Front Burner - The ‘other’ public health crisis

Episode Date: June 17, 2020

There’s another public health crisis killing Canadians in record numbers. In May, 170 people died from illicit drug overdoses in British Columbia. It's the worst death toll in the province’s history. And it’s not just B.C., people are overdosing all over the country, particularly in Ontario and Alberta. Garth Mullins is a documentarian and host of the award-winning podcast Crackdown. It was created to cover the opioid crisis from the perspective of drug users themselves. We spoke with Mullins back in April about how COVID-19 was affecting people in Vancouver’s Downtown Eastside. Today, we talk about what’s driving the unprecedented number of deaths… and why this long-running public health crisis isn’t being prioritized.

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. Hello, I'm Josh Bloch. I cannot express how difficult this news has been to hear. My thoughts and condolences go out to the families and friends of those who have lost their loved ones. And I share your grief. B.C.'s public health officer, Dr. Bonnie Henry,

speaking about the other public health crisis killing Canadians in record numbers. May was the worst month ever for illicit drug overdoses in British Columbia. This morning, the B.C. coroner's office announced 170 people in British Columbia died from overdoses in the month of May. And it's not just BC. People are overdosing all over the country, particularly in Ontario and Alberta. Ontario is experiencing a 25% increase in fatal overdoses compared to the same period last year. And in Alberta, the number of opioid-related 911 calls doubled from March to May. Garth Mullins is a documentarian, and he's the host of the award-winning podcast Crackdown. It was created to cover the opioid crisis from the perspective of drug users themselves.

We spoke with Garth back in April about how COVID-19 was affecting people in Vancouver's downtown east side. Today, we'll talk about what's driving the unprecedented number of deaths and why this long-time public health crisis isn't being prioritized. This is Frontrunner. Hi Garth, welcome back. Hey, Josh. Thanks for having me. There's been so many overdoses in the last few months. Frankly, it's hard for me to wrap my head around. And I can't imagine what it's like for you. I mean, you very much are right at ground zero of this crisis.

Yeah, it's, you know, the numbers are very difficult. And really, the crisis has gone on for years. It's my second overdose crisis. People I knew didn't, didn't stop dying in between and beyond the, the headlines. And, um, I just think in the month of May in BC, 170 people died of overdose. That's the highest ever. And I knew some of them. And in fact, in my just little circle of friends, we kind of knew four people all named Dave who died in that period of time. So that's kind of just like a metric that kind of blows my mind, you know? And I've read these statistics now for so long that sometimes I feel numb, but weirdly when I read the statistics for May, I kind of was thinking about my grandfather.

My grandfather was in the air force in world war two and people back home would read these casualty statistics on a regular basis, you know, and they would, they would look down the list and they would see is, you know, is someone they know is a family member in it. I don't know why I felt like that, but I just thought, is this what it was like? Like, is, is that, is that what it was like? Because it does, it does feel like a war, you know, and we, we sure are losing a lot of people. So I just, I guess I thought about my grandfather and he's passed along, but I was looking at this picture of him in his, you know, his Royal Air Force uniform. And he's a radar technician, you know, so he was always looking

out for things coming over the horizon. And, you know, he taught me to do that, I guess a little bit like he taught me electronics too, but, um, I, uh, I sort of, I sort of thought, um, God, I, I feel like I know what's coming over the horizon. Like it's going to be worse, you know, this is just going to keep happening unless we really change something. We just heard BC's public health officer, Bonnie Henry, getting really emotional last week, speaking about the record number of drug overdoses in her province. 170 people died last month alone. And just to put that into context, that's more than the number of people who died from COVID-19 in BC

during the entire pandemic. These are our brothers and sisters, our co-workers, our sons, our daughters, our friends, our community. We must eliminate the stigma and shame that leads people to be afraid to reach out, to tell their family, their friends, about their drug use. eliminate the stigma and shame that leads people to be afraid to reach out, to tell their family, their friends about their drug use. How did you react to her statement?

Well, you know, I think in some ways, Bonnie Henry has really been outspoken about this. She's called for decriminalization last year. The difficulty I have is there's two emergencies and there's two levels of official caring about it. So some things are Bonnie Henry orders and some things are Bonnie Henry suggestions. We must look at alternatives to the criminal justice system to support people in getting the assistance they need. And I wish that we could climb up to the category of a Bonnie Henry order, where she basically tells the government, hey, you really got to do this. And the government says, all right, yes, ma'am. I mean, that's often what we hear from, you know, the Minister of Health, you know, like, I do what Bonnie Henry says.

