Overdose Read online

  Also by Benjamin Perrin

  Victim Law

  Invisible Chains

  VIKING

  an imprint of Penguin Canada, a division of Penguin Random House Canada Limited

  Canada • USA • UK • Ireland • Australia • New Zealand • India • South Africa • China

  First published 2020

  Copyright © 2020 by Benjamin Perrin

  All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

  www.penguinrandomhouse.ca

  LIBRARY AND ARCHIVES CANADA CATALOGUING IN PUBLICATION

  Title: Overdose : heartbreak and hope in Canada’s opioid crisis / Benjamin Perrin.

  Names: Perrin, Benjamin, author.

  Identifiers: Canadiana (print) 20190141921 | Canadiana (ebook) 2019014193X | ISBN 9780735237865 (hardcover) | ISBN 9780735237872 (HTML)

  Subjects: LCSH: Opioid abuse—Canada. | LCSH: Fentanyl—Canada. | LCSH: Opioids—Overdose. | LCSH: Fentanyl—Overdose—Canada.

  Classification: LCC RC568.O45 P47 2020 | DDC 362.29/3—dc23

  Ebook ISBN 9780735237872

  Book and cover design by Andrew Roberts

  Cover image by Julius Reque / Getty Images

  v5.4

  a

  Disclaimer: Nothing in this book should be construed as providing legal or medical advice. If you or someone you know is using substances and needs help, please contact a healthcare professional.

  For Douglas “Little Doug” Nickerson

  Most people are more comfortable with old problems than with new solutions.

  —Anonymous

  CONTENTS

  Cover

  Also by Benjamin Perrin

  Title Page

  Copyright

  Disclaimer

  Dedication

  Epigraph

  Foreword

  1 WHAT IS THE OPIOID CRISIS?

  2 WHY IS FENTANYL KILLING SO MANY PEOPLE?

  3 WHY DO PEOPLE START USING? WHY CAN’T THEY STOP?

  4 HAS CRIMINALIZING DRUGS FAILED?

  5 WHY ARE DEALERS KILLING THEIR CUSTOMERS?

  6 CAN WE STOP FENTANYL AT ITS SOURCE?

  7 WHO’S BEEN HARDEST HIT?

  8 CAN WE PROSECUTE OUR WAY OUT?

  9 WHAT IS NALOXONE AND IS IT THE SOLUTION?

  10 DON’T SUPERVISED INJECTION SITES ENABLE DRUG USE?

  11 IS PROVIDING “SAFE DRUGS” GIVING UP ON PEOPLE?

  12 HOW CAN WE HELP PEOPLE STOP USING?

  13 WON’T DECRIMINALIZATION MAKE THINGS WORSE?

  14 HOW CAN WE SOLVE THIS CRISIS?

  Appendix: Vancouver Declaration on Responding to the Opioid Crisis

  Methodology

  Interviewees

  Notes

  Acknowledgments

  FOREWORD

  “If they ran a dog as the candidate I’d still vote Conservative.”

  Growing up in Calgary, I heard that saying more than once. And even though I love dogs and thought of myself as a conservative, it bothered me. It summed up my fears of party politics: at some point, you’d have to shut your mind off and blindly surrender to loyalty and ideology.

  I first became interested in politics when I was 14. A federal election had been called for October 25, 1993, and my social studies teacher asked us to keep a scrapbook about it.

  I dove into the project. I got copies of each party’s election platform and read them voraciously. This was pre-Internet, so I had to clip out newspaper stories with scissors and watch the evening news to learn what each political party leader had said. Even though I couldn’t vote, I was fascinated by the tough issues and tried to make up my own mind about them.

  In 2012, two decades later and with that election scrapbook sitting in my parents’ basement, I found myself at the heart of Canadian politics as Prime Minister Stephen Harper’s top criminal justice advisor. I’d taken a one-year leave of absence from my job as a law professor at the University of British Columbia to pursue this once-in-a-lifetime opportunity. I was eager to use my position to help the plight of victims of crime—an area I’d spent most of my professional career working on.

  In Harper’s office, I also had a front-row seat to Canada’s war on drugs. His “tough on crime” agenda had already increased jail time for drug offences and fought unsuccessfully to shut down Insite in Vancouver, at that point the country’s only supervised injection site. Since illegal drugs were viewed as bringing disorder and devastation, stamping them out was Conservative dogma. Having never spent much time thinking about drug policy, I figured it made sense. I had shut my mind off.

  A few years after moving back to Vancouver with my young family and resuming my job at UBC, I started hearing seemingly isolated media stories about illicit drug overdose deaths in the city. It struck me as a tragic yet senseless loss of life.

  As the death toll mounted and a public health emergency was declared in BC in 2016, it was clear that the status quo wasn’t working. It bothered me that I was just carrying on with my busy life as people continued to die every day in my city and across the country. I’d been spending time seeking God in dealing with challenges in my own life, so one afternoon I prayed a simple prayer: I asked him to give me a heart of compassion for the people who were being affected by the opioid crisis. I had no idea where it would lead me.

