Episode 15: Apocalypse Prescribing

(Art by Garth Mullins)

Drug users in British Columbia are facing two overlapping public health emergencies: COVID-19 and the overdose crisis. Now that countries are closing their borders–the price of street drugs have also started to rise.

It’s a grim time. Vancouver just saw the largest spike in fatal ODs since last year.

But there’s also a glimmer of hope: the government has finally agreed to provide us with safer prescription alternatives to street drugs. If you have a “Substance Use Disorder” in British Columbia, you can now access a bunch of prescription opioids, benzos and stimulants –something we’ve been demanding for years. So far, this doesn’t include diacetylmorphine (heroin), cocaine or prescription fentanyl. And it is unclear whether or not the new policy will remain in place after COVID-19 has passed.

On Episode 15, we dig deep into the new policy and tell the story of advocacy that made this possible. We ask Minister of Mental Health and Addictions Judy Darcy why this wasn’t done at the start of the overdose crisis. We also speak with editorial board members Laura Shaver and Dean Wilson about getting their new meds. And we talk with Guy Felicella about writing the new clinical guidelines. 

Transcript

A full transcript of this episode is available here.

Call to Action

Get access to the drugs you need through B.C’s new clinical guidelines

Talk to your doctor, and bring a link to the guide if you can.

GET THE PDF HERE

The new guidelines DO NOT cover heroin, fentanyl, or cocaine.

Drugs Available

• oral hydromorphone (DIlaudid / Dillies).

• M-Eslon

• Dexedrine

• Methylphenidate (Ritalin)

• A range of benzos, including xanax/clonazepam.

There are options for smokers and drinkers too. 

What do the new Health Canada guidelines actually mean?

• Your pharmacist can extend a prescription

• Your doctor can call over the phone to extend or refill a prescription

• You can get it delivered at home

• You can get carries up to 23 days

• They don’t have to watch you take it

If you don’t have a doctor

If you’re in B.C., you can call:

• Rapid access addiction clinics (RAACs) may be able to provide telehealth support.
  Victoria: 250-381-3222
  Vancouver: 604-806-8867
  Surrey: 604-587-3755

• Rapid Access to Consultative Expertise (RACE) for Addictions is available Monday-Fri 8am-5pm for consultation and support: http://www.raceconnect.ca/
  Local calls: 604-696-2131
  Toll free: 1-877-696-2131

(https://yale.app.box.com/v/COVID19HarmReductionGuidance)

BE AWARE that some early symptoms of withdrawal and COVID-19 infection are similar. These include fever and muscle soreness. If symptoms include a persistent cough, it could be COVID-19.

YOU ARE AT AN INCREASED RISK OF BECOMING SERIOUSLY ILL OR DYING because

1. COVID-19 infection will worsen breathing impacts of opioids, benzos, and alcohol

2. Opioid withdrawal may worsen breathing difficulties

3. Smoking, including drugs like crack or meth, makes breathing problems worse

DIFFICULT TO INHALE: If you smoke drugs, like crack or meth, cigarettes or vapes, COVID-19 infection will make it more difficult to inhale smoke. Smoking drugs, cigarettes, or vapes will worsen breathing problems.

IF YOU THINK YOU’RE GETTING SICK: Avoid going to your local harm reduction and addictions programs – HAVE THEM DELIVER SUPPLIES TO YOU. Tell them you are sick so they can take steps to keep themselves safe.

BE PREPARED FOR INVOLUNTARY WITHDRAWAL: Be ready to go through involuntary withdrawal. Your dealer might get sick or the drug supply might be disrupted. Try to be prepared by stocking up. Talk to a medical provider about starting methadone or buprenorphine. Make sure you have all the necessary medications, food, and drinks needed to help detox. Try to have protein-based and electrolyte drinks like Pedialyte or Ensure on hand.

STOCK UP ON THINGS YOU MAY NEED TO MANAGE YOUR SUBSTANCE USE AND PRACTICE HARM REDUCTION.

DRUGS: If you have money and are able, stock up on your drug(s) of choice before things deteriorate. AVOID BINGEING on drugs that you are stockpiling so you have access to a supply. Try to buy from people you trust and have as many WAYS TO CONTACT DEALERS in your area as possible.

ALCOHOL: If you have an alcohol use disorder, the money, and are able, stock up on enough alcohol to last a few weeks. AVOID BINGEING on stockpiled alcohol so that you have access to enough to avoid alcohol withdrawal, and things like seizures. One way to do this is by MANAGING YOUR ALCOHOL USE by consuming an amount of alcohol equivalent to one can of beer, 1.5 ounces of rum, or 5 ounces of wine hourly as needed. Try to avoid bootleg alcohol.

HARM REDUCTION SUPPLIES: Be prepared for the POSSIBILITY OF SYRINGE EXCHANGES AND DRUG TREATMENT PROGRAMS CLOSING DOWN. If you are able, stockpile enough harm reduction supplies to last you a few weeks – longer if you are at higher risk of infection or complications. This includes things like: naloxone, syringes, cookers, pipes, and straws. Get a Sharps container to get rid of used syringes. If you can’t get one, use something like a plastic laundry detergent bottle or soda bottle. Label these bottles “SHARPS CONTAINER”. Do not recycle them.

NALOXONE: Stock up on naloxone in the event of an unintentional overdose. Emergency services are likely to take longer than usual during a pandemic.

METHADONE & BUPRENORPHINE: Check with your medical provider to see if services might be changing. Ask your program and provider if you can have take homes or more and longer refills on your medications. This means that you don’t have to go to your provider to get new doses after your first collection. IF YOU HAVE A PRE-EXISTING CONDITION that puts you at greater risk of infection, LET YOUR PROGRAM KNOW.

REMEMBER THAT PRACTICING HARM REDUCTION CAN HELP YOU TO AVOID COVID-19 INFECTION AND ADDITIONAL STEPS CAN HELP TO REDUCE YOUR RISK OF GETTING SICK

DON’T SHARE YOUR DRUG USE SUPPLIES: Injecting equipment; crack or meth pipes; rose or spoons (for smoking crack or freebasing), straws or other nasal tubes (for inhaling/snorting); bongs, vapes, joints; and drinks.

AVOID INJECTING ALONE: The illicit drug supply continues to be toxic. Be careful about the risk of overdose. Try not to use alone, especially if you inject drugs like heroin, fentanyl, or drugs that might have come into contact with them. There are a couple of things you can do to try to stay safe: (1) You can reduce your risk of COVID-19 infection by staying at least six feet away from other people, coughing or sneezing into your arm, avoiding touching your face, and washing your hands for at least 20 seconds with soap and water. (2) If you have a phone, call someone, preferably nearby, and ask them to stay on the line while you are injecting so they can act or call 9-11 (or the medical emergency phone number in your country) if you become unresponsive.

IF YOU RUN OUT OF SYRINGES: These can be disinfected and help prevent HIV and Hep C with 1:10 DILUTED BLEACH. If there’s a lot of blood, rinse once with water to remove it. If not, skip this step and rinse once with bleach. Load bleach fully into the syringe and keep it there for two minutes. Then expel it. Then rinse twice with clean water. If you don’t have bleach, at least three rinses with clean water can work almost as well. Dull syringes can be sharpened using the striker on a matchbook. Rinse after sharpening to remove any particles in the syringe.

IF YOUR SYRINGES ARE NO LONGER SAFE, you have a few options but be aware that these might be difficult with COVID-19 or make symptoms worse:

1. SNORT IT – Chop them into a powder finely and sniff slowly. It works but not as well as injecting does.

2. BOOTY BUMP IT – Dissolve with citric or ascorbic acid, put in a NEEDLELESS SYRINGE and squirt it up your bum/anus. Onset takes longer but you need less and the high lasts longer.

3. SWALLOW IT – Heroin/fentanyl will go via your liver BEFORE reaching your brain, resulting in a morphine effect – but stopping withdrawal.

4. SMOKE IT – Smoke drugs instead of injecting but keep in mind this can be hard to do with some drugs.

CLEAN YOUR SMOKING SUPPLIES: Use mouthpieces and pipe covers on your smoking supplies when possible. Frequently clean these mouthpieces and pipe covers using an alcohol-based cleaner (like Purell or some other brand) or wipe (minimum 60% alcohol concentration).

