Solving BC’s drug overdose epidemic
“Ending drug prohibition, ending punitive policies and laws, and providing a safe legal supply supports life rather than destroying lives.” – Susan Boyd
May 31st, 2022
Many illicit drug users die needlessly of overdoses says scholar and activist Susan Boyd. In this Q&A, she lays out new ideas for preventing the carnage.
A recent BC coroner’s report stated 2,224 people died of suspected overdoses in the province in 2021, more than in any previous year.
Toxic drug deaths were declared an emergency in 2016 by the provincial health officer, Dr. Perry Kendall, yet more than 9,400 people in total have died from illicit drug overdoses between then and now.
Experts like activist and researcher, Susan C. Boyd say our drug laws and social prejudices have much to do with these deaths. Her eleventh book, Heroin: An Illustrated History (Fernwood $30) examines the history of harm done by criminalizing heroin users (and other drug users), leading to the overdose epidemic still underway.
BC BookLook conducted the following Q&A with Susan Boyd.
BCBookLook: How did you get involved in helping addicts?
Susan Boyd: I don’t use the term “addict” because it’s meaning is not clear and it’s often linked to negative stereotypes and discrimination. I prefer to say: people who use heroin, or people who use criminalized drugs. Because not everyone who uses a criminalized drug has a “habit;” many are casual users.
I first started thinking about drug policy when I was a teenager in the 1960s and 70s. Like many youths in the counter culture, I experimented with criminalized drugs. I could not figure out why certain drugs and the people who used them were seen as criminals and deviants. Especially since drugs like tobacco and alcohol (legal drugs) were more harmful. I continue to be curious about the purpose of drug prohibition or the war on drugs. Who does it serve?
As an adult I helped to found and work in one of the first harm reduction services for mothers and their children in Vancouver in the early 1990s. I saw the impact of our drug laws played out in a devastating way in the lives of the women I knew. Also, it became more and more evident to me that our drug policies are deeply gendered; women who use drugs are seen as doubly deviant than men. I found that our drug laws are informed by and perpetuate systemic gender, race and class injustice.
Later, I chose to study the history of drug prohibition more deeply. Why did prohibition emerge? What are the consequences of drug prohibition? Are the consequences of prohibition linked to one’s social status? How do our drug laws shape health and social policies, child protection, and drug services? Why are taxpayers willing to support violent drug laws and policies?
BCBL: You argue that our drug laws do more harm than good. Please explain.
SB: Drug prohibitionist laws negatively contribute to the very factors that they claim they will reduce. For example, criminalizing heroin and not providing a safe supply for those most affected can lead to a poisoned, unregulated, illegal heroin market and fatal drug overdoses.
Many of the harms we attribute to heroin use since criminalization (such as a higher risk of overdose and disease infection) actually stem from prohibition, which means heroin has to be bought on the illegal market and people don’t know when they are getting toxic heroin that can lead to an overdose.
Drug prohibition as a whole is not driven by evidence of its efficacy in dealing with drug use nor “addiction” but rather by violence, a growing global illegal and sometimes violent market and a poisoned drug supply.
Since their inception, harsh drug laws have been touted as a way to stop drug trafficking and importation of illegal drugs; yet, the focus of law enforcement is on people who use drugs. And the majority of drug offences in Canada have been for personal possession, not drug trafficking or importing drugs.
BCBL: Give an example of how our past ideas about heroin and drug users led to “bad” laws?
SB: In Heroin I challenge ideas about addiction and “addicts.” What does “addiction” mean? What does the word “addict” mean? What do we associate with these labels? How do these labels create discrimination and stigma?
Not all people who use heroin or other criminalized drugs use regularly, nor are they habitual users. In fact, most people who use criminalized drugs are occasional users.
However, in Canada, following criminalization in 1908, abstinence from criminalized drugs was advocated as the solution to drug use and if that failed, prison was seen as the solution. Meanwhile, other western nations like the UK, were prescribing drugs to people known to be “addicted.” Canada did not set up narcotic clinics where doctors can prescribe legal drugs for people who use narcotics regularly – i.e. a legal safe supply. Nor were publicly funded drug treatment services set up.
