Front Burner - A backlash to B.C.’s drug policies?

Episode Date: December 20, 2022

B.C. is on track to have another record-breaking year for toxic drug deaths. But as people continue to die, a backlash appears to be growing to the province’s current strategies for tackling the crisis. A recent polarizing documentary, Vancouver Is Dying, as well as a recent video by federal Conservative leader Pierre Poilievre, have pointed fingers at B.C.’s slate of harm reduction policies. But many drug policy experts argue just the opposite. Today, Moira Wyton, a health reporter for the Tyee, joins us for a look at the state of BC’s toxic drug crisis, the criticisms coming from both ends of the spectrum, and where things go from here.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. As we close out 2022, it's clear that overdose deaths in B.C. remain a serious crisis. According to the B.C. Coroner's Service, 1,827 people died from toxic drugs in the first 10 months of this year. That's six people a day. But as people continue to die, a backlash appears to be growing to the province's current

strategies for tackling the crisis. The addictions that we see that have terrorized these people and our communities, they are the result of a failed experiment. You may have seen this video that Conservative Party leader Pierre Polyev posted a few weeks ago online. He's sitting in front of a homeless encampment on a beach in Vancouver. And he says that B.C.'s safe supply policies are a big cause of addiction and homelessness in the city. This is a deliberate policy by woke, liberal, and NDP governments to provide taxpayer-funded drugs, flood our streets with easy access to these poisons. Or you may have seen this recent polarizing documentary, Vancouver is Dying.

What is happening to Vancouver? Which has been viewed more than two million times on YouTube. Violent offenders being released with little to no regard for public safety and has an ideological obsession with so-called safe supply and free drugs overshadowed the desperate need for treatment, recovery and rehabilitation. Harm reduction. Somebody's got a sense of humor, man. Because that shit ain't helping nobody, man.

It's helping everybody get high more. Everywhere you look. And on the other hand, you've got advocates who are saying that, in fact, the exact opposite is true. That the real issue is that BC's current drug policies aren't going nearly far enough to tackle the scale of the problem. So as the year draws to a close, we wanted to take a look at the state of BC's toxic drug crisis, the criticisms coming from both ends of the spectrum, and where things go from here. My guest is Moira Whiten. She is a health reporter for the TAI. Hi, Moira. How are you? Thank you so much for coming on to FrontBurner.

Hi, Jamie. Thanks for having me. So before we dive in here to some of the controversies, I don't want to gloss over the horrifying numbers of deaths that we're talking about here. 1,827 in just the first 10 months of the year, an average of about six a day. the first 10 months of the year, an average of about six a day. And can you put that into context for me? How bad is this year compared to what we've seen in previous years in British Columbia? So 2022 is going to set a record for the third year in a row for the most people dying of toxic drugs in BC's recorded history, specifically due to the increase of drug toxicity in the drug supply. It's changed rapidly. And the fact that these toxic drug deaths have skyrocketed,

can you explain what we know about why? So because the drug supply has changed so much, people can no longer know exactly how much or of what or what combination of drugs they're taking and buying because the criminalized market is so unregulated and becoming more contaminated. There are a number of drug checking and drug testing data centers in BC that have shown a huge increase in obviously the presence of fentanyl since 2016. But now an even more powerful opioid, carfentanil, is increasingly present. It contributed to almost

200 deaths in 2021. And benzodiazepines, which when combined with opioids, cause you to stop breathing and make a drug poisoning more difficult to reverse. At one point in 2022, we're present in almost in more than half of people who had died. So the drug supply has just fundamentally changed. That means even if we have the same number of people using substances, which all evidence points to, they are more likely to die simply because of how the supply has changed. And what do we know about why the supply has changed as much as it has? The supply is criminalized. So there's no consumer protection. There's no regulation. It's completely driven by profit margins and organized crime. And with COVID-19 border closures and disruptions to supply chains,

the manufacturing of those drugs is, it's incentivized to create even more potent and easily transportable and more easily concealed substances. Or when those substances, you know, enter Canada or are distributed to be cut with whatever else is available to make the most profit. Often when we talk about overdose deaths, people think about street-involved drug users. But just to be clear here, this crisis is affecting people across different classes and social backgrounds, right? Most definitely. People of all stripes and parts of society use drugs,

