In­sight gained from ’90s drug cri­sis

Vancouver Sun - - FRONT PAGE - DAN FUMANO dfu­mano@post­media.com twit­ter.com/fumano

The hu­man toll of the over­dose epi­demic cur­rently dev­as­tat­ing Van­cou­ver and B.C. can get lost in num­bers and statis­tics. But data, along with a bit of his­tory, are cru­cial if you want at least to try to un­der­stand the scope of what’s go­ing on in our city.

In the 1990s, Van­cou­ver was rocked by twin pub­lic-health crises; drug-over­dose deaths surged, while si­mul­ta­ne­ously, HIV/AIDS-re­lated deaths soared along with in­fec­tion rates among in­tra­venous drug users. Be­tween 1991 and 1993, the com­bined to­tal of B.C. deaths from HIV/ AIDS and drug over­doses more than dou­bled.

In the cri­sis’ epi­cen­tre of Van­cou­ver’s Down­town East­side, it was “a truly terrifying time to live through,” said Travis Lupick, who has spent the past six months in­ter­view­ing more than 150 Van­cou­verites about their mem­o­ries of that time.

The death tolls of over­doses and HIV/AIDS hit their com­bined peak in 1993 with a to­tal of 655 deaths across B.C. at­trib­uted to the two causes.

“That was the peak and that was considered un­con­scionably ter­ri­ble at the time,” Lupick said this week.

And, for some tragic con­text, 1993’s “un­con­scionably ter­ri­ble” tally of 655 deaths in B.C. is less than half of the pro­jected to­tal of 1,400 deaths ex­pected across the prov­ince this year from over­dose deaths alone.

The City of Van­cou­ver alone (with a pop­u­la­tion of fewer than 650,000 peo­ple) is on pace to see 400 over­dose deaths this year, av­er­ag­ing more than a death a day.

Against that grim back­drop, Lupick’s de­but book, “Fight­ing for Space: How a Group of Drug Users Trans­formed One City’s Strug­gle with Ad­dic­tion” is be­ing re­leased this month.

The deeply re­searched non-fic­tion work de­tails B.C.’s pre­vi­ous over­dose epi­demic, out of which a group of drug users and their al­lies — in­clud­ing groups such as the Van­cou­ver Area Net­work of Drug Users (VANDU) and the Port­land Ho­tel So­ci­ety (PHS) — took ac­tion to estab­lish Van­cou­ver as a pi­o­neer of progressive harm-re­duc­tion-based drug pol­icy, lead­ing the way in North Amer­ica with mea­sures like nee­dle ex­changes and su­per­vised-in­jec­tion fa­cil­i­ties.

In 1997, The Van­cou­ver Sun re­ported “the HIV epi­demic rag­ing in the heart of Van­cou­ver is now considered to be the most ram­pant in the de­vel­oped world,” and the Van­cou­ver-Rich­mond health board de­clared a pub­lic health emer­gency.

But since that time, Lupick said, “HIV in­fec­tion rates among in­tra­venous drug users have dropped to al­most noth­ing in this prov­ince.”

Van­cou­ver’s drug-over­dose deaths dropped by half, from a peak of 201 deaths in 1993 down to 67 in 2004, the year af­ter the In­site su­per­vised in­jec­tion fa­cil­ity opened, and stayed around that level for a decade.

“There were real vic­to­ries that Van­cou­ver achieved in re­sponse to that cri­sis,” Lupick said.

But while HIV deaths in B.C. have con­tin­ued to dwin­dle, over­dose deaths started creep­ing up again around 2011 be­fore spik­ing dra­mat­i­cally in the last two years and show­ing no signs of abat­ing.

Still, the resur­gence of over­doses in B.C. shouldn’t be taken as an in­dict­ment of the fail­ure of the harm-re­duc­tion poli­cies pi­o­neered in Van­cou­ver in the 1990s and 2000s, said Lupick, who has cov­ered Van­cou­ver’s new over­dose epi­demic in his day job as a re­porter for The Georgia Straight.

