Addictions
Harm-reduction activists could find common ground with critics if they kept an open mind
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By Rahim Mohamed
The recovery-oriented PROSPER Symposium was protested by harm reduction activists.
A star-studded symposium on recovery-oriented drug policy went off without a hitch in Vancouver on Thursday, despite efforts by several prominent harm-reduction activists to sabotage the event.
Harm-reduction activists oppose the enforcement of criminal laws prohibiting public drug use and the prioritization of treatment and recovery-oriented policies.
Yet, if these activists had attended the symposium rather than undermining it, they likely would have found they agreed with many of the speakers’ points.
The PROSPER symposium — which stands for Policy Roundtable on Substance Prevention, Education, and Recovery — was moved to a new venue after organizers caught wind of credible threats to the event’s security. Audio recordings leaked before the symposium depicted activists brainstorming ways to disrupt the proceedings, including by dyeing fountains red, shouting down speakers and honking horns.
The last-minute venue change didn’t stop a handful of protestors affiliated with the group Moms Stop the Harm from picketing the event. Some held photographs of lost loved ones. Others commented to on-location news crews at various points throughout the day.
Fortunately, the event’s logistical challenges didn’t dissuade three high-profile elected officials — Official Opposition leader and leader of BC United Kevin Falcon, BC Conservative Party leader John Rustad and Port Coquitlam Mayor Brad West — from attending the conference.
Even though PROSPER was a success, one can’t help but lament the missed opportunity for the event’s organizers and detractors to come together to find common ground on sensible drug policy.
Speaker after speaker reaffirmed the importance of the 4 Pillars approach to combating drug addiction and dependence. This approach says harm reduction plays an important role in drug policy, but also recognizes the importance of three other pillars: treatment, prevention and enforcement.
No speakers denied the importance of harm reduction; they only said they would like to see a more balanced approach that is recovery-oriented and sees harm reduction as one tool among many.
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One presenter, Dr. Launette Rieb of the University of British Columbia, shared findings from her research on the efficacy of supervised opioid agonist therapy, which involves using medications such as Suboxone to help patients taper their opioid use.
While some harm-reduction activists have been critical of providers of this therapy, many others advocate for its use and want to expand access to it. Why boycott a presentation about this treatment option?
Dr. Pouya Azar, a psychiatrist with Vancouver Coastal Health, had audience members watch snippets from recorded interviews he conducted with opioid-addicted patients. One of the interview subjects told Azar that his mom also used, and noted that taking drugs was one of the few activities they still did together.
These clips underscored the significance of environmental and psychosocial factors in facilitating lasting recovery. This is an idea that harm-reduction activists, at least in theory, also recognize.
The conference placed a strong emphasis on Indigenous perspectives on addiction and recovery. Indigenous leaders shared stories of how addiction had impacted their families and communities.
Harm-reduction activists often emphasize the importance of ensuring Indigenous perspectives are incorporated in treatment approaches. It seems unlikely they would have been offended by these presentations.
“I think many harm-reduction activists are well-intended, hardworking and want the right thing,” said former senior White House drug policy advisor Kevin Sabet and one of the conference’s organizers.
“But they’ve also been led astray by a much smaller group of people who want to dress up radical ideas with sympathetic faces,” he said. “It is in that small band’s group of interest to distort the truth and spread lies about what we are about.”
Sabet and fellow conference organizers have promised to meet with some of the protesters, including parents who lost their children to overdose, at a later point to find areas of agreement.
In the spirit of protecting open discussion, PROSPER also admitted several individuals who work for organizations that were implicated in the leaked audio recordings.
In his closing keynote, Stanford psychology professor Dr. Keith Humphreys expressed cautious optimism about the future of drug policy. He noted that some of the US’ most drug-addled jurisdictions, such as San Francisco and Portland, have recently taken meaningful steps toward sensible drug policies, including ramping up law enforcement in neighbourhoods with high concentrations of drug users.
“I think reality is our friend,” Humphreys said. The past few years have shown that “people who live in an ideological world can recover,” he added, referring to hardline ideological approaches to drug use and other urban issues that have become less popular in recent years.
It’s a shame that some of the people who may have benefited most from Humphreys’ message weren’t in attendance to hear what he had to say. By protesting initiatives like PROSPER, rather than engaging in good-faith dialogue with those who hold different views, these activists are hurting their own cause.
It’s too bad that they’re too blinded by their own ideology to see this.
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Addictions
B.C. addiction centre should not accept drug industry funds
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The British Columbia Centre on Substance Abuse. (Photo credit: Alexandra Keeler)
News release from Break The Needle
By Canadian Affairs Editorial Board
Data released this week brought the welcome news that opioid-related deaths in Alberta have decreased substantially since last year. Opioid-related deaths have also decreased in B.C., although not as dramatically as in Alberta.
While the results are encouraging, more work needs to be done. And both provinces, which have taken very different approaches to the drug crisis, need to understand how their drug policies contribute to these results.
