Street roots., May 25, 2018, Page 5, Image 5

Street Roots • May 25-31,2018
Conversation
Page 5
LUPICK, from page 4
when additional, similar facilities were
brought on line. Since the winter of 2016,
however, we have done a lot. Naloxone
(whose brand name is Narcan) is freely
available over the counter at most
pharmacies. We’ve flooded the streets with
it. You seen little Narcan/nolaxone kits
affixed to people’s belts when you walk
around in town. There’s more than half a
dozen mini injection sites. We call them
overdose prevention sites, which is a little
bit different than an injection site, a sort of
stripped down injection site. And the police
have taken a softer approach to hard drugs.
It would be going too far to say we’ve
decriminalized them, but every year for the
past several years now, Vancouver police are
arresting fewer people for hard drugs, the
idea being that hopefully people will be
more likely to use drugs in the open where
someone is present and can intervene in the
event of an overdose.
Umcowzier Area
Network o f D ru g Users. Was
there a galvanizing event to push people to say
enough is enough?
Travis Lupick: There was a unique
group of people that arrived from different
directions, and over a period of five to 10
years, increasingly worked with one another
to address some really shocking problems
that had developed during that time.
You had two groups primarily. You had
the Portland Hotel Society, which was
founded in 1991 by Liz Evans, and the
following year with her partner Mark
Townsend. And you had the Vancouver Area
Network of Drug Users, (VANDU) which
was established a few years later by Ann
Livingston and Bud Osborne. And they were
prompted into action and prompted to work
together by a whirlwind of terrible problems
that afflicted the neighborhood.
There was a sharp spike in drug overdose
deaths. There was an explosion of infectious
diseases, primarily hepatitis C. There was
an absolute epidemic of HIV sweeping
through the neighborhood. There was a
whole lot of different health problems that
all affected drug users especially hard and
then again, health services were not yet
there to respond.
J.Z.: A n d these were people livin g in that
comm unity, correct? This is n ’t people looking
in from the outside m easuring statistics. This
was from the inside out.
T.L.: Exactly. These were residents of the
Downtown Eastside. Which is a small
neighborhood, it’s only really 10 to 15
square blocks. And within this tiny
neighborhood, there was such a massively
disproportionate number of overdose
deaths. And the spread of HIV you could see
in a tangible sense. These problems were so
big and affecting an area that was so small,
that Liz Evans often recounts in the early
1990s, she would respond to overdoses just
walking to work each morning.
J.Z.: Your dedication in the book does not
m ince words. “O u r governments a n d police
have waged a war on people who use drugs.
T his book is fo r their victims, fo r those in
prison an d fo r those whom they have pushed
into the shadows, a n d fo r those who are no
longer with us. ” It says right o ff the bat that in
this book, the drug itself is n ’t the real bad guy
here. I t ’s governm ent a n d policy.
T.L.: That’s exactly correct, and where it
comes from, I think, is an understanding of
harm reduction, the concept that the book
seeks to explain through an anecdotal
narrative, that dedication comes through an
understanding of the roots of harm
reduction that it is not necessarily the drugs
themselves that hurt a user the most.
Rather, it is the fact that drugs are illegal
and it’s the persecution of drug users that
can inflict the most harm on an individual
that uses drugs.
As easy example is the spread of an
infectious disease like hepatitis C. It is not
cocaine or an addiction to cocaine that will
infect a cocaine user with hepatitis C. It is
the lack of access to clean needles that will
facilitate the spread of that infection. By
applying harm reduction, you would supply a
drug user with clean equipment and thus
P H O T O C O U R T E S Y O F M E G A P H O N E M A G A Z IN E
M em bers o f the Vancouver Area Network o f D r u g Users, shown here in a file photo, were
revolutionary in m aking sure d ru g users had a say in Vancouver policies affecting addicts.
removing the risk of infection. It’s very
similar with an injection site. Rather than
forcing a drug user to use drugs in an alley
where they resort to using dirty puddle
water and have to rush their injection for
fear of persecution by police. An injection
site offers them a safe environment with
clean water and no risk of arrest by police,
where they can inject drugs more carefully
and in a slower, calmer, cautious manner. It
removes the harms of prohibition.
providers. They could be connected to
services for detox and treatment. Obviously
those services did not exist in the alleyways
where they were using the drugs before.
J.Z.: A n d overdoses?
T.L.: Significantly fewer overdose deaths.
