Jordan: Welcome to week four of most of the world working from home. And before we get to today’s topic, because I’m recording this for you on a Sunday, that could be a Tuesday or it could be a Friday, I wanted us to talk a little bit about the passing of time or not. Claire, do you realize that this Thursday we’ll mark one month since any of us on this team even set foot in the office?
Claire: It’s been a long month. And also it felt really short for some reason, if that makes sense. Cause I, I did not think that we would be doing this for a month when we first started. I thought a couple of weeks tops and now to think that we could be doing this for several more months is just wild to me.
Jordan: Well, what’s been the biggest shift for you in terms of how you relate to time? Is it a not knowing what day it is? Or what week it is or everything just bleeding together? Cause there are a lot for me, but one stands out.
Claire: Yeah, all of that, but I think the biggest one has been just not having anywhere to go. I think that’s really messed up my sense of time because I’m no longer scheduling anything or thinking about places I have to be, and you know what time I have to leave my house in order to not be late. That’s a huge part of our daily routines and without it, my whole schedule is really out of whack.
Jordan: You know, for me, the biggest thing has been on a macro level, the week that we all left the office, I was leaving around 5:30 and then walking home around 5:45 and I remember being so grateful that winter was ending and it was still light out at like 5:45 that was huge.
Claire: I love when that happens.
Jordan: Yeah, and then yesterday, after almost a month of this, it was just after 8:00 and the kid was in bed and I was out in the backyard and I noticed that it was still light out and that’s when it kind of hit me that like, a whole changing of the season had slipped past while I was in my basement basically.
Claire: I mean, I hope that we don’t have another whole changing of seasons while this is happening, but I mean, since there is literally no end in sight, we’ve been doing this for a month and we’re going to continue doing it. We’re going to continue to help people find their way in this new normal. Keep people informed about what’s happening with this across the country, and also share stories of ways that this pandemic could change society.
Jordan: And those things won’t always be positive. But today at least there is a promising development concerning the last major health crisis that we were talking about before this one. But first, Claire, the straight news. What do people need to know about where we are as we start our new week?
Claire: Well, today is actually the first day that Canadians who have lost their jobs because of COVID-19 can apply for the Canadian Emergency Response Benefit. It offers up to $2,000 a month. Here’s the thing though, not everyone can apply today. You can only apply today if your birthday is in January, February, or March. So if your birthday is in the three months after that, you can apply on Tuesday, the three months after that on Wednesday, and the last three months of the year on Thursday. Friday is when the program becomes open for anyone to apply. I know it’s confusing. All the details are online at canada.ca. Prime Minister Justin Trudeau says he’s confident that the country will be able to sort out this ban put in place by the US on protective equipment being exported to Canada. Right now, Canada’s just trying to convince the US that both countries need each other in this fight, and it doesn’t help anyone to put any sort of ban in place. In Saskatchewan, health officials are trying to figure out a way to reuse N95 masks. They wouldn’t have to have trials first, of course, and those likely would not happen directly in hospitals. They would likely take place in a controlled setting like a lab. And in Yukon, the government is providing free cell phones to women in vulnerable situations during this pandemic. They’re handing out 325 phones with a free four month plan. And this is because of a rise in domestic violence and also an expected shortage of staff at women’s shelters. As of Sunday evening, over 15,000 cases of COVID-19 in Canada with 297 deaths.
