The growing problem
When you think of frequent drug users, you don’t think of students, friends, family — but the reality is, assumptions about drug users in Vancouver is causing the fentanyl crisis to reach its high. In June, drug overdose took over as the leading cause of unnatural death in BC, ahead of motor vehicle accidents. This has been in part attributed to a powerful opioid taking over the drug supply for the last few years: fentanyl.
Unlike heroin, fentanyl is synthetic. It is also around 100 times more potent. Most disturbingly, it’s recently been found cut into a wide range of different drugs. For years, fentanyl has slowly been edging out less available opioids like heroin and OxyContin. Now, it seems to have completely transformed the illicit drug market.
A four-week test at Insite, Vancouver’s safe injection site, found that 90 percent of all heroin brought into the facility contained fentanyl. It’s been showing up in more unexpected places, by some reports even being found in marijuana. As of August, there had been 488 drug overdose deaths in BC, set to be the highest number of overdoses on record in the province.
This is not just a local problem. The US has been facing similar numbers, with overdose deaths climbing higher than gun deaths. While the conversation has been cropping up in surprising places — even Donald Trump has chimed in about the fentanyl scare — it seems to be too little, too late. The situation isn’t caused by fentanyl, it’s caused by our flawed relationships and failed drug policies. It’s just taken a crisis to bring the conversation mainstream.
A community response
The headquarters of the Vancouver Area Network of Drug Users (VANDU), proudly displays a Vice article in its window that details how the organization has hosted training sessions teaching people how to respond to an overdose. Part of this training involves teaching people how to use naloxone, otherwise known as Narcan, a drug that can temporarily reverse the effect of an opioid on the brain.
“Our goals are to educate the public about the fact-based realities about drug use and advocate for the rights of users, and of course for their health and well-being,” said Karen Ward, a VANDU board member. The organization is rooted in the experience of people who use drugs, and therefore has tackled the crisis head on. “It’s obviously not acceptable in the community that we wait eight months for more safe injection sites; people have set one up in the alley down the street, an unsanctioned one. And that’s because people are not going to stand around while people are dying in the alleyways.”
In spite of the community-organized responses, deaths from drug overdoses are still a regular, tragic occurrence. Part of what puts people at risk is the secrecy that surrounds drug use. “We always say ‘Don’t use alone,’ but because of the stigma, people are isolated and they do,” Ward said.
In one incident, a young North Vancouver couple died in their home, leaving behind their two-year-old child, from an unspecified substance cut with fentanyl.
“It’s like playing whack-a-mole [. . .] fentanyl wasn’t a huge issue in Ontario until they removed OxyContin, and then you just opened up a market for 12 million people.” Jordan Westfall, SFU graduate student
Then there’s another surprising risk factor: many people who have overdosed didn’t realize they were taking an opioid at all. It was recently stated that cocaine has become the drug most commonly implicated in fentanyl overdose deaths. In the beginning of September, nine people overdosed from cocaine cut with fentanyl at four different house parties in Delta. Later that month, a man died from a fentanyl overdose at a wedding, after taking what he thought to be coke.
This may have something to do with the different attitudes towards types of drug use. Ward explained that VANDU has worked on raising awareness outside of the Downtown Eastside (DTES) because of the reluctance to discuss the occurrence of drug use in the broader community. “If it was another kind of epidemic or health crisis you wouldn’t pretend it only happened to other people. I think the result of this discrimination and stigmatization is the impulse to say, ‘Well I don’t see it’ or ‘It’s not happening to me so it’s not happening to anyone like me.’ But that’s not the case,” she said.
In spite of this, there is still a tendency to view casual users and regular opioid users in very different lights. “It’s almost a double standard in how people view drug use [. . .] recreational users are seen as somehow more innocent and less deserving of an overdose death,“ said Jordan Westfall. Westfall is a former SFU masters of public policy student who wrote his thesis on overdose prevention.
