Forty-two individuals with expertise related to the opioid crisis were interviewed using a semi-structured method for between 45 and 90 minutes each. These individuals are listed in the Interviewees section. Most interviews were conducted in person in Vancouver, Surrey, and Victoria between February and April 2018, with a few additional interviews in May and June 2018. Where in-person interviews weren’t possible they were conducted by telephone. All interviews were digitally recorded, with the permission of the participant, and transcribed by a professional transcription service. The interview transcripts were analyzed using thematic analysis, supported by Nvivo 11 software.
All interviews were conducted with the written informed consent of participants and with harmonized ethics approval from the UBC Behavioural Research Ethics Board, Vancouver Coastal Health Research Institute, Providence Health Care, Fraser Health, and Island Health. Operational approval was also secured from these health authorities. The interviews were for attribution, unless the participant wished to be anonymous.
Additional primary sources were consulted, including to check facts from the interviews, such as public court records, archival sources, judicial decisions, coroner’s reports, and records released under the BC Freedom of Information and Protection of Privacy Act. Secondary sources included legal, criminological, sociological, medical, addiction, and public health peer-reviewed literature as well as governmental and non-governmental reports. Specific written sources that I relied upon in the book appear in the Notes section.
INTERVIEWEES
In alphabetical order, titles/positions listed at time of being interviewed
Daniel Atkinson Deputy Fire Chief for Operations, Victoria Fire Department
Shawna Baher Inspector, Surrey RCMP Detachment
Troy Balderson Downtown Projects Manager, Lookout Society
Dr. Aamir Bharmal Medical Health Officer & Medical Director of Communicable Diseases and Harm Reduction, Fraser Health
Oren Bick Senior Counsel, Public Prosecution Service of Canada
Sarah Blyth Executive Director, Overdose Prevention Society
Dr. Neil Boyd Professor of Criminology, Simon Fraser University
Jennifer Breakspear Executive Director, Portland Hotel Society (PHS) Community Services Society
Chris Buchner Director of Communicable Diseases and Harm Reduction, Fraser Health
Judge Elisabeth Burgess Vancouver’s Downtown Community Court
Dr. Richard Frank Professor of Health Economics, Harvard University
Len Garis Surrey Fire Chief
Mark Gervin Director of Legal Services, UBC’s Indigenous Community Legal Clinic & Criminal Defence Lawyer
Yvette-Monique Gray Director of the Enforcement and Intelligence Division (Pacific Region), Canada Border Services Agency
Mario Harel President, Canadian Association of Chiefs of Police
Dr. Paul Hasselback Medical Health Officer, Central Vancouver Island
Dr. Bonnie Henry Chief Medical Officer, British Columbia
Dr. Ronald Joe Medical Director for Substance Use Services, Vancouver Coastal Health
Shelda Kastor Board Member and Secretary, Western Aboriginal Harm Reduction Society
Conor King Staff Sergeant, Victoria Police Department
David Lothian Chief of the Intelligence Section (Pacific Region), Canada Border Services Agency
Linda Lupini Executive Vice President, BC Provincial Health Services Authority & BC Emergency Health Services
Dr. Scott MacDonald Physician Lead, Crosstown Clinic
Leslie McBain Co-founder, Moms Stop the Harm
Dwayne McDonald Assistant Commissioner & Officer in Charge, RCMP Surrey Detachment
Dr. Shannon McDonald Acting Chief Medical Officer, First Nations Health Authority
Bill Mollard President, Union Gospel Mission
Clayton Pecknold Assistant Deputy Minister and Director of Police Services, Government of BC
Pivot Legal Society three representatives interviewed together
Laurence Rankin Deputy Chief Constable, Vancouver Police Department
Darrell Reid Vancouver Fire Chief
Mike Serr Deputy Chief, Abbotsford, BC, and Chair, Canadian Association of Chiefs of Police Drug Advisory Committee
Carolyn Sinclair Manager, BC Provincial Overdose Mobile Response Team
Marshall Smith Senior Advisor for Recovery Initiatives, British Columbia Centre on Substance Use & Chair, British Columbia Recovery Council
Bill Spearn Inspector, Vancouver Police Department
Dr. Mark Tyndall Executive Director, BC Centre for Disease Control
Andy Watson Strategic Communications Manager, BC Coroners Service
Jordan Westfall President, Canadian Association of People Who Use Drugs
Bonnie Wilson Operations Director (Inner-City Eastside) and Co-program Lead for Mental Health and Substance Use, Vancouver Coastal Health
Dr. Evan Wood Executive Director, BC Centre on Substance Use
NOTES
Chapter 1—What Is the Opioid Crisis?