WIPE DOWN DRUG PACKAGES: Use an alcohol-based cleaner or wipe to immediately wipe down your packages. If your dealer carries drugs in their mouth, ask them if they can stop doing this. If they won’t, be careful handling the packages and do the cleaning as advised above. Remember that antibacterial washes don’t kill viruses but are better than nothing, especially if they contain alcohol.

DO NOT PUT DRUG BAGS OR WRAPS IN YOUR MOUTH, VAGINA OR ANUS: If you must carry drugs in your body, clean vigorously with an alcohol-based cleaner both before and after you take it out.

WASH YOUR HANDS with soap and hot water vigorously for at least 20 seconds (but longer if you can) every time you come into contact with others, after handling money and after you get your drug packages. Paper towels are preferred for drying hands, or at least use a clean towel. If you cannot wash your hands, clean your hands with an alcohol-based cleaner or wipes (minimum 60% alcohol concentration) – like the ones distributed by harm reduction programs.

PREPARE YOUR DRUGS YOURSELF: Don’t handle or touch other people’s drugs or equipment and don’t let them touch yours. Avoid buying and splitting packages of drugs with others during this pandemic, if possible, to limit the number of people handling drugs. If you must split the drugs, make sure the person who touches the drugs washes their hands.

REMEMBER that people who use drugs and the people in their lives commonly have weaker immune systems, respiratory (breathing) problems, and other conditions that place them at a higher risk of getting COVID-19 infection. Help keep everybody safe by following this advice.

Created in collaboration by the Yale Program in Addiction Medicine, Global Health Justice Partnership, and Crackdown. Adapted with thanks from a document produced by 3D Research.

Works Cited

• BC Centre for Disease Control: Harm reduction information for people who use substances in the context of the COVID-19 outbreak.

• BC Centre for Disease Control: Weekly overdose data, March 22-March 28, 2020
  Canadian Association of People who Use Drugs. Safe Supply Concept Document. February 2019

• CBC News: B.C. releases plan to provide safe supply of drugs during COVID-19 pandemic. March 26, 2020

• Coronavirus Is Leading to Shortages of Fentanyl And Meth. Deborah Bonello. Vice.com. March 19, 2020 

• COVID-19: Open letter from DTES frontline workers to Horgan, Dix, Henry, Daly, Stewart, and Darcy—we need more, now. By Concerned registered nurses and frontline workers of the DTES. Georgia Straight, March 31, 2020.

• Fleming, T., Barker, A., Ivsins, A. et al. Stimulant safe supply: a potential opportunity to respond to the overdose epidemic. Harm Reduct J 17, 6 (2020).

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.

You can support us at Patreon.com/crackdownpod.

Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fresz, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.

Rest in Peace Chereece Keewatin.
Crackdown’s senior producer is Sam Fenn. Our producers are Lisa Hale and Alexander Kim. With help from Polly Leger.

Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.

Garth Mullins is Crackdown’s host, writer and executive producer. You can follow him on twitter @garthmullins.

Original score written and performed by Sam Fenn, James Ash, Kai Paulson and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters.

Episode 14: Emergency Measures

Image: A latex-gloved hand raises a microphone. (Photo: Garth Mullins)

Governments are taking drastic measures to try to slow down the spread of #COVID-19 – declaring emergencies, shutting down businesses and sealing borders.  But what about drug users? We have been facing a deadly public health emergency for years, with no drastic measures taken. Will they forget us again this time? 

Since the first coronavirus case was confirmed in British Columbia, around 150 people have died from a contaminated drug supply. Four people have died from COVID-19. Now we face both crises at once. 

Many drug users in our community are middle aged. And the life can really put years on you. Many of us have COPD or are immunocompromised. The pandemic could cut through us like a scythe.

Transcript

A transcript of this episode is available here.

Demands

1. Ensure patients can access medication while socially distancing. Give people take home doses. Stand down rules about witnessed ingestion of opioids and opioid agonists (like methadone). Waive requirements for doctors visits and urine screenings. 

2. Pass legislation to make pharmaceutical drugs universally free at the point of service. 

3. There are already shortages of slow-release oral morphine (Kadian). Countries need a strategic opioid reserve. Domestic production of opioids and opioid agonists must be a priority. In WW2, governments ordered car plants to retool and make tanks.

4. House everybody immediately. Alternatives are needed to crowded shelters, SROs, vehicles, and couch surfing.  Unoccupied housing in cities around the world should be expropriated and redistributed to vulnerable people and families. Immediately open hotel rooms for housing. 

5. Declare an immediate moratorium on evictions, suspend rents and halt all mortgage default foreclosures. (Vancouver Tenants Union, ACORN, The BC Government Employees Union) 

6. Legislate paid sick leave for all workers, including paid leave for all workers who are quarantined, or self-isolating. (Vancouver Labour & District Council)

7. Cancel student debt. 

8. Give everyone an immediate basic income payment. Increase income assistance and disability to a living wage. Expand access to unemployment insurance to include contract workers, freelancers, and people who work in illicit markets. (The Vancouver Tenants Union, BC Federation of Labour (BCFED), ACORN)

9. Change labour legislation to require employers to provide paid sick leave. Penalize any employer that puts workers in danger of contracting COVID-19 or harms efforts to contain the spread of the pandemic. 

10. Law enforcement should immediately stand down on all drug law enforcement for the duration of the COVID-19 pandemic and beyond. People currently held on drug charges and non-violent offenses should be released immediately. Social distancing is almost impossible inside and people often aren’t given access to basic sanitary items.

11. Provide a safe supply of drugs. Having to score every day makes self-isolation impossible. There are reports of shortages of fentanyl and meth in the U.S.  

We’ve lived through one public health emergency for 5 years already. We’ve been through sharply increasing fatality stats, rationing, scarcity, discrimination, false media reports, panics, controls on our movements, sickness & deaths of loved ones. And we’ve used harm reduction to try to survive. 

Now many of us feel anxious. And many also feel a sense of detachment and fatalism. If you inject something that could kill you several times each day for several years, a virus can seem less immediate. Government has been undermining faith in health programs and emergency responses for years. It is hard to expect everyone to suddenly take those same authorities seriously. It is also hard to ask people to take action on something when the material circumstances to do so have been denied them.  

But the virus is holding a mirror up to capitalism. And we all see a system that has always left so many of us vulnerable. Things that seemed impossible last week are  here now. And that means the solutions that we’re proposing could well be on the table too.

COVID-19 guidance for people who use substances

(https://yale.app.box.com/v/COVID19HarmReductionGuidance)

BE AWARE that some early symptoms of withdrawal and COVID-19 infection are similar. These include fever and muscle soreness. If symptoms include a persistent cough, it could be COVID-19.

YOU ARE AT AN INCREASED RISK OF BECOMING SERIOUSLY ILL OR DYING because

1. COVID-19 infection will worsen breathing impacts of opioids, benzos, and alcohol

2. Opioid withdrawal may worsen breathing difficulties

3. Smoking, including drugs like crack or meth, makes breathing problems worse

DIFFICULT TO INHALE: If you smoke drugs, like crack or meth, cigarettes or vapes, COVID-19 infection will make it more difficult to inhale smoke. Smoking drugs, cigarettes, or vapes will worsen breathing problems.

IF YOU THINK YOU’RE GETTING SICK: Avoid going to your local harm reduction and addictions programs – HAVE THEM DELIVER SUPPLIES TO YOU. Tell them you are sick so they can take steps to keep themselves safe.

BE PREPARED FOR INVOLUNTARY WITHDRAWAL: Be ready to go through involuntary withdrawal. Your dealer might get sick or the drug supply might be disrupted. Try to be prepared by stocking up. Talk to a medical provider about starting methadone or buprenorphine. Make sure you have all the necessary medications, food, and drinks needed to help detox. Try to have protein-based and electrolyte drinks like Pedialyte or Ensure on hand.

STOCK UP ON THINGS YOU MAY NEED TO MANAGE YOUR SUBSTANCE USE AND PRACTICE HARM REDUCTION.

DRUGS: If you have money and are able, stock up on your drug(s) of choice before things deteriorate. AVOID BINGEING on drugs that you are stockpiling so you have access to a supply. Try to buy from people you trust and have as many WAYS TO CONTACT DEALERS in your area as possible.

