3. Learn how to save a life.
Take the free online training course on how to provide emergency first aid in the event of a drug overdose at www.naloxonetraining.com. It takes only 10 to 15 minutes to learn how to save a life. As we’ve seen throughout this book, you never know when you may encounter someone who’s experiencing a drug overdose. Ask that this training be included in the health and safety training where you work, go to school, or volunteer. You never know when you might need it.
4. Get a take-home naloxone kit.
Once you’ve taken the online training course, get one of these kits—which, depending on where you live, may be available at your local pharmacy. Keep it secure, close by in your purse, backpack, or computer bag. You might feel nervous about getting one. Think about why that is. It’s the stigma of someone thinking you’re a drug user. Remember: you’re asking for something that could save the life of someone you know and love. Be a hero, just like Little Doug Nickerson.
5. Love and support friends and family members who use drugs.
Show friends and family members who use drugs your love and help them get into treatment when they’re willing and able. Connect with support groups in your community or a national group like Leslie McBain’s Moms Stop the Harm (www.momsstoptheharm.com) so that they can support you. It’s not going to be easy, but getting support from others who’ve walked this difficult path can make a big difference. Make sure friends or family members who use drugs know about tips for “safer use,” as suggested by medical experts. These include the following:
• It is important that help (9-1-1) is called immediately in the event of an overdose;
• Do not use alone (use drugs in an overdose prevention site or supervised consumption site where possible; have someone nearby who can call for help);
• Get trained in overdose response and have naloxone available;
• Start low (test a small amount of the drug) and go slow;
• Know your tolerance: if recently using less drugs or feeling unwell, use less of the drug; and
• Don’t mix drugs, or drugs with alcohol.
6. Raise awareness.
Host an awareness-raising event with your friends, work associates, church, synagogue, mosque, temple, or service club to tell them about the opioid crisis and commit together to doing something to address the problem. Reach out to people who have experience with substance use, and include them. We need to go from individual awareness and action to community-based awareness and action.
7. Help get our political leaders on board.
As we saw in the last chapter, one of the main reasons for inaction on the opioid crisis is a lack of political will. Politicians work for you and me. You’re their boss, and they typically want to keep their jobs. Make sure they know you care about this issue and won’t accept drug policies based on ignorance, fear, ideology, and stereotypes. Write, call, email, and social media message the political leaders in your community at the municipal, provincial, and federal levels to ask them to publicly support the recommendations in the Vancouver Declaration on Responding to the Opioid Crisis. It’s also sometimes helpful to focus on one concrete change you especially want to see happen.
8. Speak up.
Raise this issue in letters to the editor, on social media, at political debates, in the classroom or workplace, and at town hall meetings. There’s a real risk that people will simply forget about it, moving on to the next perceived crisis of the moment or cute cat meme.
9. Donate your time or money.
Donate your time or money to local groups in your community that are working to help people with substance use disorders, or groups working to help address related issues such as homelessness, mental health issues, or childhood trauma. Non-profit organizations need your help, since many of these services have been chronically underfunded for decades. That’s one of the reasons why the opioid crisis has hit so hard. Wherever we have the means to help out, no matter how little, we should.
10. Make a career out of it.
Consider making a career out of helping the millions of people in North America who are struggling with substance use disorders. There are a growing number of post-secondary education and job opportunities in the field. Or, just as I’m trying to do here, think of how you can do something to help in your existing job, volunteer positions, or circles of influence. There are people you can reach that no one else can. Achieving lasting change requires people with all kinds of unique talents and gifts. Don’t underestimate your ability to be part of the solution. Be creative.
* * *
——
How does the opioid crisis end? Unless we do something radically different to stem the tide, the realistic worst-case scenario is that overdose death rates decline because there are fewer and fewer people who use drugs left alive, month after month, year after year. In that catastrophic scenario, illicit opioid use will eventually abate by raw attrition. Crisis averted. And we’ll all go back to our regularly scheduled programming—except for the tens of thousands of friends, family, and loved ones left behind. That’s what I fear will happen if apathy and numb acceptance of massive overdose death rates become the new normal—and if prejudice, ignorance, and crass political considerations prevail over research, evidence, and a heart of compassion for people affected by this unnatural disaster.
Dr. Ronald Joe, medical director for substance use services at Vancouver Coastal Health, remarked to me that, with so many deaths among opioid users, one had to wonder whether it might stop only after everyone had died. “That’s not a very good endgame,” he said. “No one wishes that. We definitely do not wish that, but I could say that the thought is in our minds.” Of course, the threat of a poisoned drug supply remains a deadly hazard for new, occasional, or casual users, too.
