Our approach to opioid addiction isn’t working
“Yes, and how many deaths will it take till he knows, That too many people have died?” — Bob Dylan, Blowin’ in the Wind
Beginning in 1993, Justice Horace Krever led a Royal Commission of Inquiry into the tainted-blood scandal in Canada. Inquiries were held in other countries. One of the key questions was why people with hemophilia were forced to continue to inject blood products that were not screened for HIV, when newer and safer products were already available.
Criminal charges were laid in a number of settings. The Canadian Red Cross pleaded guilty to the crime of distributing a contaminated drug and made a large donation in exchange for six criminal charges being dropped.
Edward Hervé, the French minister of health during the scandal, was convicted of manslaughter. Two top officials in the French blood system were also convicted and sentenced to prison.
Why these prosecutions? Because these people and organizations knowingly allowed people to continue to inject potentially lethal substances when they had the means to stop it. That sounds like a crime, doesn’t it?
Let’s turn from blood products to opioids. The illicit drug supply accessed by people with opioid addiction has always been unsafe. Because of, and only because of criminalization, peoples’ lives are at risk from injecting unknown doses of contaminated street opioids in unsafe conditions.
While people from all walks of life are affected, it’s always the very vulnerable who suffer most. In a system that fails to provide safety, they are left to fend for themselves in dangerous times, while gangs and cartels that supply black-market drugs are enriched and emboldened to wreak violence on people and communities around the world.
Fast-forward to 2017. As if even possible, it’s infinitely worse now. The illicit drug supply is now catastrophically and irrevocably lethal. The addition of fentanyl, carfentanil and their analogs — many of which are thousands of times more potent than heroin and morphine — has transformed each illicit opioid injection from a risky activity into Russian roulette. If this seems unfamiliar to you, come to Vancouver and listen to the wail of ambulance sirens pierce the air every night.
On Friday in Vancouver, an international panel of experts from Switzerland, Holland, Germany, Denmark and the U.K. are presenting the experiences in their countries where pharmaceutical heroin is being prescribed successfully to people most adversely affected by opioid addiction.
In Portugal, possession of drugs from marijuana to heroin has been decriminalized for 16 years. As far as we know, in none of these European countries has the sky fallen in.
In Portugal, the overdose death rate is about three per million; in Canada, it’s more than 20 times higher. In Germany, there are 24 safe-consumption sites; in Canada, there are two. In Switzerland, there are 23 clinics offering medically prescribed heroin to those who require it; in Canada, there is one.
What makes these differences even more egregious? Because, to paraphrase our prime minister, “it’s 2017.” Canada should know better.
In the tainted-blood scandal, individuals were convicted of crimes for knowingly allowing people to continue to inject potentially lethal substances when they could have saved them. It was a crime.
But think for a moment. Are we now not all guilty of the same thing? Whether we are politicians, decision-makers, health professionals, legislators, researchers or members of the public — are we all not culpable in the overdose crisis? We have overwhelming evidence on what to do and yet we fail to act. What will the decision-makers of today say if called to stand before a future Royal Commission about opioids?
Dylan prompts us to ask how many deaths it will take until we know. Are we all brave enough to admit that what we are doing isn’t working and that we must change?
Can we not summon within ourselves and our society the compassion, the courage, the wisdom and the will to do the right thing — right now? We believe we can. Let us all make certain the answer doesn’t stay blowin’ in the wind.
Dr. Eugenia Oviedo-Joekes and Dr. Martin T. Schechter, faculty members in the School of Population and Public Health at the U.B.C., were lead investigators of the NAOMI and SALOME clinical trials of medically prescribed heroin and hydromorphone.