whether that be for fun, for going out to a party, for occasional stress relief, to, you know, stave off pain from maybe a work-related injury. We know that's a huge driver of opioid use. This is affecting people everywhere. And I think maybe the reason people conflate it with street based drug users is because that's the most visible form of drug use. But people are dying alone in their own homes and in other private residences. So, you know, the toxic drug poisoning crisis is really reaching every quarter of BC and of Canada, I should say. Yeah, I think that that's important to say. We're focusing on BC today, but this is certainly not solely a problem in that province. So obviously, I think it's fair to say that people across the political spectrum here would say that this is just briefly go over what is happening, some of the

main policies and things that generally fall under the umbrella of harm reduction, right? So people are probably familiar with supervised consumption sites where a person can go to use their own drugs under supervision of trained staff. But let's talk about a couple newer factors here. There's BC's prescribed safe supply policy, which came in in March 2020. And can you just briefly explain what that looks like in practice? would access from the street supply. And so that looks like methamphetamine. If you're accessing methamphetamine, they might prescribe Adderall, which is also a stimulant, or hydromorphone instead of heroin, which is an opioid analog. It's about replacing the drug supply and separating people from the supply. And those are for about 14,000 people. They've been able to access that program in BC. Okay.

And then there are also pilot programs where some people do have access to so-called hard drugs, right? Like I'm talking about heroin and fentanyl here. Yeah. are able to access prescribed heroin and prescribed fentanyl through a few federally funded pilot projects that are mostly concentrated in Vancouver, Surrey, and Victoria on Vancouver Island. And those have already seen some pretty big success. And then the federal government has signaled that they want to expand it. Okay. And then the last policy that I wanted to talk to you about was a temporary decriminalization law that's going to come into effect next month. And what is that? So essentially, the federal law that criminalizes substances like cocaine,

methamphetamine, and heroin will be suspended or exempted from application in BC starting at the end of January 2023. And that means that people who carry less than 2.5 grams cumulatively of those substances will not be subject to arrest or charge solely because of possessing those drugs for themselves. The goal is to reduce stigma and reallocate police resources towards where it can best serve community safety interests. So now that we've got a bit of groundwork laid, I think let's dig into some of the criticisms here, starting with what seems like kind of a growing backlash from people who are coming at this from the right of the political spectrum. So we heard a bit at the top from this video Pierre Polyev tweeted out a few weeks ago. And I want to break down a couple of things he says in the video.

So firstly, he says that the addictions people are experiencing are, quote, a deliberate policy by woke liberal and NDP governments to provide taxpayer funded drugs, flood our streets with easy access to these poisons. So I assume that he is referring to the safe supply policies here that we just talked about. And I know that you mentioned a little bit of this when you were laying out what they are, but just give me a sense of how widespread these policies are. Like how many drug users in BC would have access to prescribed safe supply? In reality, very few drug users have access to these programs because they are required to have a diagnosed substance use disorder and to have tried other means of treatment like opioid replacement or opioid substitute therapies beforehand. Only about 14,000 people have accessed the prescribed safe supply program in BC,

and only about 500 people are accessing the federally funded pilots for direct replacements. It's been signaled that these will expand, but truly it is not a significant enough proportion as we've seen to stop people from dying. And also we know from data and surveillance by the B.C. Coroner's Service that prescribed safe supply and alternatives are not contributing to deaths in B.C. Mm-hmm. He also says that similar policies have been tried in Los Angeles, Seattle, Portland, and that each time the results have been major increases in overdoses and a massive increase in crime. And so do you know if there's any evidence

to support that? You know, I couldn't speak to those cities specifically, but from my research, you know, across North America, we've seen drug poisoning deaths increase rapidly in the last, since 2016, certainly, but especially in the last three years since the pandemic began. And no city has been spared whether it employs, you know, more harm reduction focused policies like Vancouver and the rest of BC does, or if it takes a very hard line, tough on crime, you know, recovery focused approach. And, you know, I couldn't speak to the crime statistics, but we also know that survival crime and petty crime are, you know, an effect of people having to find ways of paying for the substances that they need and that their body is used to. Research has shown in BC that if you address the need to access the drug supply constantly and provide those drugs or provide a reliable way of accessing them,