  I began asking around the law school to see whether any of my colleagues were conducting research on the opioid crisis. Nope. I checked at the other law schools and posted an appeal on Twitter. It turned out that there wasn’t a single law professor in the province—and quite likely the entire country—who was doing any work to address the crisis at the time.

  How could I just stand by as people continued to die? I felt a moral responsibility to try to help if I could, and also a personal responsibility to do something. After all, I’d worked for a government that set up Canada’s current approach to dealing with illegal drugs—a modern-day war on drugs—and it was clearly failing to address this crisis. I was a law professor with experience in government and had helped change laws and policies before. I had contacts in law enforcement and the community. I knew how to get a message out through the media and had contacts with a major publisher. And with tenure, I could take controversial positions based on my research. It was time to act.

  I set out to investigate the opioid crisis without any team or funding in place. That would come later. It was a leap of faith. My aim was to find out why the crisis was happening, what was being done about it, and what more could be done to save lives. I would follow the trail of evidence wherever it led.

  I dropped everything to kick-start my research. And given that this was a public health emergency, I didn’t want to wait a year or two to apply for traditional research grants; instead, I proposed raising the money I’d need via crowdfunding. The law school put the brakes on that idea. Fortunately, an individual donor stepped up to cover the costs of a research assistant, travel, and transcription services for the interviews I needed to do.

  Within a month or two I’d read all the current reports on the problem and gotten ethics approval to launch the study. Then I hit the streets. I quickly learned that BC is the epicentre of the opioid crisis in Canada, and that Vancouver, Surrey, and Victoria have been hardest hit. So that’s where
I focused my investigation.

  I interviewed 42 leading experts with over 500 years of combined professional experience. I met with police chiefs, drug squad investigators, undercover police agents, border guards, intelligence analysts, firefighters, prosecutors, defence lawyers, judges, healthcare officials, medical doctors, addiction specialists, community-based service organizations, Indigenous organizations, activists, advocates, and organizations representing people who use drugs.

  I criss-crossed the BC Lower Mainland and travelled to Victoria to see firsthand what was happening. I filed Freedom of Information requests to get access to government records. I analyzed and wrote up my findings as soon as I received interview transcripts back, working from early in the morning, before the kids were awake, to late into the night. Burning the midnight oil, I felt like I was back in law school again, except now I needed to take a 15-minute nap in the afternoon.

  I was looking for answers to the tough questions I had, questions I kept hearing every time the opioid crisis seemed to pop up in conversation:

  • What is the opioid crisis?

  • Why is fentanyl killing so many people?

  • Why do people start using? Why can’t they stop?

  • Has criminalizing drugs failed?

  • Why are dealers killing their customers?

  • Can we stop fentanyl at its source?

  • Who’s been hardest hit?

  • Can we prosecute our way out?

  • What is naloxone and is it the solution?

  • Don’t supervised injection sites enable drug use?

  • Is providing “safe drugs” giving up on people?

  • How can we help people stop using?

  • Won’t decriminalization make things worse?

  • How can we solve this crisis?

  By the end of my intensive 100-day investigation, I’d made a complete 180-degree turn. I was convinced: the misguided war on drugs was not only a total failure, it was actually making things worse. The casualties of this war include the thousands who’ve died from illicit drug overdoses, most often dying alone because of the stigma that flows in large part from criminalization. Their suffering was invisible to most of us. They were counted only as they died. And unless something radical is done today, countless more of our neighbours, friends, and loved ones risk the same fate.

  This book is a chronicle of my investigation into the opioid crisis. It’s a story about lives lost and people saved. It’s a story of heartbreak and hope—a raw, tragically real story that I never expected to write but felt compelled to set down. For me, it’s also part of my story of personal transformation, a change of mind and of heart.

  –1–

  WHAT IS THE OPIOID CRISIS?

  I don’t think anybody really saw this coming.

  —Dr. Mark Tyndall, Executive Director, BC Centre for Disease Control

  A sleepy suburb on the outskirts of Greater Vancouver was about to get a wake-up call—in more ways than one. At 1:30 a.m., the stillness of a balmy late-summer night in Delta was shattered by the blaring siren and flashing lights of an ambulance racing to a family home.

  “The paramedic walked up to a house in Delta because a friend of somebody called 911 saying this guy’s passed out; he’s not breathing,” said Linda Lupini, who heads BC Emergency Health Services. “Before they got into the house there were two kids who’d overdosed on the front stairs. So they thought they were at the address—the kids are overdosed; that’s the call.”

  The paramedics began working frantically to help resuscitate them. The tell-tale signs of a drug overdose include unresponsiveness, blue lips, and difficulty breathing—or not breathing at all. The outcome can be fatal.

  “Are you coming upstairs?!” someone screamed from inside the house.

  “What do you mean?” replied a confused paramedic.

  “The kid we called for is upstairs.”

  There were three simultaneous drug overdoses at the house that night—and that was just the beginning. Within 26 minutes the 911 switchboard lit up like a Christmas tree. Drug overdose calls kept coming in. Paramedics would revive someone only to learn from them that someone else had taken drugs at the same party and could be at risk.