And so it is unfortunate that right now, at least the government hears her words as a suggestion, a recommendation, take this under advisement. And so far, it has kind of turned away from what she suggests. Because she has called for decriminalization of all illicit drugs in the past. And not just her, I mean, she's joined by Liberal MP Nathaniel Erskine-Smith. This bill deletes the possession offence completely from the CDSA, not trafficking, not producing, but the people who need our help. We should treat patients as patients and not as criminals.

And the bill's focus is fundamentally to end stigma. And Toronto's Chief Medical Officer Eileen Davila, who also called for the decriminalization of illicit drugs for personal use, at least during the pandemic. The criminalization of drug use increases stigma associated with the drug use. People are forced into unsafe practices, and they're also less likely to seek out help. It's not a new idea. So, you know So why hasn't decriminalization gained more traction? Well, I think for one, Justin Trudeau isn't interested. We are very much focused on the control and legalization of marijuana.

He's told us that. He came here in 2016 and met with a group of us on the downtown east side and said, don't hold your breath, it's not happening. happening. Our premier of the province passes the buck, says it's federal, even though Bonnie Henry has specifically sort of detailed what moves the province could make with its own policing act to get out of this. At the Vancouver Area Network of Drug Users, we've been saying defund the Vancouver police for probably a decade. And, you know, we've pointed to a myriad of ways in which the policing of an overdose among drug users. Lead author Ryan McNeil says many of those interviewed said they hesitated to call paramedics out of fear police would show up. We need to move toward more humane approaches and that means removing barriers to life-saving services. And so far there's been no audience for that. You know the drug war itself, it is racist baked in. It is a white supremacist

enterprise baked in and the police are at shock troops and it affects black and indigenous and people of color first and worst. And so we got to pull this all apart. And it starts with getting the police off the backs of people who are using drugs. And it means that they have one role in the overdose crisis and that's to stand down. We've got to take all this money that keeps going to the police and put it to better things, put it to health, put it to housing. You know, until we do that, we're just going to be in this cycle of hearing terrible stats once a month. It's so interesting what you're saying about spending a decade calling for the defunding of police. Obviously, we're in this interesting moment right now. Along with the COVID-19 pandemic, we're also witnessing this rise of protests against anti-Black racism

and a movement that's also calling to defund and demilitarize police. Our Jody Martinson talked to two people waiting for the bus at East Hastings who had very different views. Yeah, I mean, if anything, they need more down here. I think they do whatever they do whenever they need to do it. They don't care who's around. They need more police out here to actually patrol that and, you know, get rid of them, get them into the centres if they need to. We're always really hesitant to get the police involved.

They arrest everybody. Whatever personal belongings they have gets confiscated or taken away. They're just going to get more desperate and they kind of fan the flames. What are people who are using drugs telling you about how life has changed just in the past couple of months during this pandemic? What stories are you hearing? Well, there's been pinch points at the borders, right? So the supply has gotten more strained.

And every time that happens, you know, whether it's the police cracking down or the borders kind of getting more difficult to move things through, in this case because they're closed, then you get stronger drugs. It's the iron law of prohibition. It's like in the alcohol prohibition back in the day, everyone used to drink beer, then it became illegal. And so moonshine, boom, it's like they had to find something smaller, stronger, easier to smuggle around. And so that's happening in Vancouver. And the coroner's report from May shows this. Of those 170 deaths, a great proportion were what they call significant higher concentrations of fentanyl were found in the talk screens, I guess.

That shows that the contaminated drug supply is becoming more contaminated. At the same time, things like rock or like crack made with cocaine and coke itself are getting more expensive because that is, I guess, becoming more difficult to move from the South to the North. So, uh, I see it becoming a more dangerous time for drug users. Also, also people are having less access to some of the services they would have relied on. Uh, and when people are told to socially distance themselves, well, we spent the last five years telling people to not use alone. And so it's contradictory messaging and people are doing

their best to social distance. But at the same time, that means that people are dying alone. And that's what the coroner statistics show too, is that still most people die alone inside in a room in a house or something. We know that using alone right now is exceedingly deadly. The alarms of people missing have not been going off. And check up on your friends. Check up on those people, those workmates that you have that you may not be seeing as often. I spoke with Guy Felicella. He's a peer clinical advisor at the BC Centre for Substance Use in Vancouver. And here's what he had to say about how access to safe injection sites has specifically changed. You know, a lot of the services when COVID came were shut down. Some were scaled back.

And so what that did was, you know, it made long lineups for people to go in, especially for drug users to inject drugs. So most just started using, you know, outside or started using alone, felt uncomfortable going back to the facility. Obviously, there was a couple reasons. I think one was fear of possibly contracting COVID. And another one is that withdrawal just waits for no one. And sometimes when you have to wait to go into one of these facilities, it's just not feasible. So they would just use, you know, in a back alley by themselves or in a car park. And so those are some of the challenges. Garth, what do you make of what Guy is saying here? Right before this interview, we were all in a meeting together, you know, with different government officials trying to kind of move things forward a little bit. So, I mean, I just, I totally, obviously, I agree with him.

