November 21st, 2016
Portrait of a Negative Externality at a National Discussion on Opioid Use: The Elephant was Not in the Room
Ontario’s newly appointed overdose prevention coordinator stated that he doesn’t believe that bootleg fentanyl is killing people in his province.
This fact alone, sums up the conference last Friday in Ottawa that was co-hosted by Federal Health Minister Jane Philpott and Ontario Health Minister Eric Hoskins.
Denial of the facts and wilful blindness of the reality.
What good is an overdose coordinator that doesn’t believe in evidence?
This far into an overdose epidemic, you may as well have given a climate change appointment to Sarah Palin.
Canada’s Opioid conference in Ottawa saw politicians and bureaucrats from across the country deliver a plan for millions of stakeholders that weren’t invited, and certainly not consulted.
As I walk into the conference hall, pictures of drug overdose victims greet me.
There will be more pictures of dead overdose victims then people openly identifying as drug users here today, that’s a guarantee.
Politicians will tell us they’ll never take lives for granted ever again. Another guarantee.
But let’s be clear: this is a drug safety conference, brought to you by the same people who thought drug safety meant removing OxyContin from the market without an exit strategy for the people using it.
It isn’t a conference that will assure drug user safety, unless Health Canada’s definition of safety means the manager of security sitting at our table most of the day.
There aren’t any needle bins in the washrooms, that’s for sure. Why would there be? There are only two people with lived experienced speaking here today amid a cavalcade of Ministers, public health officials, and of course physicians.
Health Canada has security here to keep people out, refusing chronic pain patients entry to an event that will impact their own, and many more people’s health.
The people responsible for our health and wellbeing, are the same ones that won’t let us into the room to discuss the job they’re doing. It appears that Health Canada and the Canadian Centre on Substance Abuse think this passes as consultation.
You will find plenty of lip service to harm reduction and the need for an emergency response, but the Feds are going to leave it entirely up to someone else to come up with a commitment. Alberta’s government recently committed funded to supervised consumption services, and but didn’t even bother to announce their commitment here today.
Our federal government is spending $40 million to restrict the prescribing of opioids.
Both Quebec and Newfoundland have committed to prescription drug monitoring programs.
What’s less certain is what will happen to people who were prescribed those pills if their prescriptions get pulled back.
We have politicians restricting pill supplies and overdose coordinators denying the existence of bootleg fentanyl.
These are the people making policy for us.
Policy heading for a violent collision with denial.
#OCO16 is a bizarre arena where health professionals and physicians take more time to congratulate themselves on a job well done, then they do discussing how their policy could increase overdose deaths.
Politicians at this conference will possess the spirits of dead overdose victims, bring their memories back to life for just a moment, before finally, convincing the public of their plan to reduce them into their final state: negative externalities. Then they’ll do it again. Drug prohibition is like a negative feedback loop.
They humanize overdose victims after their deaths, cruelly granting them the humanity and compassion that could have saved their lives, were it offered earlier.
They use their deaths as an excuse to enact policy that places people prescribed opioid drugs under surveillance, which could cause more deaths and they’ll spend $40 million on it without even measuring the consequences on people accessing the illicit market.
Don’t bet on anything being fixed here. They certainly wouldn’t bet their own lives on it. They will bet someone else’s though.
The policy details feel almost irrelevant. They haven’t changed much. Much of this is a foregone conclusion.
Canada’s physicians washing their hands of prescription opioids. Prescription opioids will be restricted, bootleg fentanyl will fill a void, and Ontario’s overdose coordinator will deny that bootleg fentanyl will even exist. They’re gonna try and get more naloxone out there.
Health Minister Philpott hosts a private meeting after the conference with people with lived experience, their families, advocates, and for some reason, several provincial Ministers of Health.
Politicians suck up the room’s oxygen, “well first I want to thank Minister Philpott, and of course Dr. Hoskins for co-hosting, it’s been a great conference….” gladhanding their way over the corpses, blowing wind onto the flames, sucking the air of the tired few brought into the room to voice concern about Health Canada’s plan.
We each get two minutes to say our peace.
This is how policy made for approximately 700,000 Ontarians using opioids, the people dying of opioid overdose every 12 hours in British Columbia, every 13 hours in Ontario, every 18 hours in Alberta and all the rest of us is delivered.
Last week we published an open letter demanding that our Health Minister meet with an advisory board of people who use(d) opioid drugs to discuss the policy that was delivered to us last Friday.
She hadn’t read the letter by the time we were in the room with her.
November 14th, 2016
Open Letter: Portrait of a Negative Externality on the Eve of a National Discussion on Opioid Use.
By the Canadian Association of People Who Use Drugs
The most damaging term applied to people who use drugs isn’t junkie, fiend, or pillhead.
