Opioids: The 110 Year War

medicine 3

As featured in @TheSoundStC, Niagara’s Largest Independent News: https://thesound.rocks/opioids-the-110-year-war/

On March 26th, Health Canada announced it had corrected a disconnect between federal drug regulations and the ability of doctors to prescribe synthetic heroin for long term users who have not benefited from other harm reduction, and medication, programs thereby removing undue barriers to treatment.

Preliminary death data by Public Health suggests more people died in Niagara of suspected opioid overdoses in a 6-month period of 2017 than all of 2016. Make no mistake: this will save lives.

NRPH death data 2017 Aug - Oct
Between August and October 2017, there were a total of 29 death from opioid-related causes in the Niagara Region.
Cases of opioid-related morbidity and mortality, Niagara Region Public Health, 2003 – 2016
2017 saw 60 suspected opioid-related overdoses by the end of October. By contrast, 2016 had 40 opioid-related deaths, 2015- 36, 2014- 35, 2013-33, 2012- 34.

Pre-criminalization: From war to taxation

Once upon a time, all granny had to do was walk down to her local apothecary and order herself up some cocaine or prescription heroin; soldiers, left addicted to morphine after being wounded, could order up opium by mail until 1908. One hundred and ten years : that’s how long it’s taken Canada’s government to criminalize, to stigmatize, and finally, to take some real action on opioid addiction.

Like alcohol, opium was considered a commodity, a revenue stream for the Crown; ever wonder how Hong Kong became a British subject? Opium. For real. Hong Kong island was ceded in the treaty ending The First Opium War. A decade later, in 1856, Britain again went to war with China, this time joined by France, in an attempt to further open China to foreign merchants, and legalize the opium trade, in what is commonly called the Second Opium War.

Even Canada imposed a tax on opium factories in 1871; because consumption of opium and cocaine were viewed in terms of medical uses, opiates were not only perfectly legal, they were completely unregulated. Medicines didn’t list their ingredients until the early-twentieth century and most users of opioids and cocaine, or some combination thereof, had no idea they were even taking these compounds, they just knew they felt better.

While therapeutic usage was not the only value to opium, recreational use is as old as the Mesopotamians, addiction for most was accidental (insert deja-vu reference).

With the synthesis of morphine, then heroin, and the advent of the hypodermic needle, opium use gained popularity throughout the nineteenth century. The medical profession was beginning to explore psychiatry and even Freud spoke of morphine addiction in his 1884 On Coca (still controversial, Freud, himself a regular intravenous cocaine user, advocated the use of cocaine as a cure for morphine addiction).

Yet  wasn’t until 1908 with the passage of the Opium Act of 1908 and the Proprietary and Patent Medicine Act 1908, that regulations around opiates and cocaine were introduced.   

So what changed in the years between 1871 and 1908? Why did Canada move away from taxation to classify substance use as criminal and vilify those we deem to reject proper societal rules?   

Moral Propagandists

Tell me if any of this sounds familiar; the world is in chaos as Imperial powers fight for control of key trade routes and resources. Mass waves of immigrants and refugees flee political turmoil and famine. Colonial institutions are failing as national protectionists are blaming the loss of jobs on reciprocity agreements, or lack thereof.

Don’t forget cheap labour, provided by new arrivals to the country! (If the men don’t have work, the men drink, and when the men drink, they beat their wives)

Even worse, women are marching. For rights. Equal rights of personhood! (feign moral indignation) if women drink or smoke opium, that leads to prostitution and other moral atrocities like unplanned pregnancy, venereal disease, and, worst of all… she might engage in sodomy (collective gasp) as the Church loses it’s congregation to new morals and a new society not entirely made of the Old World.

No, I am not dishing the salacious details of Trump’s as-yet-unnamed manifesto. Surprisingly, or not?, the more things have changed in the last century, the more they have stayed the same. So it was, with the first true waves of globalization, little more than a century ago, so-called proper society rejected mind and mood altering substances in favour of advocating temperance and sexual repression.

Racism, Fear, and Moral Agendas

Where once the government saw revenue, by the early-twentieth century, labour disputes and strikes brought with them rising racial tensions and newly created drug laws.