ALCOHOL: If you have an alcohol use disorder, the money, and are able, stock up on enough alcohol to last a few weeks. AVOID BINGEING on stockpiled alcohol so that you have access to enough to avoid alcohol withdrawal, and things like seizures. One way to do this is by MANAGING YOUR ALCOHOL USE by consuming an amount of alcohol equivalent to one can of beer, 1.5 ounces of rum, or 5 ounces of wine hourly as needed. Try to avoid bootleg alcohol.

HARM REDUCTION SUPPLIES: Be prepared for the POSSIBILITY OF SYRINGE EXCHANGES AND DRUG TREATMENT PROGRAMS CLOSING DOWN. If you are able, stockpile enough harm reduction supplies to last you a few weeks – longer if you are at higher risk of infection or complications. This includes things like: naloxone, syringes, cookers, pipes, and straws. Get a Sharps container to get rid of used syringes. If you can’t get one, use something like a plastic laundry detergent bottle or soda bottle. Label these bottles “SHARPS CONTAINER”. Do not recycle them.

NALOXONE: Stock up on naloxone in the event of an unintentional overdose. Emergency services are likely to take longer than usual during a pandemic.

METHADONE & BUPRENORPHINE: Check with your medical provider to see if services might be changing. Ask your program and provider if you can have take homes or more and longer refills on your medications. This means that you don’t have to go to your provider to get new doses after your first collection. IF YOU HAVE A PRE-EXISTING CONDITION that puts you at greater risk of infection, LET YOUR PROGRAM KNOW.

REMEMBER THAT PRACTICING HARM REDUCTION CAN HELP YOU TO AVOID COVID-19 INFECTION AND ADDITIONAL STEPS CAN HELP TO REDUCE YOUR RISK OF GETTING SICK

DON’T SHARE YOUR DRUG USE SUPPLIES: Injecting equipment; crack or meth pipes; rose or spoons (for smoking crack or freebasing), straws or other nasal tubes (for inhaling/snorting); bongs, vapes, joints; and drinks.

AVOID INJECTING ALONE: The illicit drug supply continues to be toxic. Be careful about the risk of overdose. Try not to use alone, especially if you inject drugs like heroin, fentanyl, or drugs that might have come into contact with them. There are a couple of things you can do to try to stay safe: (1) You can reduce your risk of COVID-19 infection by staying at least six feet away from other people, coughing or sneezing into your arm, avoiding touching your face, and washing your hands for at least 20 seconds with soap and water. (2) If you have a phone, call someone, preferably nearby, and ask them to stay on the line while you are injecting so they can act or call 9-11 (or the medical emergency phone number in your country) if you become unresponsive.

IF YOU RUN OUT OF SYRINGES: These can be disinfected and help prevent HIV and Hep C with 1:10 DILUTED BLEACH. If there’s a lot of blood, rinse once with water to remove it. If not, skip this step and rinse once with bleach. Load bleach fully into the syringe and keep it there for two minutes. Then expel it. Then rinse twice with clean water. If you don’t have bleach, at least three rinses with clean water can work almost as well. Dull syringes can be sharpened using the striker on a matchbook. Rinse after sharpening to remove any particles in the syringe.

IF YOUR SYRINGES ARE NO LONGER SAFE, you have a few options but be aware that these might be difficult with COVID-19 or make symptoms worse:

1. SNORT IT – Chop them into a powder finely and sniff slowly. It works but not as well as injecting does.

2. BOOTY BUMP IT – Dissolve with citric or ascorbic acid, put in a NEEDLELESS SYRINGE and squirt it up your bum/anus. Onset takes longer but you need less and the high lasts longer.

3. SWALLOW IT – Heroin/fentanyl will go via your liver BEFORE reaching your brain, resulting in a morphine effect – but stopping withdrawal.

4. SMOKE IT – Smoke drugs instead of injecting but keep in mind this can be hard to do with some drugs.

CLEAN YOUR SMOKING SUPPLIES: Use mouthpieces and pipe covers on your smoking supplies when possible. Frequently clean these mouthpieces and pipe covers using an alcohol-based cleaner (like Purell or some other brand) or wipe (minimum 60% alcohol concentration).

WIPE DOWN DRUG PACKAGES: Use an alcohol-based cleaner or wipe to immediately wipe down your packages. If your dealer carries drugs in their mouth, ask them if they can stop doing this. If they won’t, be careful handling the packages and do the cleaning as advised above. Remember that antibacterial washes don’t kill viruses but are better than nothing, especially if they contain alcohol.

DO NOT PUT DRUG BAGS OR WRAPS IN YOUR MOUTH, VAGINA OR ANUS: If you must carry drugs in your body, clean vigorously with an alcohol-based cleaner both before and after you take it out.

WASH YOUR HANDS with soap and hot water vigorously for at least 20 seconds (but longer if you can) every time you come into contact with others, after handling money and after you get your drug packages. Paper towels are preferred for drying hands, or at least use a clean towel. If you cannot wash your hands, clean your hands with an alcohol-based cleaner or wipes (minimum 60% alcohol concentration) – like the ones distributed by harm reduction programs.

PREPARE YOUR DRUGS YOURSELF: Don’t handle or touch other people’s drugs or equipment and don’t let them touch yours. Avoid buying and splitting packages of drugs with others during this pandemic, if possible, to limit the number of people handling drugs. If you must split the drugs, make sure the person who touches the drugs washes their hands.

REMEMBER that people who use drugs and the people in their lives commonly have weaker immune systems, respiratory (breathing) problems, and other conditions that place them at a higher risk of getting COVID-19 infection. Help keep everybody safe by following this advice.

Created in collaboration by the Yale Program in Addiction Medicine, Global Health Justice Partnership, and Crackdown. Adapted with thanks from a document produced by 3D Research.

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations. 

You can support us at Patreon.com/crackdownpod. 

Thanks to Louise Vincent, Urban Survivors Union, North Carolina, housing activist Wendy Pedersen, and OPS Vancouver manager Trey Helton.

Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fresz, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.

Rest in Peace Chereece Keewatin.

Crackdown’s senior producer is Sam Fenn. Our producers are Alexander Kim, Lisa Hale and Alex De Boer. 

Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.

Garth Mullins is host, writer and executive producer. You can follow him on twitter @garthmullins. 

Original score written and performed by Sam Fenn, James Ash, Kai Paulson and me. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.  

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters. 

Follow us on twitter @crackdownpod. Our patreon is here.

Episode 13: Someone Else’s Problem

Image: Tanis Rose overlooking the Port of Vancouver. (Photo: Alexander Kim)

Conservatives say we need recovery not harm reduction. In some places, the right is fighting to stop safe injection sites from opening – or trying to close down existing ones. But what do they really mean by recovery? We followed one woman’s journey through four recovery homes. She had lots of family support. And these places were not the worst, most notorious ones. Still, all we found was a bureaucratic, broken patchwork of a system.

This episode discusses suicide and self harm. If you are struggling with thoughts of suicide or know someone who is, you can reach out for help at crisisservicescanada.ca 

Transcript

A full transcript of this episode is available here.

Screenshot from Westminster House self-referral form

Screenshot from Westminster House website

Screenshot from Westminster House Primary Care Guidelines

Screenshot from Westminster House Primary Care Guidelines

Recommended Reading

• BCCSU Safety Bulletin. “Avoid the use of withdrawal management as a standalone treatment for opioid use disorder”

• Ferri  M, Amato  L, Davoli M. “Alcoholics Anonymous and other 12‐step programmes for alcohol dependence.” Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005032.

• MacArthur GJ, Minozzi S, Martin N, et al. “Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.” BMJ 2012;345:e5945.

• Medola A, Gibson R. “Addiction, 12-Step Programs, and Evidentiary Standards for Ethically and Clinically Sound Treatment Recommendations: What Should Clinicians Do?” AMA J Ethics. 2016;18(6):646-655.

•  Strang J, McCambridge J, Best D, et al. “Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study.” BMJ 2003;326:959-60

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.

You can support us at Patreon.com/crackdownpod.

Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.

Rest in Peace Chereece Keewatin. It’s been just over a year since we lost you.

Crackdown’s senior producer is Sam Fenn. Our producers are Lisa Hale and Alexander Kim. This month we had production help from Alex de Boer and Polly Leger.

Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.

Garth Mullins is Crackdown’s host, writer and executive producer. You can follow him on twitter @garthmullins.

