Dr. Mark Tyndall tells TEDMED audience that harm reduction is the first step out of North America's opioid epidemic

The epidemiologist presents Vancouver's experience with injection sites and similar measures as required to save lives across the continent

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      In a TEDMED talk made available online this morning (April 18), one of B.C.’s top health-care officials makes an impassioned case for a major shift in North America’s response to its overdose crisis.

      “Can you imagine if this was any other kind of poisoning epidemic?” asks Dr. Mark Tyndall, an epidemiologist, executive director of the B.C. Centre for Disease Control, deputy provincial health officer of British Columbia, and professor of medicine at the University of British Columbia.

      “What if thousands of people started dying from poisoned meat or baby formula or coffee?” he continues. “We would be treating this as a true emergency. We would immediately be supplying safer alternatives. There would be changes in legislation and we would be supporting the victims and their families. But, for the drug-overdose epidemic, we have done none of that. We continue to demonizing drugs and the people who use them and blindly pour more resources into law enforcement.”

      TEDMED is an annual conference that’s licensed to use the TED name for events that focus on health and medicine. In a presentation recorded in Palm Springs last November, Tyndall begins by briefly recounting Vancouver’s drug crisis of the 1990s and the city’s decision to declare a public-health emergency in 1997.

      “Today, 20 years later, harm reduction is still viewed as some sort of radical concept,” he laments. “In some places, it’s still illegal to carry a clean needle. Drug users are far more likely to be arrested than to be offered methadone therapy. Recent proposals for supervised-injection sites in cities like Seattle, Baltimore, and New York, have been met with stiff opposition. Opposition that goes against everything we know about addiction. Why is that?

      “Critics [of harm reduction]…say that we are giving up on people by not focusing our attention on treatment and recovery. In fact, it is just the opposite. We know that if recovery is ever going to happen, we must keep people alive. Offering someone a clean needle or a safe place to inject is the first step to treatment and recovery.”

      Tyndall continues with the example of North America’s first supervised-injection facility, Vancouver’s Insite.

      “All we are saying is that allowing people to inject in a clean, dry space, with fresh needles, surrounded by people who care, is a lot better than injecting in a dingy alley, sharing contaminated needles and hiding out from police,” he says. “It’s better for everybody.”

      Tyndall goes on to make an argument against prohibition, explaining that the assumptions on which prohibition is based are largely false.

      From there, he delves into America’s overdose epidemic, which in many areas shares similarities with B.C.’s fentanyl crisis. But, while illicit drugs killed 993 people in B.C. in 2016, that year in the United States, more than 64,000 people died of a drug overdose.

      Vancouver's Dr. Mark Tyndall delivered a TEDMED talk last November that suggests North America make a major turn on how it responds to addiction.

      “So where should we go from here?” he asks. “First, we should fully embrace, fund, and scale up harm-reduction programs across North America.

      “I know that in places like Vancouver, harm reduction has been a lifeline to care and treatment,” Tyndall says. “I know that the number of overdose deaths would be far higher without harm reduction. And I personally know hundreds of people who are alive today because of harm reduction.”

      Toward the end, he cautions that he is not presenting harm reduction as an ultimate solution to North America’s overdose epidemic.

      “But harm reduction is just the start,” Tyndall says. “If we truly want to make an impact on this drug crisis, we need to have a serious conversation about prohibition and criminal punishment. We need to recognize that drug use is, first and foremost, a public-health issue. And turn to comprehensive social and health solutions.”