Jordan: Some of the most heartbreaking stories that we’ve told on this podcast have been about the epidemic that came before COVID-19, though it hasn’t ended either. The opioid crisis kills thousands of Canadians a year. But despite that, it is often been a real fight on the part of advocates to get our governments to try new things that would help save the lives of users. Even when those new things have already worked in other places, there are the usual political motives behind this, the optics and the party bases and law and order promises that need to be captive, but a lot of it is also just felt like stagnation. This is how we fight illegal drugs because the drugs are illegal and this is what we do. Repeat. But then, along came a virus that doesn’t discriminate between a poor user on Vancouver’s Downtown East side and the officer who hassles him or that officer’s family that he goes home to. That’s just an example. But the spread of COVID-19 has made it clear that our society is now only going to be as healthy as the poorest among us. And so at least one province has started to try something new when it comes to the opioid crisis. And if it works, who knows what could come next. I’m Jordan Heath Rawlings, and this is The Big Story. Justin Ling is a writer and reporter based in Montreal. He’s in to talk to us primarily, I guess, about the West Coast though today. Hi, Justin.
Justin: Hey. How’s it going?
Jordan: It’s going all right. We always start with how well are you coping?
Justin: I’m coping pretty well. We literally just moved houses on March 1st and we’ve unpacked fully and I feel settled in, so it could be much worse.
Jordan: Excellent. It is a good time to have a new place. You’ve done a lot of reporting on this topic and, and why don’t you start kind of level-setting for us and tell me about how the normal life of a drug user and the opioid crisis would put them at increased risk given our situation right now.
Justin: Right. So, I mean, you know, there’s already an epidemic right now in Canada, in North America and other parts of the world in terms of mostly opioid use, but not exclusively. There is a massive problem in terms of the supply of heroin and other opioids as well as methamphetamines, that is causing a huge surge in overdoses and other illnesses and deaths related to drug use. That’s mostly not because there is a serious increase in drug use. But it’s because there’s a change in what drugs are available on the market, and sort of what is being marketed as certain drugs. So, you know, users who have been using say heroin since the 1990s or the early two thousands are suddenly using heroin that’s being laced with fentanyl or Carafentanyl. Or some users have fully switched to things like fentanyl, which just pose a massive risk of overdose and potentially death. That’s the status quo. When COVID-19 began hitting, it hit these communities disproportionately hard. You’re dealing with people who might already be immunocompromised. You’re dealing with people who might not have good support systems anyway. You’re dealing with people who might be experiencing some of the symptoms of COVID-19 in their day to day life, potentially through a symptoms of withdrawal or just symptoms of drug use, and they might not even know they have COVID-19 until it’s too late. So these two epidemics are crashing together in a really dangerous way.
Jordan: And what happens then when health systems, which are trying to prepare for an oncoming crisis, start to kind of shrink into one another. What’s happening right now to the resources that drug users would normally have access to? I’m thinking of, you know, safe injection sites and street clinics and that kind of thing.
Justin: Well, you know, of course when you implement stay at home orders or when you shut down a lot of businesses or other resources, when you ask people to stay home, avoid going to work, avoid, you know, going even to the grocery store, you know, that is going to have a massive impact. Some safe consumption sites are trying to stay open. But a lot of them are dealing with staff shortages. A lot of them have had to close or reduce their hours, and all of them have tried to implement social distancing. So their capacity is significantly lower. Where maybe you were able to have 12 people inside a site at any given time, now you can only have six because you want people’s space to part of a two meters. So there’s a capacity issue here. And for people who don’t feel safe or comfortable going outside, it means they’re going back to the old days of just using drugs indoors. And nothing is more dangerous than that. If somebody overdoses, they’re overdosing alone. And we know that if people don’t get access to the overdose reversal drug, Naloxone, and if they don’t get oxygen pretty quickly, they could die. And that is a real, real pernicious risk right now. But there’s also all these little knock on effects that I think people wouldn’t even think about. When someone overdoses one of the– Naloxone is very helpful. This has become kind of well known in recent years, but a lot of overdose victims require oxygen because there’s a lack of oxygen to the brain when that overdose happens, and paramedics are not getting good guidance about whether or not to use oxygen or you know, support staff are not getting that direction. Using oxygen tanks or portable oxygen ventilators, can be really dangerous in terms of spreading viruses. They can cause, you know, saliva to be kind of splatter all over around, and it puts the first responder at particular risk. So, you know, these are really, really difficult, difficult questions to deal with, and there’s no good answer for it.