Fortunately, B.C. and Alberta both have research centres devoted to answering this very question. But we are disheartened to see that B.C.’s centre, the British Columbia Centre on Substance Abuse, accepts funding from pharmaceutical and drug companies.
As Canadian Affairs reported this week, the B.C. centre’s funding page lists pharmaceutical company Indivior, pharmacy chain Shoppers Drug Mart and cannabis companies Tilray and Canopy Growth as “past and current funders of activities at BCCSU — including work related to research, community engagement, and clinical training and education.”
This funding structure raises major red flags. Pharmaceutical and drug companies benefit from continued drug use and addiction. And in a context where B.C. has favoured harm-reduction policies such as safe consumption sites and safe supply, the risk of conflicts is especially high.
Indivior is the producer and manufacturer of Suboxone, a drug commonly prescribed to treat opioid-use disorder. Canada’s drug crisis has driven a surge in demand for prescription opioids to treat opioid-use order, with the number of Canadians receiving Suboxone and similar drugs up 44 per cent in 2020 from 2015, according to the Canadian Centre on Substance Use and Addiction.
Indivior is also the subject of at least two class-action lawsuits claiming the company failed to disclose adverse health effects associated with using Suboxone.
In 2021, Shoppers Drug Mart made a $2-million gift to the University of British Columbia to establish a pharmacy fellowship and support the education of pharmacist-focused addiction treatment at the British Columbia Centre on Substance Use. A conflict of interest exists here as well, with pharmacies benefiting financially from continued demand for drugs.
Consider, for example, if B.C.’s centre produced research showing pharmaceutical interventions were not effective or less effective than other policy measures. Would researchers feel pressure to not publish those results or pursue further lines of inquiry? Similarly, would Indivior or Shoppers Drug Mart continue to provide funding if the centre published research in this vein?
These are not the kinds of questions researchers should have to consider when pursuing research in the public interest.
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In response to questions about whether accepting drug industry funding could compromise the objectivity of their research, the British Columbia Centre on Substance Abuse referred Canadian Affairs to their website’s funding page. This page states their research is supported by peer-reviewed grants and independent ethical reviews to ensure objectivity.
We would argue such steps are not sufficient, not least because conflicts of interest are a problem whether they are real or perceived. Even if researchers at the centre are not influenced by who is funding their work, the public could reasonably perceive the objectivity of their research to be compromised.
It is for this reason that ethics laws generally require officeholders to avoid both actual conflicts of interest as well as the appearance of conflicts.
It is also why the government of Alberta, in launching their new addictions research centre, the Canadian Centre of Recovery Excellence (CoRE), has taken steps to safeguard the integrity of its work. The government has imposed legislative safeguards to ensure CoRE cannot receive external funding that could be seen to compromise its research, a spokesperson for the centre told Canadian Affairs.
It would be difficult to overstate the importance of the work done by the B.C. centre, CoRE and other centres like it. It is imperative that governments of all levels and stripes have quality, trusted research to inform decision-making about how best to respond to this tragic crisis.
The B.C. government and British Columbia Centre on Substance Abuse ought to implement their own safeguards to address these conflicts of interest immediately.
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
Break The Needle. Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.
Addictions
B.C. parents powerless to help their addicted teens
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B.C. parents say the province’s safer supply program and legal treatment framework leave them powerless to help their addicted teens
On Aug. 19, 2022, Kamilah Sword took a single hydromorphone pill, believing it to be safe. She overdosed and was found dead by her grandmother the next day. She was 14.
Kamilah believed the drug was safe — despite having bought it illicitly — because she was told it came from a government-run “safer supply” program, according to Kamillah’s best friend Grace Miller and her father.
“I’ll never get to see her get married, never have grandkids, never get to see her graduate,” said Kamilah’s father, Gregory Sword, lowering his chin to keep his voice steady.
“It’s a black hole in the heart that never heals.”
Sword faced significant challenges trying to get his daughter help during the year he was aware she was struggling with addiction. He blames British Columbia’s safer supply program and the province’s legal youth treatment framework for exacerbating his daughter’s challenges and ultimately contributing to her death.
“It’s a B.C. law — you cannot force a minor into rehab without their permission,” said Sword. “You cannot parent your kid between the ages of 12 and 18 without their consent.”
Sword is now pursuing legal action against the B.C. and federal governments and several health agencies, seeking accountability for what he views as systemic failures.
B.C.’s “Safe” supply program
B.C.’s prescribed safer supply program, which was first launched in 2020, is designed to reduce substance users’ reliance on dangerous street drugs. Users are prescribed hydromorphone — an opioid as potent as heroin — as an alternative to using potentially lethal street drugs.
However, participants in the program often sell their hydromorphone, in some cases to teenagers, to get money to buy stronger drugs like fentanyl.