a record-shattering 13,913 people across Canada Special Advisory Committee on the Epidemic of Opioid Overdoses, National Report: Opioid-related Harms in Canada (December 2019), https://health-infobase.canada.ca/substance-related-harms/opioids.
the leading cause of death for 30- to 39-year-olds Leslie Young, “Nearly 4,000 Canadians Died of Opioid Overdoses in 2017, a New Record,” Global News, June 20, 2018, https://globalnews.ca/news/4282699/canada-opioid-death-statistics-2017.
By 2018 that number had almost tripled, reaching 1542 BC Coroners Service, “Illicit Drug Toxicity Deaths in BC (January 1, 2009–October 31, 2019)” at 3, https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf.
“We are in urgent need of temporary body storage” Email correspondence from Aaron Burns, “BC Coroners Service: Body Storage (Vancouver and Area)” (December 19, 2016), released under the Freedom of Information and Protection of Privacy Act (File No. OCC-2018-83144) on June 4, 2018.
“Bodies are kept at hospital morgues or funeral homes” Ibid.
In 2017, an estimated 70,237 people died from illicit drug overdoses in the U.S. National Institute on Drug Abuse, “Overdose Death Rates” (revised January 2019), www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
President Donald Trump has instead insisted on building a wall Josh Katz, “How a Police Chief, a Governor and a Sociologist Would Spend $100 Billion to Solve the Opioid Crisis,” The New York Times (February 14, 2018).
illicit drug overdose deaths where fentanyl has been detected BC Coroners Service, “Fentanyl-Detected Illicit Drug Overdose Deaths (January 1, 2012 to January 31, 2019),” www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/fentanyl-detected-overdose.pdf.
Chapter 2—Why Is Fentanyl Killing So Many People?
Dr. Jules Blanchette, a 36-year-old veterinary surgeon, sold Inovar-Vet R. c. Blanchette, [1990] J.Q. no 236 (C.A.Q.).
The first time fentanyl is mentioned R. v. Reid, 2008 NSPC 41, [2008] N.S.J. No. 287, para. 15.
in just 10 months carfentanyl was detected BC Coroners Service, “Fentanyl-Detected Illicit Drug Overdose Deaths (January 1, 2012 to March 31, 2018),” www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/fentanyl-detected-overdose.pdf.
Purdue Pharma introduced OxyContin in the mid-1990s Caitlin Esch, “How One Sentence Helped Set Off the Opioid Crisis,” Marketplace, December 13, 2017, www.marketplace.org/2017/12/13/health-care/uncertain-hour/opioid.
Medical residents were allegedly taught Jon Kelvey, “How Advertising Shaped the First Opioid Epidemic: And What It Can Teach Us About the Second,” Smithsonian Magazine, April 3, 20
18, www.smithsonianmag.com/science-nature/how-advertising-shaped-first-opioid-epidemic-180968444.
The company has denied deceptive marketing Harriet Jones, “Purdue Pharma to End Marketing of Oxycontin,” WNPR, February 12, 2018, http://wnpr.org/post/purdue-pharma-end-marketing-oxycontin.
Some people have even chewed used fentanyl patches R. v. Chivers, 2017 ONCJ 904, [2017] O.J. No. 6889, para. 6.
Prescription drug theft has been increasing in provinces like Ontario Tara Carman & Vik Adhopia, “More Than Half a Million Prescription Drugs Are Stolen Each Year—And Most Are Opioids,” CBC News, June 27, 2018, www.cbc.ca/news/canada/missing-drugs-pharmacies-part1-1.4708041.
Some pointed to a study by the BC Coroners Service BC Coroners Service, “Preventing Pharmaceutical Opioid-Associated Mortality in British Columbia: A Review of Prescribed Opioid Overdose Deaths, 2009–2013” (July 17, 2017), www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/pharmaceutical-opioid-mortality.pdf.
On the morning of April 20, 2018, his parents found him in his bedroom Cindy E. Harnett, “Parents Called 911 and Injected Naloxone, but It Was Too Late to Save Teen,” Times Colonist (Victoria), April 25, 2018.