The most damaging term would never be applied to someone in public.
Some of us may have never even heard it ourselves.
This term appears only in government policy papers, research, and grey literature.
This term is “negative externality”.
It’s borrowed from economics and is used to describe a “cost suffered by a third party as a result of an economic transaction.”
In policy, it can refer to negative impacts to either the producer or consumer of an economic good.
In the case of heightened restrictions on prescription opioids, it refers to the consequences of a policy on the consumer of said drugs.
It refers to the death of the opioid consumer.
But you might not ever know that.
Government doesn’t show us whom a “negative externality” looks like.
It looks like me, or it looks like you. It looks like anybody who uses opioid drugs.
The term is as damaging as it is benign sounding.
It’s a term that policymakers use to describe the “unintended negative consequences” of their decision making.
When OxyContin was taken off the market with no planning or consultation with the people using it, many of whom started buying street drugs instead, that was a negative externality. A change that led to people dying of opioid overdose every 13 hours or so in Ontario shortly after it was made. That is a “negative externality”.
When a doctor kicks a patient off prescription opioids as a result of surveillance or a prescription drug monitoring program and that person buys bootleg fentanyl and dies, they term it a “negative externality” as a consequence of some larger policy change.
When a doctor pledges to “First Do No Harm” and failing that then, “I’m going to cut you off your prescriptions” to punish a patient, that’s a negative externality.
When an overdose epidemic worsens because of decisions made by policymakers, by exclusion of the fact that their policy could take more lives, that’s a negative externality.
The Centre for Addiction and Mental Health believe that delisting high-dose prescription opioids is proactive and preventative over a long term time horizon. The move they say, prevents more people using Rx opioids in the future.
In the short term, however, doctors fearful of sanction or discipline for their prescribing practices (see: 86 Ontario physicians cited for overprescribing) pull-back on their prescriptions.
For the people being prescribed opioids, this means the possibility of buying bootleg fentanyl instead.
The people using these drugs right now, whose lives may take an entirely negative turn in the face of these events, who may die as a result of them, are an outcome described simply as “negative externality”.
The public must understand that despite all the media coverage opioid overdose deaths are receiving, our government is not being held accountable about what restricting supplies of prescription drugs can do to the people using them.
They deem overdose deaths as “negative externalities” as a result of another policy change.
These deaths are not negative externalities.
These deaths are cruel and unusual punishment.
They freely get away with using a term so defanged, so banal but yet so unrelenting in its meaning for a person who uses drugs. A term that can be so determinative of somebody’s destiny. A term that crushes those bearing the weight of its structural violence.
It’s not that Health Canada can’t measure impacts of their policy changes (prescription drug monitoring programs, Rx opioid restrictions, etc.) on opioid overdose deaths, it’s that they can get away with NOT measuring them.
Because too many people are unaware of how much life is sucked away when its potential demise is represented in 12 size Arial font as a “negative externality”.
The public needs to know whom a “negative externality” looks like.
Because our government seems unwilling to recognize that their plans to restrict prescription opioids could very well cause a many deal more “negative externalities”.
When it comes to planning our national drug policy, we are all negative externalities.
This week, our federal Health Minister Jane Philpott and Ontario Health Minister Eric Hoskins are co-hosting a conference in Ottawa on the opioid epidemic.
Almost all of us will be “negative externalities” that were not invited into the room to discuss opioid-related drug policy that impacts whether we live or die.
By now, you shouldn’t be surprised that this would be the case.
In decisions that impact our wellbeing to a degree of life or death, once again we are not being consulted.
There will be much talk (if little debate, being that none is allowed) about prescription drug safety in Canada this Friday, November 18th, 2016.
Public, understand that drug safety starts and ends with people who use drugs.
If a drug policy were safe for public health, you’d know it.
On the most basic and essential level, because we’d still be around to tell you about it.
We wouldn’t be locked in a cell, or even worse.
Instead we’re dying in ever increasing numbers.
Those of us surviving their decisions aren’t invited into the room to explain how much things need to change, or how integral we are to a healthy and safe drug policy.
If a drug policy is unsafe, or unsound, we likely weren’t consulted about its implementation.
In September 2016, our organization, the Canadian Association of People Who Use Drugs, sent a letter to federal Health Minister Jane Philpott to invite her to consult with an advisory board comprised of current or former persons who use opioid drugs.
We received no response from her office.
On the eve of a national discussion that will determine the fates of so many of us, our government has once again, treated our lives as negative externalities.
Once again, we call on our Health Minister to meaningfully consult with the people who live and die by the decisions that she has final responsibility to make.
The way forward for a better drug policy is through our experience, intelligence, and understanding of the policy issues that our Minister has called this conference about in the first place.