You know, it's a rough time. So you can look at these specific causes of, you know, COVID-related causes of why, you know, the number is higher. But the number was 170. And we've seen a few years ago, a number that was in the 160s in a month of people who died. So really, the cause is the drug war. The reason we have high numbers is because nothing has fundamentally changed. changed. I've lost probably over 100, maybe 150 friends in my lifetime of addiction, and a lot of them have died since 2016. So it's really traumatizing and heartbreaking for people that don't understand that new trauma relives old trauma. So it's just this big cycle that I go through. And, you know, I broke down a few times last week in meetings. I just, you know, didn't feel present. I felt this immense sadness, this loss.

And, you know, it's been 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. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people, and I have some startling numbers to share with you. Did you know that of the people I speak to,

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and you spoke about the importance of safe supply of drugs for people who struggle with addiction. And this is something that British Columbia greenlit in March when they allowed doctors to prescribe safer alternatives to illicit drugs. And back then, it felt like there was almost this feeling of optimism. Tell me about how that has played out. Well, yeah, this initiative started really small. You know, it was early March.

There's a doctor from the downtown east side called me up. She was on the ferry coming home. You know, she was getting ready to sort of, you know, social isolate and all that. And she said, Oh, what do drug users need when they have to quarantine or something? And I said, well, uh, drugs, obviously like, um, and I know for people out there, they might think, well, if the drug supply is toxic and people are dying from that, why don't they just not do it? Why don't they just get to abstinence? And, you know, that may be a goal for a lot of people. I never could myself. I still can't. You know, I've been an opioid user my whole adult life. And so I just think in the emergency,

you have to substitute the toxic drug that people are getting off the street. And you substitute that with a pharmaceutical version that you know what's in it. You know how strong it is. You know there's no strange mixed in contaminants like we've found pig dewormer and domestic detergent and brick dust and all kinds of terrible things. You know, that's just like a nicotine patch, right? If you're smoking, you can put that patch on

and yeah, you're still wired to nicotine, but at least you're not damaging yourself so much. And I say that as somebody who smokes. So it's, it's like, it's that struggle started very small, a kind of policy came up that maybe was just going to be used in some local housing on the downtown East side, how to help people who have to quarantine. And then the local health authority got interested. And we kind of made this bigger. Like, what about people who just don't have to quarantine because they have COVID, but we're at risk of it? Like, what about everybody?

And then the province said, okay, we'll, like you said, green light this. But there was no implementation plan, no budget, no communication plan. So there was really no big provincial-wide reach out to all the doctors or all the drug users. And I think a lot of doctors were like, well, this is weird. I don't know about this. I don't like this. And just said, no. And some pharmacists did the same thing. So, you know, we're stuck kind of debugging the system. You know, it's, it's basically, it's a policy that gives people a little bit more access to a little bit more of what's in a pharmacy. It doesn't give them

heroin. It doesn't give them heroin. It doesn't give them cocaine, but it gives them these sort of distant cousins to those drugs that are available at a pharmacist if they're able, if the person meets certain criteria. So it's a, it's a step in the right direction towards what would be a safe supply. With the toxic drug market, it's not a thousand hits that'll kill you. It's just one hit. It doesn't matter if you're a seasoned user, first time user. And so if you have something that's completely unpredictable, you know, you need to give people a better option.

And for those people that can access that safe supply, how effective is it for them in replacing what they would otherwise get on the street? Well, you know, I think about some of the people who are on the editorial board of my podcast and they have, you know, a couple have been able to access it. And so it's meant that they don't have to go to the street as much.

It's probably made things a lot safer. Like I said, it's not, it's like, it's a cousin, it's a distant cousin of the drug that they're doing. So it doesn't quite meet the need. It doesn't quite fill that hole. So there's still that, there's still, you still got that itch, you still kind of got that drive. And that's, it's, that's hard to address unless you just meet it with the, with the exact replacement, the exact substitute. We've been fighting for prescription heroin for a very long time.

And it's really, to me, it's what could save people. It's what could end the overdose crisis overnight is if people could get the thing they're buying on the street and dying from, if they could get the pharmaceutical version of that. Like the pharmaceutical version of heroin is called diacetylmorphine. Heroin was invented and started as a pharmaceutical

that was given to people at a pharmacy. Same with cocaine, same with fentanyl. And that's what we need to do. But I think it is helping because it's giving people options other than just purely the street. So it's helping people reduce the risks. I have used street supplies because my prescription doesn't always work. Using it in a safe place, like safe injection sites, was really important to me.