In the midst of the despair, destruction, and death that has characterized the opioid crisis, is there any hope? This was the final unanswered question I had—and the one that almost everyone who read the manuscript had. Beyond the public health interventions, latest pharmaceutical treatments, social programs, and legal reforms, could this crisis abate? And even if we’re able to keep more people alive, is there any hope that people can be ultimately freed from addiction’s chains?
“Addiction doesn’t occur in needles and spoons and lighters and bottles and whatnot. Addiction occurs in the brain,” said Marshall Smith, senior advisor for recovery initiatives at the British Columbia Centre on Substance Use. “No matter what the substance is that people are using out there, this is a people problem. This is a crisis of community. It’s a crisis of connection and it’s a crisis that’s occurring in people, in families, in workplaces. We like to simplify that and say that it’s an opiate problem and point the finger at the drug as if it’s the bad thing, and that’s just not the case.”
Having hope for a better future is vital in overcoming despair. Indeed, without hope, people perish. Alone and without hope, people are continuing to die in large numbers during this epidemic. But there’s no prescription for hope. It doesn’t come in a pill. You can’t manufacture it.
“You know what gets you through? Number one is the community. It’s just having support. The second is faith,” said Bill Mollard, president of Union Gospel Mission. “When you talk to most of the people out on the streets, they all have faith. And how else could you live on the street? So there is a faith component out there. People are saying ‘I need something to believe in that’s on my side and willing to help me.’ And then they’ll begin to look at it.”
Finding hope through faith resonated with me. But I wanted to know whether there was any research that would support what Mollard was saying about his personal experience working in Vancouver’s Downtown Eastside.
Dr. Alexandre Laudet, director of the Center for the Study of Addictions and Recovery in New York, has investigated the role of faith in the str
uggle against addiction. “Human beings have long looked to faith for strength and support, particularly in difficult times,” she writes. “Scientific research and clinical practice were slow to acknowledge and to investigate the role of this dimension of the human experience, in large part because it is not easily defined or captured using traditional quantitative measures.”
Dr. Laudet notes that in recent decades there have been over 200 studies demonstrating the positive role played by faith in mental adjustment and better health. It’s been found to support greater emotional well-being and improved coping by giving people hope and strength to deal with stressful events. And there’s an increasing interest in the role that faith can play in addressing addiction.
“A growing body of empirical research supports the notion that religiousness and spirituality may enhance the likelihood of attaining and maintaining recovery from addictions, and recovering persons often report that religion and/or spirituality are critical factors in the recovery process,” Dr. Laudet writes. “The hope for a better life that sets many substance users on the path to recovery can be a reality.”
Recovery can be a life-changing transformation for people emerging from years or even decades of addiction. Since addiction has provided temporary relief from the pain and suffering in their life, being in recovery means finding new and healthy ways to deal with those feelings. Addiction has robbed them of genuine connections to the people around them, and may have disrupted their spiritual connection as well. Indeed, as Dr. Laudet puts it, some “substance users often come into recovery feeling abandoned by God or alienated from God or from the religious community.” And yet a new life is possible.
“Being in recovery has changed the way I see God. I came into recovery with a God, but it was a punishing, vengeful and unforgiving God. I had done so many things…I knew were ungodly, that I thought for sure I was going to Hell,” said Craig, a 44-year old in recovery. “When I came into recovery I found a new God. I found a God that was loving, forgiving, understanding and responsive to the need that I have. In retrospect, I can see that God has been with me all the time.”
A study of 14 countries (including Canada) by the World Health Organization found that people with drug addiction had the highest level of social disapproval or stigma of any class of individual—worse even than those with leprosy. That gave me real pause as I remembered back to why I started looking into the opioid crisis in the first place—a prayer to God for a heart of compassion for people affected by it. The same Jesus who I follow laid his hands on people with leprosy when no one else would even come near them. Are more professing Christians willing to similarly love and care for people who use drugs, rather than judge and condemn them? A diverse coalition, including people who use drugs, families and friends affected by the opioid crisis, health and medical practitioners, Indigenous communities, human rights advocates, liberals, progressives, fiscal conservatives, libertarians, and people of faith, need to be part of a major societal shift in how we think about and deal with substance use.
Each of us is on our own unique journey in life, but we’re not alone. It’s being increasingly acknowledged that the opposite of addiction is connection. When important relationships in our life are disrupted or never fully developed, it causes pain and suffering and makes it more difficult to cope with all the stress, challenges, and trauma of this world. Substances and unhealthy behaviours may appear to soothe that pain temporarily, but are ultimately self-destructive. That path leads to isolation, shame, and despair. Our society often makes it worse by heaping judgment and blame on top of that brokenness. The other path is totally different. It is one of connection, love, and hope. The first path leads to death, the other to life.