  “Then we were working with dispatch, trying to find all these kids,” said Lupini.

  In total, 11 young people who were at the party overdosed the night of September 1, 2016, after taking what they thought was a small amount of cocaine. What they didn’t know was that it had been laced with fentanyl—a potent opioid drug. One went into full cardiac arrest.

  “We had parents doing CPR on the front lawn on their kids,” said Lupini. “We had 11 teenagers literally not breathing. They were all resuscitated, but barely. A few came close to not making it. It was so traumatic for the front-line staff. We just didn’t have the resources to respond to something like that.

  “The problem for an ambulance service is that the increase in calls are your highest acuity—Code 3,” she continued. “They’re gonna die in minutes.”

  * * *

  ——

  Between January 2016 and June 2019, a record-shattering 13,913 people across Canada died from opioid-related drug overdoses. In 2018, when the annual death count hit 4588, a life was lost every two hours. According to Dr. Theresa Tam, Canada’s chief public health officer, opioid-related overdoses have become the leading cause of death for 30- to 39-year-olds. And although every part of the country has been affected by the opioid crisis, British Columbia, Alberta, Ontario, Saskatchewan, and Manitoba have been the hardest hit.

  On April 14, 2016, British Columbia declared the opioid crisis a public health emergency after illicit drug overdose deaths began skyrocketing. Historically, about 200 to 300 people a year had lost their lives this way, but by 2015 the number of overdose deaths had risen to 530. Worst was yet to come. By 2018 that number had almost tripled, reaching 1542. It hit me just how serious the situation was when the BC Coroners Service announced that illicit drugs were claiming more lives than murder, suicide, and car accidents combined. By 2019, the number of overdose deaths in the province finally started to decline as thousands had already died and the response to the crisis ramped out, even as the number of 911 overdose calls continued to grow to almost 25,000.

  “For the longest while we said it’s a crisis,” said Jennifer Breakspear, executive director of the Portland Hotel Society (PHS) Community Services Society, which provides supportive housing for over 2000 people in Vancouver and Victoria as well as various programs and services. PHS also operates Insite, North America’s first supervised injection site. Breakspear was hired to head up PHS in January 2017. And although she’d had experience in leading a non-profit focused on reproductive health, she described the transition to PHS as a real “crash course.”

  As I sat on a couch in Breakspear’s office on East Hastings Street, fire truck and ambulance sirens kept interrupting her—a constant reminder that Vancouver’s Downtown Eastside is ground zero in this crisis. “The soundtrack of my workday,” she remarked as another emergency vehicle raced by. Without a doubt, several of them that hour would have been heading to overdoses in the immediate area.

  When the public health emergency was declared in 2016, Breakspear told me, everyone thought it was the height of the crisis. Since then, though, “the numbers have continued to worsen. I don’t want to say it’s become the normal—the new norm. That sounds so offensive,” she said. “This is still a situation in which people are dying every day, and I don’t know how you could ever wrap your head around calling it ‘normal.’ ”

  That harsh realization is especially disturbing for the loved ones of those who’ve died during this overdose crisis. “The thought that it’s the new normal is just crushing,” said Leslie McBain, co-founder of Moms Stop the Harm, a national advocacy group of families that have lost loved ones to d
rug overdoses, including her own son. “Fentanyl is still out there; it’s still killing people. People have no alternative.”

  “Crisis” is the word that everyone I spoke to used to describe this state of affairs, including police officers, medical experts, and groups of people who use drugs alike. And BC is like the canary in a coal mine; the problem has spread across the rest of the country, too. The only place you’d see more body bags would be in an actual war. But even that’s not an entirely accurate comparison: 159 courageous Canadians died during the conflict in Afghanistan, and 516 died during the Korean War. Combined, those losses are significantly lower than the number of Canadians who died from fatal overdoses in 2018 alone.

  Given the massive fatalities during the opioid crisis, Vancouver’s morgue has been filled to capacity and the BC Coroners Service has been forced to develop extraordinary plans to store bodies while the coroner investigates. “We are in urgent need of temporary body storage owing to the public health emergency,” wrote Aaron Burns with the BC Ministry of Justice in a December 19, 2016, email plea to funeral home directors in the BC Lower Mainland. (The email was released under the Freedom of Information and Protection of Privacy Act.) “Bodies are kept at hospital morgues or funeral homes while the coroner conducts the investigation,” Burns continued. “It would only be situations where those places are overwhelmed by volume that storage would pose a problem for us. That being said, we’ve come close to that point in the recent past and looked into refrigerated shipping containers as a contingency.”

  The impact of the opioid crisis is widespread. For people who use drugs, it means never knowing whether they’ll be next. It means being blamed. It means being treated like criminals and lowlifes. This crisis continues to catastrophically affect families, friends, and loved ones of those who have died or are using substances and are at risk. And it’s had a devastating impact on those working hard to save lives, including “peers”—people with lived experience using drugs—and professional first responders like paramedics, firefighters, and police officers.