• Dysphoric mood (e.g., depression, anxiety, irritability, inability to concentrate, fatigue)
• Nausea or vomiting
• Muscle aches
• Lacrimation (flowing tears from the eyes) or rhinorrhea (nasal cavity filled with fluid)
• Pupillary dilation, piloerection (hair on skin standing up), or sweating
• Diarrhea
• Fever
• Insomnia
In extreme cases, withdrawal can cause seizures. For many people with opioid use disorder, withdrawal is part of an “escalating pattern in which an opioid is used to reduce withdrawal symptoms, in turn leading to more withdrawal at a later time.”
“Most people, when they’re addicted to heroin or fentanyl or whatever, they don’t actually get high anymore,” said Dr. Bonnie Henry. “It’s all about trying to stave off those feelings of being dope sick. The withdrawal from it is quite horrendous, makes you feel really bad. So you need more and more just to feel normal again. Opioids change your brain and it resets your normal level, if you will.”
Dr. Hasselback has seen the same thing with his patients: “I try to emphasize that there aren’t that many users out there that are taking the opioid fentanyl to get high. They’re taking it to prevent the withdrawal symptoms. It’s the avoidance of the dope sickness that is the major driver to individuals who continue to use illicit drugs.”
What exactly is “dope sickness,” or withdrawal? How bad is it?
“I mean it’s the worst flu, times 100,” said Troy Balderson, downtown projects manager at Lookout Society in Vancouver. “It really is that bad. Debilitating. People can’t think straight. All you want to do is get well. As you get through it, you get into day three or four, you get hallucinations. I mean it’s terrible.”
Illicit opioids promise relief from trauma and suffering, often for people who have lost all hope and have nowhere else to turn. They might start as a short-term fix to make the pain go away. And it works, at least for a little while. But then they demand their due, and exact a heavy price. The unresolved trauma and suffering were always there, but now they come back. Added to that are the crippling effects of withdrawal that demand to be satiated—and they won’t take no for an answer.
By the time you realize it, it’s too late. It’s a vicious cycle that exposes that initial promise of a quick relief from suffering as a lie. A cruel hoax that can have deadly consequences.
* * *
——
People who regularly use drugs because they’re addicted describe the daily struggle they face just to feel some sense of normalcy. Jordan Westfall was one of them. As a university student with a secret, he’d managed to keep up with his studies but was struggling with an increasingly serious substance use problem.
“I was kind of living a double life,” said Westfall. “I was a daily opioid user for about five years of my life in my late teens, early twenties. I tried to keep my grades up and at the same time I was dealing with this, which is chaotic. It’s exhausting.”
Westfall would spend hours every day trying to get access to illicit drugs while juggling a full course load. On days when he wasn’t successful he’d go to class feeling like a wreck owing to the harsh and unrelenting symptoms of opioid withdrawal. And on days when he didn’t have any money, he’d even sell his textbooks for cash to buy drugs.
OxyContin was supposed to be a temporary fix. But when regulatory changes made these pills much more expensive and, eventually, unavailable on the street, Westfall turned to heroin. “It’s almost like if you took food, or took a muffin, and made it illegal and that’s your breakfast for the day, but now it’s $40 and you have to go hustle on the streets for it. The outcome would be entirely different for a lot of people just to get their breakfast. For us, it puts our lives into chaos.” And, of course, your morning muffin isn’t laced with illicit fentanyl that could kill you.
Fortunately, Westfall stopped using drugs around the time when he completed his undergraduate degree, just before illicit fentanyl became widespread. He went on to graduate from Simon Fraser University and connected with a group called the Canadian Association of People Who Use Drugs (CAPUD). He says he found acceptance and a platform to call for reforming Canada’s drug laws and policies.
By the time I met with him next to the outdoor skating rink at Robson Square in downtown Vancouver, Westfall was leading CAPUD and representing thousands of drug users. In his T-shirt and jeans, he reminded me of many of the law students I’ve taught over the years. He looked a bit tired (I’m sure I did too), but was bright and engaging. How many of my students were, like Westfall, juggling their studies and their struggles with substance use? How many of them were keeping it secret from everyone? How many of them were, or are, using alone?
Although law schools like UBC have done a lot to raise awareness of and help students with various mental health issues and disabilities, I’ve never heard of any concrete measures to support students with substance use issues. Meanwhile, the heavy workload, stress, and competition of law school and then legal practice contribute to problematic alcohol and substance use as students and young lawyers grasp for something to relieve the pressure. Some studies have found that one in five lawyers experience problematic substance use—and that the vast majority of those challenges started in law school. It can come with big personal and professional costs. I’m grateful to Westfall for opening my eyes to the opioid crisis that could be in my own classroom and quiet neighbourhood.
Westfall is also concerned about people today who are using alone, despite the prevalent warnings describing the risks of doing so. “First of all, give people a reason to get out of their house. We need to engage with people, and I think that can be done on a community level. If we can get those people to come out and just be like, ‘We have a safer option for you when you do it,’ we have to be pursuing that.”