Our suggestions for policy improvement:
DON’T measure successful policy just in terms of reducing the amount of prescription opioids in circulation.
DO measure impacts of policy change on people accessing illicit opioids
DO measure rates of people accessing illicit opioids as a result of policy change.
DO Provide evidence-based rehabilitation and concurrent disorder treatments.
DO Provide treatment on demand.
DO Repeal the Respect for Communities Act
DO scale up supervised consumption services.
DO Provide funding for drug user-based organizations.
DO ensure that consequences to people who use drugs are meaningfully considered when enacting policy change.
DO broaden access to methadone and suboxone.
DO decriminalize possession of illicit substances.
DO provide access to prescription injectable opioid treatments (heroin or hydromorphone) for people who have not found success with methadone or suboxone treatments and are in danger of being removed from prescription drugs.
DO expedite licensing for the pharmaceutical manufacture of diacetylmorphine (heroin) within Canada.
Canadian Association of People Who Use Drugs
October 6th, 2016
To add your organization’s name to the open letter condemning the murder of people who use drugs in the Philippines, please fill out the fields below. The final letter will be released, with all endorsements, the week of October 10th, as part of the Global Week of Action. It will be sent directly to the Philippines’ diplomatic representatives in Canada and to the Canadian Minister of Foreign Affairs. We will send you a final copy once it is ready for release and ask you, at that time, to help spread the word and send a brief message of your own.
September 30th, 2016
Canada is in the midst of the worst opioid overdose epidemic in its history.
Every 12 hours someone in British Columbia dies of opioid overdose.
Every 13 hours someone in Ontario dies of opioid overdose.
But across the entire world not a single human being has died inside of a supervised consumption site.
Despite this fact, Canada’s federal government passed legislation called the “Respect for Communities Act” that makes opening a supervised consumption site almost impossible.
Consider these facts when you think about Canada’s opioid overdose epidemic.
Join Us at: http://capud.ca/index.php/join-us/
Directed by Dominik Marciniec
French translation by Réal Doutre and Lynne Belle-Isle
Big thanks to MAC AIDS Fund and Canadian AIDS Society for their support.
Learn more about the Respect for Communities Act here: http://www.theglobeandmail.com/news/british-columbia/bill-c-2-could-impede-harm-reduction-sites-advocates-say/article23608197/
September 6th, 2016
Fraser Health Authority Announces New Overdose Awareness Advertising Campaign. So Do We.
Recently, Fraser Health Authority announced a public health campaign focused on increasing awareness and reducing overdose deaths within the region of British Columbia that it serves (1.6 million people).
An ad campaign Fraser Health Authority participated in has been criticized by us recently for depicting a corpse with a toe-tag that says “fentanyl” on it.
We felt the ad stigmatized us, and did little to help the general public understand the facts about this epidemic.
Here’s one of those facts: An opioid overdose is a medical emergency, not a crime scene.
The “Corpse Ad”, co-sponsored by VCH, BCCDC, Fraser Health, Vancouver Police and Provincial Health services depicted us as the future dead, our fates inevitable if we use fentanyl.
This couldn’t be further from the truth.
Here’s another fact: We know what works. We know what saves our lives.
Naloxone (which remains prohibitively expensive when purchased over the counter in BC) works. Hydromorphone and heroin-assisted treatment reduce the risk of overdosing significantly. Having a safe space to use in the form of supervised consumption prevents people from dying.
Drug decriminalization works.
This is only one of the reasons communication campaigns like this are so hazardous to our health. They ignore the fact that inconvenient fact that every death can be prevented.
Fraser Health’s new ads feature text-based overdose warnings with yellow tape similar to police tape found at a criminal investigation.
The corpse conceptualization of people who use drugs still underlies their campaign (one of the ads feature a pair of feet hanging out of an autopsy locker).
Ironic, considering a Fraser Health representative’s quote on campaign launch, “It is very unfortunate that there’s quite a bit of stigma around people that use substances,”.
Unfortunate, yes. Surprising, no. Look how our health authorities communicate to us.
The new ads just put yellow tape up around the “corpse ad”, implying criminal activity occurred at the scene of an overdose death.
What’s criminal is the government’s slow speed in responding to this epidemic.
We are NOT criminals, but we are criminalized.
This is a public health emergency.
Public health communication during an opioid overdose epidemic is of vital importance. Every twelve hours someone in the province dies of opioid overdose.
We have so many heroes in British Columbia (also across Canada, and the world) that save lives. These heroes use drugs.
People who use drugs are the first line of defense against this overdose epidemic.
Treat us as human beings in your communication with us.
Communicate to the public how invaluable we are in reducing overdose deaths.