the related survival and property-related crime does go down. There's also this documentary we played a clip from at the top of the episode, Vancouver is Dying, and it was released about two months ago. It draws quite a strong connection between a few different threads in the city, the addiction, overdose crisis, homeless encampments, violent crime. Once released, these criminals are allowed to return to their life of crime and dodge any further accountability by hiding in highly populated, lawless areas that this city has allowed to exist

without supervision. These areas are called tent cities. And the documentary also takes aim at safe supply. It's been viewed 2.4 million times on YouTube. And what does the popularity of this documentary say to you? Because it's clearly striking a court. You know, I think the documentary speaks to a lot of the fear people who don't use drugs have because they've seen homelessness, they've seen mental health crises, they've seen substance use become more visible in the last three years as homelessness has increased because of the housing market, you know, ratcheting up and the pandemic and designated places to use drugs and to gather have had their capacities reduced and shut down and people are using, you know, publicly where

they can. And, you know, that's, of course, that's, I think that's going to strike fear in people who are confused by what they're seeing and, you know, just want a quick solution to make it go away. But the truth was, this was always happening. It's become more visible. So I don't know if you think it would be fair to say, but the recent mayoral election could be seen as an indication of this sentiment as well. The new mayor, Ken Sim, ran largely on a public safety platform with a big emphasis on increasing police numbers and tamping down on crime. We ran on a mandate of we want to have more public safety in our city. We're going to hire 100 police officers and 100 mental health nurses.

And we let the city of Vancouver decide if they wanted that or not. And they gave us a resounding yes. Tell me more about what that win says to you. I think people respond to that because simple solutions, you know, win votes. And people want to feel like they voted for someone who's going to implement, you know, what they think is going to work when it comes to the visibility of these issues that is really probably driving them in these spheres. And, you know, in my neighborhood, too, I don't count myself out of the group of people who've seen that visibility increase. But, you know, the solutions to the overlapping homelessness, mental health, crime, you know, drug toxicity issues are very complicated.

You know, if more police solve this problem, it would be gone by now because we have lots of police in Vancouver working on this. And we've seen, you know, these problems worsen because, you know, as a number of reports and experts have urged, we haven't focused on the supply and we haven't focused on the other supports people need to stay well and to stabilize their lives, however that looks for them. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix.

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podcast, just search for Money for Cops. I think it's probably also important to highlight here that there are criticisms of safe supply that are not coming from a certain part of the political spectrum, right? Some doctors are critical of it. Last year, there was a widely shared op-ed in the Globe and Mail by an addictions medicine doctor in Toronto named Vincent Lam, and it was quite critical of safe supply policies. And one of his concerns was that if doctors like him are prescribing fentanyl alternatives like hydromorphone, that it would actually just end up increasing the overall availability of opioids on the street. So people who are prescribed hydromorphone might just resell it on the street, you know, thereby making it like a gateway or an available drug for other people and that they would continue using the much stronger drug fentanyl themselves,

which could lead to more people overall using opioids. And do we have any sense of the extent that might be happening? So researchers call this diversion, which is when someone who doesn't have the prescription for a controlled substance uses it or is sold it by the person who does. And from evaluation with BC's prescribed safe supply programs, we've seen diversion doesn't appear to be large, in less than 5% or 10% of cases, even though the evidence is quite early. And I think it's important to note that a lot of doctors, I've spoken to doctors who are hesitant,

and I think for good reason, because traditionally, doctors' role has been in medicine and addictions medicine and now in the context of a public health crisis where it's not about medicine necessarily it's about you know a completely unregulated supply that's that's killing people doctors are now you know rethinking their role in the health care system is having to rethink its role of whether prescribing something they, you know, maybe wish they didn't have to is actually going to reduce the chance that their patient is going to die because they'll continue to access the drug supply anyways. So in that sense, diversion among a lot of public health policy researchers and drug user rights advocates isn't seen as a huge problem necessarily, because their argument is that anyone who's accessing a regulated drug instead of the illicit supply is much safer than if they were. And, you know, we know that if people are looking for a drug, they will find it.

