Pubdate: Mon, 12 Feb 2018
Source: Globe and Mail (Canada)
Copyright: 2018 The Globe and Mail Company
Author: Adrienne Tanner
Page: A9


Councillors might still squabble over budgets, but no one questions
the fact that the opioid crisis must be solved

Mark Tyndall stood before Vancouver City Council at a recent meeting
to proselytize for his latest harm-reduction scheme: vending machines
to dispense opioids to drug users.

"I really wish we could get 50 of these things going in the next
year," said Dr. Tyndall, executive medical health director of the BC
Centre for Disease Control. "We could supply clean drugs to thousands
of people and our overdose numbers would plummet." He plans to start
with a pilot project in Vancouver.

Remarkably, Vancouver's city council, which is so divided its members
can't agree on a bike lane, barely flinched - even though this plan
goes far beyond current supervised drug-distribution programs
conducted primarily in clinical settings.

Mayor Gregor Robertson and almost every councillor thanked Dr. Tyndall
and Dr. Patricia Daly, Vancouver Coastal Health's chief medical health
officer, for their efforts to reduce the number of overdose deaths.
Even Non-Partisan Association (NPA) councillor Hector Bremner, who
questioned the logic of a program that would profit the corporate
purveyors of addictive opioids, said after the meeting he would
support a pilot project.

"I am open to any idea if it will save a life."

Dr. Tyndall's plan may sound reckless if you don't know that these are
nothing like candy machines that can be rocked and kicked into submission.

Manufactured by the medical marijuana industry, each one is made from
750 pounds of military-grade steel and programmed to dispense
prescribed quantities of pills only to registered users, using
biometric identification. The advantage of circumventing a clinical
setting is that many drug users are too ashamed or find it
inconvenient to present at clinics or pharmacies for clean drugs.
Instead they shop on the street, where deadly fentanyl contamination
is rampant.

The cross-party acceptance of Dr. Tyndall's vending-machine experiment
by our civic politicians indicates both how serious the overdose
crisis has become, and how far the harm-reduction dial has moved over
the past two decades.

In 2017, more than 1,400 people died of illicit drug overdoses in
British Columbia, most of them fentanyl-related. It was the most
catastrophic year ever, despite myriad harm-reduction efforts, which
include legal and extralegal supervised drug-use sites, widespread
naloxone-kit distribution and a smattering of supervised hydromorphone
(opioid) distribution programs.

Are opioid vending machines another step on the slippery slope to the
complete decriminalization of drugs? Maybe, and that would be
supported by Dr. Tyndall, many city councillors and Vancouverites who
are weary of the crime, disease and misery associated with the illegal
street drug trade.

And if the new program defies a whole bunch of provincial and federal
regulations, Dr. Tyndall is the first to admit and defend that too.

"We don't have time to get everyone agreeing on it. If we went through
the federal process for the overdose-prevention units, we wouldn't
have any."

Perhaps because Vancouver is a port city with a long history of drug
problems, it has always been more willing than other Canadian
municipalities to flout the law and lead the country in harm reduction

As Dr. Tyndall spoke, many councillors nodded in agreement. Tim
Stevenson called him brave. Green councillor Adriane Carr proclaimed
addiction should be treated as a medical condition and supplying safe
drugs is the way to go. NPA councillor Melissa De Genova said she was
disappointed when the NAOMI trial, which dispensed free heroin to
users, ended.

What a sea change since 2002, when the NPA dumped Mayor Philip Owen
because he supported Insite, Vancouver's first supervised drug-use

Today, councillors still squabble over harm-reduction budgets and
which of the four pillars championed by Mr. Owen - prevention,
treatment, enforcement or harm reduction - deserves the most
resources. But no one questions harm reduction itself.

It is a rare person in Vancouver who hasn't stumbled upon a paramedic
crew crouched over a limp body and watched anxiously, hoping this is
not another bump in the dismal statistics. And most of us now know
someone touched by the overdose death of a family member or friend.

Vancouver City Council, despite all its flaws and factions, seems to
have figured out that the opioid crisis is no place to play politics.
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