Some will argue that drug laws were entirely morally based but that simply isn’t true; the Opium Act of 1908 was initiated by then Deputy Minister of Labour MacKensie King after helping negotiate the end of two major labour strikes in 1907, both directly related to cheap Asian labour. While we might like to judge history less harshly, or turn a blind eye to the chronology of events, Canadian archives show that, by 1922, nearly three quarters of those imprisoned for opium offences were Asian Canadians.

The disproportionate number of Chinese charged under the Opium Act, and subsequent narcotics legislation, lead to the general population, European Canadians, to believe the laws didn’t apply to them.

And they didn’t; while opiates were restricted, there was nothing in the original legislation to prevent doctors from writing themselves scripts. That’s right. While granny could no longer walk over to the apothecary, Doc Magoo could… and so could granny after doc wrote her a script.

How many people do you think sought a doctor before Tommy Douglas gave us universal health care? Don’t hurt yourself, it was a rhetorical question.

If you still question whether race plays a factor in the application of drug laws, let’s look at current data. According to a 2013 report by the Office of Correctional Investigator, one in four people incarcerated in Canada are Indigenous, despite representing 3% of the general population; Black Ontarian’s are 3 times more likely to be charged for drug possession or trafficking and despite Black males representing 2.9% of the general population, they represent 9.8% of Canada’s incarcerated population; visible minority offenders increased 40% in the 5 years covered by the report.

And still, people use drugs; the threat of death by overdose and/or incarceration simply do not work as a deterrent; while we are busy locking people up, people are dying. Not just on the streets but in detention centres – there were 5 OD’s at the Niagara Detention Centre on March 24th (thankfully, all are expected to recover).

As our prisons grew to overcapacity, people found new ways to get high, and disputes over social moors continue. We’ve bumbled along, incarcerating and marginalizing; we’ve synthesised new, deadlier opioids; we’ve created a third Opium War.   

Peeling Back The Shame of the Twentieth Century

Alcohol use by humans predates the written word while archeological evidence points to opium being discovered around 5,500 years ago and chewing coca leaves around 5,000 years ago; addiction has been around as long as humans have sought to alter our perception through the use of chemical compounds. Colloquially known as the village drunk, it is only with societal disacceptance, and the advent of modern psychiatry, that we have tried to conceptualize drug and alcohol (ab)use.

One hundred and ten years after first passing regulations on opioid use, there is hope for drug users and those who suffer from addiction. We are peeling back the stigma we created to see the human beneath and acting on scientific data not moral superiority. We are easing access to medical treatments that have proved successful in managing addiction while providing users a modicum of respect and humanity… for that’s what harm reduction is: seeing the human being inside the addiction.

Once upon a time, all granny had to do was walk down to her local apothecary and order herself up some cocaine, morphine, or even prescription heroin; soldiers, left addicted to morphine after being wounded, could order up opium by mail.

After one hundred and ten years of stigmatization and criminalization, anyone who seeks to reduce the harm of their addiction to opioids through the use of medical heroin will again have access outside of a hospital setting. Those who seek to manage their opioid addiction through methadone, will have easier access and doctors who wish to prescribe methadone will no longer need to seek an exemption from drug laws.

__________________________________________

For hundreds of years, Colonizing powers have fought for Afghan poppyfields; Britain, Russia, the US, have all sought control of, and benefitted financially, from Afghanistan’s main harvest: the poppy. There is a direct correlation between the ongoing war in the middle east and the inability of world powers to stabilize the region, an addiction older than our love of fossil fuels, opium.

According to the United Nations Office of Drugs and Crime (UNODC), Afghan opium production was up 87% in 2017 – over 2016 – to 9000 metric tonnes. To put that in perspective, in 2001 opium production was at an all time low of 180 metric tonnes while in 2002, after the US invasion, it jumped to 3000 metric tonnes. If we are to understand how the twenty-first century has led to soaring opioid death rates, we need first examine the economic benefits. But alas, that is a topic best covered in depth; til next time, Niagara. Stay safe.   

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Calling On NPCA’s Board To Drop Its Lawsuit Against A Former Employee — Niagara At Large

@NPCA_Ontario #Niagara #NiagaraPeninsula #ISupportJocelynBaker #DropTheSuit

‘The taxpayers of Niagara do not fund the NPCA with their tax dollars so that it can pursue lawsuits, under any circumstance, against private citizens. We expect the NPCA to spend our money on conservation efforts.’ A Message from Friends of Jocelyn Baker, a Niagara, Ontario-based citizen group organized in support of former NPCA employee […]

via Calling On NPCA’s Board To Drop Its Lawsuit Against A Former Employee — Niagara At Large

Port Dalhousie Secondary Plan

Yesterday. I posted this without comment as, per usual, I prefer humility to accolades. A day later, I’ve changed my mind.
 