But if people aren't looking for a drug, it's very unlikely that someone selling them their prescription off the side of their, you know, off the side of their desk or whatever is going to, you know, pull them into that. So related to this, though, I know one of Dr. Lam's concerns in that article was about lack of evidence, right? And he said, quote, thus far, there has been little objective evidence that safe supply reduces fentanyl usage or deaths. And does he have a point there? Like, what kind of evidence is out there at this point? I mean, he's right that the evidence base is very new. However, it's growing and it's promising from what I read and from what I followed around the world. In Europe, in Switzerland specifically, but also in the Netherlands and other countries, they've been prescribing heroin since the early 1990s.

success and remained a relatively small and stable proportion of users who access that. You know, it's about six to eight percent, depending on where you are, of users who are accessing heroin. And the program has shown huge benefits for their housing stability, their employment stability. And two early trials based in the downtown east side also showed huge ability to help stabilize people's lives and employment, find housing, access health care. So that was, those are really promising statistics. So I guess what people on the other side of this debate are doing now is building off of that initial research. And I think it's fair to say that these people are on the left, more progressive side of the political spectrum. There are a number of drug policy experts in B.C.

And they're saying actually the real problem is that the policies don't go nearly far enough. saying actually the real problem is that the policies don't go nearly far enough. And you mentioned before when we were talking about safe supply, that it's a relatively small number of people that are actually able to access it here. And so just flesh that out a little bit more for me about why many advocates want this to be expanded. People want everyone to be able to access safe supply because fundamentally, what I'm hearing from public health experts and from the coroner's service death review panel of experts is that the supply is driving the crisis. So while harm reduction services like overdose prevention sites and decriminalization can help stem that flow. Really addressing it means addressing and replacing the supply. So some people have, you know, pointed to the example of alcohol prohibition and said, you know, people were dying when alcohol was prohibited and regulated by the illicit market, controlled by the illicit market. by the illicit market. And the government said, you know what, we're not going to do that.

People are saying, you know, we're going through the same thing with these drugs now. Why haven't we tried a regulated, you know, de-medical model to make sure that people aren't dying simply because of the drugs they choose to take? And related to this, those same advocates are calling for changes around that decriminalization law that we talked about earlier, right? Like they think the 2.5 gram limit on possession is not nearly high enough and could actually cause bigger problems. And just flesh out that argument for me there. With the decriminalization threshold of 2.5 grams right now, people are saying, you know, that's barely enough for me for half a day.

What if I buy a few days at a time so that I don't have to deal with the dealer all the time? And also there's concern that, you know, police have said, and Vancouver at least have said, you know, we don't arrest people for simple possession, but we know that drug seizures continue. So I think there's a lot of distrust around how this is actually going to be rolled out and whether it might also incentivize these manufacturing of even more potent substances to stay under that 2.5 gram limit. when we're talking about possibly expanding these programs, expansions that are backed up by emerging research and data, if this recent backlash that we've been talking about, this desire for more policing, more law and order, if that sentiment is going to make it even more of an uphill battle to try and expand these policies.

Something I've seen in my years as a journalist is that people often aren't as swayed by evidence and studies and data as they are by their own personal emotional experiences, right? And what do you think about that? This is a hugely emotional issue for people. What do you think about that? This is a hugely emotional issue for people. You know, hardly anyone in BC doesn't know someone struggling with substance use or who's experienced a drug poisoning. So it is very personal in this province, and I know increasingly across Canada as well.

And I think people want solutions. And as you said, they respond better to personal stories and to their own personal experiences of a problem. But I think a lot of the backlash and the conflation of the toxic drug crisis, which is inherently about the drug supply with addiction and with homelessness and mental health crises and with crime, has really muddled the public understanding of how we can move forward through these issues. And researchers that I've spoken to and drug user advocates for these evidence-based policies are really worried that because they can't keep pace and they haven't been funded and expanded to keep pace with and address the drug supply, they're going to be deemed as a failure when

these problems continue, when in reality, we know that a lot of these solutions have saved many lives, despite, you know, this unprecedented rise in death that we're trying to come to terms with. All right, Moira, thank you so much for this. Thank you so much, Jamie. Thank you so much, Jamie. All right, that's all for today. I'm Jamie Poisson. Thanks so much for listening.

We'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.