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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How to reduce drug overdose deaths

There is no easy way to reduce drug overdose deaths but a simple first step is to provide users with safe opioids. The hard part will take time.

 North Vancouver couple die of fentanyl-linked overdose. Image:Vancouver Sun

The grim toll of deaths –of community leaders and ordinary citizens -marches on relentlessly. In just eight months of 2017, more British Columbians died of drug overdoses than the whole year before.

Lots of things don’t work. Still, politicians persist in the tried and unproven. B.C. Solicitor-General Mike Farnworth echoed concerns that rose in meetings with federal and provincial public safety ministers:

“We strongly believe that if you’re dealing fentanyl, you’re dealing death, and you should be facing much more severe penalties such as manslaughter charges,” Farnworth said (Globe and Mail, October 19, 2017.)

Tough talk has failed in the past. The divide between pushers and users is not as clear as Farnworth might think. Provincial Health Officer Perry Kendall says there is a risk that “the policy implementation will not be able to distinguish between importers or non-user, large-scale dealers and the easier-to-apprehend street-level user/dealer.”

“Our attempts to destigmatize,” adds Kendall, “through decriminalizing the user and treating him or her as a person with an illness rather than a criminal, could be jeopardized.”

Restrictions on importation will fail as well. LifeLabs in B.C. has been testing urine samples of patients screened for fentanyl and found that these patients also tested positive for the even more powerful carfentanil. Now another synthetic opioid, U-47700, has been detected. More synthetic opioids could be on the way. Garth Graham, director for LifeLabs says:

“Are we two steps ahead? No, we’re not. In my opinion, there’s more of this coming … I think it is difficult. We’re working with provincial stakeholders . . . They mentioned another fentanyl analogue, and we are now trying to work that up so we can look for that.”

It’s a cat-and-mouse game. As soon as one variety of fentanyl is identified, another is cooked up. Testing equipment for the new analogue has to be built and laws restricting it enacted.

Naloxone kits save lives but only if someone nearby is lucid enough to administer them. Bob Hughes, Executive Director of ASK Wellness, suggests an alternative:

“We’re not going to fix this with one approach, such as providing Naloxone. That they’ve got some other option like basically pharmaceutical-grade heroin for some of those folks who just can’t seem to shake it,” Hughes told Radio NL.

Providing heroin to drug addicts may seem like a bad idea because it enables an addiction. But if we’re concerned about saving lives rather than making moral judgements on users, then legal heroin or other opioids like hydromorphone is a good first step.

However, the hard part is not the supply of safe opioids. The hard part is the destigmatization of drug users. Deaths due to drug overdose are still seen as a moral failing rather than a disease or “a person with an illness” as Dr. Kendall put it.

Open discussions about mental illness have helped destigmatize what was once thought of as lunacy or possession by evil spirits. Now the conversation needs to start around addiction; not as a weakness of character; not an embarrassment to be hidden from public view by friends and family.