The topic is personal: Westfall experienced opioid addiction during his undergrad in Windsor, Ontario and has seen firsthand the effects of the crisis both at home and in Vancouver. He is now president of the Canadian Association of People who Use Drugs (CAPUD), an organization which is currently working on a campaign around the drug war in the Philippines.
He said while he previously kept personal details out of his work, his experiences have led him to speak about his own history. “The silence is deadly and it’s so needless,” he said. “When I was in grad school I was closed, I didn’t tell anyone that I was a former opioid user and somebody else in my program at some point passed away of an overdose and I just wanted to scream because it was dead silent. After that I decided, I’m going to be open about this.”
How did BC get hooked on fentanyl?
Considering the loss of life fentanyl has caused, many people are left asking how to solve the problem. SFU criminology professor Neil Boyd puts it down to lack of foresight.
“The drug trade has a logic of profit, like many other industries,” he explained. “Yes, killing off your consumers is self-defeating, but many dealers are greedy and stupid, and believe that they can cut their product and increase their profits.”
Fentanyl’s popularity as an ingredient with which to cut drugs is often attributed to its accessibility and price point. Most importantly, it is much more highly concentrated than heroin. For this reason, it tends to be unpredictable when cut with other substances. “Getting the right dose of fentanyl — strong but not lethal — is very tricky,” Boyd said. Its proliferation is also a symptom of the growing online drug trade.
A Globe and Mail investigation featured one online exchange where a seller in China explained that he would send the drugs as silica desiccant — the packages with the “Do not eat” label — along with other goods to in order disguise the product. Because fentanyl is much stronger than heroin, it can be sold in small amounts that are easier to get through the border.
There is perhaps no better illustration of our flawed drug policy than cases like this, where a more dangerous drug crops up on the market to fill a void. Westfall has seen how the changes in pharmaceutical drug distribution influenced the illicit drug trade back in Windsor.
“It’s like playing whack-a-mole,” he said. “Fentanyl wasn’t a huge issue in Ontario until they removed OxyContin, and then you just opened up a market for 12 million people.” OxyContin is a pharmaceutical painkiller that was placed under increased restrictions in Canada in 2012 due to its addictive potential.
Westfall said that this trend continues to be an issue. “Overdose deaths are used to enact policy which could increase overdose deaths,” he pointed out. “We see our federal government wanting to put into place prescription monitoring programs, which basically means that prescribers are going to tighten restrictions on drugs that are safer, so people get kicked off and go on the streets.”
Reports have indicated that many who begin to take prescribed painkillers for medical purposes end up taking illicit drugs.
Stemming the crisis
Some important steps forward have happened this year. In March, BC made naloxone available over the counter, meaning that it could potentially be sold at places as varied as a 7-Eleven, or a community centre, Westfall explained. However, there are still barriers.
“Naloxone distribution has been greatly expanded, but it’s still expensive to buy,” he said. Previously, naloxone was only available by prescription for people who had a known history of opioid use, something which Westfall critiqued in his 2015 thesis.
“There is no clinical drug and substance program offered to students through SFU” – Martin Mroz, Director of Health and Counselling Services SFU
“Oftentimes the person who is suffering the overdose is unresponsive and unable to use naloxone on themselves. If they are living with concerned family members or friends who are unaware of where the naloxone kit is stored, an overdose can potentially turn fatal.”
Vancouver Island University and the University of British Columbia have both made kits of naloxone available to students. But the UBC program has seen these kits mostly unclaimed. This has been attributed to the fact that they require interested students to specifically come forward and identify themselves as being a “drug user,” a self-identification that carries significant stigma.
Unfortunately, this also echoes the issues that Westfall highlighted in his thesis, wherein naloxone programs aren’t useful unless they take into account that someone other than the person using has to administer the drug.
Martin Mroz, the director of Health and Counselling Services at SFU, said that while there has been discussion about the possibility, SFU is not looking into providing naloxone for students at the moment and that in his knowledge they have not received any requests. “It would be a duplication of service and the training required would take clinicians out of exam rooms,” he explained.