Original score written and performed by Sam Fenn, James Ash and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters

Episode 12: Love in a State of Emergency

Image: WAHRS treasurer Linda Steinhauer stands by a mural painted by Trey Helten and Sean “Heph” Hefele in the alley outside OPS on the Downtown Eastside. (Photo: Alexander Kim)

You can’t understand Canada’s overdose crisis without knowing the truth about this country –  and that’s the story of colonization: a centuries-long effort to steal land and erase Indigenous peoples.

In April 2019, Garth and Thunder Bay podcast creator Ryan McMahon were chatting on the phone. Ryan said that some Indigenous communities are reticent about harm reduction and that Crackdown should look at that.

Transcript

A full transcript of this episode is here.

Image: Garth Mullins interviews Ryan McMahon. (Photo: Lisa Hale)

We’ve been talking about making this episode since our first editorial board meeting in 2018, when Chereece Keewatin, Shelda Kastor and Jeff Louden talked about how the overdose crisis affects them as Indigenous people. Since then Chereece died – and we blame racist drug war policies for that.

Shelda guided the work on this episode, mapping the connections between abstinence programs, the Red Road and Indigenous approaches harm reduction.

WAHRS treasurer Linda Steinhauer. (Photo: Alexander Kim)

The names of loved ones who have died in this crisis on Trey and Sean’s mural, “For the Loved Ones We Have Lost”. Joseph Steinhauer was Linda’s son. He worked at this OPS before he died, and was recognized for his work there by the Nurses and Nurse Practitioners of BC Awards. (Photo: Alexander Kim)

Tracey the Bannock Lady from Alexander Kim and Stefan Labbé on Vimeo.

KEY FINDINGS from the work of our editorial board member Shelda Castor and our science advisor, Ryan McNeil.

• Canada’s drug overdose crisis disproportionately affects Indigenous Peoples differently owing to a legacy of colonialism, racism and intergenerational trauma.

• Disaggregated data on Indigenous people are needed to understand more clearly how Indigenous Peoples are affected by drug overdoses.

• Indigenizing harm reduction and addiction treatment must involve integrating cultural and traditional Indigenous values that align with the principles of harm reduction.

• Reconciliation with Indigenous Peoples must include ending the war on drugs to address underlying structural conditions that produce drug-related harms, including overdose.

Some of the CALLS TO ACTION from the Truth and Reconciliation Commission:

18. We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

19. We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long- term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.

21. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

Recommended Reading

• We recommend Bob Joseph’s book “21 Things You May Not Know About the Indian Act.”

• The Truth and Reconciliation Commission’s final report and the 94 Calls to Action should be read by everyone.

• Chelsea Vowel’s book Indigenous Writes: A Guide to First Nations, Métis & Inuit Issues in Canada is essential reading.

• We recommend listening to all of Ryan’s CANADALAND’s podcast THUNDER BAY. Ryan also produces Red Man Laughing and Stories From The Land.

(Graphic: First Nations Health Authority)

Works Cited

• An Act Further to Amend “The Indian Act,” Chapter Forty-Three of the Revised Statues. 1888.

• Ben, Leon W. 1991. “Wellness Circles: The Alkali Lake Model in Community Recovery Processes.” A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education, Northern Arizona University.

• Cariou, C. 1986. “Native Alcohol Workers See No End to the Problem.” Kainai News, April 25, 1986.

• FNHA. 2019 “First Nations Opioid Overdose Deaths Rise in 2018.”

• Giovannetti, Justin. 2016. “Alberta Reserves Struggle to Access Fentanyl Antidote.” The Globe and Mail. March 2016.

• Goodman, Ashley, Kim Fleming, Nicole Markwick, Tracey Morrison, Louise Lagimodiere, and Thomas Kerr. 2017. “‘They Treated Me like Crap and I Know It Was Because I Was Native’: The Healthcare Experiences of Aboriginal Peoples Living in Vancouver’s Inner City.” Social Science & Medicine, no. 178 (April): 87–94.

• Government of Canada. 1876. The Indian Act.

• Joseph, Bob. 2018. “A Look at First Nations Prohibition of Alcohol.” ictinc.ca.

• Joseph, Bob. 2018. 21 Things You May Not Know About the Indian Act. Indigenous Relations Press.

• Kelly, Doug. 2017. “The Hidden Complexities in Substance Abuse.” The Globe and Mail. August 25, 2017.

• Lavalley, Jennifer, Shelda Kastor, Jenna Valleriani, and Ryan McNeil. “Reconciliation and Canada’s Overdose Crisis: Responding to the Needs of Indigenous Peoples.” CMAJ. December 17, 2018.

• Lucas, Phil, dir. 1986. The Honour of All. Film. UCLA Film & Television Archive.

• Mail, Patricia D., and Linda J. Wright. 1989. “Point of View: Indian Sobriety Must Come from Indian Solutions.” Health Education 20 (5): 19–22.

• McMahon, Ryan. 2018. “Thunder Bay.” Podcast. Edited by Jesse Brown. CANADALAND.

• Narcotics Anonymous. 1996. “Bulletin #29: Regarding Methadone and Other Drug Replacement Programs.” na.org. 1996.

• Truth and Reconciliation Commission of Canada. 2015. “Truth and Reconciliation Commission of Canada: Calls to Action.”

• Willie, Elvin. 1989. “The Story of Alkali Lake.” Alcoholism Treatment Quarterly 6 (3–4): 167–74.

• Western Aboriginal Harm Reduction Society. Talking Circle Series: The healthcare experiences of aboriginal peoples living in the downtown eastside; National Collaborating Centre for Aboriginal Health. (2009).

‌Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations. 

You can support us at Patreon.com/crackdownpod. 

This month, editorial board member Shelda Kastor provided invaluable advice and direction to me and the production team. Thank you Shelda.

We’d also like to thank Esk’etemc for letting us use clips of their film and Trey Helten and Shawn “Heph” Hefele, whose mural is in the art for this month’s show. 

Our Editorial Board is:  Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.

Rest in Peace Chereece Keewatin.

Crackdown’s senior producer is Sam Fenn. Our producers are Alexander Kim and Lisa Hale.

Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.

Garth Mullins is Crackdown’s host, writer and executive producer. You can follow him on twitter @garthmullins. 

Original score written and performed by Sam Fenn, James Ash, Kai Paulson and me. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.  

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters.

Episode 11: The Year That Nothing Happened

Image: Samona Marsh and her dog Ollie ride a mobility scooter outside VANDU’s Downtown Eastside storefront. (Photo: Alexander Kim)

Dean Wilson—a Crackdown editorial board member and  elder statesman of Vancouver’s drug user movement—thinks 2019 might be his most disappointing year as an activist. “We’ve accomplished absolutely fucking nothing, I’m incredibly depressed about it,” he recently told Garth Mullins. 

“2019, will be known to me as the year that nothing happened.” 

Dean’s right. We haven’t had a big win in a while. And 2019 feels a bit like a depressing blur. But it was also a year where we fought back. In the last Crackdown episode of the year, we tell four stories about surviving the drug war. Each story is one small moment–something that might otherwise be forgotten. Maybe these stories can tell us something about where we are now—and what we need to do in 2020.

This episode discusses suicide. If you are struggling with thoughts of suicide or know someone who is, you can reach out for help here.

Transcript

A full transcript of this episode is available here.

Image: Jeff Louden’s arm, covered in Tagaderm. (Photo by Garth Mullins)

Sam Fenn interviews Samona Marsh and Kevin Yake upstairs at the Vancouver Area Network of Drug Users. (Photo by Alexander Kim)

Image: Garth Mullins sits with Ollie. (Photo by Dexter McMillan)

Reading List

• Bardwell, Geoff, Taylor Fleming, Alexandra B. Collins, Jade Boyd, and Ryan McNeil. 2018. “Addressing Intersecting Housing and Overdose Crises in Vancouver, Canada: Opportunities and Challenges from a Tenant-Led Overdose Response Intervention in Single Room Occupancy Hotels.” Journal of Urban Health 96 (1): 12–20.

• Bardwell, Geoff, Thomas Kerr, Jade Boyd, and Ryan McNeil. 2018. “Characterizing Peer Roles in an Overdose Crisis: Preferences for Peer Workers in Overdose Response Programs in Emergency Shelters.” Drug and Alcohol Dependence 190 (September): 6–8.

• Bardwell, Geoff, Evan Wood, and Rupinder Brar. 2019. “Fentanyl Assisted Treatment: A Possible Role in the Opioid Overdose Epidemic?” Substance Abuse Treatment, Prevention, and Policy 14 (1).