B.C.’s cur­rent opioid cri­sis would be far worse, he said, if not for the progressive drug poli­cies whose ori­gins his book de­scribes.

But Lupick’s not the only one who be­lieves that. Last week, B.C.’s chief coroner, Lisa La­pointe, told CBC that if B.C. didn’t have harm-re­duc­tion mea­sures like su­per­vised drug-in­jec­tion sites, she be­lieved B.C.’s death toll would be triple what it is now.

It’s worth not­ing that while In­site sees hun­dreds of thou­sands of vis­its a year from in­jec­tion drug users ev­ery year — and 6,440 over­dose in­ter­ven­tions at the fa­cil­ity, ac­cord­ing to Van­cou­ver Coastal Health — there has not been a sin­gle death.

One cru­cial thing dif­fer­en­ti­at­ing the cur­rent cri­sis from the 1990s is the emer­gence of in­cred­i­bly po­tent syn­thetic opi­oids like fen­tanyl, which the B.C. Coroners Of­fice found in 83 per cent of fa­tal, il­licit, drug over­doses last year.

Hu­mans have strug­gled for cen­turies with the ad­dic­tion and health risks of opi­oids, from opium to heroin through Oxy-Con­tin.

But fen­tanyl, far stronger than heroin or mor­phine, is “a gamechanger,” Lupick said. “An opioid ad­dic­tion was al­ways a dan­ger­ous thing. Now it’s a daily game of Rus­sian Roulette.”

In the ’90s, peo­ple died from pure heroin flood­ing the DTES. But today, Lupick said, “there’s no such thing as pure heroin” in the neigh­bour­hood, and even di­luted heroin is scarce. It’s all syn­thet­ics.

Driven by economies of scale and mar­ket forces, drug traf­fick­ers have em­braced fen­tanyl to in­crease their profit mar­gins.

“But that’s al­ways the way it’s been un­der pro­hi­bi­tion,” Lupick said. “There’s a rea­son Al Capone made his money off whisky and not beer. Whisky was easier to smug­gle be­cause the po­tency was higher.”

Lupick cites a con­cept called “the Iron Law of Pro­hi­bi­tion.” Amer­i­can drug-re­former Richard Cowan coined the term dur­ing the 1980s U.S. crack-co­caine epi­demic, say­ing that “the harder the en­force­ment, the harder the drugs.”

Ac­cord­ing to U.S. Drug En­force­ment Agency data, A kilo­gram of heroin bought from Colom­bia for US$6,000 can be sold whole­sale for around $80,000, the New York Times re­ported last year, whereas a kilo­gram of fen­tanyl pur­chased from China for less than $5,000 can be cut and sold for a profit of more than $1.5 mil­lion.

“The an­swer is en­tirely eco­nomic .... The profit mar­gin is sig­nif­i­cant enough that it makes the loss (of cus­tomers through over­dose deaths) ac­cept­able,” Lupick said. “Fen­tanyl is a very, very cyn­i­cal re­sponse to mar­ket forces.”

To co­in­cide with Lupick’s book’s re­lease, the au­thor will ap­pear in a panel dis­cus­sion Thurs­day at 7 p.m. at Beau­mont Stu­dios at 316 West 5th Ave, along with rep­re­sen­ta­tives from PHS and VANDU, as well as B.C. deputy provin­cial health of­fi­cer Bon­nie Henry and fed­eral NDP health critic Don Davies, MLA for Van­cou­ver Kingsway.

In a email Tues­day, Davies said: “It is crit­i­cal to treat ad­dic­tion as a health is­sue, not a crim­i­nal or moral one. Lives de­pend on us mak­ing this tran­si­tion.

“Travis Lupick has done so much to bring rea­son, com­pas­sion and courage to an is­sue too long shrouded in stigma,” Davies said. “I’m hon­oured to share a stage with him and ex­plore how we can turn tragedy into hope.”


Travis Lupick has writ­ten a book on Van­cou­ver’s over­dose epi­demic in the 1990s and how it led to Van­cou­ver be­com­ing a North Amer­i­can leader in harm-re­duc­tion-based drug pol­icy.

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