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There Is A Solution To Canada's Fentanyl Overdose Crisis: End Drug Prohibition

"How can we possibly ever guarantee people's safety if they don't know what they're taking?"

Imagine you lived in a world where the alcohol content of your drink varied dramatically, and might be laced with poison. You could die and, in fact, you might have if you were around during the Prohibition Era when there was no regulation to keep alcohol safe.

In the U.S., PBS reported that on average "1,000 Americans died every year during the Prohibition from the effects of drinking tainted liquor." Even more were left blind or paralyzed.

Yet people kept drinking anyway.

That can be compared with Canada's state of affairs when it comes to drugs, both opioids people take on purpose and cocaine or MDMA unknowingly cut with fentanyl, which is up to 100 times more powerful than heroin, or carfentanil, a further 100 times stronger and fatal at a dose the size of a grain of salt.

Yet people keep doing drugs anyway.

"How can we possibly ever guarantee people's safety if they don't know what they're taking?"

— Katrina Pacey, executive director of Vancouver's Pivot Legal Society.

"This is a moment where we're coming up against the reality of what prohibition creates in terms of danger," said Katrina Pacey, executive director of Vancouver's Pivot Legal Society.

"How can we possibly ever guarantee people's safety if they don't know what they're taking? That's the reality when you have a criminalized context with people using drugs. You're going to continue to have them facing enormous harm because they just aren't going to be able to say for sure what they're consuming."

Canadians are dying in shocking numbers, prompting last week's National Day of Action on the Overdose Crisis with demonstrations across Canada on Feb. 21. Three days later there was also a conference call between Canadian mayors, Health Minister Jane Philpott and Public Safety Minister Ralph Goodale about next steps.

Last year there were 914 overdose deaths in B.C., two-thirds linked to fentanyl, setting a horrific record. That number included 142 deaths last December, 11 in one night. It was the worst month ever and prompted the province to set up emergency overdose prevention sites. Another 116 overdose deaths happened in January.

While the West Coast is the epicenter, drug users are dying across the country. There were also 343 fentanyl and carfentanil-related deaths in Alberta last year, and while Ontario numbers have not yet been released, there were 253 overdose deaths in Toronto alone in 2015.

"This is what happens when people are accessing substances through an illicit unregulated market," Pacey says. "It's a recipe for complete disaster."

Canada's harm-reduction approach began in the 1990s after Vancouver went through a similar epidemic of overdoses when ultra-pure "China White" heroin arrived.

"That was the last time there was a public health emergency declared and it was in response to both very grievous and extreme HIV rates that were taking place in the [Downtown Eastside] but also the overdose rates," Pacey says.

Last year there were 914 overdose deaths in B.C., two-thirds linked to fentanyl, setting a horrific record.

"A whole bunch of important things happened after that time. There was an increase in needle distribution programs and then eventually, as a result of a lot of important grassroots organizing, there was the first sanctioned supervised injection site in 2003."

But the injection sites, which are now coming to Toronto, only serve a certain type of user. Others may take pills, use in their homes or only use on occasion. Increasingly, non-opioid drugs are tainted, whether on purpose to create addiction (and therefore demand) or by mistake from cross-contamination.

"People are using substances," Pacey says, "and they want to know what they're taking and they want to be able to do so safely."

While there's still no comprehensive national strategy to address the epidemic, efforts are being made.

Most notable is prescription heroin, which became available to 150 people last fall at Vancouver's Crosstown Clinic following clinical trials. The cost of treating each addict is $27,000 annually but the program saves money in the grand scheme by keeping users healthy and out of the criminal justice system.

Sam Sullivan, a Liberal MLA for Vancouver - False Creek, was the city's mayor from 2005 to 2008 and "helped raise money and get that program going," he tells HuffPost Canada. During his term, Vancouver ran the North American Opiate Medication Initiative (NAOMI) followed by the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME).

"The trials happened, journal articles were written saying how successful it was proven to be as a valid and very effective treatment for addiction and yet... doctors aren't prescribing," Sullivan says. "I thought 'OK good, we solved that problem. Let's get on to the next one.' Yet no one is taking all this research and actually acting on it."

Sullivan adds that B.C. history has already proven the effectiveness of this approach.

"I just go back to the prohibition on alcohol. The reason you wouldn't find a lot of statistics in British Columbia for deaths from alcohol is because we had a very active medical alcohol problem here. So people could get prescriptions for alcohol. I believe in one year alone they wrote around 300,000 prescriptions in a population of 500,000."

"I think [prohibition] has been a tremendous failure. We need to rethink the way we deal with drugs and laws. We should have legalization with very strict regulations."

— Sam Sullivan, Vancouver MLA and former mayor.

Prescription heroin is also available in Germany, the Netherlands and Switzerland. Liberal MP for Vancouver Centre Hedy Fry travelled with Swiss police in 1999 where she saw them offer users medical help rather than arrest.

"That person would register as an addict and would then, as a registered addict, go to a clinic to get their drugs. The state paid for opiates," she told the Georgia Straight. "I said, 'People in my part of the world will say that you are enabling.' And he said, 'No, what we are doing is cutting off organized crime. So people don't have to buy adulterated stuff; they don't have to wallow in the dirt; and they don't have to mug people and steal money to buy their stuff.'"