Preliminary data from a study by the BC Centre for Disease Control BC Centre for Disease Control, “BCCDC Public Knowledge Summary: Analyzing Prescription Drug Histories Among People Who Overdose” (February 21, 2018).
Chapter 3—Why Do People Start Using? Why Can’t They Stop?
“I help them decrease stress and anxiety” Michael Stone, “My Story,” https://michaelstoneteaching.com/my-story.
“Unbeknownst to everybody, he was growing more desperate.” Carina Stone, Erin Robinsong, & Rose Riccio, “Michael Stone’s Passing—Official Statement,” https://michaelstoneteaching.com/official-statement-michael-stones-passing/#.
he’d died of acute fentanyl toxicity BC Coroners Service, “Coroner’s Report into the Death of Stone, Michael Jason,” Case No. 2017-1037-0048 (April 10, 2018).
In BC, the vast majority of illicit drug overdose deaths are men BC Coroners Service, “Illicit Drug Overdose Deaths in BC (January 1, 2008–March 31, 2018),” www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf.
it wasn’t possible to determine the frequency of drug use Michael Egilson, BC Coroners Service Death Review Panel: A Review of Illicit Drug Overdoses (April 5, 2018) at 15 [Death Review Panel].
only 9% of illicit drug overdose deaths were officially homeless people Ibid. at 14.
In BC in 2017, 59% of illicit drug overdose deaths occurred in private residences BC Coroners Service, “Illicit Drug Overdose Deaths in BC (January 1, 2008–March 31, 2018)” at 12, www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf.
More than half (52%) of illicit drug overdose deaths involved people using alone Death Review Panel at 16.
Two other reasons focus groups have found Ibid. at 16.
“Each of the friends used the drugs from the same delivery.” BC Coroners Service, “Coroner’s Report into the Death of Adkin, Edmond Paul,” Case No. 2016-0573-0157 (April 12, 2018).
“Rarely did you see Paul without a smile” Dignity Memorial, “Obituary: Edmond ‘Paul’ Adkin,” www.dignitymemorial.com/en-ca/obituaries/kamloops-bc/edmond-adkin-7115359.
Each ACE point represents a two- to fourfold increase S.R. Dube, V.J. Felitti, M. Dong, D.P. Chapman, W.H. Giles, & R.F. Anda, “Childhood Abuse, Neglect and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experience Study” (2003) 111(3) Pediatrics 564–572.
classified as a mental disorder by the American Psychiatric Association American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Publishing, 2013) (“DSM-5”) at 541–546.
“clinically significant distress or impairment in social, occupational, or other important areas of functioning” Ibid. at 548.
“escalating pattern in which an opioid is used to reduce withdrawal symptoms” Ibid. at 549.
Some studies have found that one in five lawyers experience Indra Cidambi, “Drug and Alcohol Abuse in the Legal Profession,” Psychology Today (July 17, 2017), www.psychologytoday.com/us/blog/sure-recovery/201707/drug-and-alcohol-abuse-in-the-legal-profession.
Chapter 4—Has Criminalizing Drugs Failed?
for every mile of track laid through the Rocky Mountains Chinese Regulation Act, 1884, 47 Vict., c. 4, s. 18 (Source: University of British Columbia. Library. Rare Books and Special Collections. The Chung Collection. CC-TX-279-14); CBC, “Legacy of Hate: Chinese Immigrants Encounter Prejudice and Violence as They Settled in Canada,” www.cbc.ca/history/EPISCONTENTSE1EP11CH3PA3LE.html.
Except for medical or surgical purposes, its use was punishable Extract from Votes and Proceedings of the Legislative Assembly, 25th February, 1885 (Source: University of British Columbia. Library. Rare Books and Special Collections. The Chung Collection. CC-TX-100-43-9).
After the Chinese Regulation Act and other anti-Chinese laws. Ibid.
“Of course we ought to exclude them,” House of Commons Debates, 5th Parl., 3rd Sess., Vol. 2, p. 1588 (May 4, 1885) (Sir John A. Macdonald).
If you look around the world you will see that the Aryan races Ibid. at 1585.
Twelve-foot-wide banners bore slogans that read “Vancouver Was in the Throes of Serious Riot Saturday Night,” The Weekly News-Advertiser (Vancouver), Vol. XXI, No. 2, September 10, 1907.