I don't want to be in a bathroom in Tim Hortons. I don't want to be in an alley. I OD'd three times and woke up, you know, alone because I was using alone. And when you talk about contaminated drug supply, it sounds like one of the big concerns is just how prevalent fentanyl is and how toxic and unpredictable it is in terms of how it's cut into drugs that people are getting on the street. Tell me a bit about that. years and decades of law enforcement activity against heroin, seizing heroin. And, you know, heroin has to be grown in a poppy field in a different continent and processed, harvested,

processed, you know, smuggled across the world. It's much easier to make something in a lab locally. You know, it's much less risky. You know, I was last year, I was in Scotland where they still have heroin. It's actually rather hard to get heroin around here right now. It's, it's, there's things sold as heroin, but they're mostly fentanyl and, and food coloring and a bunch of other crap. And I said, I said to them, you guys should protect your heroin trade because when it gets to fentanyl, things will get much, much worse. You know, so tell the coughs to just take it easy. You know, until we have a more permanent solution to this,

people are better off for the heroin market than they are with the market we have now. Right. I want to be clear that the spike in overdoses is actually happening all over the country. We've been talking about British Columbia, where there's been a 93% jump in drug overdoses when you compare this May to the same time last year. In Alberta, the number of opioid-related calls to emergency services increased from 257 in March to 550 in May. And in Ontario, the coroner reported a 25% increase in fatal overdose from March 2019 to May 2020. Why, again, do you think we're seeing this happen right across the country. I think it doesn't help that you have in Alberta and Ontario leaders who've really been anti-harm reduction.

There's really no reason to have four sites within a kilometer of one neighborhood. And it's all right for people to say, yes, help them, help them, help them. And with all due respect, Colin, if I put one beside your house, you'd be going ballistic. You would. They're now more than injections, by the way. They're just illegal drug sites that do all sorts of drugs, not just injectables. You know, that makes it very difficult for the rest of the system to operate. They've kind of been ground to a standstill, right? So harm reduction hasn't been able to expand significantly in either of those places, but people have done a good job of defending what's there. But harm reduction is still just like first aid at the side of the road after a motor vehicle accident or something.

You need a lot more than that. And you at least need to let the first aid practitioners out to do their job. job. Well, it's so interesting because when it comes to COVID-19, you know, we as a country made this ethical call that the potential number of deaths from the virus warranted this really radical response that basically we would shut down the economy and we would tell people to socially isolate. 14,000 people have died in Canada because of the opioid crisis in just the last four years. So why, in your view, have we not had that same kind of response when it comes to the opioid crisis? I guess the wrong people are dying. You know, that's the only thing I can figure.

You know, we've called on government, especially around here, to use the powers that a declared emergency entitles them to. You know, like in British Columbia, the overdose thing has been a public health emergency with that emergency declaration for four years. And you see governments moving heaven and earth, shutting borders, shutting the economy, like taking big drastic steps. You know, it shows that there's power

and it shows that there's concern and we don't see equivalent effort. And I guess that means that all of us have to do a better job of organizing because we have to save ourselves because we know government is not interested and not willing to do it. This is my second dual public health crisis I'm living through. And same thing with the HIV crisis in the 90s, the overdose crisis took a backseat. I mean, what number or what is it that the government's waiting for? 170 people in one month? Is it 200 people? Is it 250 people? Is it 350 people a month? And if you could snap your fingers right now and bring about some kind of policy change, what specific policies would you bring about to stop people from dying from overdoses right now?

Well, decriminalize drugs, legalize a safe supply and defund the cops. decriminalize drugs legalize a safe supply and defund the cops you were probably looking for more than that hey it turns out the answer is quite simple yeah i mean and it's no i'm i'm no i'm no special genius or anything like that people have been calling on this, calling for this stuff for a long time, you know, and the answers are all there. People have been calling on it so long that there's actually a body of research, studies, and even jurisdictions

that have tried it to show the successes. So the only thing that's left is the political will of the leaders to change the laws and policies. And it's just obstinance and lack of courage. You know, we just have too many chicken shit people in charge of things. I guess that's not very CBC language. I don't know. Sorry. Yeah, it's a lack of courage, I think. think garth thank you so much for your insight into this yeah thanks thanks very much josh um i always uh love listening to the show and thanks for letting

me on Before I let you go, an update to the ongoing conversation sparked by the Black Lives Matter movement. On Tuesday, over 800 Canadian academics and lawyers released an open letter calling for the police to be defunded. The letter calls our current model costly and ineffective and pushes for Canadian political leadership to take action to reduce the powers of the police and address racial inequalities in public safety across the country.

All right, that's all for today. I'm Josh Bloch. Thanks for listening to FrontBurner. Thanks for listening to Frontburner.