“The councillors agreed to drop their FOI request a month later when city staff agreed to show the report to them confidentially with the rest of council. At least one member of the public, Emily Spanton, then filed her own FOI.”
 
Our councillors made a deal with the Devil and left it to us, the public, to fight for transparency and accountability on a highly contentious issue. We answered that deal by saying it was inappropriate and filing our own FOI requests to make the report public. We collected the funds to pay for report from community members. We answered the emails and calls from staff with further questions. We took time out of our day to twice go to city hall, first to file papers, second to pay the fee.
 
And it was only with their imminent release to me that councillors changed their tune and decided to fight for what is rightfully ours. So please, stop giving the credit to 3 men who couldn’t stick with their convictions and are taking the credit for the hard work of a woman and other community members.
It’s uncouth and highly inappropriate.

Niagara the Victim in Press Freedom fiasco, says Quirk

Our friend, and Grimsby representative at Niagara Region and Niagara Peninsula Conservation Authority, Tony Quirk flat out denies the December #PressFreedom incident happened and states #Niagara is…. a victim.

That’s right folks, Tony Quirk believes it acceptable to use the terminology sexual assault survivors use to describe their experiences in relation to the Region confiscating a venerated member of the press’ notes and laptop before ejecting him from a public building.

If anyone has a right to feel victimized, it is St Catharines The Standard’s Bill Sawchuk and the shocked citizens who were helplessly watching.

No amount of spinning will doctor this record, Tony.

 

The latest from The Standard: https://www.stcatharinesstandard.ca/news-story/8312515-region-victim-in-press-incident-says-quirk/

Or catch up on previous FEWniagara coverage: Cap Caper (the #PressFreedom Fiasco)

The Crux of Reles’ Uncouthness

Also Known As Why the NPCA’s Michael Reles pisses me off.

Reles

Why is Michael Reles’ comment so flippant?

Michael Reles is the Communications Manager/Freedom of Information and Privacy coordinator at the Niagara Peninsula Conservation Authority (@NPCA_Ontario); it is literally Reles’ job to release documents requested of the publicly funded NPCA

(or The Authority as they’ve become known in the dystopia that is #Niagara politics).

The Authority’s board of directors comprises of 15 members, 12 of whom represent the Region of Niagara; most of the Niagara representatives at the NPCA are also lower-tier municipality Mayors and/or Regional Councillors.

The FOI process

NPCA 1 001
I requested full expenses including mileage in OCTOBER 2017…

Over a month later, I received a reply from Michael Reles (to the left).

I was called frivolous and vexatious.
For making a request. Through the Freedom of Information process.
For board and member expenses. Of a publicly funded agency.

So, I appealed.

I then requested a two week limit to mediation in favour NPCA 1 003of arbitration.

Mid-JANUARY, 2018, the Mediator informs me Michael Reles has reversed his position; not only am I no longer frivous and vexatious, Mr Reles, and the Authority, now state they would release the records, online, within 90 days.

NPCA 1 002

 

 

and I am not alone.

Local resident, and retired RCAF Major Ed Smith recently spoke with The Standard about his FOI dispute with the NPCA: https://www.stcatharinesstandard.ca/news-story/8291010-smith-npca-in-dispute-over-documents/

The Crux of Reles’ Uncouthness

What about it pissed me off so much?

In his Twitter post, Michael Reles states the media has never mentioned NPCA board mileage before now.

We’ve established Michael is withholding the required records to comment (remember, this guy is the NPCA Communications Manager), but, before he stopped complying with FOI requests, he released Authority Chairman Sandy Annunziata, and former Chairman Bruce Timms, 2017 Q1 & Q2 Expenses (below).

 

The hi-lited lines represent dates where MORE THAN ONE (two or more) PER DIEM were charged in a single day by a single board member.

Unless Latin has made a secret comeback, and changed without my knowledge, per diem translates to per day. Per day, by the day, for the day, daily. Not loosely translates as, or kinda means, but quite literally, and simply, translates to per day.