Many of the courageous people who are leading the effort to address the opioid crisis and whom I got to know through this book are themselves in recovery from substance use disorders. Today they’re leading recovery centres, running safe consumption sites, and acting as powerful advocates for change. They’re living full, satisfying lives. And each of them in their own way has found hope and is living free from the chains of addiction. What’s most remarkable is that they’re now supporting others in their journey of recovery. They’re sharing the love that was poured into their lives in order to help others who can hardly dare to imagine one day being free.
APPENDIX
I wrote the Declaration that follows as a way to summarize the book’s main legal and policy recommendations in a clear and concise format that could be helpful for those who want to advocate for a more compassionate, evidence-based drug policy. I named it the Vancouver Declaration on Responding to the Opioid Crisis not only because it’s the city that’s been hardest hit in Canada by the opioid crisis, but also because it’s the city that’s been at the forefront of courageous and innovative responses to it. Fittingly, I finished drafting this Declaration the morning of July 1, 2018—Canada Day.
It doesn’t include everything that could or should be done to address the crisis, but instead focuses on the most significant proposals that would have the greatest immediate to mid-term impact. If you want to show your support for these life-saving ideas, you can visit www.overdosebook.ca, share it on social media, and call on your elected officials and community leaders to publicly declare their support for it too.
Vancouver Declaration on Responding to the Opioid Crisis
Whereas all people have the right to life, liberty, and security of the person, yet thousands of Canadians have lost their lives to illicit drug overdose;
Whereas the opioid crisis is a public health emergency;
Whereas opioid use disorder is a chronic, relapsing condition affecting thousands of Canadians;
Whereas the majority of people who are dying from illicit drug overdose are using alone and stigma is contributing to them doing so;
Whereas Indigenous people and people released from custody have been disproportionately affected by fatal overdoses;
Whereas drug use is a health and social issue, not a criminal issue;
Whereas over a century of drug prohibition has failed to meet its objectives and it has instead created a lucrative underground market for illicit drugs with significant harm to individuals, families, communities, and nations;
Whereas criminalizing people who use drugs has exacerbated the opioid crisis by punishing people for having substance use disorders, fuelling stigma, endangering their health and lives, isolating them from support, fostering other criminal and risky behaviours, increasing the risk of overdose death upon release from prison and for years later, and raising barriers to rehabilitation;
Whereas drug laws and policies should be based on evidence and compassion for people who are using drugs—not ignorance, fear, ideology, and stereotypes;
Therefore, we call on all levels of government, health authorities and medical practitioners, criminal justice and corrections professionals, and civil society to do everything within their power to:
1. Make naloxone freely and widely available to individuals, and at public and private locations, and provide emergency first aid training in how to respond to an overdose;
2. Immediately expand, and remove all legal barriers to, supervised consumption sites, overdose prevention sites, witnessed-use rooms, and “no-questions asked” drug testing services in all affected communities;
3. Dramatically expand rapid access to evidence-based treatment as recommended in the new national guidelines for treating opioid use disorder, including Suboxone as a first-line treatment option;
4. Provide legal, low-barrier, regulated access to opioids of known contents and potency (“safe supply”), under medical direction and supervision (e.g., diacetylmorphine, hydromorphone, and extended release medications) to people with opioid use disorder who would otherwise use contaminated street drugs and be at greater risk of a fatal overdose;
5. Invest in research to develop new treatment options f
or opioid use disorder and a holistic response to responding to substance use disorders;
6. Increase support to Indigenous communities, front-line and peer-based organizations, and families of people with opioid use disorder so that they can enhance their response to the opioid crisis;
7. Stop criminalizing people who use drugs, including:
a. Expand Good Samaritan overdose laws to include immunity from prosecution for any non-violent offence and related breaches of conditions and warrants, as well as increase awareness of this legal protection;
b. Decriminalize simple possession of illicit drugs;
c. Cease imposing drug paraphernalia prohibitions, which prevent the possession of naloxone kits and harm reduction supplies like clean syringes;
d. Stop criminal law conditions that prohibit people from using illicit substances (“abstinence orders”);
e. End the imposition of geographic restrictions (“red zoning”) of people who use drugs;
f. Make substance use disorder a mitigating factor at sentencing;
g. Expunge criminal records for possession of illicit substances;
h. Provide people in prison with equal access to overdose prevention services, harm reduction supplies, and evidence-based treatment options; and
i. Prior to their release from custody, provide people with access to a medical practitioner who is trained in substance use disorders and who can provide them with the necessary information and medications to reduce their risk of suffering a fatal overdose.
METHODOLOGY
For the geeks (I admit to being one) and the skeptics (I used to be one), here’s a brief word about how I conducted my investigation. My research involved a mixed-methods approach. Given the emergent nature of the opioid crisis, in addition to conducting a thorough literature review on the subject, my primary sources of information for this study derived from empirical research, using qualitative methods.
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