Safe supply

Why did activists give out free cocaine? Stunt addresses “drug poisoning crisis”

"Step up and address the issues that are killing us."

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On Tuesday afternoon, in downtown Vancouver’s Eastside, drug-user advocates rallied and marched in the streets in response to record high overdose deaths in British Columbia, and across Canada. At the demonstration, organizers took an unconventional tactic to promote a province-wide "safe supply" of drugs — giving away free fentanyl-free cocaine and opium.

The group called for changes to prescription guidelines in the B.C.’s safe supply program, asking authorities to add pharmaceutical-grade cocaine and heroin to the prescription list.

They also called for decriminalizing simple possession of drugs as well as defunding the Vancouver police and reallocating funds to community organizations.

Organized by a group called the Drug User Liberation Front, demonstrators set up an overdose prevention site and passed out cocaine and opium they say they tested for fentanyl, carfentanyl, benzodiazepines, and other dangerous contaminants. They planned to distribute 200 doses of uncontaminated heroin but could not find any, Jesse Winter, a reporter atThe Tyee, writes.

Journalist and photographer Jesse Winter reporting from the June 23 demonstration.

The activists say access to “clean” cocaine and heroin are crucial resources in a pandemic that has made access to non-contaminated drugs difficult: According to the group, Canada's borders shuttering in response to Covid-19 has disrupted the flow of drugs and increased drugs' toxicity, making it difficult to procure the substances they and other drug users need.

"British Columbia joined the global community in quickly and effectively dealing with the Covid-19 pandemic in order to prevent the deaths of many of its at-risk citizens," the Drug User Liberation Front announced. "Still, those at risk of overdose death have not benefited from the same kind of decisive and definitive action. This discrimination against a vulnerable population, resulting in death on this scale, is unacceptable."

The group calls for access to prescription narcotics in the province, providing a safe supply of cocaine and injectable heroin, covering injectable hydromorphone under B.C.’s prescription drugs plan, decriminalizing simple possession of drugs, and defunding Vancouver police while reallocating funds to community organizations.

Searching for a "safe supply" — In May, 170 people died of an overdose in British Columbia, topping the previous record of 161 set in December 2016. Of the 170, the presence of fentanyl was detected in 119 cases. These deaths add to an ongoing overdose crisis in the country, which authorities declared a public health emergency in 2016.

The safe supply program emerged in 2019 in an effort to address one of the primary causes of overdose: contamination of the illicit drug supply.

Safe supply refers to a legal and regulated supply of drugs with mind and body altering properties that traditionally have been accessible only through the illicit drug market. Instead of taking an "abstinence-only" approach, the program aims to reduce drug-related deaths by offering drug users a non-contaminated option for use.

"We often hear this crisis referred to as an overdose crisis, but really, we are in a drug poisoning crisis," a statement regarding the safe supply program, approved by the Vancouver City Council, says.

"One of the primary causes of overdose is the contamination of the illicit drug supply, and we believe that future deaths could be prevented if people could access a regulated safe supply."

The latest safe supply prescription guidelines in contention were introduced by the province in late March as an emergency measure during the Covid-19 pandemic. The program allows doctors and nurse practitioners to prescribe take-home pharmaceutical alternatives to people at risk of an overdose from an increasingly contaminated street drug supply.

The safe supply programs are part of a series of drug policies implemented by the Canadian government over the past few years aimed at harm reduction. In 2016, Canada made prescription heroin legal, a shift that reflected an "increasingly progressive and science-based approach to viewing drug addiction — one that emphasizes public health over criminalization," Yasmin Tayag wrote for Inverse in 2016.

Initially praised as a harm reduction strategy, the safe supply program has recently been criticized for perpetuating barriers to access, drug users and advocates say. Other health professionals say the safe supply program perpetuates the cycle of addiction without addressing the root cause of substance use.

"Activists and drug policy leaders, in their zeal to undermine the previous “war on drugs” or the criminal justice approach to addiction, are unwittingly creating a prison system of their own: a mental prison of perpetual, state-sponsored drug use," Jeremy Devine, a psychiatry resident at McMaster University, wrote in 2019. "This prison is even more insidious because it purports to offer treatment while keeping patients trapped in their addiction."

These policies have also come under fire in recent years — not because they give access to supervised injection sites or prescription drugs, but because they don't fully address the issue of a toxic supply.

Health professionals treating drug users in Toronto argue that the Canadian government has not responded quickly or effectively to the pressing problem. In a 2019 article published in the medical journal The Lancet, they write:

"From the frontline perspective, working at an overdose prevention site at the epicenter of the overdose crisis in Canada's largest city, our major lesson is that all levels of government are not acting fast enough and that the stigma against and criminalization of people who use drugs are impeding the public health response."

These authors called for drug policy reform to support safer supplies of drugs, echoing some of the drug user activists' demands:

"While overdose prevention sites and supervised-consumption services are life-saving, these facilities do not address the root cause of the current overdose crisis: an increasingly toxic illicit drug supply that is killing 11 Canadians per day. Safer supply programs provide alternatives to the illicit drug supply."

Ashley Heaslip, a family physician and the medical lead at PHS Community Services Society, told The Tyee that there are systemic barriers in the safe-supply system that need to be addressed. Specifically, Heaslip notes the lack of wraparound services and the inability to access pharmacies as persistent issues.

“When you look at those overdose numbers from May, nobody can turn a blind eye to the impact of that devastation," Heaslip said. "Every single option that could possibly be on the table I think is on the table right now.”

From April to May 2020, approximately 19 percent of illicit drug toxicity deaths had extreme fentanyl concentrations as compared to 9 percent from January 2019 to March 2020.

The organizers' strategy of "clean" drug distribution highlights these dangerously high levels of fentanyl and other contaminants in the drug supply. But giving out free drugs — even those tested for contaminants — comes with serious legal and health risks.

Cocaine has been associated with aortic ruptures, heart arrhythmias, strokes, and seizures. Opioids are linked with slowed breathing, choking, clogged and collapsed blood vessels, and increased risk of cancer.

It's too early to know whether these demonstrations will result in policy change. But what is clear is the street drug supply is increasingly contaminated and contributing to the high rate of overdose. How to accurately address that issue is far from decided on yet.

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