Crisis becomes us

In reports about the 2019 BC coroners report on illicit drug toxicity events the emphasis has been on the decrease in deaths of about one-third province-wide. However the number of calls for an EMS response to an overdose have gone slightly up. And those calls are an undercount of events, as often overdoses are responded to without a 911 call.

But, fewer deaths. 981. 19 per 100,000. 5,010 since 2016.

why? how? yes, harm reduction is in effect. In December 2016 the BC Health Minister Terry Lake signed a order authorizing overdose prevention services. Of course that’s quite a euphemism: overdoses happen frequently. But someone had eyes on you and brought you back. Thousands of deaths have been prevented. Would anything be different now if they were called Death Prevention Sites?

Now, there are many such sites, except where people don’t want them, or regional health authorities won’t fund them. Yes, not having that happen is the purpose of declaring a Public Health Emergency.

Another mitigating factor is the non-opiate contamination in the mix: benzodiazepines, cannabinoids, veterinary tranquilizers… a wide range of psychoactive substances in the supply which can produce what Dr. Kendall describes as a “traumatic brain injury that will last a lifetime.” Young people, rendered psychotic by the poison sludge, wander the streets for days or weeks and die in unspeakable ways. These losses are not counted in this report.

This isn’t about fentanyl, and it’s an opioid crisis only at the moment.

The decrease is not due to everyone already being dead. There isn’t a finite pool of users; the pipeline to the coast is open and flowing.

Not Dead Is Not Enough

A brief comparison of the comments made by the province’s leading Health officials and the statement released by the minister of mental health and addictions might be helpful to illustrate where precisely the problem lies. 

The coroner’s report, Illicit Drug Toxicity Deaths, is accurately titled, but it’s an enumeration of just that: deaths, rather than catastrophic events. The situation is not actually improving; the supply is continuing to degrade. This is the part of the Coroner’s statement that I stared at intently:

“͞Collectively, we continue to urge for greater access to safe supply for those in our community who are experiencing, and struggling to live with, substance use disorder.”

and noted that it’s not “struggling with substance use” but “struggling to live with substance use.” It’s living that’s the issue here (and disorder is really subjective).

Provincial Public Health Officer Dr Bonnie Henry (who submitted a special report to the provincial legislature under the authority of the Public Health Act last March called Stopping The Harm which recommended the decriminalization of people who use drugs and therein thoughtfully provided our elected leaders with several options for doing so, all within their jurisdictional purview – the report was aggressively ignored and its recommendations were never debated in the legislature) stated:

“ And in the meantime, we need to change our approach so that people who use drugs are able to seek help without the fear of being charged criminally and with access to a pharmaceutical alternative, instead of what is clearly a toxic street-drug supply.”

And Dr Perry Kendall, who declared the emergency almost four years ago:

“We must also acknowledge that overdoses are still occurring at an equal or greater rate than ever as a result of the toxic drug supply, posing a significant public health threat that will impact a generation of British Columbians.

Lives are being saved, but saving lives alone is not nearly enough. We must now turn our attention toward implementing strategies to prevent overdoses from occurring in the first place — which must start with a legally regulated drug supply.”

Legally regulated, as if drugs were pop or lettuce or ridesharing or busking or banking or housing. OR DRUGS. Here’s the problem we seem to be encountering:

We know how to do this. Stop saying that individuals need help with their problems when our problem is a political massacre a generation in the making, driven by a century of prohibition. And rather than recognizing our collective moral imperative to address it directly, people complain that the corpses are bad for business.

Minister of Mental Health & Addictions, Judy Darcy:

“I want to extend my deepest gratitude to first responders, peers, families, health-care professionals and community workers who are dealing with the deeply emotional toll of doing everything they can to save lives and connect people to care time and time again. Our province owes you a debt we can never repay. 

“The way we act and speak can make a life-changing difference for someone who is living with addiction, to find a pathway to hope and to healing. We cannot afford to stop caring. It really will take all hands on deck to stem this terrible tide and reduce the stigma that leads to so many people using and dying alone. 

“As we look to the year ahead, we will continue to work closely with and listen to the valuable advice of our partners, including people with lived experience to save lives and build a better, more connected continuum of care options for people living with addiction.” 

Two separate issues are being avoided interchangeably here – individual struggles shouldn’t be confused with the tide of death, and the solutions are distinct. The solutions for the second thing are safe supply, decriminalizing the person, restructuring social assistance into guaranteed income, and rapidly expanding public housing.

This deathspiral was not your creation, but it’s your responsibility now.

Minister of Health, Adrian Dix

“…..”

(that is to say, he said nothing.)