“I felt sweet, swinging bliss, like a big shot of heroin in the mainline vein; like a gulp of wine late in the afternoon and it makes you shudder; my feet tingled. I thought I was going to die the very next moment. But I didn’t die…”
— Jack Kerouac, On The Road
Before we talk about solutions, we need to understand the problem. There are several theories, or schools of thought, on drugs; chemical use, abuse, and/or addiction, as a disease of the spirit, or a moral weakness, is as old as chemical use while philosophizing. It’s the model on which the Temperance movement and Alcoholics Anonymous (AA) are based and… it doesn’t work.
Early twentieth century temperance movements were focused on alcohol consumption – and despite short periods of prohibition, it’s known addictiveness, and morbidity and mortality rates, alcohol is widely consumed and accepted. Why is alcohol legal when we know it causes drunk texting?
Alcohol is legal because the majority enjoy it, the economics of banning alcohol is prohibitive, and criminalization led to tainted homemade product and sky-rocketing death rates. (Sound familiar?)
In short, regulation saves lives and builds government coffers through taxation while those who over imbibe, abuse and/or are addicted to, alcohol, are seen as having an illness and treated medically.
Just as AIDS would be a “gay issue” and crack cocaine would be a “Black issue”, the issue of opiate usage was seen as a race and poverty problem – best dealt with by locking people away. But, addiction is indiscriminate… even when society is not. Racialized, criminalized, stigmatized; enter the Age of Jazz, white children of counter-culture movements, and drug use in the twentieth century becomes a War on Drugs.
“You can jail a Revolutionary, but you can’t jail a revolution.“
— Dr Huey P. Newton
Hemingway was fond of saying he drank to make other people more interesting… people forget alcohol is a drug and has the same use. Drug and alcohol use by intellectuals, artists, and those seeking to expand their reality, will always take place. Not everyone uses drugs and alcohol to mask pain, just as not all of those who use will be become addicted; people do not fit in boxes.
Generations of this shit and we are no more evolved in our treatment of drug use and addiction than we were a century ago. We continue to lock people up for drug use despite it having no consequence to the user, even withdrawal isn’t assured – five people overdosed in 1 day last month at Maplehurst Correctional Complex. We continue to treat addiction like a moral fault with little regard for the biopsychosocial aspects of drug use. Those who do seek help for addiction, are faced with long waitlists for 21 day inpatient treatment, the current OHIP covered standard, which is basically supervised withdrawal and no better than prison.
Detoxing alone does not address the underlying issues: why did someone begin using in the first place? What has their use done to their relationships? How is their self-image?
In order to successfully maintain sobriety, people need a comprehensive approach including ongoing counselling, not groups or relapse prevention but actual psychotherapy, integrated life skills, employment programs, stable housing, and, if they choose, pharmacotherapies.
Desperation is the raw material of drastic change. Only those who can leave behind everything they have ever believed in can hope to escape.
— William S. Burroughs
People who are street-involved, as many addicts are, are one of the most elusive and difficult populations to reach having been burnt, repeatedly, by the system. These are often the people with multiple problems, who shun offers of assistance, and are frequently loners.
People who isolate and avoid contact with others. People who live alone, use alone, die alone. It takes patience, consistency, and, honesty, to build trust; in a world where addicts have few choices, when we only offer limited services, at limited locations, we limit the persons ability to access help.
People are dying and whether you believe addiction is a weakness of the soul or a medical illness, we need to be discussing other strategies; we must do more than make token band-aid gestures.
Supervised injection sites are but one harm reduction strategy and, in a region as vast as Niagara, aren’t expected to have the efficacy we see in denser urban areas. One option, being used in BC, is supervision of injection opioid use via webcam – you don’t get the immediate CPR help but you do get EMS immediately dispatched.
If we really want to prevent overdose deaths, we need to invest in providing drug purity testing kits with Naloxone. We need to offer the option of supervised injectable opioid agonist treatment (siOAT), a prescription hydromorphone, outside hospital settings as an alternative to methadone or suboxone treatments.
What we have been doing, for over a century, does not work. The economics of our failed system need to be addressed through decriminalization of drug use, to be replaced by long term treatment options.
In a region that is known for its wine, and it’s soaring overdose death rates, we need to be asking why we aren’t treating drugs like we treat alcohol – taxable, regulated, and most importantly, readily available for those who wish to consume it.
This is Emily Spanton’s third article in a series about the war on opioids. You can read previous articles at thesound.rocks