B.C. health minister Terry Lake reflects on the fentanyl crisis, legalization, and the limits of government response
B.C. health minister Terry Lake insists his government has been active with its response to the overdose epidemic for some time. In a telephone interview, he points to the declaration of a public-health emergency that was issued last April. But there’s no doubt that since the beginning of this month, he’s tackled the crisis with renewed urgency.
Since December 8, Lake has overseen B.C.’s five regional health authorities establish 18 overdose-prevention sites, dodging federal drug laws to make spaces available where people can use intravenous narcotics like heroin in the presence of someone who will intervene should an overdose occur.
There’s good reason for the minister to feel a new sense of urgency. Last month, 128 people in B.C. died of drug overdoses, a figure miles above the previous all-time high of 82, set last January. For the year, it’s projected deaths will surpass 800, compared with 510 in 2015 and 366 in 2014.
What will Lake do if the province’s latest actions fail to stem the sharp rise in overdose deaths?
If you accept that addiction is a disease and that people will always use drugs regardless of how dangerous they know them to be, and if you acknowledge that B.C.’s illicit-drug supply is hopelessly polluted with deadly synthetic opioids like fentanyl, what’s the next step?
Lake let out a sigh before he responded.
"I guess I’m ever-hopeful that, number one, people who do use [drugs] will be using in the presence of others, where we can revive them if there is an overdose,” he said. “Number two, those who are not addicted and don’t need to be using any illicit drugs will make a choice not to at this time. I’m ever-hopeful that will happen, because I can’t take the needles out of people’s hands and I can’t put people behind bars.”
Without being prompted, Lake went on to speak about legalization.
“The federal government, really, has the policy pen on the way we look at controlled substances,” Lake began. “A lot of people are saying we should be like some countries in Europe and just legalize all drugs and make sure there is a safe supply. But I’m not sure—I don’t know enough—to know that that’s the way to go. And it’s beyond our provincial area of constitutional responsibility. So we’re doing everything we can within our realm to try to keep people alive.”
(It’s important to understand the difference between decriminalization and legalization. Decriminalization simply removes judicial penalties for possessing drugs, leaving supply in the hands of criminals who have proven a willingness to mix fentanyl in with the substances they sell. Legalization involves bringing the supply of narcotics under government control, heavily regulating their distribution and sales.)
Lake noted that legalization is a topic that's making its way into policy discussions.
“When I was at the opioid summit in Ottawa [on November 18], people would bring this up,” he said. “As a policy maker, I hear the discussion, but I don’t have enough information. I have seen some of the research out of Europe, and it is an area that I have an interest in. But I don’t have a position on it because I like to get as much information as possible. And it is out of our realm, so it would be difficult for me to have a official position on that anyway.”
In Vancouver yesterday (December 20), Prime Minister Justin Trudeau happened to field very similar questions during a meeting with the Vancouver Sun’s editorial board.
“I’m a big fan—as you’ve all heard me say many times—of evidence-based policy,” he began. “I know there have been pilot projects here in Vancouver leading the way on prescription heroin. I’m very interested in seeing the results of those. I’m certainly not philosophically or ideologically opposed to something that is going to work to save lives. But I do know that there is still more work to be done, both on public awareness and on determining how best to help people.
“There is no one magic bullet that is going to fix this situation,” the prime minister continued. “There is a broad range of things. Harm reduction is a piece of it. Maybe prescriptions for opioids, in certain situations, might be a piece of it as well.”
(The Straight has reported in-depth on the studies of prescription heroin alluded to by Trudeau.)
Lake has repeatedly described the war on drugs as a "failure".
“My view is that, as a society, we are taking a different sort of approach to drug use than we used to,” he said last June. “I think that any politician that I have talked to understands that the so-called war on drugs has been a failure and that we need to have different approaches. That will take some time.”
Speaking to the Straight this week, he warned that the situation appears to be growing more dangerous. He noted that while B.C. does not yet have the ability to test for carfentanil, another synthetic opioid significantly more deadly than fentanyl, authorities suspect the arrival of that drug is partly to blame for the November surge in overdose deaths.
“Something changed,” he said. “With what appears to be the increased presence of carfentanil, I think we need to monitor it [effectiveness of the province’s response], literally, on a week-by-week basis.”
If the situation continues to deteriorate, Lake said, health authorities could open more overdose-prevention sites beyond the 18 already established. He added the province also plans to announce additional response measures in January.
Lake said his office has received some criticism for its additional spending on harm-reduction services in response to the crisis. He urged constituents to think about addiction as a disease.
“One thing that I’m starting to see are emails to me saying, ‘Why are you spending our money on addicts when other health-care needs are not fully met?’” he recalled. “We treat people who smoke their whole lives and develop lung cancer, we treat people who speed on the highway and get into car accidents, we treat people who have heart disease after a life of poor diet and poor exercise. So there is this judgmental stigma that goes along with addiction. But humans are frail and everyone deserves to have an opportunity to get treatment.”