"This is the discourse that we must have now," Fry added. "Nobody is ramming anything down anybody’s throats. I’m not saying, 'Let's legalize.' But I am saying, 'It's time we discussed this, openly and publicly.'"

Sullivan, however, is saying let's legalize.

"I think [prohibition] has been a tremendous failure. We need to rethink the way we deal with drugs and laws. We should have legalization with very strict regulations," he says.

"We've got to make it so people don't die. How do you do that? In the end you have to be flexible. But when you make drugs illegal you take all that flexibility out of it. You can't respond in normal ways. It makes it completely impossible. The only people who get to regulate at that point are criminals."

NDP health critic Don Davies, MP for Vancouver Kingsway, echoes his fellow politicians.

"The evidence is clear that criminalizing addiction...can drive addiction underground, increase crime, spread disease and cause avoidable injury and death."

— NDP health critic Don Davies

"The evidence is clear that criminalizing addiction has a number of harmful consequences. It can drive addiction underground, increase crime, spread disease and cause avoidable injury and death," he tells HuffPost Canada. "While drug prohibition does express a social aversion to drug use – a positive message – it also stigmatizes those suffering from a recognized mental health disorder."

Citing the NAOMI and SALOME studies, Davies says he'd like to expand prescription heroin programs for "patients who suffer from substance-use disorder and for whom all other treatments have proven unsuccessful."

"This would ensure safer consumption under the supervision of health professionals and avoid the dangerous use of street drugs of unknown type and strength. It would also save lives," he says, adding he'd also like to see more emergency overdose prevention sites, expanded detox and addiction treatment and more research into non-opioid pain management therapies.

Prime Minister Justin Trudeau was asked about prohibition during a January visit to Vancouver where he met with front-line workers in the Downtown Eastside, including Coco Culbertson who works for the Portland Hotel Society, which runs the Insite supervised-injection facility.

"Everyone brought up full legalization," Culbertson told the Georgia Straight. "His reaction was that it made common sense, but that creating a policy that reflects common sense, especially around drug-policy reform, is far more complicated than he anticipated."

This week Trudeau reiterated that stance, telling press during a Vancouver Island visit that "We are not planning on including any other illicit substances in the move towards legalizing and controlling and regulating." The next day he went to the Downtown Eastside and said that harm reduction is "a pillar of our comprehensive drug strategy" and he will be expanding access to the opioid antidote naloxone and streamlining the process for safe injection sites.

British Columbians, however, would like to see the prime minister reconsider his anti-legalization stance.

A survey released in December mental health and addiction non-profit InnerChange Foundation found that two-thirds of the province is "completely willing" to consider legalizing hard drugs, and one-quarter of those are already in favour of legalization. Another 17 per cent are interested in learning more about potential risks and benefits.

A survey found two-thirds of the province is "completely willing" to consider legalizing hard drugs.

"They don't like what they're seeing in terms of the deaths," InnerChange Foundation's Laura Tate told the CBC, "and they're wanting to send a message to decision makers that they're open to a range of options that they may not have been open to in the past."

The crisis is getting worse, and moving east as Toronto mayor John Tory addressed in January.

"It is not acceptable in our city, it is not acceptable in our country that people who in many cases are suffering from a form of mental illness through addiction are dying in a lonely fashion and dying without us doing everything we can when we know there are things we can do to prevent those deaths,'' he told the press after a meeting of the new Toronto Overdose Early Warning and Alert Partnership.

Tory called for increased access to the drug naloxone, which can be used like an EpiPen to prevent opioid overdoses, and is hoping three supervised injection sites will be operating before summer.

Dr. Barbara Yaffe, Toronto's acting medical officer of health, added that one reason for the deaths is an unintended consequence of current drug laws because "bystanders are often reluctant to call 911 because they fear legal repercussions, so paramedics may not arrive in time to save the person who is overdosing."

On Feb. 23, Ontario Provincial Police concluded an 18-month investigation, dubbed Project Silkstone, by seizing 11,500 pills containing fentanyl, as well as other drugs and guns, and charging 18 residents of Ontario and Quebec. Last week, Ottawa police landed another huge fentanyl bust.

"We seized thousands of pills today, so the potential there is for mass casualties,” Ottawa Staff Sgt. Rick Carey told the Ottawa Sun. "We're trying to make sure this doesn’t hit the street, because it's being accessed by youth who aren't aware of what’s going on. People have no idea what it is they're ingesting."

"But it’s not going to stop the issue," he added. "This is just one [bust]."

Pacey argues the only real solution is to end the "futile" war on drugs with decriminalization and regulation.

"When are we going to wake up to the harms created by Canada's drug laws and actually have a conversation that lets go of the hopes and dreams of what prohibition was supposed to do [and] talk about how we regulate drugs in a way that is going to better protect the health of people that are using them?"

Sullivan agrees, arguing that if we had already legalized hard drugs, we could have saved 914 lives in his province alone.

"It would be similar to the issue of bad alcohol that people used to die from during Prohibition," he says. "You wouldn't have people dying of this if there was a strictly regulated market."

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