Without further adieu, here is our latest “revision” of Fraser Health’s advertising campaign.
It’s created entirely by people with lived experience.
Huge shoutout to @naloxoneguru for conceiving of the brilliant messaging for this ad.
WE WANT YOUR SUGGESTIONS FOR FURTHER ADS.
Got any other ideas for health communication “revisions”? Let us know.
Or message us privately on Twitter or Facebook.
CAPUD president’s speech at Charting New Pathways in Drug Policy conference
June 17th, 2016
by Jordan Westfall
When I was an undergrad student, I experienced firsthand the discrimination and violence that persons who use drugs live with on a daily basis.
This wasn’t part of a research project I did for school, it was my daily life.
I was using OxyContin, Fentanyl and heroin.
I’d go to school in drug withdrawal, and during desperate times I’d sell back my textbooks for drug money. During an increasingly traumatic period of my life, when I saw five family members diagnosed with cancer, my mom paralyzed and unable to work, my family go bankrupt, and the community I grew up in facing mass unemployment, drug use was the only stability I had in my life.
Contrary to what many people would believe, I found my direction and purpose in life while I was an active drug user.
nd not from drug addiction.
Today, the Canadian Association of People Who use Drugs is here to say “let us in”
We demand inclusion into the decisions that impact whether we live or die.
The only way we can win the fight against stigma that prevents so many of us from reaching our full potential, is if YOU allow us to.
You can’t destigmatize us.
We can only destigmatize ourselves.
But in order for that to happen, the only way forward is through drug decriminalization.
The only way forward is recognizing us as being the most important stakeholder in our National Drug Policy.
Most of us live and die because of decisions made in boardrooms most of us never see.
Instead, we see the inside of prison cells.
We see our friends die on a daily basis.
We see people belittle us, judge us, and minimize our ability to function
One of the most difficult perceptions that we encounter is a public belief that we are unable to, or not responsible enough to make decisions for ourselves.
Perhaps this explains why almost all of the people making decisions on our behalf do not have lived experience as current or former drug users.
My life experience led me to believe that my health and quality of life were determined by decision making processes that were far from my control.
To have your voice be irrelevant in discussions that are vital to your health and wellbeing is to NOT have a voice at all.
However, as part of the Canadian Association of People Who Use Drugs, I found strength and a voice. Together, our organization demands access to employment, policy decision making, and program development that hold so much power over us.
I witnessed the worst outcomes of our policies not because of my own drug use, but because of changes that were made well above our heads and completely removed from our context.
What I am referring to is the OxyContin reformulation in 2012.
Oxycontin was removed from the pharmaceutical marketplace and was no longer available for prescription.
Instead, heroin was for sale. The next year my home province had more drug overdose deaths than at any time in its history.
Like many of us here today, I survived an epidemic.
People who use drugs are survivors.
Despite public belief, people who use drugs are some of the bravest, resourceful, and hard working people you will ever meet.
To survive in that environment, you have to adapt to an ever-changing set of circumstances.
You have to carry on through the worst traumas, sometimes without even a moment to process your reaction it.
We are not pathetic.
We are not cowardly.
We are not criminals, but we are criminalized.
Some of us, owing to racial or gender discrimination are more criminalized and feel the worst effects of prohibition.
We have so much potential, but because the substances we use are prohibited by law, our potential is never seen.
This is why we need to expand access to heroin and opioid assisted treatment.
I took my life experience as a person who uses drugs, and used it to inform my educational and career goals.
I took an experience, when a friend told me that I could go to prison for calling 911 at the scene of an overdose and turned it into a research question.
From that research question I wrote a thesis.
Because of that thesis I received a Master’s Degree.
I use this to illustrate a point to everyone here
The thing that you’re most ashamed of,
That you’re made to feel that you can’t talk about in public,
That we are all too commonly discriminated for,
Is the same thing that can get you a Master’s degree,
It’s the same thing that can save lives, improve the public health of your country and prevent overdose deaths.
In British Columbia, someone dies of opioid overdose every 12 hours, and here in Ontario it happens every 14 hours.
Each death is needless.
An expected 800 people will die in British Columbia this year, and a comparable number in Ontario.
Across the entire world not a single person has died inside a supervised injection facility.
But Federal legislation requires 27 different pieces of paper to open a supervised injection site.
There is no other public health intervention that requires this level of scrutiny to provide healthcare to a marginalized group.
Bill C-2 reinforces the notion that we are unable to make decisions for ourselves, and it means an entire community makes decisions on our behalf.
Decisions that our lives will NOT wait for.
We call on our Federal government to repeal Bill C-2, expand access to heroin-assisted treatment, allocate Federal funding to help our drug user organizations grow, and show you the great potential that we are so capable of.