Not only has the public and media questioned this double diem-ing, Port Colborne council grilled CAO Mark Brickell and Chairman Sandy Annunziata about it in December 2017 https://www.niagarathisweek.com/news-story/8004769-port-colborne-seeks-provincial-supervisor-for-npca/

Stop the political skullduggery and misinformation at the Niagara Peninsula Conservation Authority (NPCA); one could make the argument it is you who is vexatious, Mister Reles.

Dozens Dead, Numbers Expected to Rise

I have recently completed the first in a series on opioids for The Sound @TheSoundSTC,
Niagara Region’s largest independent paper, and will be releasing it in the weeks to come.

As an addictions counsellor, I am not only qualified to speak on this issue but have experience working with street-involved youth and adults struggling with addiction and active mental health crisis.

As first printed in The Sound, March 2018:
https://thesound.rocks/dozens-dead-numbers-expected-rise/

Dozen’s Dead, Numbers Expected to Rise

I could write an opus on drugs; explain how our brains are wired with neurotransmitters or discuss how different chemicals have different rates of bioavailability, half-life, and pharmacokinetics. I could explain how the therapeutic index (TI) of a drug – the prescribed dosage – is the ratio between the effective dose (ED) and the lethal dose (LD) in 50% of the population; but, it’s time, Niagara.

We need to talk some real shit.

At least three people have died following suspected opioid overdoses in the Niagara Region between Valentine’s Day and February 20th, 2018; at least one opioid death in February could have been avoided if St Catharines had a safe injection site.

According to Niagara EMS, they responded to 155 suspected drug overdoses in 2016 and 520 in 2017. Preliminary death data, released by the province, shows 40 people died from opioid overdoses in Niagara in 2016 while numbers for 2017 are expected to at least double.

NRPH

For the three months available (May-July 2017), there were 7 suspected opioid deaths in each month – 16 confirmed and 5 probable opioid overdoses – for a total of 21 deaths. In 3 months. Compare that to 40 the entire year before.

If we look further, we discover Niagara emergency departments treated 43 overdoses in July 2017, 7 of whom died (6 confirmed opioid, 1 probable). While the death data is not yet available, if the death to ER visit ratio was 7:43 (1/6) in July, and data shows 62 people were treated for opioid overdoses in both August and September, statistically speaking, 10 people probably died in each month.

NRPH_ERThat would mean we surpassed the total opioid deaths in 2016 in just 5 months of 2017 (May through September); the total lives lost to opioids in 2017 is probably around 87… if not higher.

People are dying; this is no longer a problem to be swept into the darker corners of the region. Niagara needs wider-sweeping harm reduction initiatives including a supervised injection site. Mayor Sendzik, of St Catharines, has been vocal in his support, stating he’d like to see a site open in his city as quickly as possible.

“Everyone knows someone who has struggled with addiction.

Just like lifting the stigma of mental health, we have to lift the stigma around addictions to tackle the opioid crisis.”

–  Mayor Walter Sendzik, St Catharines

The City of St Catharines, which has one of the highest overdose rates in Ontario, is currently working with the Region of Niagara Public Health and a coalition of local organizations – known as the Overdose Prevention & Education Network Niagara or OPENN – to open a temporary safe injection site in St Catharines.

Public health officials anticipated the ‘nearly complete’ application for a temporary supervised injection site, once submitted, will take approximately 10-12 weeks (although I was unable to ascertain when, exactly, submission was anticipated to occur).

What Is A Supervised (or Safe) Injection Site?

Supervised injection (SI) sites are a safe place for someone to use their IV drugs; when someone uses their pre-purchased drug in a controlled environment, it allows for the immediate detection and treatment at the onset of overdose symptoms.

Administering Naloxone (formerly Narcan®), a compound which binds at the opioid receptor sites in the brain displacing the drug molecules from those receptors, in combination with respiratory and cardiac support, at the onset of overdose symptoms, saves lives.

In fact, the data shows in 86% of opioid overdoses, Naloxone is effective, and, within 10 minutes the person is conscious.

Here’s where the supervision comes in: how do you self-administer Naloxone if you have lost consciousness? How do you self-administer chest compressions? or call for EMS?

