Federal Election 2019 - Questions to ask candidates & parties

Here are some questions that we encourage you to ask of your candidates and the parties vying for your vote on Monday, October 21st, 2019. Don’t know who your candidates are for your riding? You can find the information here. Please review and consider the background information below the corresponding questions and help to bring more awareness to this public health crisis that is killing 12 Canadian's per day an make it an important election issue! You can help us by sharing this widely to friends and in social media using these hashtags: #OverdoseCrisis #Elxn43 #CDNpoli.

Questions to ask candidates and their parties:

1. What will you/your party do to address the overdose crisis?

2. Where do you/does your party stand on the decriminalization of personal possession of illicit substances?

3. Where do you/does your party stand on providing safe supply of prescription grade substances in order to stop the preventable overdose deaths from tainted illicit drugs in this country?

4. Where do you/does your party stand on harm reduction measures, such as access to naloxone free of charge, distribution of harm reduction supplies and supervised consumption services?

Background information to Question 1:

Canada has a "Four Pillar Drug Strategy": Harm Reduction, Treatment, Prevention and Enforcement. In the past, most investment (90+ %) has been in enforcement and only in recent years more investment has been made into harm reduction and treatment. Prevention still falls short in many ways with mental health issues, trauma, poverty and other contributing factors going unaddressed. Ideally, we would like to see candidates support the four pillars approach, with a strong focus on harm reduction and treatment including safe supply (see below) to address the immediate crisis and a long-term prevention focus that addresses underlying issues. Currently investment in each of the pillars, other than enforcement, is not proportionate to the magnitude of the crisis, so we are looking for parties to commit to greater investment to address the crisis.

Background information to Question 2:

People using and dying alone is closely related to the stigma and criminalization of substance use. Criminalization also means that a disproportionate amount of resources goes into the criminal justice system. Portugal has shown that decriminalization and shifting resources to treatment and prevention can drastically reduce overdose rates and provide more people with the help they need. While this model does not address the issue of the tainted illicit supply, it is an important step to reduce stigma and see problematic substance use as a health rather than criminal justice matter.

Background information to Question 3:

Overdose data has shown that in the worst hit provinces, including BC, AB and ON, over 80% of the deaths are attributed to toxic street drugs, in most cases involving fentanyl and fentanyl analogues. The high number of deaths (12 people die in Canada every day) has resulted in a drop in the overall life expectancy in BC and Alberta and a plateau across the country, after years of increases in overall life expectancy.  Models for "heroin assisted treatment" in Switzerland and in BC have shown that providing people who use drugs with safe prescription grade supplies not only reduces deaths, but also contributes to a decline in overall problematic use and in crime rates. This is referred to as #SafeSupply by the drug policy community. There are models of #SafeSupply in BC, however, they reach too few people in few places and have a high threshold of criteria to enter the programs. Large scale #SafeSupply models are needed to immediately address the crisis and models for substances other than opioids, such as stimulants and benzodiazepines, are needed. Once people are stable they are in a better position to deal with the issues that contributed to problematic use. Using drugs should not mean that people need to risk losing their lives.

Background information to question 4:

#HarmReducationSavesLives! This has been shown in a study in BC that showed overdose death would be 2.5 times higher without these measures, including naloxone distribution and supervised consumption (the study also considered the impact of opioid substitution treatment), yet, in the general public and amongst politicians harm reduction is often seen as "encouraging" substance use or "giving up on people". Our answer is that harm reduction encourages life, and dead people don't recover. We have learned that substance use occurs regardless of risk, but if we keep people safe we can build relationships and give people a chance. This is shown by over 10,000 referrals to treatment services made by Alberta supervised consumption services (SCS) in the past 2 years, as well as studies from BC that show that people using an SCS are 30% more likely to enter treatment. We also recognize that some people don't seek treatment for a range of reasons, including severe trauma. We repeat: Using drugs should not mean risking your life.

Available information based on party platforms:

---

My sister died alone at the age of 18. Zoe might be alive today!

Max is speaking ins support of Supervised Consumption Services to the SCS Review Panel Open House on September 18, 2019.

Hello my name is Max.

I have 2 sisters, one is alive and one isn’t. We grew up in a middle-class family. My father started his own construction company when he was 24 years old and was a respected tradesmen and business owner for over 30 years.  Both my parents worked hard to provide for their family. We traveled more than many other families, both abroad and across Alberta as my dad would pack up my sisters and I when he had projects out of town. We loved spending time with him and getting to know the Alberta that he loved. 

