Dan Fumano: ‘A daily game of Russian Roulette’ — lessons from Vancouver’s last overdose crisis

Dan Fumano

November 14, 2017

The human toll of the overdose epidemic currently devastating Vancouver and B.C. can get lost in numbers and statistics. But data, along with a bit of history, are crucial if you want at least to try to understand the scope of what’s going on in our city.

In the 1990s, Vancouver was rocked by twin public-health crises; drug-overdose deaths surged, while simultaneously, HIV/AIDS-related deaths soared along with infection rates among intravenous drug users. Between 1991 and 1993, the combined total of B.C. deaths from HIV/AIDS and drug overdoses more than doubled.

In the crisis’ epicentre of Vancouver’s Downtown Eastside, it was “a truly terrifying time to live through,” said Travis Lupick, who has spent the past six months interviewing more than 150 Vancouverites about their memories of that time.

The death tolls of overdoses and HIV/AIDS hit their combined peak in 1993 with a total of 655 deaths across B.C. attributed to the two causes.

“That was the peak and that was considered unconscionably terrible at the time,” Lupick said this week.

And, for some tragic context, 1993’s “unconscionably terrible” tally of 655 deaths in B.C. is less than half of the projected total of 1,400 deaths expected across the province this year from overdose deaths alone. The City of Vancouver alone (with a population of fewer than 650,000 people) is on pace to see 400 overdose deaths this year, averaging more than a death a day.

Against that grim backdrop, Lupick’s debut book, “Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction” is being released this month. The deeply researched non-fiction work details B.C.’s previous overdose epidemic, out of which a group of drug users and their allies — including groups such as the Vancouver Area Network of Drug Users (VANDU) and the Portland Hotel Society (PHS) — took action to establish Vancouver as a pioneer of progressive harm-reduction-based drug policy, leading the way in North America with measures like needle exchanges and supervised-injection facilities.

In 1997, The Vancouver Sun reported “the HIV epidemic raging in the heart of Vancouver is now considered to be the most rampant in the developed world,” and the Vancouver-Richmond health board declared a public health emergency.

But since that time, Lupick said, “HIV infection rates among intravenous drug users have dropped to almost nothing in this province.”
Travis Lupick, whose book being published this month looks at the history of Vancouver’s overdose epidemic in the 1990s and how it changed the Downtown Eastside and led to Vancouver becoming a North American leader in harm reduction-based drug policy in action, in Vancouver, BC., November 14, 2017. NICK PROCAYLO / PNG

Vancouver’s drug-overdose deaths dropped by half, from a peak of 201 deaths in 1993 down to 67 in 2004, the year after the Insite supervised injection facility opened, and stayed around that level for a decade.

“There were real victories that Vancouver achieved in response to that crisis,” Lupick said.

But while HIV deaths in B.C. have continued to dwindle, overdose deaths started creeping up again around 2011 before spiking dramatically in the last two years and showing no signs of abating.

Still, the resurgence of overdoses in B.C. shouldn’t be taken as an indictment of the failure of the harm-reduction policies pioneered in Vancouver in the 1990s and 2000s, said Lupick, who has covered Vancouver’s new overdose epidemic in his day job as a reporter for The Georgia Straight. B.C.’s current opioid crisis would be far worse, he said, if not for the progressive drug policies whose origins his book describes.

But Lupick’s not the only one who believes that. Last week, B.C.’s chief coroner, Lisa Lapointe, told CBC that if B.C. didn’t have harm-reduction measures like supervised drug-injection sites, she believed B.C.’s death toll would be triple what it is now.

It’s worth noting that while Insite sees hundreds of thousands of visits a year from injection drug users every year — and 6,440 overdose interventions at the facility, according to Vancouver Coastal Health — there has not been a single death.

One crucial thing differentiating the current crisis from the 1990s is the emergence of incredibly potent synthetic opioids like fentanyl, which the B.C. Coroners Office found in 83 per cent of fatal, illicit, drug overdoses last year.

Humans have struggled for centuries with the addiction and health risks of opioids, from opium to heroin through OxyContin. But fentanyl, far stronger than heroin or morphine, is “a game-changer,” Lupick said. “An opioid addiction was always a dangerous thing. Now it’s a daily game of Russian Roulette.”

In the ’90s, people died from pure heroin flooding the DTES. But today, Lupick said, “there’s no such thing as pure heroin” in the neighbourhood, and even diluted heroin is scarce. It’s all synthetics.

Driven by economies of scale and market forces, drug traffickers have embraced fentanyl to increase their profit margins.

“But that’s always the way it’s been under Prohibition,” Lupick said. “There’s a reason Al Capone made his money off whisky and not beer. Whisky was easier to smuggle because the potency was higher.”
An ambulance delivers a patient to a mobile emergency facility in Vancouver’s Downtown Eastside in December 2016. The tent, staffed by emergency and addictions physicians, was set-up by the government health authority to help tackle the fentanyl crisis. DEBORAH JONES / AFP/GETTY IMAGES

Lupick cites a concept called “the Iron Law of Prohbition.” American drug-reformer Richard Cowan coined the term during the 1980s’ U.S. crack-cocaine epidemic, saying that “the harder the enforcement, the harder the drugs.”

According to U.S. Drug Enforcement Agency data, A kilogram of heroin bought from Colombia for US$6,000 can be sold wholesale for around $80,000, the New York Times reported last year, whereas a kilogram of fentanyl purchased from China for less than $5,000 can be cut and sold for a profit of more than $1.5 million.

“The answer is entirely economic … The profit margin is significant enough that it makes the loss (of customers through overdose deaths) acceptable,” Lupick said. “Fentanyl is a very, very cynical response to market forces.”

To coincide with Lupick’s book’s release, the author will appear in a panel discussion Thursday at 7 p.m. at Beaumont Studios at 316 West 5th Ave, along with representatives from PHS and VANDU, as well as B.C. deputy provincial health officer Bonnie Henry and federal NDP health critic Don Davies, MLA for Vancouver Kingsway.

In a email Tuesday, Davies said: “It is critical to treat addiction as a health issue, not a criminal or moral one. Lives depend on us making this transition.

“Travis Lupick has done so much to bring reason, compassion and courage to an issue too long shrouded in stigma,” Davies said. “I’m honoured to share a stage with him and explore how we can turn tragedy into hope.”


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