POLICY
SHARED PERSPECTIVES
Having had to postpone his trip to the DDN
conference, Bill Nelles reflects on the differences in
drug policy between the UK and his Canadian home
S
ometimes things happen
in life that force us to
change our plans, but
it’s especially hard to
miss a planned journey.
I’m writing, of course, about
the COVID-19 virus that forced
the postponement of the DDN
conference, which I was planning
to attend in order to talk about the
‘overdose crisis’ in Western Canada
where I now live. I was particularly
annoyed because I was looking
forward to being back home in the
UK and seeing dear friends and
colleagues.
I’m never sure how many UK
users and drug workers remember
me when I lived and worked in
London, but there’s a good chance
that if you were working or using
from the mid ‘80s to 2004, you
heard me training about AIDS, drug
treatments, overdoses and user
involvement.
Here in Canada we don’t have
any national publication like DDN
that gets to users and professionals
alike. DDN’s February editorial,
and its article about Vancouver,
reminded me how good it is to read
sound and unambiguous editorials
and articles that say what they
mean and don’t pull their punches.
The issue had excellent content on
the increasing level of danger to
users from contaminated supplies.
Jussi Grut’s article described the
five-fold rise there has been in fatal
overdoses in British Columbia (BC)
since the street supply has become
contaminated by cheap and often
poorly made synthetic opioids
like fentanyl and carfentanyl. The
already high number of overdose
deaths here suddenly climbed
steeply from just over 400 in 2014
to 1,600 in 2018, in a province with
only 3m people.
I also wanted to express the
same fears that I felt in 1985
that something bad was on the
horizon. Something that could,
and should, change the balancing
trick we cling to when keeping a
safe drug supply just out of reach
of the people who need it, and
who may live or die depending on
‘I remembered
DATs and DAATs,
which we have
never had here,
but which are
often envied. Then
I heard they have
gone the way of the
dodo, with no ring-
fenced drug funds.’
reaching such services. Nowhere
is this more evident than in the
cohort of around 500 people in
Vancouver who have access to
clean pharmaceutical heroin, or
hydromorphone. Hydromorphone
2016: Vancouver’s
Downtown
Eastside
neighbourhood,
a mural
highlighting
fentanyl-related
drug deaths
Credit: Gerry
Rousseau/Alamy
8 • DRINK AND DRUGS NEWS • APRIL 2020
isn’t used a lot in the UK but it’s
kind of like North America’s legal
heroin. It’s also much cheaper than
importing heroin from Holland.
This group has had no direct
overdose deaths, because of course
they don’t need to use the poison
on our streets. Massive publicity
and easy availability of naloxone
kits have also helped hundreds to
reverse their overdose and stay alive.
I planned to outline the differences
between UK and Canadian services.
I remembered DATs and DAATs,
which we have never had here,
but which are often envied. Then
I heard they have gone the way of
the dodo, with no ring-fenced drug
funds any longer. My reaction was
like Charlton Heston’s at the end of
Planet of the Apes: ‘You fools, you
went ahead and did it!’
One thing that is very evident
here is the absence of any arguing
about whose treatment is better.
Users are much more united
here. BC has had comprehensive
availability of opioid treatments to
rival any European programme for
five years now, and peer educators
are employed by health providers
to educate, encourage trust and
provide advocacy. The challenge
is to scale these services down
for people using in rural settings
– including many First Nations
people, who were living here when
Europeans settled in their lands.
There are certainly some shafts
of light to mark our progress.
Last year saw the first reduction
in overdose deaths since 2012,
dropping from 1,600 to 1,000.
While they remain far above the
400 a year before the crisis, we are
getting much better at responding
to them.
Bill Nelles is an advocate and
activist, now in Canada. He founded
The (Methadone) Alliance in the UK
WWW.DRINKANDDRUGSNEWS.COM