In 2014, our father was diagnosed with terminal cancer and my youngest sister Zoe, who had just turned 16 took this news very hard and became depressed and withdrawn. My parents did the best they could to support her as all parents do when their child is ill while our family faced my dad's cancer diagnosis as well. They visited our family doctor who suggested they keep my sister busy and prescribed medication for depression. A psychologist and later a psychiatrist were also consulted who also prescribed medication.

Somewhere during this time of trying to find Zoe proper help, she discovered cannabis, and she liked how it calmed her much more than what she was taking already. When Zoe started high school, the anxiety worsened and in school she discovered the availability of oxycodone, MDMA, ecstasy and other forms of illicit drugs. Make no mistake that junior high and senior high school is sadly where dependency oftentimes begins for youth and Zoe was no exception. Before my family realized it, she had developed a dependence on these products. We watched a vibrant, athletic, extremely bright young girl wither into someone unrecognizable and troubled. Her addiction to drugs alienated her, criminalized her and stigmatized her before a lethal poisoning from fentanyl killed her on November 7, 2016.

I’m here today because our provincial government has chosen to evaluate the social and economic impacts of the current and proposed supervised consumption sites in the province and I needed to voice my concern about this. The sites both open and proposed in this province are extremely important. These were not in place in 2016 when my sister began using drugs intravenously. This is something that my family and I are concerned with every day when we hear about sites being targeted for closure or not being funded appropriately. My sister died alone at the age of 18. The people she lived with did not have naloxone and were frightened to call 911 for fear of being arrested. If she had had access to supervised consumption services she could have used safely and not have overdosed because of the poisoned drugs she purchased.  Zoe might be alive today.

To the panel members, I’m sure you have heard of all the merits of these sites as we come towards the end of the process, but I will state them one more time for myself.  The medical efficacy of supervised consumption services in keeping people as safe as possible while connecting them to services that could help them further is critical. There has not been an overdose death at any site in Alberta. And for every dollar spent on harm reduction, we save 5 dollars in other medical costs. 

You have heard stories from citizens who are scared of sites in their neighborhoods. People have spoken in previous town halls about finding discarded needles and how they feel that sites are a haven for degenerates and criminals. These words sting. My sister was more than those words. Drug dependency does not discriminate and people who used drugs have pasts and families who love them deeply. 

What is important is that we ensure that the proper services are available to keep people alive not just with supervised sites, but beyond the sites with medically assisted treatment for some, as well as supportive housing, detox facilities and treatment spaces. All people in this city and province are worthy of care. All people. When my dad was battling cancer not one oncologist told him he wasn’t worthy of care and he was shown respect and compassion until he passed away in May of 2018.

I understand that there is also so much frustration and misunderstanding towards people who use drugs. Before my sister died of fentanyl poisoning I was ignorant to the failure of the drug policies in our country and around the world. I felt that people who were addicted to drugs had made a choice and that they were to blame for their behaviour and that they should just stop using drugs. After seeing my sister brain dead in a hospital bed I do not feel that way anymore. This wasn’t something she could have just stopped doing. Unless you experience this, you don’t understand. I hope everyone sitting in this room thinks about the families that are affected the next time you see a person on the street who is vulnerable. 

Some people believe that safe consumption sites are enabling people who use drugs and view them as a band aid solution. The reality is that before people can move to recovery from the crisis of addiction and overdose that is gripping our country, they have to be alive to do so.  My family learned the hard way that forced or mandatory detox is not effective. Supervised consumption services offer overdose reversals first and then provides mental health support and other services to help people. By meeting people where they are, SCS can connect them to life saving resources, curb illicit and unsafe behaviors and ultimately reduce the public costs associated with addiction and overdoses as I mentioned earlier.

It is my hope that this review panel will do the right thing in honour of the life of my sister Zoe and the other 2,182 people who have died since January 2016 from overdose and the hundreds of clients who are using SCS every day. I respectfully ask that your review will show that all Edmonton sites remain open and that they are funded accordingly and that furthermore more sites should be opened to address the rate of death that we are experiencing. 

My sister died alone from fentanyl poisoning – it could be your loved one who dies alone tomorrow. 

I fully support harm reduction and safe consumption services and hope you will too.

Thank you.

Max

---

Ask a Nurse: How does a supervised consumption site really work

Taliesin Magboo Cahill, September 22, 2019 on Twitter

Is anyone up for a #tweetorial about what it's like to work as a nurse in a supervised consumption site? Not sure if I've seen one before and I feel like there are some things I could clear up. #harmreduction

FYI - It's not all nurses! Some sites don't have nurses at all! All sites in Canada have harm reduction workers (oft. with SW background) and people with lived exp of drug use employed in their sites. Some have RNs or RPNs as well. [Some sites have paramedics on staff to respond to overdoses and have limited nursing support to address other medical issues, such as infections, wound care, and other.](*) Supervised Consumption sites (SCS) and Overdose Prevention Sites (OPS)(**) are variable in terms of staffing, vibe, usage patterns. Personally, I've know of sites with as few as two booths and as many as 12. Staffed by 1 to 3 or 4 people.

