Opioid vending machines won’t help B.C.’s addicts

The British Columbia public health authorities are making a huge mistake. The province is advancing a series of reckless interventions that are counterproductive in fighting the opioid epidemic. If B.C. continues in this manner, the province is destined to remain in a state of perpetual opioid addiction.

Ottawa recently granted approval of a B.C. pilot to distribute high-dose hydromorphone, a potent opioid, three times daily at supportive housing units and supervised injection sites. Drug users are free to use the hydromorphone as they please; authorities anticipate many will crush and inject the opioids to intensify their high. Moreover, the province has plans to grant “qualified” opioid users biometric access to vending machines of hydromorphone for drug users’ convenient consumption.

Proponents argue that providing a readily accessible supply of “clean opioids” is necessary to reduce overdose deaths in an environment contaminated by fentanyl. The program’s architect, Dr. Mark Tyndall, executive director of the British Columbia Centre for Disease Control, admits that installing opioid vending machines isn’t treatment but suggests there will be an ensuing transition to “substitution therapy and eventually recovery.”

But this plan of “eventual recovery” is vague and undefined. By what means will the individual be delivered from the chains of addiction if high-dose opioids are so readily available?

According to B.C. addiction philosophy, opioids, if medically administered, can have a positive “stabilizing” effect on the active drug user because that eliminates the desperate struggle inher- ent in habitual drug use. For this reason, the province is actively expanding access to both heroin-assisted treatment and the dispensing of morphine for dependent opioid users. The province has imported expensive pharmaceutical-grade heroin from Switzerland specifically for this treatment. The theory is that the drug user who has a regular supply of safe opioids administered under the auspices of the medical system will be in a good position to begin their risk-free progression toward recovery.

But this plan lacks common sense.

The notion is completely at odds with the lived experi- ence of many former severely addicted opioid users who were able to free themselves from chemical dependence only after a long and bitter battle.

Herein lies the crux of the problem with the B.C. model: it enables drug use seemingly without end or consequence. The system places all its resources into attempting to “stabilize” an intrinsically unstable and harmful activity. The B.C. notion of recovery is so compromised that one can scarcely differentiate addiction treatment from active drug use.

Why not instead capitalize on the wisdom of those who have overcome the illness?

Since 2010, the Rhode Island government has funded Anchor Recovery, a program formed exclusively by past opioid addicts. Termed “recovery coaches,” these individuals connect with active drug users in the streets and in shelters; they meet patients as they recover in the emergency department after an overdose. Having lived on the streets and spent time in prison or in hospital, these individuals understand the challenges of drug use. Their very existence serves as an encouraging reminder that a life free from narcotics is possible.

Instead of listening to those who have recovered from addiction, the province is doing just the opposite. Drug policy is directly informed by a number of active drug-user advocacy groups. Released in August 2017, the B.C. Overdose Action Exchange II Meeting Report was written in partnership with the Canadian Association of People Who Use Drugs (CAPUD), the Vancouver Area Network of Drug Users, and the Society of Living Illicit Drug Users. It was this document that first called for the expansion of freely available hydromorphone.

It is unclear to what extent members of these organizations view their own drug use as problematic. Jordan Westfall, president of CAPUD, argues that B.C.’s hydromorphone distribu- tion intervention contains “no misguided attempts at ‘fixing’ the human being.” He states: “I’m not recovering from drug addiction; I’m recovering from bad drug policy.” This frank denial of individual pathology in addiction, or of any need to take responsibility for one’s conduct, is representative of B.C.’s dangerously flawed approach.

Both the criminal justice system and medicine are limited. Neither can artificially provide a reason to stay sober. To a real extent, these are questions to be worked out by the individual. This enormous challenge can be facilitated by those who have conquered their addiction.

The government should take the millions of dollars it intends to spend on hydromorphone and heroin and instead redirect those dollars towards a blitz of Anchorstyle recovery programs. This would offer a two-fold benefit: It would provide both a source of meaningful work (which solidifies sobriety), and would encourage other drug users to do the same.

THE PROBLEM: IT ENABLES DRUG USE SEEMINGLY WITHOUT END OR CONSEQUENCE.