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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Legalize heroin and save lives

Legal opiates are being use to adulterate illegal ones with tragic consequences. More than 800 British Columbians were killed in fentanyl-related overdoses last year. Many of them were ordinary Canadians you might find living next door. One of them was my nephew who died a few years ago.

Calgary Herald

Calgary Herald

They injected what they thought was heroin, or some other illegal drug. If they had injected legal heroin, of known purity and strength, they would still be alive. I’m not naive; they would still be addicted but their quest for bliss would not have ended in death.

It’s a question of harm prevention. Legalization of heroin may seem like a radical idea but not long ago so did giving drug addicts clean needles and a safe place to inject.

Like the prohibition of alcohol, the prohibition of drugs has been a dismal failure. Prohibition simply pushes the drug trade underground. When a trade is unregulated, who knows what junk users will end up taking? Drug manufacturers don’t intend to kill users: it’s bad for business to kill your customers. They just want to maximize profits.

Fentanyl is perfectly legal. It’s prescribed by doctors for controlling pain. Fentanyl is just one the opium family. It turns out that all of them are addictive.

A brief history of legal opiates is a guide to the intersection of illegal ones. Opium from Persian poppies has been used for pain control since the fourth century. Researchers discovered the active components of opium -morphine, codeine and theobain- in the 1800s. In an attempt to find a non-additive painkiller, heroin was derived from morphine. The manufacturer of heroin, Bayer, pulled it from shelves in 1913 once it was found to be addictive.

In the quest for a non-addictive pain killer, Perdue Canada filed a patent in 1992 for OxyContin, a pill that would treat pain “without unacceptable side effects (Globe and Mail, Dec. 30, 2016).” Perdue encouraged doctors to prescribe the pill and soon it was a blockbuster hit with billions of dollars being made.

But OxyContin turned out to have terrible side effects and thousands of were hooked. Canadians consume more prescription opiates on a per-capita basis than any other country in the world according to a United Nations report.

As in all opiates, those hooked on OxyContin become habituated so that they needed more pills to control pain. Purdue attempted to control the problem with the replacement OxyNEO in 2012, a tamper-resistant alternative that is difficult to crush, snort or inject. And that same year, the provinces stopped paying for both opiates.

Both factors drove addicts to the streets to find a fix. Illegal drug manufacturers care not how their clients get hooked, whether it be from the pursuit of bliss or the relief of pain.

Fentanyl is now the universal opiate. Manufactured in China in concentrated form, it can be ordered on the internet and sent through the mail. From there, it is pressed into pills to mimic OxyContin and other opiates.

Making fentanyl illegal is not the solution. Drug abuse is a medical problem, not a criminal one. All opiates should be legalized and safe doses prescribed. Education, as in tobacco and alcohol abuse, is the only solution.