Our main goal is to respond to overdoses (opiate and stimulant) and keep people alive, using stimulation, supplemental O2, and Narcan. We are also trained in responding to other medical emergencies (e.g., anaphylaxis, cardiac arrest, hypoglycemia) and mental health crises.

But we aren't a hospital! We have some medical supplies, but no advanced airways, no cardiac monitor. Common equipment includes MANY pulse oximeters, AED, ambubag and oral airway, BP machine, glucometer, maybe a vein finder. Any emergency requiring more than this - we call 911.

Although we are here to keep people alive, we only spend maybe 10% of our time responding to overdoses. We also do wound care, referrals to all different kinds of treatment/health care, and personally, I spend a lot of time playing DJ and just chatting.

At all sites in Canada, nurses or PWUD will give advice on safer injection techniques and finding veins to use. In a few sites in Canada, peers can help each other inject. The idea is to keep people using IN the site.

The sites vary in how medical they appear, but the idea is to make them welcoming for people who use drugs. Clean, but ideally a little more comfortable than a doctor's office. Welcoming, non-judgemental, fun. Or people won't use them.

Liability - in Canada, these rooms are exempt from laws against possessing and being around drugs. I'm not endangering my license as long as I am responding in an appropriate and safe way to an overdose.

Safety - Most sites don't have security as it exists in the hospital. No chemical or physical restraints. There are often panic buttons as there are in many community health settings. All sites have behaviour standards.

What is great about my job: getting to know/talk to all different kinds of people, the feeling of providing an essential service that saves lives, working in a team, having a standard intervention that I do over and over again so I become really confident in what I'm doing.

What sucks about my job: seeing ppl I know almost dying, hearing some very sad stories, and yes sometimes people are [angry/using foul language] (not very common). Mostly feeling powerless to help people in the long term. Sometimes overdoses are scary.

Addendums: - We don't provide the drugs! (although there are small pilot safe supply programs in Canada) - I get paid! I've done this work as a volunteer before but currently I get a paycheck/benefits/pension. As do the PWUD who work at the sites.

Vibe can lean medical or casual, but most have easily cleaned injection surfaces, lots of mirrors, decent lighting, sharps containers. Some play music. Some have time limits. Some have security. Some have a lot of rules, some have close to none.

Why do people use SCSs? The people who do use them could address this best, but I can try: preventing overdose, clean space, protection from cops, medical care. Access to wraparound services.

What drugs are people using? That varies as well although it's absolutely not all opiates - estimates from sites I've worked in or visited vary from 40 to 60 percent fentanyls or 'heroin'. Other drugs include meth, speed, rx opiates and stimulants, cocaine (crack).

Policing: That depends on the site, but they aren't just allowed inside to check for people without a warrant. Ideally, they aren't parked outside deterring people from coming in either.

Getting people help: Do you talk to your patients about their motivations for using, med assisted treatment, going to rehab/non-profit centers, getting clean? Yes we do, but when they are ready. When someone is dopesick, I know their motivation in the moment. Clients are the ones who will initiate conversations about motivation and recovery when they begin to trust us and feel safe in the space. Trauma/culture informed care is a must.

Sharing drugs:  People are not sharing because it's considered trafficking. It's unfortunate because people often buy together and want to split it at the site, but not sharing is one of the conditions of the exemption that let's us operate. [In most sites people are also not allowed to help each other inject, called “doctoring”, which is problematic, as some users inject in hard to reach locations or have difficulty injecting themselves This is more common for women than men, which might be a contributing factor in lower fatal overdoses in women.]

Link to the original tweet https://twitter.com/tmc_RN/status/1119269129293221888

(*) Text in [square brackets] was added by MSTH

(*) An Overdose Prevention Site (OPS) is a “supervised consumption site lite”. Approval is typically time limited (from a few days to 12 month), but can be extended. It is used as a response to an immediate crisis while steps for a full SCS are taken. It is at times in temporary locations, such as trailers/tents and has fewer or no auxiliary services, such as nursing, counselling, social work. Some are funded by government or grants, some through donations, most have paid staff, but some are run by volunteers. When approvals and funding for SCS in Ontario was put on hold by the Ford government volunteer groups managed to keep many of the sites open as an OPS, with federal approval and in some cases federal funding and fundraising. We might see this situation evolve in Alberta, depending on the outcome (expected November/December 2019) of the SCS reviews currently being held in that province.

