Three profiles of opioid users

The fish-bowl lives of drug users on the streets of downtown East Vancouver provides an easy, but distorted, window to drug use. That picture is as distorted now as it was 139 years ago when B.C.’s second premier, Amor De Cosmos, headed a commission to investigate opium use.

The window to most drug overdose deaths is closed. Typical victims are single men, in the prime of their life, who die alone from opioids containing fentanyl according to a report from the BC Coroners Service released last Thursday.

Michael Strange. image: Globe and Mail

Even reports of typical deaths are somewhat distorted. For some opioid users, the drug is a godsend. Take the case of Michael Strange. He injured his back while working as a cameraman and found opioids to be the only treatment that provided relief.

“I’ve tried so many different things for my pain,” said Strange. “People say, ‘Have you tried acupuncture?’ Yeah. I’ve had two different kinds of laser therapy. I had doctors and friends say I had to try marijuana. I got the vaporizer and it did nothing for my pain (Globe and Mail, September 7, 2018).”

It wasn’t easy but Michael Strange finally found a doctor who would treat him. Many doctors were “running scared” because they didn’t want to be seen to be contributing to addiction. Now his pain specialist gives him a two-month prescription and before renewing, asks: “Michael, how are you? Are you OK with the drugs? Do you need more? Do you need less?”

Self-medication turned deadly for Chris Willie, a university lecturer with a PhD in environmental physiology from UBC Okanagan. He wrote memoirs about his recovery from fentanyl addiction but he died from an overdose before they were published. With the approval of his family, his memoirs were published in the September, 2018, edition of the Walrus. He describes his mental pain as a child and the calm he found in taking dangerous risks:

“I have never excelled at coping. I was that infant child who hammered his head on the ground when frustrated by anything at all. It must have been embarrassing to parent the son with the ever-present forehead scabs. Perhaps I found it soothing, because, thirty years later, I still find serenity in chaos and derive calm from risk. By fighting to live through near-death situations, I could find the high I needed to briefly escape the pain.”

Like Michael Strange, Emily Wharton lived a productive life with opiates. The twenty-year old opium smoker from Victoria, told a House of Commons Select Committee on Chinese Immigration of her use. The federal committee was initiated by John A. Macdonald in 1879 and headed by B.C.’s second premier, Amor De Cosmos (a.k.a. William Alexander Smith).

Back then, the stereotypical opium user was Chinese. They lured good white women into lives of depravity in opium dens. The real agenda of the committee was to rid Canada of Chinese immigrants.

Wharton’s testimony 139 years ago is recorded in Dan Malleck’s book, When Good Drugs Go Bad. She told the committee that she had been using opium for four years and suffered no ill effects. Wharton testified that opium’s “somnolence and complete rest” left her productive. Chinese men in opium dens treated her well and she objected to the characterization of the dens as depraved. She suggested that if the government legalized opium, “one need not have to come into such holes as this to smoke (p. 102).”

Medical-grade opioids are not the problem. The social stigma of drug use that drives users to overdose, and the lack of pain-treatment specialists, leads mostly young single men to self-medicate, and to die, alone.

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Opioid use rises despite crisis

Am I the only one not surprised that the opioid crisis has worsened? Despite the widespread distribution of naloxone kits to save lives from fentanyl overdose. Despite increased prescriptions of methadone to treat addiction.

       opium den

It’s all so predictable. The fuse to the opioid bomb was lit long ago.

I just finished reading Dan Malleck’s thoroughly researched book When Good Drugs Go Bad: Opium, Medicine, and the Origins of Canada’s Drug Laws. He traces the opioid crisis that gripped young Canada at the turn of the twentieth century and led to the Opium Act of 1908.

As now, the problem wasn’t the “recreational” use of opium, but rather the prescribed and drug store concoctions of opium. Laudanum, a tincture of opium, was commonly found in medicine chests to treat toothaches and diarrhea, and as a cough suppressant.

Opium was, and still is, a powerful drug in a doctor’s medicine bag. It was especially useful to treat the illnesses of urbanization before the advent of antibiotics; diseases such as dysentery, cholera, and tuberculosis. Even today, nothing surpasses it as a pain killer.

As now, the crisis then was triggered by drugs other than opium. Cocaine had been introduced as a pain killer. The effect on users was startling different than that of opium and its sister morphine. The concept of “drug fiends” didn’t exist until cocaine came on the scene. Now the term easily applies to crystal meth addicts. Charles Heebner, Dean of the Ontario College of Pharmacy commented in 1906 that the public alarm over drug users was non-existent until “the Cocaine Monster came upon the arena . . . Cocaine proved to be a far more enslaving drug than opium or morphine (p.199 of Malleck’s book).”

The politics of the opium scare were quite different than the reality of the problem. Whereas the medical problem was opium addiction and the crazed effect of cocaine, the politics dwelt on the anti-Asian sentiment, especially in B.C.

Nineteen hundred and eight was a federal election year and Prime Minister Laurier was looking for his fourth majority in a row. In response to “race riots” in Vancouver, Laurier sent his minister of labour, William Lyon Mackenzie King, to Vancouver to investigate.

King found that Chinese workers had been brought to British Columbia to build the railway and there now 16,000 Chinese immigrants and their decedents which amounted to eight per cent of the population of B.C. White Canadians claimed they were taking jobs away. Chinese Canadians were demonized for leading good, white, Canadian women astray in “opium dens.” The Chinese were perfect scapegoats: too many, too shady. Laurier played the race card and was returned to power in 1908.

One hundred and eight years later, nothing much has changed. The opioid problem is characterized by sensational news coverage of ordinary Canadians, many of them in the prime of their lives, being killed in alarming numbers by overdosing on fentanyl.

However, the root of the problem is not the recreational use of opioids but the prescription of opioids by doctors. “Prescriptions for hydromorphone have soared 57 per cent over the past five years (Globe and Mail, March 27, 2017).”

And predictably, the more opioids that are prescribed, the more Canadians get hooked. The problem is compounded as users get habituated and require increased dosages for them to work. So they turn to multiple doctors to get them. Failing that, they turn to the streets and the deadly fentanyl.

The problem is not recent -it’s been going on for generations according to the Globe and Mail. “The problem is particularly challenging for new doctors who have inherited patients on high-dose opioids from a colleague who has retired.”

It feels like 1908 all over again.