However, he emphasized that there has been a lot of discussion between Health and Counselling and other campus groups around how SFU can address the issue. Student Health Peers have been incorporating the topic of fentanyl into their outreach programs, and campus security is looking into training for addressing potential overdoses.
While the discussion is “encouraging,” Mroz said, he emphasized that they are “still [in the] early days in planning.” There still appears to be a ways to go, not just around fentanyl but around substance use issues in general.
A quick browse of the SFU Health and Counselling Services brings up minimal drug-specific programming. The web resources feature information on topics ranging from Internet addiction to nutrition, but nothing specifically on drug or alcohol addiction. “There is no clinical drug and substance program offered to students through SFU,” Mroz echoed.
However, Mroz recognized that the impact of the overdose crisis goes beyond campus. “This crisis is widespread. It can affect friends and family, so it certainly can have a negative impact on our students without even happening on campus,” Mroz said. “Any tragedy, not just to a student, can have an awful impact on our community.”
A change in culture
“We love you. Be safe. Carry Naloxone,” reads the ad. These four lines on a black background carry a powerful message: they tell the viewer that their life is valued.
Put out by CAPUD, the ad seeks to counter a public service announcement that was seen on bus shelters earlier in the year. The PSA featured a corpse with a toe tag, an image that CAPUD said portrays people who use drugs as doomed. “We are human fucking beings, stop depicting us as the future dead, it doesn’t work, it never worked, and it’s offensive,” a public response on the CAPUD page reads.
“It’s basically saying if you keep doing this, you’re going to be dead, which places a lot of personal responsibility on the person and ignores the fact that overdose deaths are entirely preventable,” said Westfall. “It’s just barriers to accessing overdose prevention or accessing all these things that lands us in an epidemic.”
One significant barrier is the fear of legal penalties. Westfall highlighted Good Samaritan laws, which provide some level of legal immunity to people who call 911 in cases where someone’s life is at risk, as an important tool to reduce overdoses. One such law is currently under review in the Canadian government. Bill C-224, which would give immunity for drug possession in the case of an overdose, was advanced unanimously in Parliament in June but has not yet been passed.
Meanwhile, the premise of these laws can be extended to school policies. “SFU and other schools have to take a non-judgemental approach to drug use and ensure that disclosing it doesn’t come with negative consequences,” Westfall said. “If someone overdoses, for instance, in a dorm, I think it’s important to have a guarantee that someone can call 911 without facing outcomes like being kicked out of school or losing their residence.”
SFU’s code of academic integrity doesn’t include any specific policies around drug use, but does mention illegal conduct and “creating a situation that endangers or threatens the health, safety or well-being of any individual.” The SFU residence handbook for 2016–17, however, explicitly includes drug possession and owning drug-related paraphernalia as a violation of their community standards, which could potentially begin an eviction process.
As someone who used drugs throughout his undergraduate degree, Westfall wants to clear up some misconceptions.
“People cope with so much different stuff during university years and for some people it makes their lives bearable, which is hard for some people to understand,” Westfall said. “I was one of them. It helped me maintain being a functional person during a very difficult time in my life. So I think people need to understand that perspective. It’s not a moral thing, it’s not a weakness, it’s just that people all cope differently with life circumstances.
“If we ignore it or make people feel invisible, it makes it worse.”
It is difficult to evaluate the role of drug use in the lives of students, because for many, it remains a private matter. However, as Ward points out, it goes beyond the individual level.
“[This crisis] is happening to individuals and it’s happening to our society,” Ward said. “If we have any sense of justice then we need to get educated about it and step in, and that means individually learning about overdose prevention as part of basic first aid and caring for other people but it also means learning about, rethinking the role of drug use, broadly, as a social justice and as a health issue, and as a fact, a simple fact, of something that humans do.
“Pretending that it doesn’t exist is simply not acceptable.”