Awful effects of Opium Habit. Cited in W.L. Mackenzie King, The Need for the Suppression on the Opium Traffic in Canada, 7–8 Edward VII, Sessional Paper No. 36b (Ottawa: 1908) at 7–8.
“Smoking opium was not considered to be physically harmful” R. Solomon & M. Green, “The First Century: The History of Nonmedical Opiate Use and Control Policies in Canada, 1870–1970” (1982) 20:2 UWO Law Review 307–337 at 309.
“This crusade succeeded because it was directed against Chinese opium smokers” Ibid. at 308.
Despite over a century of trying to eradicate illicit drugs Channing May, Transnational Crime and the Developing World (Global Financial Integrity: March 2017) at xi.
From 1990 to 2007, the average price of heroin in the United States Researchers adjusted prices for inflation and relative purity. See Dan Werb et al., “The Temporal Relationship Between Drug Supply Indicators: An Audit of International Government Surveillance Systems,” BMJ Open 2013;3:e003077.
Downward price trends were also observed in Europe and Australia Ibid.
during the Prohibition period, the potency of alcohol products increased by 150% Leo Beletsky & Corey S. Davis, “Today’s Fentanyl Crisis: Prohibition’s Iron Law, Revised” (2017) 46 International Journal of Drug Policy 156–159 at 157.
Richard Cowan, a Republican-turned-cannabis-activist Richard C. Cowan, “How the Narcs Created Crack: A War Against Ourselves” 38(23) National Review 26–31 (December 5, 1986) at 27.
Between 2008 and 2015, enforcement at the border with Mexico Leo Beletsky & Corey S. Davis, “Today’s Fentanyl Crisis: Prohibition’s Iron Law, Revised” (2017) 46 International Journal of Drug Policy 156–159 at 157.
Chapter 5—Why Are Dealers Killing Their Customers?
“I’m french speaking organic chemist so excuse my rusty english” Siegfried, “Synthesis of Fentanyl” (undated), https://erowid.org/archive/rhodium/chemistry/fentanyl.html.
The United Nations Office on Drugs and Crime’s 2017 report United Nations Office on Drugs and Crime, “Fentanyl and its Analogues—50 Years On” Global Smart Update Volume 17 at 7.
Dr. Mayer was able to obtain the necessary ingredients Brian P. Mayer et al., “Chemical Attribution of Fentanyl Using Multivariate Statistical Analysis of Orthogonal Mass Spectral Data”
(2016) 88 Analytical Chemistry 4303–4310 at 4305.
99% pure illicit fentanyl can be bought from China U.S. Drug Enforcement Administration, 2017 National Drug Threat Assessment (October 2017) at 62, www.dea.gov/docs/DIR-040-17_2017-NDTA.pdf.
Heroin in the Vancouver area typically sells for approximately $70,000 per kilogram R. v. Mann, [2017] B.C.J. No. 2663, 2017 BCPC 401, para. 26.
drug trafficking over the dark web is on the rise United Nations Office on Drugs and Crime, “Global Overview of Drug Demand and Supply: Latest Trends, Cross-Cutting Issues,” World Drug Report 2017 (Vienna: UN, 2017) at 42–46.
some illicit fentanyl manufacturers in China were once offering customers free replacements Eric Stewart, “Fentanyl,” Vol. 79, No. 1—Just the Facts (RCMP: January 13, 2017).
Chapter 6—Can We Stop Fentanyl at Its Source?
“We need to help [the media] by providing the right commentary” Chad Skelton, “CBSA Spokeswoman Admits: We Tell Reporters ‘Basically Nothing,’ ” Vancouver Sun, August 16, 2010.
others are new “designer drugs” created by chemists working for the benefit of organized crime United Nations Office on Drugs and Crime, “Fentanyl and Its Analogues—50 Years On” Global Smart Update Volume 17 (Vienna: UNODC, 2017) at 4.
Despite reportedly seizing 1.8 tonnes of illicit drugs between 2015 and 2017 “Thousands of Tons of Hallucinogens, Stimulants Busted in China,” The Standard (Hong Kong), June 19, 2017.
“My feeling is that it’s just like a race and I will never catch up” Nathan Vanderklippe, “China, Claiming Success on Fentanyl, Admits It Is Being Outrun by Criminal Chemists,” The Globe and Mail, June 19, 2017.
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