Jordan: So what are some of the suggestions. That have come out of trying to mitigate these risks?
Justin: Well, the BC government put out some recommendations that I think were really plainly worded, and I know that other health systems across North America have kind of issued similar sort of, you know, nonjudgmental recommendations, basically saying, listen, if you’re going to use heroin anyway, try to do it with a friend. Invite a buddy over, you know, keep two meters apart, but do it together so you can keep an eye on each other. So if one of you starts overdosing, the other can kind of spring into action and administer Naloxone. You know, they’re saying things like, you know, just be cautious, be aware if you can switch to a less dangerous alternative, do it. But you know, the reality is those sorts of recommendations can only go so far. If people are seriously addicted to these drugs, then, you know, they might not have a lot of other alternatives. The symptoms of withdrawal can literally be fatal. If you are sick on top of the withdrawal symptoms, it can be very hard on your heart or other parts of your body and it can kill you. So, you know, it’s not as though it’s as simple as saying, okay, I’m going to stop doing heroin tomorrow and I’ll be fine next week. It is not that simple. So what some jurisdictions have been looking at for a while in which BC has finally sort of pulled the trigger on just in the past a week or so, is administering a safe supply, allowing doctors to prescribe alternative opioids, or alternative treatments to drug users, in a much more liberal fashion than they were doing before. So they required to getting an exemption from the Federal Controlled Drug and Substances Act. And it allows doctors to say, you know, you’re a heroin user. Why don’t you try this oral methadone pill every day as an alternative? It’s safe. It’s reliable. The chances of overdosing are incredibly low. And it provides some of the same, you know, responses as heroin might, but you know, what’s in the drug you’re taking. This is something that a lot of drug user advocates have been talking about for decades at this point, but it took this crisis for it to finally start getting out the door.
Jordan: Tell me how that would work on the ground. So a user would find a doctor who’s willing to prescribe, or would that be at a safe injection site or a clinic and just they’d get the drugs there?
Justin: Well, so this has been done on a very small scale across the country already. Specific groups and doctors and clinics have been administering alternatives. Sometimes that’s called opioid agonist therapy. So providing alternatives to the opioid that these drug users are used to, and then sort of monitoring it in a controlled fashion. And I think a lot of people think this is sort of out there and scary, but we’ve actually been doing this and in one form or another for many decades through methadone. You know, methadone is a very kind of commonly prescribed opioid agonist. And it’s not perfect. You know, it has been successful for a lot of people and getting them off opioids and heroin and other drugs. But it is a really imperfect solution. Withdrawal from methadone can, in some cases be worse than withdrawal from heroin. We have regulated it and tightened control of it’s so drastically that a lot of people, you know, their entire life is just maintenance of their methadone addiction, essentially. They have to go to a pharmacy every morning, be given a, you know, a couple of pills of methadone. The, the pharmacist has to watch them take it, and then they go back home and come back and do the whole thing the next day. This therapy, this new set of guidelines from British Columbia aims to let doctors prescribe alternatives, other versions of methadone, oral morphine or others, in a much more sort of sensible common sense, functional way. The new guidelines actually say tha pharmacies can actually deliver these drugs to the user’s doorsteps, which is, you know, I think already a huge step forward. It would allow these drug users to get jobs in a way that they couldn’t, if they had to report to a pharmacy every morning to get their methadone. And some of these alternatives are just much better tolerated than methadone. They’re easier on the system, the withdrawal is not as severe. So this is a big step forward. This is really significant. And I think it really could be life changing in a lot of instances.
Jordan: Have you talked to advocates who work with users in the community? How big do they think this is, and why it took this for it to happen?