• Bula, Frances. 2019. “B.C. Municipalities Pass Bylaws Targeting Homeless.” The Globe and Mail. The Globe and Mail. November 15, 2019.

• Government of Canada. 2014. “Evidence – SECU (41-2) – No. 36 – House of Commons of Canada.” Ourcommons.Ca. Government of Canada. November 4, 2014.

• Government of Canada. 2019. “Opioid-Related Harms in Canada – Public Health Infobase | Public Health Agency of Canada.” Canada.Ca. Government of Canada. 2019.

• Johnston, Jesse. 2019. “Meet the B.C. Man Who Has Reversed More than 190 Overdoses.” CBC. April 15, 2019.

• Kennedy, MC, Jade Boyd, Samara Mayer, Alexandra Collins, Thomas Kerr, and Ryan McNeil. 2019. “Peer Worker Involvement in Low-Threshold Supervised Consumption Facilities in the Context of an Overdose Epidemic in Vancouver, Canada.” Social Science & Medicine 225 (March): 60–68.

• Kennedy, MC, David C. Klassen, Huiru Dong, M-J S. Milloy, Kanna Hayashi, and Thomas H. Kerr. 2019. “Supervised Injection Facility Utilization Patterns: A Prospective Cohort Study in Vancouver, Canada.” American Journal of Preventive Medicine 57 (3): 330–37.

• Kerr, Thomas, Sanjana Mitra, Mary Clare Kennedy, and Ryan McNeil. 2017. “Supervised Injection Facilities in Canada: Past, Present, and Future.” Harm Reduction Journal 14 (1).

• Mayer, S., Boyd, J., Collins, A., Kennedy, M. C., Fairbairn, N., & McNeil, R. (2018). Characterizing fentanyl-related overdoses and implications for overdose response: Findings from a rapid ethnographic study in Vancouver, Canada. Drug and alcohol dependence 193, 69-74.

• Luymes, Glenda. Vancouver. 2017. “‘I’m Going to Allow These Things to Drive Me Forward … :’ Maple Ridge Mayor on Threats to Her Safety.” Vancouver Sun. Vancouver Sun. July 7, 2017.

• McNeil, Ryan, Thomas Kerr, Hugh Lampkin, and Will Small. 2015. “‘We Need Somewhere to Smoke Crack’: An Ethnographic Study of an Unsanctioned Safer Smoking Room in Vancouver, Canada.” International Journal of Drug Policy 26 (7): 645–52.

• McNeil, Ryan, Will Small, Hugh Lampkin, Kate Shannon, and Thomas Kerr. 2013. “‘People Knew They Could Come Here to Get Help’: An Ethnographic Study of Assisted Injection Practices at a Peer-Run ‘Unsanctioned’ Supervised Drug Consumption Room in a Canadian Setting.” AIDS and Behavior 18 (3): 473–85.

• Notta, Dania, Brian Black, TianXin Chu, Ronald Joe, and Mark Lysyshyn. 2019. “Changing Risk and Presentation of Overdose Associated with Consumption of Street Drugs at a Supervised Injection Site in Vancouver, Canada.” Drug and Alcohol Dependence 196 (March): 46–50.

• Shearer, Daniel, Taylor Fleming, Al Fowler, Jade Boyd, and Ryan McNeil. 2019. “Naloxone Distribution, Trauma, and Supporting Community-Based Overdose Responders.” International Journal of Drug Policy 74 (December): 255–56.

• Wallace, Bruce, Katrina Barber, and Bernadette (Bernie) Pauly. 2018a. “Sheltering Risks: Implementation of Harm Reduction in Homeless Shelters during an Overdose Emergency.” International Journal of Drug Policy 53 (March): 83–89.

• Woo, Andrea. 2019. “Unsanctioned Overdose-Prevention Site Opens in Maple Ridge, Renewing Debate over Drug Use and Homelessness.” The Globe and Mail. The Globe and Mail. June 6, 2019.

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.

Thank you to Nathan Crompton, Ivan Drury, Andrea Woo, Samara Mayer, and Andrew Ivsins.

Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, Laura Shaver.  Rest in Peace Chereece Keewatin.

Crackdown‘s host, writer and executive producer is Garth Mullins. 

Crackdown’s senior producer is Sam Fenn. 

Crackdown‘s producers are  Alexander Kim, Lisa Hale, Polly Leger and this month, Alex de Boer.

Crackdown‘s science advisor is Ryan McNeil, now of Yale University.

All of the music on today’s program was composed, preformed, and produced by Sam Fenn, Jacob Dryden, Kai Paulson, James Ash and Garth Mullins. Our theme song was written by Garth and  Sam with accompaniment from Dave Gens and Ben Appenheimer.  

Today’s episode also featured the song “Fuck You Pigs” by Trey Helton’s band The Fuck You Pigs.

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters. You can support us at Patreon.com/crackdownpod. 

Follow us on twitter @crackdownpod. Our website is: crackdownpod.com.

Episode 10: Passing the Marker

In 2018, Scotland had a higher rate of drug-related deaths than Canada or the U.S. — even though fentanyl hasn’t yet taken over the U.K.’s drug supply. In episode 10, Crackdown crosses the Atlantic to try to figure out what’s going on.

Transcript

A full transcript for this episode is available here.

Sources: Scotland and Glasgow; Canada; B.C and Vancouver; US

Reading List

• U.K. House of Parliament. Scottish Affairs Committee. “Problem drug use in Scotland.” 2019

• National Health Service Scotland, “Measuring Health Inequalities”. NHS Scotland. (retrieved Nov 25, 2019)

• Izundu, Chi Chi. “Fake Xanax: Anxiety drug deaths an ‘escalating crisis.” BBC Six and Ten O’clock News. February 4, 2019

• The Scottish Government, Population Health Directorate. “Road to Recovery Strategy: A new approach to tackling Scotland’s drug problem”. ISBN: 978075595657. May 29, 2008

• C. Matheson, D. Liddell, E. Hamilton and J. Wallace. “Older People with Drug Problems in Scotland: A Mixed Methods Study Exploring Health and Social Support Needs. Report to the Scottish Government.” Scottish Drugs Forum. June 2017

• Scottish Drugs Forum. “HIV in Glasgow: Responding to an Outbreak.” 2018

• Scottish Drugs Forum. “A Drugs Strategy For Scotland: Response to the Scottish Government proposal to refresh Scotland’s existing strategy”. 2018

• Scotland Drug Strategy Delivery Commission. B. Kidd, C. Lind, K. Roberts. “Independent Expert Review: Opioid Replacement Therapies in Scotland”. 2013

• The Scottish Government, Population Health Directorate. Ministry of Public Health. “Rights, Respect and Recovery; Scotland’s strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths.” ISBN: 9781787810747 . November 28, 2018

• The Scottish Government, Scottish Drugs Forum and Hepatitis Scotland. “Staying Alive in Scotland: Strategies to combat drug related deaths”. June 2016

• National Records of Scotland. “Drug Related Deaths in Scotland in 2018” 2019

• Ewan Angus. “The Scheme”. 2010. Kilmarnock . BBC One Scotland. Television series

• Mornings, With Kaye Adams. BBC Radio Scotland. Glasgow. Radio Interview. Aug 28, 2019

Credits

We would like to thank the following for their help in Scotland: Martin Coyle, Gary, Robbie, Cas, Babs, and Michelle.

Jason Wallace and Kirsten Horsbru from the Scottish Drugs Forum.

Peter McDade.

Andrew McAuley from Glasgow Caledonian University.

Mark McGhee from the band Girobabies .

Amanda Craig.

Donna Boyd.

Everyone at Sunny Govan Community Radio, 103.5 FM in Glasgow. You can listen online at sunnyG.com.

And Val D’oro Chippy.

Garth Mullins is Crackdown‘s host and executive producer. Crackdown is produced by Alexander Kim, Lisa Hale, Sam Fenn, Polly Leger and this month Cal Murray.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, and Al Fowler. Rest In Peace Chereece Keewatin.

Our science adviser is Ryan McNeil from the Department of Medicine at the University of British Columbia Original score written and performed by Sam Fenn, Jacob Dryden, Kai Paulson, James Ash, Cal Murray and Garth Mullins. Our theme song was written by Garth Mullins and Sam with accompaniment from Dave Gens and Ben Appenheimer.

