RE­DUC­ING OVER­DOSES

The Georgia Straight - - Front Page - > BY TRAVIS LUPICK

There is no sil­ver bul­let for North Amer­ica’s fen­tanyl cri­sis, ac­cord­ing to the ar­chi­tect of Por­tu­gal’s drug­pol­icy frame­work, widely con­sid­ered the most pro­gres­sive in the world.

“It is a dif­fi­cult prob­lem,” Dr. João Goulão told the Straight by phone. “I have no mag­i­cal in­sight for it.”

Il­licit drugs are on track to kill more than 1,500 peo­ple in B.C. this year, up from an an­nual av­er­age of 204 deaths recorded be­tween 2001 and 2010. So far in 2017, the B.C. Coroners Ser­vice has de­tected fen­tanyl, a syn­thetic opi­oid, in 78 per­cent of drug fa­tal­i­ties.

In a wide-rang­ing in­ter­view, Goulão re­counted how be­gin­ning in 2001, his coun­try de­crim­i­nal­ized all il­licit nar­cotics, in­clud­ing co­caine and heroin.

Por­tu­gal did not le­gal­ize hard drugs, which would have in­volved reg­u­lat­ing their sales sim­i­larly to how Canada deals with al­co­hol and to­bacco. But it took a step in that di­rec­tion, re­mov­ing crim­i­nal penal­ties for per­sonal pos­ses­sion.

At the same time, Por­tu­gal es­sen­tially flipped how it spends money on cit­i­zens who strug­gle with an ad­dic­tion, noted Goulão, now Por­tu­gal’s na­tional drug co­or­di­na­tor. Whereas the coun­try once spent about 90 per­cent of funds on en­force­ment and 10 per­cent on treat­ment, af­ter 2001, that ra­tio was re­versed.

“Since then, we have had dra­matic im­prove­ments in all avail­able in­di­ca­tors,” Goulão said. “Over­dose deaths, HIV in­fec­tions, and the num­ber of prob­lem­atic drug users have all dropped since then.”

In Por­tu­gal in 2015, the rate of fatal over­doses was three peo­ple per 100,000, ac­cord­ing to the Euro­pean Mon­i­tor­ing Cen­tre for Drugs and Drug Ad­dic­tion. The B.C. Coroners Ser­vice has re­ported that as of June 2017, the rate of over­dose deaths per 100,000 res­i­dents of this prov­ince is 32.5.

On Septem­ber 7, Goulão is sched­uled to visit the Lower Main­land for the first time as a keynote speaker at the Re­cov­ery Cap­i­tal Con­fer­ence of Canada, in New West­min­ster. Ahead of his trip, he an­swered ques­tions about North Amer­ica’s fen­tanyl prob­lem and dis­cussed what les­sons Por­tu­gal’s ex­pe­ri­ence might have to of­fer pol­i­cy­mak­ers here.

Goulão be­gan by em­pha­siz­ing that if Canada were to de­crim­i­nal­ize drugs as Por­tu­gal did, this would not ad­dress the is­sue of fen­tanyl. That’s be­cause it would leave sup­ply in the hands of deal­ers. How­ever, he said that re­mov­ing crim­i­nal penal­ties for per­sonal pos­ses­sion could be help­ful.

“De­crim­i­nal­iza­tion is im­por­tant be­cause drug users will no longer fear ap­proach­ing [health-care] re­spon­ders,” Goulão ex­plained. “It would be an im­por­tant step. Ev­ery­thing is eas­ier in an en­vi­ron­ment of de­crim­i­nal­iza­tion than it is in an en­vi­ron­ment of crim­i­nal­iza­tion. Of course, it will not solve ev­ery prob­lem. But it would con­sti­tute a suc­cess for drug users and help drug users with re­sponses.”

His trip to Van­cou­ver fol­lows a re­cent meet­ing Goulão had with Canada’s for­mer min­is­ter of health, Jane Philpott, and min­is­ter of jus­tice, Van­cou­ver’s Jody Wil­son-ray­bould. The pair trav­elled to Por­tu­gal in July.

In a brief tele­phone in­ter­view, Health Canada spokesper­son An­drew Mack­endrick said the trip was fo­cused on Por­tu­gal’s health-based ap­proach to ad­dic­tion and not the coun­try’s record with de­crim­i­nal­iza­tion. In a sim­i­lar vein, Prime Min­is­ter Justin Trudeau has re­peat­edly said the Lib­eral gov­ern­ment is not con­sid­er­ing de­crim­i­nal­iz­ing or le­gal­iz­ing hard drugs such as heroin.

That’s de­spite a grow­ing num­ber of B.C.’S top health of­fi­cials call­ing on the fed­eral gov­ern­ment to at least con­sider such a move in re­sponse to the prov­ince’s out-of-con­trol in­crease in drug-over­dose deaths.

Goulão re­peat­edly told the Straight that de­crim­i­nal­iza­tion should not hap­pen with­out a gov­ern­ment en­act­ing com­ple­men­tary re­forms to its jus­tice and health-care sys­tems.

“The re­sults that we’ve had since then [2001] are the re­sult of a set of poli­cies, not only de­crim­i­nal­iza­tion by it­self,” he said.

Asked if the answer to the fen­tanyl prob­lem could be in le­gal­iza­tion and reg­u­la­tion, Goulão paused and re­sponded “Prob­a­bly.”

“Le­gal­iza­tion and the reg­u­la­tion of mar­kets, con­trol­ling the qual­ity of the sub­stances, and mak­ing them avail­able only in ap­pro­pri­ate places, it would be pos­i­tive,” he added.

But Goulão noted le­gal­iza­tion re­mains a tough sell, even in Por­tu­gal, where “ev­ery­body agrees on the pos­i­tive ef­fects of our cur­rent poli­cies.”

He said what’s re­quired to move gov­ern­ments to­ward le­gal­iza­tion is care­ful study and ev­i­dence. For ex­am­ple, he’s closely watch­ing Colorado, where in 2014 state laws were changed to al­low recre­ational­mar­i­juana sales.

Goulão said that’s one rea­son he’s look­ing for­ward to vis­it­ing Van­cou­ver. His itin­er­ary in­cludes a tour of the city’s Down­town East­side, where one clinic of­fers heroin by pre­scrip­tion to a se­lect group of pa­tients and where an­other doc­tor is treat­ing more than 20 cases of se­vere-ad­dic­tion disor­der with hy­dro­mor­phone, a drug very sim­i­lar to heroin.

“We are fol­low­ing, very at­ten­tively, the steps that other coun­tries are tak­ing,” Goulão said. “I be­lieve that when we have the ev­i­dence of the ef­fec­tive­ness of le­gal­iza­tion, it prob­a­bly will be pos­si­ble to go in that di­rec­tion.”

Por­tu­gal’s na­tional drug co­or­di­na­tor, Dr. João Goulão, is mak­ing his first trip to B.C. as the prov­ince strug­gles with an in­crease in over­dose deaths.

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