State of neglect: Smoking & other drug consumption trends
BC's drug/death mess: Looking for logic -- and love -- in all the wrong spaces
British Columbia’s street opioid consumers prefer smoking their drugs. In fact, “smoking illicit drugs has been the leading mode of drug administration causing overdose death,” going as far back as 2017.
Surprised? You’re not alone. Just ask your doctor, or your parents, or even other folks who use drugs. There’s a good chance they will insist that intravenous drug use is — still — the deadliest practice.
The dangers of intravenous drug use are top-of-mind for many. It’s easy to find close-ups of syringes accompanying a story about local drug busts. A Google search reveals several articles describing the dangers of IV use, authored by (for-profit) recovery-oriented treatment programs. Also, fictional stories about drug use often portray IV use as the last — and most damning — stop on a downward spiral (remember Requiem for a Dream?).
Injection drug use was indeed the leading method of injestion among folks using opioids — until 2017, when smoking outpaced injection drug use.
Quite a few folks — from the public and private sectors — seem to have missed the memo on smoking. And, considering tremendous efforts by our federal government to squash the tobacco industry, the lack of attention paid to opioid smokers feels neglectful and careless.
Let’s rewind a bit…
BC declared a public health emergency in 2017. The catalyst? A wave of overdose-related deaths, stealing our loved ones, and decimating our communities. The culrpit? Black-market fentanyl, said to be 100 times more potent than heroin, and highly potent, making it easier to transport and conceal.
Pretty soon, public scrutiny shifted away from heroin — often considered one of the world’s most dangerous drugs. And many, many PWUD lost their lives to an increasingly unpredictable, poisonous street drug supply.
In Vancouver, drug user activists and advocates called for widespread availability of Naloxone — and peer training sessions — so that folks could (appropriately/effectively) reverse overdoses.
Our provincial government was slower to respond. But they eventually turned their attention to the overdose crisis, and began launching healthcare interventions designed to slow and/or stop the drug-related death toll.
Since 2017, more than $495 million has been committed through Health Canada's Substance Use and Addiction Program to more than 380 projects to support community-based treatment, harm reduction, prevention and stigma reduction activities, as well as legislative and regulatory action. — Government of Canada
Overdose deaths reached record highs in 2020, as COVID-19 overwhelmed the nation. Amidst the lockdowns and toilet paper hoarding, our federal and provincial governments prioritized a coordinated response to the novel pandemic. Overdose-related deaths took a back seat, as COVID vaccines hit the streets, eventually slowing the novel virus.
Initially launched as a way to provide British Columbians with pharmaceutical options to those at risk of contracting COVID-19 — as well as those risking overdose from contaminated street drugs — pandemic prescribing promoted a (government-sponsored) version of “safe supply” (a term that they co-opted from the drug user movement).
So-called safe supply might have pacified some of us — had it not been a shabby approximation of the real thing, and a shameless misunderstanding of a human rights-based intervention advocating the end of prohibition and criminalization of people who use drugs (PWUD). Even worse, safe supply medications were only presribed to a minority of British Columbians.
Smokers need services
Despite government-funded actions like “safe supply,” decrim, and the launch of “more beds,” the bodies keep stacking up.
Stephanie Parent, Kristi Papamihali, Brittany Graham & Jane A. Buxton (authors/researchers of the study) recommend that we pay more attention to smoking as a mode of ingesting drugs, and its role in drug-related deaths. We think they’re right.
“These findings identify actions to better respond to the overdose crisis, such as targeted harm reduction approaches, educating on safer smoking, advocating for consumption sites where people can smoke drugs, and providing a regulated supply of opioids that can be smoked.”
The BC coroner’s data confirms that folks dying today tend to be males in their 30s to 50s. Many die alone in private residences. And most of them were smoking the drug(s) that killed them.
And, yet, many folks continue to believe that IV drug use is riskier than smoking.
The belief that smoking is safer is troubling. For one thing, safe consumption sites tend to cater to IV users. Vancouver has a few outdoor tents for folks who smoke drugs, but they are mostly located in the Downtown Eastside, and inaccessible for many PWUD.
Furthermore, if smokers believe they are safer, then its likely they are under-estimating their own risk of death and harm. And if that’s true, they may be less likely than injection users to employ harm reduction practices that just might save their lives.
But smoking as a mode of injesting drugs is just one of many correlates worth examining. Correlates do not reveal causes of death. But surely they put us on a path more worthy of our time and attention.
An effective, impactful strategy considers who is dying, and why (also, where, when and how).
If you’re wondering how the Ministry of Health could ignore trends and demographic data in their response to the drug poisoning epidemic, you’re not alone. The government-funded response feels disconnected, and based on a pro-abstinence agenda. Moreover, it’s not saving lives.