Pubdate: Tue, 23 Jul 2013
Source: National Post (Canada)
Copyright: 2013 Canwest Publishing Inc.
Contact: http://drugsense.org/url/wEtbT4yU
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Chris Selley
Page: A 10

YOU CAN'T GET CLEAN IF YOU'RE DEAD

The social media instant outrage machine has had its digs at Licia
Corbella's bizarre argument, in the Calgary Herald last week, that
it's much easier to score heroin in Vancouver than in other Canadian
cities because everyone knows where to go to find someone who knows
where to find it: Insite, the safe injection operation on the Downtown
Eastside. She suggests that had actor Cory Monteith been staying in
another Canadian city, he probably wouldn't have been able to score
and it's "highly likely" he would still be alive.

I won't heap more scorn upon it, because I think the issue she raises
- - with the aid of a time machine, how might we have prevented Mr.
Monteith from dying? - is a potentially productive avenue of
contemplation for people who share her negative views on harm
reduction. Indeed, it goes to the heart of the debate. It's incredibly
hard to get addicts into treatment, harder still to make the treatment
stick. But crucially, the patient has to be alive to have any chance
at all.

No one disputes that hundreds of people have overdosed at Insite and
lived to tell. I suppose it's possible that a few risk-averse users
would give up the habit for lack of available supervision. But knowing
Insite's track record, it seems downright reckless to advocate
shutting it down based on a hunch that it encourages or facilitates
drug use, or that its clients serve as easily locatable middlemen for
out-of-towners. Mr. Monteith is dead; we wish he were alive. Whether
or not Insite played any role in the last night of his life, surely
even its opponents must wish, all other things being equal, that he
had shot up there instead of at the Fairmont.

Many accused Ms. Corbella of believing and writing that Insite
distributes heroin. Pleading awkward wording, she has insisted she was
aware that it does not. But this raises another a key question that
got lost in the outrage. One of the first reports on the nature of Mr.
Monteith's overdose concerned the absence of fentanyl, a powerful
heroin-related opiate, in his bloodstream. This was newsworthy because
there has been a massive spike in fatalities related to the drug in
British Columbia - 23 in the first four months of this year, versus 20
in all of 2012. Fentanyl is much more addictive and potent than
heroin, and thus incredibly dangerous if you don't know you're taking
it.

"We have periodic reports of bad heroin or extra-strong heroin, and we
believe it is likely that is referring to fentanyl, or fentanyl mixed
with other drugs," B.C. provincial health officer Perry Kendall told
The Province in May.

"If a heroin user thinks they bought $10 of heroin" but actually
bought fentanyl, Insite supervisor Russ Maynard warned, "the risk of
overdose is through the roof." And it's not just fentanyl; there can
be all kinds of garbage in street drugs. Last week an Abbotsford
police officer told The Globe and Mail that a local sample tested as
"unusually potent" for reasons as yet unknown. Basically, heroin users
are rolling the dice.

So no, Insite doesn't distribute heroin. But what if it did? What if
users and addicts had access to a pure, pharmaceutical-grade product
of known intensity? It's safe to say a lot of people, celebrities and
otherwise, would be saved. As Gerald Thomas of the Canadian Centre on
Substance Abuse memorably put it to me some years ago, other than
addiction and overdose, "the two biggest physical effects of heroin
use are sleepiness and constipation" - if only heroin was the only
thing Canada's "heroin addicts" were using.

Of course the same goes for other drugs, notably MDMA, or ecstasy,
which police blame for dozens of deaths that are actually caused by
far more dangerous drugs contaminating or substituting for the real
thing. We are governed by people who think the best solution is to
keep cracking down on the real thing.

If you come at this debate as a moralizer, it's easy to oppose safe
injection sites. But Ms. Corbella's stated purpose was practical: She
wants Cory Monteith to be alive. For the sake of argument, let's say
Insite's theoretical non-existence did have some roundabout chance to
save his life.

Surely we can all agree that a registered nurse trained in overdose
management would have a rather better chance. Once you start talking
about individuals, the case for harm reduction becomes overwhelming.
You can't get clean if you're dead.
- ---
MAP posted-by: Matt