Funding for Crackdown comes from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research.

Episode 9: Change Intolerance Part 2

Image: Garth’s collection of “old school” methadone bottles. (Photo: Garth Mullins)

Crackdown investigates the relationship between the BC government and Mallinckrodt Pharmaceuticals. Many people on methadone complain that Methadose® “doesn’t have legs.” Why hasn’t the government provided them with a more effective option?

This episode follows Episode 2: Change Intolerance.

More information on methadone formulation treatment options in BC is available here, from the BC Centre on Substance Use.

Transcript

A full transcript of this episode is available here.

Crackdown and BCAPOM Demands

1. We demand access to the old methadone formulation immediately. Give us medication that works for us, whether that is methadone, Metadol-D, Suboxone, slow release oral morphine, injectable Dilaudid, or prescription heroin.

2. We demand to have a say in policy decisions about our lives. Nothing about us without us.

3. We demand an apology from Mallinckrodt, the BC Ministry of Health, and the BC College of Pharmacists.

4. We demand a formal investigation to determine why Methadose® failed.

Works Cited

• Gourevitch, Marc, Diana Hartel, Peter Tenore, Katherine Freeman, Ira Marion, Joe Hecht, Joyce Lowinson. “Three Oral Formulations of Methadone: A Clinical and Pharmacodynamic Comparison.” Journal of Substance Abuse Treatment 17:3 (1999): 237-241.

• Greer, Alison. Sherry Hu, Ashraf Amlani, Sarah Moreheart, Olivia Sampson, and Jane Buxton, “Patient Perspectives of Methadone Formulation Change in British Columbia Canada: Outcomes of a Provincial Survey.” Substance Abuse Treatment, Prevention, and Policy 11:3 (2016): 1-8.

• McNeil, Ryan, Thomas Kerr, Solanna Anderson, Lisa Maher, Chereece Keewatin, M.J. Milloy, Evan Wood, Will Small. “Negotiating Structural Vulnerability Following Regulatory Changes to a Provincial Methadone Program in Vancouver, Canada: A Qualitative Study.” Social Science and Medicine 133 (2015): 168-176.

• Mullins, Garth. “New Methadose is Failing the People it’s Designed to Assist, Says Local Researcher.” Megahopne, June 15, 2015.

• Silver, Junell, Howard Shaffer. “Change Intolerance to Shifts in Methadone Formulation: A Preliminary Investigation.” Journal of Substance Abuse Treatment 13:4 (1992): 331-39.

• Socias, Eugenia, Evan Wood, Ryan McNeil , Thomas Kerr, Huiru Dong, Jean Shoveller, Julio Montaner, M.J. Milloy. “Unintended Impacts of Regulatory Changes to British Columbia Methadone Maintenance Program on Addiction and HIV-related Outcomes: An Interrupted Time Series Analysis.” International Journal of Drug Policy 45 (2017): 1-8.

• Steels, M.D., M. Hamilton, and P.C. McLean. “The Consequence of a Change in Formulation of Methadone Prescribed in a Drug Clinic.” British Journal of Addiction 87 (1992): 1549-54.

Additional Reading

• Moreheart, Sarah. “BC’s Change in Methadone Formulation: A Metanarrative Review of the Literature.” 2016.

• Soyka, Michael and Christina Zingg. “Feasibility and safety of transfer from racemic methadone to (R)-methadone in primary care: Clinical Results from an Open Study.” The World Journal of Biological Psychiatry 10:3 (2009): 217-224.

Credits

Crackdown is produced on the territories of the Musqueam, Squamish, and Tseil-Waututh Nations.

Special shout out this month to Zoe Dodd for showing us all how to most effectively interrupt a minister while they’re giving a speech.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, Laura Shaver, and Chereece Keewatin. RIP Chereece.

Crackdown is produced by Sam Fenn, Lisa Hale, and Alexander Kim.

Our science advisor is Ryan McNeil.

I’m Garth Mullins, host, writer and executive producer.

You can follow me on twitter @garthmullins.

Original score written and performed by Sam Fenn, Jay Heen, Kai Paulson, James Ash and me. Our theme song was written by me and Sam with accompaniment from Dave Gens and Ben Appenheimer.

We get funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada.

Episode 8: The Cost of Cereal

Image: Colouring pages posted on the back wall of SisterSpace, North America’s first women-only overdose prevention site. (Photo: Garth Mullins)

Men are dying at a higher rate than women during the opioid crisis, which means women sometimes get left out of the conversation. On Episode 8 of Crackdown, we go to SisterSpace, North America’s first women-only safe consumption site. 

CORRECTION: Overnight funding for SisterSpace runs out at the end of September, 2019.

Transcript

A full transcript for this episode is available here.

Call to Action

If you want to see more funding to extend hours of overdose prevention sites like SisterSpace, write to The City of Vancouver, Vancouver Coastal Health, and the B.C. Ministry of Health.

August 31 is International Overdose Awareness Day. Events are taking place around the world.  Check out Overdoseday.com. 

If you want to learn how to use Naloxone to reverse an overdose, you can get training here: naloxonetraining.com

Image: Patricia Monty points out an early piece of colouring she did at SisterSpace. The piece reads “Don’t compromise yourself. You are all you got.” (Photo: Garth Mullins)

Image: Garth “Big Galoot” Mullins, next to Patricia Monty in the entrance to SisterSpace (Photo: Polly Leger)

Reading List

• Boyd J, Collins A, Lavalley J, Mayer S, McNeil R. (2019). “Bed Bugs and Beyond”: An ethnographic analysis of North America’s first women-only supervised drug consumption site. 26th Harm Reduction International Conference. Porto, Portugal.

• Collins et al. (2019) Gender and the overdose crisis in North America: Moving past gender-neutral approaches in the public health responseInternational Journal of Drug Policy

• Boyd et al. (2018) Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada Society for the Study of Addiction

• Bardwall et al (2018) Characterizing peer roles in an overdose crisis: Preferences for peer workers in overdose response programs in emergency shelters. Drug and Alcohol Dependance

• Kennedy et al. (2019) Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada. Social Science & Medicine

• Collins et al. (2019) The intersectional risk environment of people who use drugs. Social Science & Medicine

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Crackdown is produced by Alexander Kim, Polly Leger, Lisa Hale, Sam Fenn, and Gordon Katic. 

Thank you to SisterSpace for having us. 

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, and Al Fowler. Rest In Peace Chereece Keewatin.

Our scientific advisers are Ryan McNeil and Jade Boyd from the BC Centre on Substance Use and the Department of Medicine at the University of Britsh Columbia. 

Original score written and performed by Sam Fenn, Jacob Dryden, Kai Paulson, James Ash and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.  

Funding for Crackdown comes from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research.

Episode 7: Stand Down

Image: Vancouver Police vehicles parked outside an overdose prevention site on East Hastings Street. (Photo: Alexander Kim)

The Vancouver Police say they’re for harm reduction, but everyone we talk to in the Downtown Eastside says otherwise. On Episode 7 of Crackdown, Garth asks the cops to stand down. 

Transcript

A full transcript of this episode is available here.

Alley graffiti with a public service announcement by artist Smokey D.

Alleys in the DTES are social spaces. (Photo: Garth Mullins)

Vancouver Police regularly park cruisers in alleys in the DTES. (Photo: Alexander Kim)

Three VPD vehicles parked outside the Vancouver Overdose Prevention Society on July 2, 2019. (Photo: Alexander Kim)

Justin Van Westen is an harm-reduction outreach worker in the DTES. (Photo: Garth Mullins)

Ronnie Grigg, also known as the legendary Narcan Jesus. (Photo: Garth Mullins)

Caitlin Shane, lawyer with Pivot Legal Society, at an action to establish a supervised consumption site in Maple Ridge.

Know Your Rights

The Pivot Legal Society has put together this handbook for people who rely on public space. It has basic information about your rights when you’re stopped by the cops, and what you can do.

Reading List

• Bennett, Darcie and Larkin, DJ (2018) Project Inclusion: Confronting Anti-Homeless & Anti-Substance User Stigma in British Columbia. Vancouver: Pivot Legal Society.

• Boyd, Susan (2018) Drug use, arrests, policing, and imprisonment in Canada and BC, 2015-2016. Vancouver: Author.