Justin: Yeah. So I had a good chat with Garth Mullins. He’s a drug user advocate, a former user himself, and he hosts the Crackdown Podcast, which looks at drug use policy, especially from the lens of those who are either former users or current users. And he’s optimistic about it that, you know, he’s happy that this step has been taken, but he says it’s, you know, it’s really not enough and it’s coming so late.
Garth: First of all, it’s bittersweet. It’s like, why did we have to wait so ******* long? So many thousand people dead, before making a move like this.
Justin: So, you know, it’s a mix of sort of frustration and optimism and relief.
Jordan: Why did this take a pandemic to come about? Has anybody spoken to that or given us an idea of, if this is something that’s been around for years, why we’re trying to now?
Justin: Yeah. I mean, I think the reality is, is that there’s just a real reluctance from governments to move forward on any of these sort of measures. You know, Garth talks about this a fair bit and he kind of says, you know, listen, that, you know, they don’t really see us as human beings.
Garth: They’re worried about us as disease vectors. So that’s why. That’s why the movement happened. Not because they’re worried about us dying, they’re worried about them dying.
Justin: You know, which is not the way we deal with other public health crises. Right? Even just look at the response to COVID-19. We’re not dealing with people who catch this virus as, you know, being a burden on our public health system. We’re not, you know, sort of humming and hawing and, you know, racking our brains and wringing our hands about how maybe we can help these people out. We’re responding rapidly and quickly to a pandemic. The speed of response to the opioid epidemic is just night and day. Governments have sort of fretted and worried, you know, what happens if we start giving, you know, people heroin? You know, and this is a real kind of solution that has been on the table for a long time. Just prescribe people heroin. If people are dying from heroin, they’re going to buy anyway because it’s laced with fentanyl or whatever else, why not just give them heroin? If they’re gonna use it anyway, right? Why not just give them the drug they’re going to use, and so you can ensure that the quality is consistent, that it’s not laced with other drugs, that it won’t kill them. Right? Countries have done this. Switzerland has done this. Portugal has decriminalized drugs, so people can kind of rely on their supply. And the numbers are very heartening. They’re encouraging, it seems to work. But governments here are just so reluctant because of the stigma that has been wrapped around drug use and certain drugs in particular. And you know, we’re not seeing good outcomes from this. Everything we’ve tried, which has mostly been criminalization, has not worked yet. We’ve seem completely allergic to trying something different. And I think people like Garth and a lot of other drug advocates that I’ve spoken to over the years have just said, listen, we need to start moving on this. People are dying by the thousands. There’s tens of thousands dead in Canada alone.
Garth: But we didn’t need to be here. You know, we could have made it so there was no overdose situation while a pandemic hit. You know, we could have worked on safe supply years and years ago.
Justin: How is it that governments are so slow in acting here? And I think, you know, the fact that it took this pandemic for even British Columbia, arguably the most progressive government in North America on these things, it took a COVID-19 for them to act. I think it sort of really underlines, you know, just how easy these changes could be, but how reluctant governments have been to do them.
Jordan: Has there been any reaction, either federally or in other provinces to the move BC has made? Any sense that other provinces might try to follow suit or try something different of their own?