An injection site does not necessarily
prevent overdoses, although it does because
people are using slower without fear of
police, but what a safe injection site really
does is prevent an overdose from turning
J.Z.: Part o f the harm reduction model is
into a fatal overdose.
recognizing that
Insite’s been open since
addiction is a health
2003 and there has never
"And 1 d©a?t know what we been an overdose death
care issue. B u t there is
an attitude out there
cast do but legal«© and
on the premises.
that those negative
consequences are a
deterrent to drug use,
and i f you remove those
deterrents y o u ’re not
g ivin g anyone any
incentive to not use.
regulate. I know that's a
scary Idea that w ill sound
radical, but fentanyl, on the
scale ©I North America's
opioid epidemic, is a
radical problem«"
T.L.: I understand
the logic. It is intuitive
that by enforcing penalties against drug
users that we instill a message that they
shouldn’t do that. Unfortunately, the data
doesn’t really bear out that that is actually
the effect of punishment. The war on drugs
is almost 100 years old in North America,
and drug use is higher than ever, or close to
as high as ever. One hundred years of police
officers chasing drug users down alleys and
locking people in prison hasn’t stopped
people from using drugs.
A big part of Insite’s founding was the
research component. You have this really
great research team of health care
researchers and scientists in Vancouver who
worked with Insite’s founders around the
era when it opened in 2003, and they
studied drug use in the Downtown Eastside,
before and after North America’s first
supervised injection site opened. What they
found is that giving people a safe place to
use intravenous drugs, that is, opening
Insite, did not increase drug use in the
neighborhood. And what actually happened
to a small degree, was that drug use actually
declined. And they attributed that to Insite
serving as a gateway to the health care
J.Z.: You mentioned
100 years now o f the war
on drugs. Historically,
have we seen anything like
the opioid epidemic we
have now?
T.L.: Nothing close to
this extent. Nothing close to an epidemic
problem that is this scary. Vancouver’s crisis
of the ’90s was deemed so terrible that it
eventually revolutionized how all of Canada
responds to addiction. The worst year of
that crisis was 1998, when there were 400
fatal overdoses across British Columbia. And
last year in British Columbia, there were
1,448 fatal overdoses. What’s happening
now is an overdose epidemic so much more
terrible than anything that we ever could
have conceived possible. And it’s not just
B.C. of course, it’s all across North America.
J.Z.: What has been the response from
medical and pharmaceutical comm unities on
this issue?
T.L.: B.C. has pushed harm reduction
further, significantly further, than any other
jurisdiction in North America. Unfortunately
it took the crisis for that to happen. In 2003,
we established North America’s first
injection site. And that’s all we did. We only
established one in a province that’s roughly
the same landmass as the state of California.
So obviously a lot of people didn’t have
access to that one site. It was finally in 2016
J.Z.: The last chapter is about fentanyl,
which is frightening. A n d recently you wrote
about testing what was brought into Insite,
and there was a lot o f fentanyl in products that
people d id n ’t realize.
T.L.: Those tests are still going on today.
There were 1,448 overdose deaths in B.C.
last year and more than 80 percent were
associated with fentanyl. So while many
areas of America see prescription opiates as
the largest problem in their overdose crises,
B.C.’s problem is illicit fentanyl. Where
there’s a demand, organized crime will rise
to meet that demand with supply. The
economics around fentanyl are astoundingly
strong. I think regardless of who supplies it,
it’s a problem that’s here to stay.
J.Z.: What do you see as the solution?
T.L.: I think that if you acknowledged two
basic facts, I don’t know what else you do
but legalize and regulate drugs. Those two
facts are, first, people have always used
illegal drugs, all the way back to before the
Romans, and I believe, for better or worse,
always will use drugs.
And the second fact is that all of North
America’s drug supply is hopelessly polluted
with dangerous, synthetic drugs like
fentanyl, that these overdose numbers are
going to remain as high as they are unless
we do something about supply. And I don’t
know what we can do but legalize and
regulate. I know that’s a scary idea that will
sound radical, but fentanyl, on the scale of
North America’s opioid epidemic, is a
radical problem to which we need to apply
new ideas.
J.Z.: Who’s the audience fo r this? For a lot
o f readers, this is not a sympathetic issue.
T.L.: “Fighting for Space” recounts a
Vancouver story, but I tried to tell it with
audiences of other jurisdictions in mind.
North America is in the grips of a terrible
opiate epidemic, and 20 years ago,
Vancouver struggled through a similar
problem and we made a lot of mistakes, we
learned a lot of lessons, and we also
accomplished a lot. So my hope is with this
book that other jurisdictions can learn from
Vancouver’s experience from the ’90s, apply
those lessons and hopefully save everybody
some time and save a lot of lives.
joanne@ streetroots. org