Efforts to train and pass out Naloxone kits are having a positive impact within the community but that doesn’t save the life of the man who uses, alone, in a Tim Horton’s bathroom, does it?

Benefits to the Community At Large

Don’t supervised injection sites encourage drug use? Studies show this to be false, nobody starts shooting heroin because they can do so while supervised; to say otherwise is ridiculous and contrary to the data.

A recent study in Toronto found that 36% of people who use drugs reported injecting in public places such as washrooms and alleyways. In St Catharines, we could replace alleyways with parks.

Supervised injection sites promote safety and hygiene while discouraging inappropriate disposal of used needles. Proper disposal of paraphernalia, such as needles, reduces the risk of accidental needle sticks for first responders, and in our public spaces including parks.

With some simple changes to the way we treat addiction and narcotic abuse, we can reduce the overall costs to our healthcare system – including emergency rooms and EMS resources. We end up with a net positive for the entire community.

We are not going to solve age-old issues of narcotics use, and abuse, by providing harm reduction programs and safe environments to addicts, but we may regain some of our humanity.

Every interaction a worker has with an addict or at-risk client is another opportunity for non-judgmental conversation and education; every interaction is another chance to build trust and, when the person is ready, change.

We created the stigma, the hair shirt, addicts wear; it’s time we share the burden.


This is the first in a series on opioids; check out The Sound (@TheSoundStC) for more. Up next, Social Indicators: Mental Health, Substance Abuse, and Poverty.

Emily Spanton, @FEW_Niagara

UPDATE: On February 26th, St Catharines City Council unanimously voted to support an application by Niagara Region Public Health and a collective of harm reduction and social service agencies to the Province for a temporary supervised consumption site.

Opioid Crisis and Overdose Prevention Site

At the meeting of February 12, 2018, Mayor Sendzik provided notice that he would present the following motion:

WHEREAS the use of dangerous opioids is contributing to an epidemic of drug overdoses across the country, including 520 suspected opioid overdoses attended by Niagara EMS in 2017; and

WHEREAS the federal government has responded with temporary exemptions under the Controlled Drugs and Substances Act for overdose prevention sites; to permit temporary overdose prevention sites to respond to the opioid crisis; and

WHEREAS the Province of Ontario has created a program to establish overdose prevention sites on a time-limited basis as a low barrier, life-saving service providing supervised injection, naloxone, and the provision of harm reduction supplies, to be funded by the Ministry of Health and Long-Term Care; and

WHEREAS first responders, including St. Catharines Fire and Emergency Services, are being equipped with naloxone kits and trained to respond in the event of an overdose medical emergency call;

WHEREAS the Overdose Prevention and Education Network of Niagara (OPENN) is a network of local agencies coordinating the response to this crisis, including St. Catharines Fire and Emergency Services, Niagara Region Public Health and Positive Living Niagara;

THEREFORE BE IT RESOLVED that St. Catharines City Council supports the Opioid Prevention and Education Network of Niagara / Positive Living Niagara application to the province for a temporary overdose prevention site and requests that the City be consulted in the location of a temporary site and any future considerations for a permanent site in St. Catharines.

 

 

#Niagara Theatre of the Absurd: The Pelham Witchhunt

Tit for TatTonight, Niagara Regional Councillors Tony Quirk and David Barrick will continue their attack on the Town of Pelham and lower-tier autonomy. That’s right people, this is an attack on our local political structure and can not be allowed to pass.
While Councillors Quirk and Barrick try to distract council, and the public, with skullduggery, we have a Niagara Regional Police Service board, on which Niagara Regional Chair Alan Caslin, and Councillors Barrick and Bob Gale sit, is running $7.2 million dollar deficit and just paid nearly $1 million to well-respected former Police Chief McGuire to force him to retire.
The board of NRPS is asking the Niagara Region to cover at least $2 million of the police services boards deficit in addition to the previously approved 2018 budget.
 Councillor Quirk sits on the Niagara Peninsula Conservation Authority board, where Councillor Barrick is Director, and who spent over a quarter of a million to sue Ed Smith and untold millions on other legal fees and severance packages (claiming poverty as the need to let longterm employees go), has a newly created Board Lounge at HQ, where they never go. This new NPCA board *lounge* includes new leather furniture and decorations.
Niagara Region – leave #Pelham alone and clean up your own boards finances.
#Niagara