Westfall had brought it all back to the difficult issue that I knew I’d eventually have to confront when I started this investigation: whether Canada should decriminalize illicit drugs and, even more controversially, whether we should make a “safe supply” available to illicit drug users. Given how miserably the status quo had failed to address the opioid crisis, I’d committed to being open to all options. But I wasn’t even close to being convinced yet. I still had too many unanswered questions and a lot more to learn before I could consider something that still seemed so radical.
All this made me wonder: if people who are addicted to illicit drugs can’t stop taking them and need support, what was the reason for punishing them with criminalization in the first place?
–4–
HAS CRIMINALIZING DRUGS FAILED?
It was a lot less than what white workers got. In the early 1880s, one dollar a day was all that some 15,000 Chinese workers were paid to finish the transcontinental railway that would connect British Columbia to the rest of Canada. Even worse, these labourers were given the most treacherous jobs. It’s estimated that, for every mile of track laid through the Rocky Mountains, one worker died. But no sooner was the railway nearing completion than these Chinese labourers were no longer welcome—and both the provincial and federal governments were determined to send them that message through a series of racial exclusion and discrimination laws.
In Victoria, the BC legislature adopted the Chinese Regulation Act, 1884, which, among other oppressive measures, imposed an annual tax on every Chinese person; required employers to provide a list of all Chinese employees on demand; authorized the creation of toll gates for Chinese people; and placed restrictions on dwellings rented or occupied by Chinese people. This racist law also enacted the first legal prohibition on opioids in Canada. Except for medical or surgical purposes, its use was punishable by a fine of up to $100—the equivalent of approximately $2500 today. Banning opium, which was smoked at the time and had a far lower potency than today’s illicit drugs, was par
t of a suite of measures intended to harass and discriminate against the Chinese population who had brought the practice with them. Indeed, the historical record suggests that the case for prohibiting opium in Canada was racism, pure and simple.
As Dr. Neil Boyd, professor of criminology at Simon Fraser University, told me, “Matthew Begbie, chief justice of British Columbia, held a commission in 1885 that established that smoking opium wasn’t nearly as dangerous as alcohol. And that the people who used it were more able to work the next day and didn’t get into all kinds of fights that they did in saloons and stuff. There was no need to criminalize.”
After the Chinese Regulation Act and other anti-Chinese laws were struck down by the courts, the BC legislature adopted a racist motion calling on the federal government to take action “to prevent our Province from being completely overrun by Chinese.”
Sir John A. Macdonald, Canada’s first prime minister, was a willing ally. On May 4, 1885, he rose in the House of Commons to personally make the case for excluding Chinese people from voting. “Of course we ought to exclude them,” said Macdonald, “because if they came in great numbers and settled on the Pacific coast they might control the vote of the whole Province, and they would send Chinese representatives to sit here, who would represent Chinese eccentricities, Chinese immorality, Asiatic principles altogether opposite our wishes; and, in the even balance of the parties, they might enforce those Asiatic principles, those immoralities which he speaks of, the eccentricities which are abhorrent to the Aryan race and Aryan principles, upon this House.”
Macdonald went even further, setting out an astonishingly racist vision for this new country based on theories of white supremacy and racial superiority:
If you look around the world you will see that the Aryan races will not wholesomely amalgamate with the Africans or the Asiatics. It is not to be desired that they should come; that we should have a mongrel race; that the Aryan character of the future of British America should be destroyed by a cross or crosses of that kind. Let us encourage all the races which are cognate races, which cross and amalgamate naturally, and we shall see that such an amalgamation will produce, as the result, a race, equal, if not superior, to the two races which mingle.
On September 7, 1907, rabid anti-Chinese sentiment in Vancouver reached a flashpoint with three days of anti-Asian riots. It began with a parade organized by the “Asiatic Exclusion League,” starting at City Hall then proceeding to Chinatown. Twelve-foot-wide banners bore slogans that read “Stand for a White Canada” and “We have fought for the Empire and are ready to fight again.” The mob smashed windows and storefronts throughout Chinatown and the Japanese quarters, with several reports of violence against people.
Responding to the 1907 Vancouver riots, the federal government sent William Lyon Mackenzie King, who was then deputy minister of labour but would later become a Liberal prime minister, to investigate. Even though it wasn’t in his initial mandate, King wrote a 13-page Report on the Need for the Suppression of the Opium Traffic in Canada. It’s hardly the stuff of any policy justification I’ve ever seen: it reproduces his correspondence with the Anti-Opium League, mentions a visit to an opium den and his own over-the-counter purchase, discusses how other countries were dealing with the issue, and includes some newspaper clippings. King argued that prohibition should be national policy and promised it would completely stop the use of opium. He appealed to the moral panic that opium use was causing among white people, particularly concerning young white women. He reproduced the following newspaper clipping in his report:
Awful effects of Opium Habit.
In the police court this morning, while Vancouver lay in the beauty and brightness of early sunshine, there emerged into the light, ugly and horrible evidence of the dire influence which the opium traffic is exercising among the ranks of British Columbia womanhood. May Edwards, pretty and young, had been found in a Chinese den. She said she had a husband in Victoria, and if allowed to go would return to him. She was allowed to go.