Justin: On the federal level, you know, the federal government very quietly made these things possible over the last couple of years. They’ve been slowly changing the regulations, reducing the red tape and the regulatory burden that would allow provinces and cities to do exactly that sort of thing. But they haven’t really encouraged it, right? They’ve made it possible if jurisdictions want to do it, but they haven’t really taken leadership on this front. So it’s sort of a mixed bag there. I don’t think you’re going to see the federal government start pushing for more expanded access to opioids for drug users. But at the very least, they’ve gotten out of the way. So the jurisdictions who want to do this can. But you know, if you’re going to start feeling optimistic about governments actually taking action here, there’s so many cases of government actually going backwards. Throughout the United States, President Donald Trump and as Attorney General William Barr have made it harder for safe consumption sites, which is really the base minimum you can do to reduce overdoses. They’ve made it harder for safe consumption sites to open, and they’ve threatened criminal penalty for those who try to open them. Some groups have tried to fight that, but you’re really seeing a mixed bag of success. In Canada Premier Jason Kenney in Alberta has sort of sworn to try to shut down some overdose prevention sites. So, you know, it’s not really heartening, the direction we’re going. We’ve dealt with this for so many decades. We’ve already gone through waves of overdose crises, and yet governments still seems so convinced that they can police their way out of this problem, or that this time, if there’s more money for addiction clinics, that will solve everything, that will suddenly unlock the key to addiction. And I think it’s a fool’s errand. And I think governments know this, they just don’t want to spend political capital on drug users. You know, that is the baseline thing here. The science, the evidence tells us that opioid agonist therapy is safe consumption sites and handful of other solutions around addressing safe supply, save lives. There are peer reviewed studies about this that are very convincing, that basically are unanimous, that these measures work. And yet governments have been putting their head in the sand and pretending like they don’t exist.
Jordan: All that stuff is just so frustrating, but I do want to get back to BC because Lord knows we could use some positive steps right now. So if this shows the results that it has in other places in the world, what comes next if is leading the way on this? When you talk to people like Garth, you know, this is a big step. What’s the next step?
Justin: So, you know, this allows for opioid alternatives or opioids that are not heroin or fentanyl to be prescribed to patients. You know, what would be the really progressive and sensible next step, I think, would be to just give up on the idea that we can ever really restrict the supply of heroin or fentanyl. Governments have been trying for a century to crack down on the supply of illicit drugs. And you know what? Things, drugs are more readily available than they ever were. We will never improve interdiction and policing to the point where we’re going to stop people from getting the drugs they want. We should abandon that idea. If you think the police will solve this problem, they’re not going to. The police can do a great many things here in terms of going after violent criminal gangs that profit off of the drug industry. But, you know, one of the best things we can do, both for public health, both for public safety, and to go after criminal gangs is just to start figuring out ways we can get some of these drugs to people in a sensible way. There have been conversations in Mexico about growing opium poppies, and cultivating, you know, opioids or heroin, for basically clinical use, like what we’re talking about in British Columbia right now. You know, it’s really high time we figure out how to plug those two things together where we can cut out the cartels and the drug dealers and the criminal gangs and start prescribing people heroin or opioids if they are addicted. You know, I think the measures in BC are a step in that direction. But we’re not there yet. We’re still trying to give them pharmaceuticals that, you know, we hope will be a good replacement for heroin and fentanyl, but some drug users, I’m sorry, are just going to keep using heroin. So to that end, what are you going to do about that? Are you gonna let them die? Are you going to just keep reviving them as they overdose because there’s fentanyl in their supply that they don’t know about? Or are you gonna start figuring out a way where you can provide them with, you know, the heroin they’re gonna use anyway, in a sensible way that maybe supports farmers who otherwise turn to a life or– turn to supplying the cartels in Mexico. That cut out a lot of those gangs. That actually, you know, let doctors have some oversight, about how users are using those drugs. This requires sort of abandoning everything we think we know about, you know, policing and drug addiction. But, you know, these are the things that seem to work. And I think British Columbia is getting there. We’re still a couple miles away, if not tens of miles away. You know, but I think we’re slowly getting there. And I think you’ve seen a seismic shift in terms of how people talk about these issues now. You have health authorities in British Columbia and Ontario talking openly about drug decriminalization as a necessary next step. The prime minister is being asked about it quite often. He’s still, you know, basically says it’s not on the table. But you’re hearing, you know, people talk about this openly. Former Health Minister Jane Philpott talks openly about probably the need to move to drug decriminalization. So I think you’re seeing such a huge shift in the way we talk about these things, that it’s no longer inconceivable that we could see some form of decriminalization or legalized supply of some of these drugs, in the next 5 or 10 years.
