the list. Drug trafficking still remains illegal and these substances are not to be sold in stores. If drugs are found in schools, airports and such sensitive locations will be seized and criminal charges will be laid. However, local governments would still have the authority to pass bylaws restricting public substance use.

BC’s fight against toxic drug overdose crisis

What is the need to decriminalize certain drugs? The aim is to intensify BC’s fight against toxic drug crises and to reduce the barrier and stigma that prevents addicts from accessing life-saving support and services. It is also an attempt to divert the issue to public health from criminal justice, as the latter has not drawn results in the province. As of now, people arrested for small possession would go to jail, be bailed out within 24 hours, and then go back to their drugs, whether it is consumption or trafficking. Legal Aid is provided to those who are not able to afford a lawyer so, money to pay the lawyer is never an issue.

Traffickers are used to commit the crimes

It’s a vicious cycle where the traffickers or addicts come and goes through revolving doors a number of times in their lives. Their brush with the law is unlimited as arresting and getting out becomes a part of their lives. The social stigma attached to drug addict result in their family and friends shunning them, further rendering them out into the streets and in isolation; therefore, when they overdose, there is no help around. Downtown Eastside in Vancouver is a case in point where tent city houses these addicts, who not only belong to BC but people from other parts of the country find Vancouver streets welcoming, due to the easy availability of not only drugs but other facilities in the area available to the homeless and addicts like the supervised injection site – Insite.

Drug supply and overdose in rural and urban areas

There is a difference between drug supply and overdose deaths between rural and urban areas. Rural and remote areas are the worst affected. According to a study by BC Centre for Disease Control, published last year, the incidence of people living in rural British Columbia is 30 percent more likely to die than in the cities, if they experience drug poisoning, which can go up to 50 percent in some rural areas. The study led by author Kevin Hu looked at a variety of acute and emergency healthcare sources between January 2015 and December 2018. This was around the time when fentanyl started contaminating the illicit drug supply. 9.1 percent of 35,569 overdose deaths occurred in rural areas where 13 percent of British Columbians live. According to the study, the life-saving impacts of harm reduction services in rural areas are limited compared to urban areas.

The pilot project is also likely to affect negatively in rural areas. According to advocates, since the supply of illicit opioids is limited in rural areas, most of them will pay a visit to the city once a month or twice a month and therefore may be found with an excess of 2.5 grams of any substances at any given time as they would be carrying a week’s or a month’s supply at a time.

Role of social services in the overdose crisis

When caught, social services have to provide referrals to treatment centers and recovery services. Where are the rehab facilities and are they easily accessible? Not for many say, experts. Unless you are a youth or from a First Nations community, these rehab facilities may have a wait time from one day to six months or more in BC. For mothers wanting to get their children into rehab, it is a frustrating experience. Says a Victoria mother who lost her daughter to a drug overdose, “I tried my level best to get her admitted to one rehab center but couldn’t. My daughter died waiting to be admitted.”

Overdose crisis in Canada
Photo: ANM

Consuming drugs for momentary pleasure or as part of a routine to suppress pain and suffering is nothing new. The question being raised now is how did the drug industry in Canada turn so deadly? According to reports, the drug industry became deadly after synthetic drugs were introduced into the drug stream, not only in Canada but also all through North America.

Synthetic drugs, a lead contributor to the overdose crisis

The deadliest known synthetic drug is fentanyl, which is at least 50 times stronger than heroin and can easily turn fatal. The BC drug supply is known to be contaminated with carfentanyl, which is a synthetic drug manufactured in China. This is then mixed with cocaine or heroin or any other substances to increase profits for the drug dealers. A drug addict pays for just cocaine or heroin and is mostly unaware of the contamination; therefore, it is easy for them to overdose. For those who are aware of the presence of fentanyl, their tolerance level keeps going up, unless their body finally shuts down.

Not only Canada, America too is suffering from the overdose opioid crisis, especially fentanyl. The crisis is so severe that President Joe Biden even referred to the overdose crisis and the urgent need to take action during his State of the Union speech on February 7, 2023. According to Rahul Gupta, Director of the White House Office of National Drug Control Policy predicted 107,477 deaths of an overdose in the 12-month period ending in August 2022. Clandestinely manufactured fentanyl and methamphetamine, often in combination with other drugs, including cocaine and heroin is the cause of concern across the border in the US.

Fentanyl, the latest addition

BC Coroner service has warned that fentanyl is just the latest addition to an opioid addiction crisis brewing in Canada for years. Nick Jansen, who lost both his brother and girlfriend to fentanyl, warns not to try it ever. Talking to the media he said, “Illicit fentanyl is much more than just a toxic and addictive opioid. It is pure evil. It just grabs hold of your mind and destroys you and you can’t beat it.” Acetyl fentanyl, carfentanyl, and norfentanyl have been detected in 82 percent of toxic drug deaths in 2022.

He said it right. You can’t beat it once it has consumed you. Just a tiny dose, as small as a grain of salt, can lead you to your grave. Many have gone too early and bodies continue to pile up. The opioid or overdose crisis is affecting all generations –X, Y, or Z; both in rural or urban areas and to people from all walks of life. Just because it is more visible in the cities and on the streets, does not mean that people are not overdosing in their private homes or in remote areas. The three-year project to decriminalize small amounts of some drugs for personal possession certainly is a start. Moving the opioid crisis from the criminal justice system to health care certainly will preserve life.  With health care in Canada, already under tremendous strain, how successful the project will be can only be a wait-and-watch game. However, we have miles to go before we sleep. The journey has just begun.

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