Shortly before 7 p.m. on a quiet night in late September, Marilou Gagnon was in an Ottawa park, teaching two volunteers how to watch a drug addict for signs of an overdose.
The briefing took about 20 minutes and involved showing the volunteers through basic first-aid kits and simple procedures. Gagnon’s instructions culminated in one message: if it seemed that an overdose was under way, experienced volunteers on hand would call 911, and the city’s emergency services would take it from there.
This is the bare-bones mission of Overdose Prevention Ottawa (OPO), which was open for the 25th consecutive night when I visited it in mid-September. Shortly after 7 p.m., people began arriving at the park—really only a scruffy patch of grass next to a parking lot in Ottawa’s hardscrabble Lowertown neighbourhood—and making their way into one of two tents that had been pitched on the grass for the evening. In one tent, the “guests,” as OPO unfailingly calls them, would inject drugs they had brought to use. In the other, guests would smoke their product.
None of this activity is sanctioned by law. Public authorities issued no approval for OPO before it opened. Ottawa’s fabulously controversy-averse mayor, Jim Watson, has made his personal disapproval abundantly clear ever since.
Gagnon, an associate professor at the University of Ottawa School of Nursing, and a loosely knit group of community activists simply started operations one night in midsummer because they figured enough people had died from drug overdoses. It has subsisted on donated supplies, volunteer time and crowdfunded cash ever since. Gagnon and her associates have not been clear about when they will shut OPO down. But in the meantime, more than 1,000 guests have consumed their drugs in its tents. Every one has survived to see another day.
“We’re the 26th site,” Gagnon says later in a restaurant around the corner, where the staff is always happy to let OPO volunteers relax and nurse a soft drink. By “site,” she meant OPO is the 26th informal pop-up overdose-prevention site to open in Canada in a year.
That’s in addition to the much more elaborate supervised consumption sites, which have received formal legal sanction, provincial funding and an exemption from the federal Controlled Drugs and Substances Act so drug users can inject or smoke on the premises without worrying about legal sanction.
Fifteen of these more elaborate sites have been approved across Canada since the 2015 election. There were only two before that, in Vancouver, including the Insite facility that started it all. Stephen Harper’s Conservative government was so opposed to the notion of supervised consumption that it fought all the way to the Supreme Court for the right to shut Insite down. It lost, but Harper then passed a law that erected a series of procedural obstacles to opening more sites.
Last year Jane Philpott, the physician and hospital administrator who was then serving as Justin Trudeau’s health minister, brought in a new law to radically simplify the approval process for supervised-injection sites. That’s how Canada went from two supervised sites to what will soon be 17, with more likely to follow. The reason for Philpott’s urgency was simple: Canadians are dying of opioid and other drug-related overdoses by the thousands, in a public-health crisis without many precedents.
The best information Health Canada can gather puts the number of opioid-related deaths in Canada in 2016 at 2,816. By comparison, during the 2003 outbreak of Sudden Acute Respiratory Syndrome (SARS), 44 people died in Canada. SARS was treated as a massive public-health emergency, with daily official briefings and, when the epidemic ended, a Rolling Stones concert outside Toronto.
In British Columbia, by far the province hardest hit by opioid deaths, overdoses are killing twice as many people as traffic accidents. Yet too many Canadians still view opioids as somebody else’s problem. And for many front-line workers like Gagnon, every level of government is still too sluggish to respond to the crisis.
Hence the pop-up site in Ottawa’s Lowertown, and dozens more like it across Canada. Supervised consumption sites like Insite and a new clinic that opened two blocks away from OPO shortly after I visited are evidence of the Trudeau government’s willingness to act more boldly than its predecessor. But the pop-up sites exist in the gap between the federally sanctioned sites and the far greater demand. Gagnon is the first to admit the fully sanctioned sites are more elaborate. “They actually do wound care on-site. They do counselling. They do treatment for hepatitis C. Referrals. Testing for hep C, pregnancy, HIV, whatever. If someone coming in has just been sexually assaulted, they do counselling for that. They can link people to detox services,” she says. “Whereas for us, it’s basically just overdose prevention and first aid. If someone drops to the ground, you save them.”
Now that the more elaborate legally sanctioned site was opening a stone’s throw from OPO, why keep the pop-up site going? Because there’s still a demand, Gagnon says. “I have this feeling of being at the right place at the right time doing the exact right thing,” she says. “It’s just very special to witness the kind of resilience and support that people have. And the message that they get [from OPO volunteers] when they visit us is, ‘You know what? We show up every night on our own time and on our own money because your life matters.’ ”
At the federal level, the story of the Liberals’ response to opioids isn’t one of inaction or apathy. Soon after Trudeau made Philpott his first health minister, she took a personal interest in opioid overdoses and deployed a coordinated set of responses quickly. “We are in a crisis,” she said in 2016. “But in this crisis, we will not merely be spectators.”
Philpott moved quickly to increase access to naloxone, a self-administered remedy for opioid overdoses, which is now available without prescription and often free of charge at hundreds of pharmacies. The government supported a private members’ bill by B.C. Liberal MP Ron McKinnon that protects people against drug possession charges if they called 911 because somebody they knew was overdosing. The bill is now law.
At a two-day opioid summit in Ottawa in November 2016, the feds, provinces and an array of groups—medical, dental and nursing schools, chiropractors and more—agreed to coordinate their efforts. Six months later, a senior health department official, Suzy McDonald, took over full-time responsibility for coordinating the federal response to the crisis. The minister “was very interested and very engaged,” McDonald told Maclean’s. “She really wanted us to turn the tide on this crisis.”
