Pubdate: Fri, 06 Jan 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Author: Michael Mulligan (Michael T. Mulligan is a Victoria lawyer.)
Page: A10


As of the end of November, 755 people had died of drug overdoses in B.C.
Prescription heroin could greatly reduce this toll.

One of the principal reasons for the large number of overdose deaths has
been the increasing presence of fentanyl, an opioid 100 times more
powerful than heroin. Fentanyl is often substituted for, or added to,
other illegal drugs.

A single envelope of pure fentanyl is enough to produce thousands of pills
and tens of thousands of dollars in profit. One kilogram of fentanyl,
which can be purchased online for less than $100,000, is enough to produce
one million pills that can be sold for $20 each.

It's unrealistic to think we are going to prevent such a concentrated
substance from entering the country when there is an enormous profit
motive. Experience has shown us we are not able to do so even with much
less concentrated drugs.

Fentanyl overdoses occur because the original substance, or pills that are
produced from it, are of varying strength. Because the substance is so
potent, even a small variation in concentration can cause death. Because
the substance is produced illegally, it is not subject to quality control
- - variations in the amount of the active ingredient is a certainty.

For people addicted to opioids such as heroin or fentanyl, daily existence
typically involves the commission of property offences or the sale of
their bodies in a desperate effort to secure enough money to purchase more
drugs and avoid the pain of withdrawal. The impact of these activities,
along with the corruption and criminal organizations they foster, are the
costs we pay for our failed efforts to solve this problem.

Safe-consumption sites reduce the number of deaths by allowing antidotes
to be administered more quickly when people overdose, and by providing
clean needles to reduce disease transmission. As currently operated,
however, they are a half measure.

The premise of a safe-consumption site is that people addicted to these
substances bring their own drugs, of unknown strength, purchased with
money often obtained by crime.

On Sept. 19, the federal government reinstated a program that permits
doctors to apply for special access to prescribe pharmaceutical-grade
heroin to people who are severely addicted.

The Special Access Program requires an application from a doctor or other
medical practitioner for special permission to prescribe the drug where a
patient has a serious or life-threatening condition, such as a serious
opioid addiction, where other treatments have failed, are unsuitable or
are unavailable.

Currently, Island Health staffs safe-consumption sites in Victoria with a
paramedic, tasked with resuscitating people when they inevitably overdose
on illegal drugs.

Island Health should also staff the consumption sites with a doctor to
assess people and make applications, in suitable cases, for inclusion in
the Special Access Program. Rather than administering naloxone to people
overdosing on illegally obtained drugs, the paramedic could help with the
applications and monitor the use of the legally obtained, safer,
pharmaceutical-grade heroin.

This would save lives and reduce property crime caused by people
attempting to obtain money to purchase dangerous drugs illegally.

Communities surrounding safe consumption sites, operated in this way,
would not have to deal with a concentration of drug trafficking and
property crime.

The profit motive to import and manufacture dangerous illegal drugs would
be reduced, as people provided with safer prescription drugs would no
longer be buyers.

It would also reduce the sex trade, as this activity is also driven by
people desperately trying to earn money to purchase drugs illegally.

Once people who are severely addicted are stabilized, and no longer
spending their days trying to obtain drugs illegally, there would be an
opportunity to encourage and provide detox and drug treatment.

Finally, operating safe-consumption sites in this way would be lawful.
While the federal government has introduced legislation that will
eventually make it easier to obtain permission to open safe-consumption
sites where people consume illegally obtained drugs, this is not yet in
place, and the sites in Victoria enjoy no exemption from federal drug

At least in theory, operating safe consumption sites without such an
exemption might amount to being a party to offences under the Controlled
Drugs and Substances Act.
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