SCS are an essential health service within the fabric of our Canadian Charter of Rights and Freedoms - SCS Review in YEG

Shelley Williams – Ex Director at HIV Edmonton for 8 years, I was Chair of the Coalition known as Access to Medically Supervised Injection Services Edmonton, and was the executive director of Bissell Centre for 10 years. Bissell Centre has been providing supports and services to people in these communities for over a hundred years. These are not new issues in the community. 

Crime, garbage, tent cities, homelessness, poverty, real estate prices, policing, and the success of businesses cannot be tied directly to SCS.

These issues and dialogues have been around for a long time and continue to be important.  We do need to address them but Consumption services should not be the punching bag for these or for the lack of governments’ leadership in addressing them.

Taking them away – the issues being identified will NOT disappear.

The indisputable evidence clearly shows that SCS has a positive impact in our community. The reversal of an overdose means a life has been saved! To support a person who inject substances by helping them out of the back alleys and into a safer and respectful environment is the right way to address a societal issue that has been shunned. Punishing, telling people to stop or putting our heads in the ground - hoping that it will go away -- hasn’t worked. It takes acknowledgement, effort and quite frankly leadership to develop a range of supports. I commend the community organizations for their leadership. Consumption Services is the first critical service within the spectrum that is necessary because it keeps people alive AND provides the opportunity to develop a relationship and information as appropriate, when people are ready, of other possibilities. 

Edmonton tailored a strategy to meet the complex issues of people who would be using the services. Rather than building one stand-alone, storefront facility, such as Insite in Vancouver, the unique model took one site of 13 booths and dispersed micro sized services within community agencies that are already within the area and where the people are - who would utilize the program. The three sites have booths of 5, 5, and 3 making up the equivalency of one site. This is important - they are not 3 stand alone sites as being suggested. They also provide other health and social supports. 

There is work to be done, we need solutions - more services, more innovation, support to communities, and better municipal, provincial and federal strategies to address the range of issues that have been brought forward. BUT it cannot be at the cost of SCS. It is an essential health service and one that is within the fabric of our Canadian Charter of Rights and Freedoms – both sections 7 and 15; legal and equality rights. It is an effective service to support the being in human being.

I implore the panel to be just and thoughtful. Ensure you decipher the comments heard appropriately, recommend that the document be public and make recommendations that include the continuation and expansion of SCS across the province. 

I stand in honour of my son's life & the lives of the lives of thousands of others who have died because of a poisoned drug supply.

Presentation to the SCS Review Panel in Medicine Hat

Kym Porter, September 3, 2019

My name is Kym Porter. I am a member of MSTH, the MH Drug Coalition and the MH SCS coalition. I stand before you tonight as an advocate for the marginalized, vulnerable, stigmatized, voiceless members of our community. After my son, Neil’s death from fentanyl poisoning, I retired as a director with the MH Catholic Board of Education. Grief encompasses every aspect of my life.

I stand in honour of his life and the lives of the over 11, 577 who have died because of a poisoned drug supply.

Because none of us can legitimately comment on the socio-economic effects of a supervised consumption site here in MH, and because this panel has access to the many reports containing such effects of these sites in this province, specifically I refer to the Alberta Community Based Report on Alberta’s Supervised Consumption Service Effectiveness, I will propose solutions to the crisis as I would see that as the overarching goal of this review.

As like all harm reduction advocates, we believe in evidence-based solutions.

As garnered from Chief Medical Health Officers across this country, the current drug policies are not only creating much of the harm, they are also a catastrophic failure. Drug policies are making things worse.

Solution # 1 -We need to end drug prohibition. The drug policies are as toxic as the drug supply. Read Chasing the Scream.

New policies, with a shift to a public health approach, instead of a political approach need to be developed quickly.

Solution # 2 - We need to deliver a safe supply as the toxicity will continue to drive the number of corpses increasingly higher.

Solution # 3 - We need to remove the barriers to harm reduction services, not take away what few life saving supports we have.

Solution # 4 - we need to connect people with life saving health services and supports such as safe care, ancestral healing practices, safe housing and income assistance.

Finally solution # 5 - we need to decriminalize possession for personal use.

In closing, I would like to share these words from Tommy Douglas, a pioneer and founder of Medicare:

We are all in this world together, and the only test of our character that matters is how we look after the least fortunate among us. How we look after each other, not how we look after ourselves. That’s all that really matters.

Thank you.