In an ungainly federation like Canada, where provincial health departments are jealous of their jurisdictional prerogatives, simply working together can pose a challenge. How do you count an overdose death? Some provinces were reluctant to conclude an overdose until many months after a death. That made tracking a crisis cumbersome.
The Public Health Agency of Canada sent epidemiologists into every province and territory to investigate how to get timely data. Coroners from across the country met in Ottawa to debate a common definition for overdose deaths. But now that better information is coming in, the picture is not encouraging, McDonald says. “We know that this crisis is ongoing, we know it’s increasing, we also see signs that it’s spreading across the country. Based on the projections we have from the first quarter of 2017, if nothing happens, [this year] will be worse [than 2016].”
A big part of the problem is fentanyl, entering from China and hitting communities in Western Canada first. That’s one reason B.C. and Alberta account for nearly half of all overdose deaths in 2016, and the provinces east of Ontario for less than 10 per cent among them. “If we have a contaminated drug supply that spreads across this country, deaths will increase,” McDonald says.
So the federal government is seized with the urgency of the crisis. It’s changed laws and knocked heads to accelerate the speed and scope of the response. One of the best ministers in Trudeau’s government took a personal interest in the scale of human suffering. And yet these tricky and complex synthetic compounds, often hiding undetected in impure street drugs, will almost surely kill more Canadians this year than last year.
I asked OPO’s Gagnon whether she’s met Philpott. “Depends what you mean by ‘meet,’ ” she says. With other activists, she stood and turned her back on Philpott when the minister spoke at an opioid conference in Montreal last year.
What’s missing? In a nutshell, greater willingness by governments to climb a steep slope that starts with reducing the stigma on drug addiction, and progresses to decriminalization, either in controlled circumstances or more broadly. Not because drugs aren’t associated with grave problems, but because the problems in question are mostly socio-economic, and anti-drug laws aren’t helping solve them.
The federal Liberals, following Philpott’s lead, have actually put considerable effort into reducing the stigma around drug addiction and use. At a Canadian Medical Association conference in Quebec City this summer, Philpott urged delegates to spread the word that “people who use drugs are people who do not need judgment. They need what all Canadians expect from health systems—that is, compassionate care.” In early October, MPs were invited to a social mixer in Parliament’s Centre Block where members of the Canadian Pharmacists Association taught them how to administer naloxone, a potent overdose blocker. The event would have been unimaginable in the days of the Harper government.
But people who work with drug users say there’s a big layer of stigma that won’t go away as long as drug use is criminalized. Stigma, and added danger. “Having an unregulated market that is super-competitive, mixed with prohibition, creates the perfect formula for the most dangerous drugs to be introduced,” Gagnon argues. “It’s a very competitive market. So if you provide a stronger drug, people will notice that. They’ll want to purchase your product.”
Ottawa’s mayor, Jim Watson, can’t quite find his way to destigmatize chronic drug use. He has refused to visit OPO, and when the new supervised consumption site opened two blocks away, began calling for the pop-up site to shut down. “The reality is that we have a legitimate, federally approved, provincially funded, city-operated facility that is safe, that is secure, that is clean, that is run by health professionals, and it’s in an appropriate location,” Watson told reporters. “It’s time for that volunteer group to go and work with public health and give the park back to the children and families in the Lowertown neighbourhood.”
This is two kinds of farce. first, the cramped and grimy park where OPO operates was never a big hit with “children and families” at any point in its history. Second, Watson fought for years against the sort of safe, secure site he now embraces as a solution to opioid overdoses.
A surprising champion has been leading the charge in Ottawa for some measure of decriminalization of hard drug use. Vern White used to be Ottawa’s chief of police, and he was appointed to the Senate by Stephen Harper. He has emerged as a supporter not only of supervised consumption sites but of allowing them to provide clean drugs at the door to visitors, so they won’t have to spend the rest of their day trying to score. Gagnon is an enthusiastic advocate of the notion.
If job one at any overdose-prevention facility is to keep people alive, it’s obvious that giving them a known dose of a known drug is better than letting them scrounge for doses of mysterious origin and composition, she says. “And also you won’t have to engage in sex work or do other things, maybe steal, to find money. And the rest of your day you can focus on maybe employment, or care. And that money you used to buy drugs, you can use it for better housing now, or better food.”
The next step beyond the supervised provision of hard-drug dosage to addicts at supervised sites would be broader decriminalization. Philpott travelled to Portugal last year, in part because the country has decriminalized simple possession and use of most classes of drugs. But she and her successor, the newly appointed health minister Ginette Petitpas Taylor, have flatly refused to consider following suit in Canada. Even advocates of a far more concerted national response to the opioid crisis are divided over decriminalization.
Many are at least tempted. Chris Mackie is the medical officer of health for Middlesex-London in southern Ontario. A stubborn epidemic of injection drug use in London has led officials to launch the country’s most ambitious needle-exchange program. Last year, more than three million needles were distributed in London, more than in Montreal or Toronto. Mackie’s office works hard on street-level counselling and a range of other responses to the drug epidemic. And he emphasized that he is not advocating decriminalization: “I don’t think we’re quite ready at this point in our country.”
But the paradoxes of current policy haunt him. “As soon as someone’s got a criminal record, it’s really hard to get into the formal economy” of good jobs and steady wages, he says. “And they tend to get picked up very quickly in the informal economy”—petty theft and sex work. Improving their lives, and addressing the mix of trauma, mental illness and low wages that are intimately associated with hard drug use, becomes far harder then.
What should be clear by now is that the scale of Canada’s drug problem is far out of proportion to even a conscientious government’s attempts to get on top of it. Maybe a few local politicians, like Ottawa’s mayor, can get comfort by averting their gaze from the obvious gap between the scale of the human tragedy and the scale of the available government-sanctioned remedies. But a caring country needs to do better.