Also, the concept of the “criminal addict” was advanced by the RCMP, the Narcotic Division, and other professionals from the 1930s on, to explain the nature of illegal drug use and to justify punitive drug laws in the first half of the twentieth century.
Those people labelled criminal addicts were seen as criminals first and foremost, and their use of heroin (or other drugs) was considered secondary. Thus, it was believed that even if poor and working-class people stopped using heroin or other illegal drugs, they would remain a menace to society due to their criminal nature. Stemming from these misinformed ideas, publicly funded drug treatment was not set up in Canada until the late 1950s and 1960s. Prison time, not drug treatment, was considered the appropriate penalty for personal possession of an illegal drug such as heroin.
Since the 1960s, the majority of the drug services and treatments set up in Canada draw from the disease model of addiction (where addiction is seen as a biological, life-long condition) — sobriety is required or seen as the end goal of treatment.
I argue in Heroin that repeated and regular drug use does not need to be understood as criminal, or a fixed pathological identity or a “neurobiological condition.” Alternatively, addiction could be understood instead as a habit. Researchers Suzanne Fraser, David Moore and Helen Keane examine the concept of habit. They define it as: “a settled or regular tendency or practice, especially one that is hard to give up … [such as,] he has an annoying habit of interrupting me [and/ or] good eating habits.” So, they say, “habit is neither good nor bad.” Yet, people who use illegal drugs such as heroin continue to be seen and treated as abnormal, disordered and criminal.
Also, conventional theories about addiction and drug policies ignore how the experiences and outcomes of drug use are influenced by one’s social status (race, class, gender, sexuality) and one’s cultural, legal and social environment. Thus, in Canada, Indigenous, Black and poor people have been targeted by law enforcement.
BCBL: Why do you find better solutions in harm reduction policies?
SB: Harm reduction is a response to punitive drug laws, to save lives. Activists in Canada began to set up harm reduction services, such as needle distribution in the late 1980s and 1990s (to lower transmission of disease, such as HIV/AIDs and Hepatitis C). Harm reduction is not a rejection of abstinence, but it is not the sole objective of services or drug treatment. Harm reduction advocates assert that non-judgmental and practical services can reduce harms.
Harm reduction advocates also see drug use and services on a continuum: for some people, abstinence-based drug treatment or twelve-step programs work best; for others, alternative options provide essential support, such as education, drug substitution programs and overdose prevention sites. These services save lives.
BCBL: Please give some examples to illustrate how criminalization has hurt people.
SB: Steve Rolles, an international expert at Transform Drug Policy Foundation, explains that drug prohibition itself, not the drug or effects of its use, causes the most harms. To quote him: “Consider, for example, two injecting heroin users; the first is … using ‘street’ heroin (of unknown strength and purity) with dirty, possibly shared needles in unsupervised and unsanitary environments. Their supplies are purchased from a criminal dealing/trafficking infrastructure that can be traced back to illicit production in Afghanistan. They have HIV, Hepatitis C and a long, and growing, criminal record. The second uses legally manufactured and prescribed pharmaceutical diamorphine of known strength and purity in a supervised, clinical setting, with clean injecting paraphernalia. There is no link to failing drug producer states; no criminality, profiteering or violence involved at any stage of the drug’s production, supply or use; no blood borne disease transmission risk; and a near zero risk of overdose death.”
I argue that ending drug prohibition, ending punitive policies and laws, and providing a safe legal supply supports life rather than destroying lives. 978-1773635163
An edited version of this Q&A will appear in the Summer 2022 issue of BC BookWorld newspaper.
Dr. Susan Boyd is a scholar/activist and distinguished professor emerita at the University of Victoria. Her research examines a variety of topics related to the history of drug prohibition and resistance to it, drug law and policy, including maternal drug use, maternal/state conflicts, film and culture, radio and print media, heroin assisted-treatment, community-based research and qualitative research methodology.