According to Grace Miller, she and Kamilah would obtain hydromorphone — which is commonly referred to as Dilaudid or “dillies” — from a teenage friend who bought them in Vancouver’s Downtown Eastside. The neighbourhood, which is the epicentre of Vancouver’s drug crisis, is a 30-minute SkyTrain ride from the teenagers’ home in Port Coquitlam.
Sword says he initially thought “dillies” referred to Dairy Queen’s Dilly Bars. “My daughter would ask me for $5, [and say], ‘Yeah, we’re going to Dairy Queen for a Dilly Bar.’ I had no idea.”
He says he only learned about hydromorphone after the coroner informed him that Kamilah had three substances in her system: cocaine, MDMA and hydromorphone.
“I had to start talking to people to figure out what [hydromorphone] was and where it was coming from.”
Sword is critical of B.C.’s safer supply program for being presented as safe and for lacking monitoring safeguards. “[Kamilah] knew where [the drugs] were coming from so she felt safe because her dealer would keep on telling her, ‘This is safe supply,’” Sword said.
In February, B.C. changed how it refers to the program from “prescribed safer supply” to “prescribed alternatives.”
Grace says another problem with the program is the quantities of drugs being distributed.
“It would be a big difference if the prescriptions that they were giving out were dosed properly,” she said, noting addicts would typically sell bottles containing 14 pills, with pricing starting at $1 a pill.
‘Safer supply’
Sword estimates his daughter struggled with addiction for about 18 to 24 months before her final, fatal overdose.
After Kamilah overdosed for the first time on Aug. 21, 2021, he tried to get her into treatment. A drug counsellor told him that, because she was over 12, she would need to verbally consent. Kamilah refused treatment.
B.C.’s Infants Act allows individuals aged 12 or older to consent to their own medical treatment if they understand the treatment and its implications. The province’s Mental Health Act requires minors aged 12 to 16 to consent to addiction or mental health treatment.
While parents can request involuntary admission for children under 16, a physician or nurse practitioner must first confirm the presence of a mental disorder that requires treatment. No law specifically addresses substance-use disorders in minors.
When Kamilah was admitted to the hospital on one occasion, she underwent a standard psychiatric evaluation and was quickly discharged — despite Sword’s protests.
Ontario also has a mental health law governing involuntary care. Similar to B.C., they permit involuntary care only where a minor has been diagnosed with a mental disorder.
By contrast, Alberta’s Protection of Children Abusing Drugs Act enables a parent or guardian to obtain a court order to place a child under 18 who is struggling with addiction into a secure facility for up to 15 days for detoxification, stabilization and assessment. Alberta is unique among the provinces and territories in permitting involuntary care of minors for substance-use issues.
Grace, who also became addicted to opioids, says her recovery journey involved several failed attempts.
“I never thought I would have almost died so many times,” said Grace, who is now 16. “I never thought I would even touch drugs in my life.”
Grace’s mother Amanda (a pseudonym) faced similar struggles as Sword in trying to get help for her daughter. Amanda says she was repeatedly told nothing more could be done for Grace, because Grace would not consent to treatment.
“One time, [Grace] overdosed at home, and I had to Narcan her because she was dead in her bed,” Amanda said. “I told the paramedic, ‘Our system is broken.’ And she just said, ‘Yes, I know.’”
Yet Grace, who today has been sober for 10 months, would question whether she even had the capacity to consent to treatment when she was addicted to drugs.
Under B.C.’s Health Care (Consent) and Care Facility (Admission) Act, an adult is only considered to have consented to health care if their consent is voluntary, informed, legitimately obtained and the individual is capable of making a decision about their care.
“Mentally able to give consent?” said Grace. “No, I was never really mentally there.”
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System failure
Today, Sword is one of two plaintiffs leading a class-action lawsuit against several provincial and federal health authorities and organizations, including the B.C. Ministry of Health, Health Canada, Vancouver Coastal Health and Vancouver Island Health.
All four of these agencies declined to comment for this story, citing the ongoing court proceedings.
The lawsuit was filed Aug. 15 and is currently awaiting certification to proceed. It alleges the coroner initially identified safer supply drugs as a cause of Kamilah’s death, but later changed the report to omit this reference due to pressure from the province or for other unknown reasons.
It further alleges B.C. and Ottawa were aware that drugs prescribed under safer supply programs were being diverted as early as March 2021, but failed to monitor or control the drugs’ distribution. It points to a Health Canada report and data showing increased opioid-related problems from safer supply programs.
According to Amanda, Kamilah had wanted to overcome her addiction but B.C.’s system failed her.
“I had multiple conversations with Kamilah, and I know Kamilah wanted to get clean,” she says. “But she felt so stuck, like she couldn’t do it, and she felt guilty and ashamed.”
Grace, who battled addiction for four years, is relieved to be sober.
“I’ve never, ever been happier. I’ve never been healthier. It’s the best thing I’ve done for myself,” she said. “It’s just hard when you don’t have your best friend to do it with.”
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
Break The Needle. Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.
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