• Boyd, Susan (2018) Drug Arrests in Canada, 2017 (Addendum). Vancouver; Author.

• Collins et al. (in press) Policing in the overdose crisis: A rapid ethnographic study of the impact of law enforcement practices on the effectiveness of Overdose Prevention Sites.

• Pivot Legal Society (2019) Know Your Rights: A guide for people who rely on public space. Vancouver: Authors.

• Lupick, Travis (2016) Injection tent volunteers seek better relations with Vancouver police to help manage fentanyl crisis. The Georgia Straight.

• Lupick, Travis (2019) B.C. harm-reduction groups ask Mike Farnworth to reconsider top health officer’s report on overdose deaths. The Georgia Straight.

• McNeil et al. (2015) Area restrictions, risk, harm, and health care access among people who use drugs in Vancouver, Canada: A spatially oriented qualitative study. Health & Place 35: 70-78.

• Vancouver Police Department (2006) Vancouver Police Department Drug Policy (Adopted Sept 2006).

• Vancouver Police Department (2018) Regulations & Procedures Manual. Policy 1.6.28 (Effective 2006.06.29)

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Crackdown is produced by Alexander Kim, Lisa Hale, Sam Fenn, Polly Leger and Gordon Katic.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, and Al Fowler. Rest In Peace Chereece Keewatin.

Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.

Original score written and performed by Sam Fenn, Jacob Dryden, Kai Paulson, James Ash and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.

Funding for Crackdown comes from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research.

Episode 6: Room 821

Image: The Balmoral Hotel from street level, shut down and boarded up. The building was declared unsafe by the City of Vancouver in 2017. (Photo: Alexander Kim)

What happens when your options are being kicked out on the street or living in a room filled with mould, trash and rats? Episode 6 of Crackdown looks at how the housing and overdose crises are intertwined, and what happens when tenants fight back.

This story features a profile of Vancouver’s Downtown Eastside SRO Collaborative as well as their Tenant Overdose Response Project. Find out more here. 

If you want to learn how to use Naloxone to reverse an overdose, you can get training here: naloxonetraining.com.

Transcript

A full transcript for this episode is available here.

Image: “Battle of the Balmoral” Block Party, June 11, 2017. (Photo: Garth Mullins)

Image: Jay Slaunwhite and Garth Mullins across the street from the Balmoral. Jay moved into the Balmoral Hotel in 2014. (Photo: Sam Fenn)

Call to Action

The housing crisis and illegal evictions disproportionately impact people who use drugs. The BCCSU is calling on the City of Vancouver and the Government of British Columbia to:

1. Include people who use drugs in policy-making decisions around low-income rental housing. Nothing for us without us;

2. Track evictions from private and non-profit housing to help identify potentially problematic landlords;

3. Revise the Residential Tenancy Act to protect and meet the needs of the most vulnerable tenants;

4. Change to opt-out arbitration for evictions and fund community legal advocates to support vulnerable tenants;

5. Enforce standards and maintenance by-laws and issue real penalties, including expropriation for the worst offenders;

6. Require a higher threshold for evicting tenants from non-profit housing;

Download the BCCSU’s new report summarizing these recommendations, “Evictions in Vancouver’s Downtown Eastside: Policy failures and ways forward.”

Reading List

• Bardwell et al. (2018). Addressing Intersecting Housing and Overdose Crises in Vancouver, Canada: Opportunities and Challenges from a Tenant-Led Overdose Response Intervention in Single Room Occupancy Hotels. Journal of Urban Health.

• Collins et al. (2018). Surviving the housing crisis: Social violence and the production of evictions among women who use drugs in Vancouver, Canada. Health and Place.

• Fleming et al. (2019) Housing in Crisis: A qualitative study of the socio-legal contexts of residential evictions in Vancouver’s Downtown Eastside. International Journal of Drug Policy.

• Kennedy et al. (2017) Residential eviction and exposure to violence among people who inject drugs in Vancouver, Canada. International Journal of Drug Policy.

• Wendy Stueck and Mike Hager (May 28, 2018) For low-income residents in Vancouver, a different kind of real estate. The Globe and Mail

• Paul Johnson (Jun 11, 2018) Protest block party held outside Balmoral Hotel on the eve of evacuation deadline. Global News B.C.

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Crackdown is produced by Alexander Kim, Lisa Hale, Sam Fenn, Polly Leger and Gordon Katic.

Production help from Alex de Boer and Sharon Nadeem.

Consulting from Samantha Pranteau, Jay Slaunwhite and Al Fowler. Glen Mofford, author of “Along the E&N: The Historic Hotels of Vancouver Island” gave us some Balmoral history.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, and Al Fowler. Rest In Peace Chereece Keewatin.

Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.

Original score written and performed by Sam Fenn, Jacob Dryden, Kai Paulson, James Ash and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.

Funding for Crackdown comes from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research.

Episode 5: The Portugal Paradox

Garth and Magda at IN-Mouraria in Lisbon.

In 2001, Portugal decriminalized the simple possession of drugs. Ever since it has become a  beacon for progressives, activists, and drug users around the world. On episode 5 of Crackdown, Garth goes to Portugal to figure out whether the country has found a solution to North America’s overdose crisis.

Transcript

A full transcript of this episode is available here.

Garth interviews Rui Coimbra Morais on the way to an unsupervised injection facility in Barrio Cerco, near Porto.

An unsanctioned supervised consumption site near Porto, Portugal.

The methadone van in Lisbon.

Garth recording narration in an apartment in Lisbon.

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Sam Fenn and Lisa Hale were this month’s lead producers.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, and Al Fowler. Rest In Peace Chereece Keewatin.

Crackdown is produced by Garth Mullins, Sam Fenn, Alexander Kim, Lisa Hale and Gordon Katic. 

Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.

Special thanks to journalist and translator Enrique Pinto-Coelho for his help telling this story. You can follow Enrique on twitter here and you can hire him here. 

Thanks as well to the Portuguese Canadian journalist Susana Ferreira. Check out here longform piece about Portugal’s drug reforms in The Guardian here. 

Thanks as well to Rui Coimbra, Diana Castro, Renato Pinto, Sara Tuppen Veloso, Joana Canedo, Sofia Pereira, Sonia Ferreira, João Santa Maria, and Maria João Brás for helping our team while we were in Portugal. 

The music for this episode was written by Garth Mullins, Sam Fenn, and Jacob Dryden.

Funding for Crackdown comes from the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research. 

Episode 4: Blame

Image: Moms Stop the Harm rallies for decriminalization of illegal drugs at that BC Legislative Assembly in June 2018. (Photo: Alexander Kim)

This is not just some force of nature. Someone is to blame.

Transcript

You can download a full transcript here.

Petra Schulz, co-founder, Moms Stop the Harm. (Photo: Alexander Kim)

Moms Stop the Harm members march in Victoria, BC to decriminalize illegal drugs. (Photo: Alexander Kim)

Reading List

• Werb, D. et al. (2016) The effectiveness of compulsory drug treatment: A systematic review. International Journal of Drug Policy, 28, 1-9.

• Beletsky, L. and Davis C.S. (2017) Today’s fentanyl crisis: Prohibition’s Iron Law, revisited. International Journal of Drug Policy 46, 156-159.

• Urban Survivors Union. Do Not Prosecute Order/Advance Directive/Living Will: An Advance Request to Limit the Scope of Failed Drug War Policy.

• See Beyond, a knowledge translation project partnership between researchers and members of Moms Stop the Harm and mumsDU.

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Alexander Kim was this month’s lead producer.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, Al Fowler, and Chereece Keewatin (RIP).

Crackdown is produced by Garth Mullins, Alexander Kim, Sam Fenn, Lisa Hale and Gordon Katic. Our scientific adviser is Ryan McNeil from the British Columbia Centre on Substance Use.

The music for this episode was written by Garth Mullins, Sam Fenn, Kai Paulson, and Jacob Dryden.

Thanks to the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research for ongoing funding to Crackdown.

Episode 3: Unsanctioned

Two men sit in the injection room at the Vancouver Area Network of Drug User’s storefront. (Photo: Alexander Kim)

Across North America, governments are opposing supervised injection sites. In Crackdown‘s third episode, we tell you how to open one anyway.

Vancouver has become famous for Insite–North America’s first supervised injection facility. Insite is one of the more exciting (and effective) drug policy interventions in the world. However, most people don’t know about the story of civil disobedience that preceded it, or that came after.