Much the sadder of the cases, however, was that of Belle Walker. A terrible record of the effects of indulgence in opium was written upon her appearance this morning. She was found by the police in an opium den. She had been there for three weeks. Magistrate Williams sent her to prison for six months.
In short, the case for criminalizing opioids in Canada in the early 1900s didn’t rest on concerns for public health and safety, nor was it founded on any scientific or medical evidence. It was politically motivated, based solely on racism and appeals to moral rectitude.
“Smoking opium was not considered to be physically harmful or socially degenerate,” writes Robert Solomon, a professor with the University of Western Ontario Faculty of Law who has researched the history of drug prohibition in Canada. “Yet, the public strongly disapproved of opium smoking among whites, because it involved mixing of the races—a matter considered far more serious than the drug’s effects….
“This crusade succeeded because it was directed against Chinese opium smokers and Chinese opium factories, but at the same time posed no threat to the larger number of predominantly middle-class and middle-aged Caucasian users who were addicted to the products of the established pharmaceutical industry.”
At the turn of the twentieth century, morphine, heroin, and cocaine were unregulated; they were even found in such products as teething medicine for children, toothpaste, and cough syrup. In fact, as Dr. Scott MacDonald from the Crosstown Clinic pointed out, the word “heroin” was the marketing name given by pharmaceutical company Bayer for its “heroic cough suppressant” that contained the narcotic at the time.
King’s report was the launching pad for a national policy of drug prohibition that would criminalize illicit drugs across Canada, with increasingly severe sentences for both users and traffickers. The promise was to eliminate illicit opioid use. More than 110 years later, that promise remains a failure.
* * *
——
Despite over a century of trying to eradicate illicit drugs, today the global illicit drug trade is estimated to be worth somewhere between US$426 billion and US$652 billion annually. One of the main goals of the war on drugs—that is, the prohibitionist model—is to eradicate the supply of illegal drugs, or at least disrupt the supply to a major degree, in order to curb drug use and associated criminality. It has failed to achieve that aim.
“The message has to be loud and clear,” said Dr. Mark Tyndall, executive director of the BC Centre for Disease Control. “This is a totally demand-driven epidemic.” He had a good point, but I wasn’t totally convinced until I met his colleague, Dr. Evan Wood, who leads the BC Centre on Substance Use.
Dr. Wood, together with other experts from Canada and the United States, has conducted extensive research into the impact of efforts to reduce the supply of illegal drugs over the last several decades. They used data from the United States, Europe, and Australia, including the inflation-adjusted price of illicit drugs and their average purity (relative potency or strength). The researchers found that not only has it been impossible to address illicit trafficking from the supply side, but that attempting to do so entails serious unforeseen consequences, casting doubt on the whole concept of prohibition.
Between 1990 and 2007, seizures of heroin, cocaine, and cannabis in major production regions and major domestic markets generally increased. The war on drugs was doing what it was supposed to do: cracking down on the supply of illicit drugs in both source and destination countries. What were the outcomes of this apparent success?
Paradoxically, despite massive and incredibly costly efforts to shut down or disrupt their supply, these drugs became cheaper to buy. From 1990 to 2007, the average price of heroin in the United States actually decreased by 81%, the price of cocaine dropped by 80%, and the price of cannabis went down by 86%. Downward price trends were also observed in Europe and Australia.
Even more interesting,
between 1990 and 2007 in the U.S., the average purity of heroin increased by 60%, cocaine’s by 11%, and cannabis’s by 161%. How could that be?
You could call it the law of unintended consequences—by trying to eradicate the supply of these drugs, things were actually made worse as these drugs became less expensive and more potent. That policy outcome is precisely the opposite of what the war on drugs was supposed to accomplish. As drug enforcement intensified and more illicit drugs were seized, illicit drug manufacturers responded by making their products more potent so that they’d be more compact. That way, they could be shipped in smaller quantities that were less likely to be interdicted. Goodbye shipping containers of cocaine from Colombia; hello greeting cards of fentanyl from China.
The war on drugs has also seen unprecedented levels of violence, with global drug cartels, organized crime, and gangs vying for their piece of the pie and battling with police. In many instances, the blood spilled to reap these illicit drug profits has come to the streets, including in major Canadian cities like Vancouver, where innocent lives have been lost in the crossfire.
This whole phenomenon isn’t new; it’s part and parcel of prohibiting substances. We’ve seen it before. From 1920 to 1933—the Prohibition era in the United States—there were massive efforts by law enforcement and border agents to shut down the importation and domestic manufacturing of alcohol. That created a huge opportunity for organized crime to make monopoly profits to meet the demand for alcohol products, and led to a lot of bloodshed in the criminal underworld for battles over turf.
Also, since low-alcohol-content products like beer took up a lot of space, they were harder to smuggle. Enter moonshine. Producing spirits with very high alcohol content made the product more compact, so it was harder for law enforcement to detect. But some of these higher-potency products ended up causing blindness and even death. Studies show that, during the Prohibition period, the potency of alcohol products increased by 150%.
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