Vincent Lam is an addiction treatment physician. His recent novel, On The Ravine, examines Canada's opioid crisis.
Recently, one of my patients was arrested. She asked to see me, her addiction doctor, before going to the police station and was taken to my office. I asked the officers to wait outside the clinic. My patient wanted to resume treatment for his addiction, and I was happy to provide that.
She said she had one bottle of “down” (a colloquial name for fentanyl) in her bag. I provided her with a biohazard disposal box to avoid adding her drug possession to her other charges. Instead, she began preparing medicine for injection. I reminded her that my office is not intended for drug injections. She agreed, apologized, and got the injection. We made arrangements for her first medical treatment and she accompanied the police.
As British Columbia seeks to humanely recalibrate its position on drug decriminalization, keeping drugs decriminalized in private spaces while denying their use in public, David Prime Minister Eby said: “There are important lessons to be learned about our current situation.'' Some of these lessons are central concepts in the practice of addiction medicine.
First, recovery requires addiction treatment, healthy engagement with loved ones, and wider society. I ask my patients, “Why do you want to be cured?” They often say it's because of their partner, children, or job. They want to get involved with people and activities that interest them. The goal of decriminalization is to enable drug users to participate in necessary public services. When you call 911, multiple types of responders often arrive. Drug users need to be able to seek help without fear that if someone overdoses, the police will arrive with medical personnel and they will be jailed for possessing small amounts of hard drugs. If someone with drugs in their apartment is afraid to call 911 in the event of a fire, everyone in the building is at greater risk.
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Meanwhile, British Columbia is clear about what healthy engagement looks like. We want all citizens, including drug users, to interact with public places such as parks and restaurants in accordance with community norms. My patients who are trying to avoid drug use say it's hard when they encounter drugs in public because it can be a trigger. The use of hard drugs in these shared public spaces is not engagement. This violates community norms and creates risks, such as injuries from drug paraphernalia and risks arising from unpredictable behavior. A social approach to engagement can also provide access to addiction care, safer places of consumption and overdose prevention if drug users simply do not want to engage in more isolated and dangerous spaces. It also means you need facilities. .
The second important lesson in addiction medicine, which BC is learning, is that proper boundaries are critical to maintaining cooperation. I watched a patient take a down shot while the police stood outside my office. But what I always insist on is that patients not use drugs in the waiting room because other patients in the waiting room can induce the drug.
To the patient's family, I emphasize that their loved one absolutely needs the patient in their life and that they need to be clear about their boundaries. Whether it's space usage, finances, or other issues, these keep families involved long-term. My patients in recovery also tell me that boundaries and expectations at home, during treatment, for legal reasons, and at work can form part of the structure that supports their recovery. The public has the right to set boundaries that prevent them from being exposed to illegal drug use in public shared spaces, and it is only when the public feels they can set acceptable boundaries that drug users engage in harm reduction practices. We will continue to support them so that they can receive treatment.
B.C. withdraws drug decriminalization pilot project after outcry
A third lesson well known to addiction medicine professionals is that addressing substance use disorders requires a sustained commitment to both a compassionate approach and problem solving. This means learning and adjusting your own practice while also trusting that others can achieve their own best expectations if given the chance. Staying the course can be a lot of work.
That's what Eby is seeking for an acceptable version of decriminalization that involves “respect and compassion for those suffering from addiction.” Both Conservative leader Pierre Poièvre, who points his finger while shouting about “drugs, disorder, death and destruction,” and Ontario Premier Doug Ford, who vows to “fight tooth and nail,” find the right balance on decriminalization. I wouldn't be able to do that. Mr. Eby has done something rare and admirable in politics. It was about admitting a mistake and hoping that the insight would help others.
Patients who received injections in my clinic continued their addiction treatment in prison and then returned to my clinic for treatment. Many medical practices are being adjusted, and we should expect that social and legal initiatives around drug use, such as decriminalization, will also be adjusted.
An effective response to the opioid crisis goes beyond decriminalization. It is also important to provide excellent addiction treatment, psychosocial care that incorporates the knowledge of experienced people, and affordable housing and employment options. In all of these areas, the principles we need to use are engagement, boundary setting, and a long-term commitment to helping drug users recover.