Transcript

You can download a full transcript here.

Boomer prepares harm reduction supplies at the Vancouver Area Network of Drug Users. (Photo: Alexander Kim)

Activists protesting for a supervised injection facility in Halifax. (Photo: Matt Bonn)

Reading List

• The Canadian Association of People who Use Drugs, “This Tent Saves Lives: How to Open an Overdose Prevention Site.”

• McNeil, R., Small, W., Lampkin, H., Shannon, K., & Kerr, T. (2014). “People knew they could come here to get help”: an ethnographic study of assisted injection practices at a peer-run ‘unsanctioned’ supervised drug consumption room in a Canadian setting. AIDS and Behavior, 18(3), 473-485.

• McNeil, R., Kerr, T., Lampkin, H., & Small, W. (2015). “We need somewhere to smoke crack”: An ethnographic study of an unsanctioned safer smoking room in Vancouver, Canada. International Journal of Drug Policy, 26(7), 645-652.

• Kennedy, M. C., Boyd, J., Mayer, S., Collins, A., Kerr, T., & McNeil, R. (2019). Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada. Social Science & Medicine, 225, 60-68.

• Kerr, T., Small, W., Peeace, W., Douglas, D., Pierre, A., & Wood, E. (2006). Harm reduction by a “user-run” organization: a case study of the Vancouver Area Network of Drug Users (VANDU). International Journal of Drug Policy, 17(2), 61-69.

• Kerr, T., Mitra, S., Kennedy, M. C., & McNeil, R. (2017). Supervised injection facilities in Canada: past, present, and future. Harm Reduction Journal, 14(1), 28.

Episode 2: Change Intolerance

Chereece Keewatin, pictured in 2015, died on February 20th, 2019. (Photo: Garth Mullins)

“I never used heroin for years and years on the other stuff . . . Why would they change something that is already working?”

— Cheerece Keewatin, quoted in a 2015 Megaphone article about Methadose® written by Garth Mullins.

This episode is dedicated to Chereece Keewatin. Chereece was a member of Crackdown‘s editorial board, a former president of the British Columbia Association of People on Methadone (BCAPOM), and our friend.

In 2014, British Columbia switched nearly 15,000 methadone patients, including Chereece, to a new formulation called Methadose®. In Crackdown‘s second episode, Garth Mullins, Laura Shaver, and their colleagues at BCAPOM investigate what happened after the switch.

Transcript

You can download a full transcript here.

Chereece Keewatin pictured at a Crackdown editorial board meeting in 2019. (Photo: Alexander Kim)

Laura Shaver in 2013. Right before the switch to Methadose® . (Photo: Garth Mullins)

Laura Shaver at a listening party for “Change Intolerance” in 2019. (Photo: Ryan McNeil)

Garth presenting “Change Intolerance” to BCAPOM. (Photo: Ryan McNeil)

Crackdown and BCAPOM Demands

1. We demand access to the old methadone formulation immediately. Give us medication that works for us, whether that is methadone, Metadol-D, Suboxone, slow release oral morphine, injectable Dilaudid, or prescription heroin.

2. We demand to have a say in policy decisions about our lives. Nothing about us without us.

3. We demand an apology from Mallinckrodt, the BC Ministry of Health, and the BC College of Pharmacists.

4. We demand a formal investigation to determine why Methadose® failed.

The Emails

In 2014, Garth emailed Mallinckrodt Pharmaceuticals and told them methadone patients in BC were getting dopesick after the Methadose® switch. A few hours later, Mallinckrodt responded.

Next, Garth sent Ryan McNeil’s 2015 paper to the BC Ministry of Health. Ryan started interviewing people the same week as the Methadose® switch and he also consistently heard Methadose® wasn’t holding.

This is how the Ministry responded:

Finally, Garth sent the Ministry Alison Greer’s 2015 paper. They responded by criticizing this study’s sample size as well.

Comments from Mallinckrodt, the BC Ministry of Health, and the BC College of pharmacists

Mallinckrodt, The BC Ministry of Health, and the BC College of Pharmacists denied our requests for interview for this story.

We emailed Mallinckrodt a list of questions. A representative for the company responded:

They will kindly decline to comment.

— Statement from Mallinckrodt Pharmaceuticals in February, 2019

The BC Ministry of Health and The BC College of Pharmacists also refused to answer emailed questions. Instead the College provided us with a one sentence statement:

“Using a commercially available drug over a pharmacy-compounded drug is a required practice for public safety.”

— Statement from the BC College of Pharmacists in February, 2019.

Works Cited

• Gourevitch, Marc, Diana Hartel, Peter Tenore, Katherine Freeman, Ira Marion, Joe Hecht, Joyce Lowinson. “Three Oral Formulations of Methadone: A Clinical and Pharmacodynamic Comparison.” Journal of Substance Abuse Treatment 17:3 (1999): 237-241.

• Greer, Alison. Sherry Hu, Ashraf Amlani, Sarah Moreheart, Olivia Sampson, and Jane Buxton, “Patient Perspectives of Methadone Formulation Change in British Columbia Canada: Outcomes of a Provincial Survey.” Substance Abuse Treatment, Prevention, and Policy 11:3 (2016): 1-8.

• McNeil, Ryan, Thomas Kerr, Solanna Anderson, Lisa Maher, Chereece Keewatin, M.J. Milloy, Evan Wood, Will Small. “Negotiating Structural Vulnerability Following Regulatory Changes to a Provincial Methadone Program in Vancouver, Canada: A Qualitative Study.” Social Science and Medicine 133 (2015): 168-176.

• Mullins, Garth. “New Methadose is Failing the People it’s Designed to Assist, Says Local Researcher.” Megahopne, June 15, 2015.

• Silver, Junell, Howard Shaffer. “Change Intolerance to Shifts in Methadone Formulation: A Preliminary Investigation.” Journal of Substance Abuse Treatment 13:4 (1992): 331-39.

• Socias, Eugenia, Evan Wood, Ryan McNeil , Thomas Kerr, Huiru Dong, Jean Shoveller, Julio Montaner, M.J. Milloy. “Unintended Impacts of Regulatory Changes to British Columbia Methadone Maintenance Program on Addiction and HIV-related Outcomes: An Interrupted Time Series Analysis.” International Journal of Drug Policy 45 (2017): 1-8.

• Steels, M.D., M. Hamilton, and P.C. McLean. “The Consequence of a Change in Formulation of Methadone Prescribed in a Drug Clinic.” British Journal of Addiction 87 (1992): 1549-54.

Additional Suggested Reading

• Moreheart, Sarah. “BC’s Change in Methadone Formulation: A Metanarrative Review of the Literature.” 2016.

• Soyka, Michael and Christina Zingg. “Feasibility and safety of transfer from racemic methadone to (R)-methadone in primary care: Clinical Results from an Open Study.” The World Journal of Biological Psychiatry 10:3 (2009): 217-224.

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Laura Shaver was this month’s lead editorial consultant.

Sam Fenn was this month’s lead producer.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, Al Fowler, and Chereece Keewatin.

Crackdown is produced by Garth Mullins, Sam Fenn, Alexander Kim, Lisa Hale and Gordon Katic. Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.

The music for this episode was written by Garth Mullins, Sam Fenn, Jacob Dryden and “Ray.”

Thanks to the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research for ongoing funding to Crackdown.

Episode 1: War Correspondents

Vancouver Area Network of Drug Users members observe a moment of silence dedicated to those who lost their lives to the war on drugs. (Photo: Alexander Kim)

Drug users are the experts.

We’ve survived.

We know policy better than policy-makers. We know law better than lawmakers. We know pharmaceuticals better than pharmacists.

We know nobody’s coming to save us. So we gotta save ourselves.

Transcript

You can download a full transcript here.

Credits

Garth Mullins is Crackdown‘s host and executive producer.

Alexander Kim was this month’s lead producer.

Crackdown’s Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fess, Jeff Louden, Dean Wilson, Laura Shaver, Dave Murray, Al Fowler, and Chereece Keewatin.

Crackdown is produced by Garth Mullins, Alexander Kim, Lisa Hale, Sam Fenn and Gordon Katic. Our scientific adviser is Ryan McNeil from the BC Centre on Substance Use.

The music for this episode was written by Garth Mullins, Sam Fenn, and Jacob Dryden.

Thanks to the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research for ongoing funding to Crackdown.