Jordan: Given all that then, is it safe to say it would be difficult for BC to put this genie back in the bottle, when we eventually do conquer the pandemic? Or, along with a host of actions that governments across the country have taken, is it something that expires when the current emergency does?
Justin: I don’t think you put the genie back in the bottle. Cause I think you’re gonna start seeing positive outcomes from this, right? And you know, these are the sorts of things we’ve been building to for many years. And I don’t think we’re going to want to put it back in the bottle. I don’t think people are going to see negative outcomes from giving, you know, heroin users a more, you know, steady and safe supply of some of the opioids they use. I think if anything, you’re going to see fewer people overdosing on the streets. You’re going to see more of these people getting into the workforce. And you know, getting back into being, you know, contributing members of the economy. I think you’re going to see people who, you know, who no longer are, you know, waiting in line up at the pharmacy for methadone. I think you’re going to see just a general improvement of a lot of these people’s lives. And I think that for people might be the sort of key that unlocks the reality that this is the solution. Not arresting them, you know, not trying to force them into addiction counselling that, you know, is often ineffective. You know, I think, a suite of solutions that really let people either get off the drugs they don’t want to be on anymore, let people get onto the safe supply that’s not causing overdoses, or letting them use the drugs they want to use, but in a sensible, you know, more regimented way. I think when people see that that’s working, you know, they’re going to come around to it. And alternatively, some people might not. But I don’t think they’re going to see things get worse. And I think as long as things are not getting worse, you have a lot of political capital to keep moving forward, even if it’s really slow and steady.
Jordan: Well you obviously wish it didn’t come from such an awful situation. But it’s good that something has finally moved us down this road.
Justin: Yeah. And, you know, I think five years ago, I don’t think I would have assumed that I would have been this sort of convinced that legalization, decriminalization, this sort of safe supply mechanism would be the way to go. But, you know, I’ve come around to this from reading the literature, from talking to drug users, from talking to doctors, from talking to epidemiologists. And I’m convinced and you know, I have not seen or read anything, spoken to anyone that has disabused me of the notion that this is the way to go. If anything, I’ve just become more convinced the, you know, the more I walk through the downtown East side, the more I talk to people who have been using heroin for 20 some-odd years, and who are finding that, you know, they were on death store but are now kind of coming around because they’ve managed to find, you know, a steady supply of heroin or because they’ve moved on to oral opiates. So I think, you know, I’m a heartened that, you know, the solution, you know, might be in front of us.
Jordan: I guess we’ll see when this is all over. Thanks so much for taking the time, Justin.
Justin: Thanks Jordan.
Jordan: Justin Ling has been covering the opioid crisis for a while. We expect he will stay on it as this develops. That was The Big Story. If you would like more head to thebigstorypodcast.ca, you can find us there. You can also find us on Twitter. We love to talk at @thebigstoryfpn and of course, we are in all your podcast players, whichever one you want, leave us a rating, leave us a review. We love to read them. And as you know by now, we want to hear from you, too. So if you want to send us a voice memo or a video clip, you can record it on your phone and email it to firstname.lastname@example.org we received a bunch of them over the weekend. So here’s some of it. Thanks for listening. I’m Jordan. Heath Rawlings we’ll talk tomorrow.
Clips: How we’re sending isolation, well I guess making any room possible an office during the week, and then enjoying as much time as possible actually cooking dinner and eating together and drinking a lot of wine. I’m gonna sit down. And I am going to work on my taxes since I have nothing better to do. I’ll do it for the whole family, about ready to try for my daughter. Just going to go download what CRE has on her, since I never seem to be able to get all the documents from her directly. Hey Jordan, today I was just baking cookies with my kids and just broke my cookies. Thanks. I am trying to renew my space, which I am trapped in for two weeks, by keeping it very, very clean. That is the sound of me vacuuming. And then we are in a roll up all of our rugs and tomorrow we are going to scrub our floors. Hope you guys are staying healthy and stay tidy.
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