Thursday, April 28, 2016


Brian Hutchinson: Finding used drug needles in public spaces has become the new normal for Vancouver

Dirty needles found near children's playground in Vancouver's West End

VANCOUVER — You have found a used needle, in one of the last places you ever expected — or wanted — to see one. On the playground. Inside the schoolyard. On the beach. Now what?

Shiloh Sukkau was shocked at first. Then resigned. Now she’s upset. Same with Joel Reid and Jessica Leung, and now they’re speaking out.

Three people, unknown to each other, living and working in different parts of the city. Finding dirty needles in public places. Kids’ spaces.

In this permissive city, where open drug use is sadly common, people have finally reached a boiling point. They’re fed up with finding dangerous materials left behind by intravenous drug users, whose numbers in Vancouver exceed 12,000, according to local health authorities.

Dirty needles, called “sharps,” along with cooking gear, water ampoules and rubber ties are the most common detritus.

The problem isn’t confined to Vancouver’s drug-infested Downtown Eastside. Used needles with trace amounts of heroin, cocaine, crystal methamphetamine, prescription opioids and blood are turning up across the city.

On one Vancouver street corner, residents were recently confronted with discarded sharps and, on a wall next to them, the image of a happy face, drawn in blood.

Here’s the brutal irony, an unintended consequence. Millions of needles are handed out in Vancouver every year, more than in any other Canadian city. Free needle exchanges funded by taxpayers and private donors are considered an effective form of harm reduction; clean, disposable “rigs” can help prevent the spread of such diseases as HIV and hepatitis.

Most of the used needles from exchange programs are collected and disposed of properly. But every year, more than 100,000 needles are carelessly discarded outside, creating hazards for the rest of us. Last year, the number of needles recovered outside was a staggering 250,732, according to Vancouver Coastal Health.

Shiloh Sukkau is a young mother with an eight-year-old child attending school in Vancouver’s West End, adjacent to the downtown core. On Saturday, she found a used needle lying in a children’s garden that she and other parents built in a city park. Her daughter’s school, Lord Roberts Annex, takes up about one-quarter of the same block.

Sukkau had previously found needles left in and around the schoolyard. On each occasion she called a local social-service agency, the Portland Hotel Society (PHS), for help.

The PHS has a needle exchange and recovery program and will send someone to collect used rigs from city parks and other places. The City of Vancouver, the Vancouver Park Board and other agencies also offer needle-recovery programs and daily “sweeps.”  Clearly, though, these efforts aren’t enough.
It’s really upsetting, especially because I’ve been trying to encourage … children to use the (garden) space
For Sukkau, finding a needle in the school’s outdoor garden plot was a tipping point. “It’s really upsetting, especially because I’ve been trying to encourage other parents, teachers and children to
use the (garden) space,” she says. “Now I’m not sure it’s a good idea.”
The morning after her discovery, Sukkau’s partner found eight more needles in the same garden, which children had recently planted with vegetables.

Enough, they said. Sukkau went public this week, contacting media and local politicians, asking why residents are forced to deal themselves with Vancouver’s drug-use problem. With few exceptions, no one in a position of authority or elected office got back to her.

Joel Reid teaches music at a Montessori school not far from Vancouver’s False Creek. He often takes his young students to a nearby park but first, he has to inspect the place for needles.

“It’s become a hot spot,” Reid says.

He has also encountered people shooting up outside his school; in those cases, he asks the drug users to move on. “They are very compliant, most of them,” says Reid.

Fortunately, he’s not aware of any needle-related injuries sustained by students. “The kids are pretty aware. I’ll show them a needle if I find one, and warn them not to touch one if they find one themselves.”
Jessica Leung and her family moved to an Eastside neighbourhood last year. She finds discarded needles as many as four times a week. “Places that families frequent are being overrun with sharps,” she says.

The greater, underlying problem, she feels, is “prolific drug use.”

Like Sukkau and Reid, she’s found such agencies as the PHS helpful at collecting sharps. But the situation persists, and, she says, it’s getting worse.

Some have suggested installing plastic needle disposal boxes on street corners, in parks and inside public washrooms. Leung and the others aren’t convinced they would solve anything.
Would drug users who currently drop their needles on the ground suddenly change their behaviour and put their needles safely inside a box? Would a homeowner want a needle box placed outside their house? Fat chance of that.

There is no simple solution. In Vancouver, scattered, dirty needles are approaching “normal” status, sad facts of city life. It seems we’re stuck with that.

Wednesday, April 27, 2016


A survey about Recovery is being conducted on behalf of the Canadian Centre on Substance Abuse (CCSA) and the National Recovery Advisory Committee (NRAC.)

Please read the short preamble and do the survey to the degree you feel comfortable. Every little bit helps.

Saturday, April 16, 2016


As we approach the big smoke-in at Sunset Beach in Vancouver with tens of thousands, it might be instructive and mildly helpful to look at another viewpoint...if that's allowed.
Scientists Across the Globe Call for Greater Awareness of the Harms of Cannabis Use

April 16, 2016

Contact: Jeff Zinsmeister

A new call to action has been released from scientists around the world, reflecting "a growing consensus among experts that frequent cannabis use can increase the risk of psychosis in vulnerable people and lead to a range of other medical and social problems," according to the The Guardian.

Researchers now believe the evidence for harm is strong enough to issue clear warnings, said the article.  For example, Sir Robin Murray, professor of psychiatric research at King's College London, stated:

"It's not sensible to wait for absolute proof that cannabis is a component cause of psychosis. There's already ample evidence to warrant public education around the risks of heavy use of cannabis, particularly the high-potency varieties. For many reasons, we should have public warnings."

Estimates suggest that deterring heavy use of cannabis could prevent 8 to 24% of psychosis cases handled by treatment centers, depending on the area. In London alone, where the most common form of cannabis is high-potency marijuana (or "skunk" as it is sometimes called in the United Kingdom), avoiding heavy use could avert many hundreds of cases of psychosis every year.

"It is important to educate the public about this now," said Nora Volkow, director of the US National Institute on Drug Abuse (NIDA). "Kids who start using drugs in their teen years may never know their full potential. This is also true in relation to the risk for psychosis. The risk is significantly higher for people who begin using marijuana during adolescence. And unfortunately at this point, most people don't know their genetic risk for psychosis or addiction."

Ian Hamilton, a mental health lecturer at the University of York, said more detailed monitoring of cannabis use is crucial to ensure that information given out is credible and useful. Most research on cannabis, particularly the major studies that have informed policy, is based on older low-potency cannabis resin, he points out. "In effect, we have a mass population experiment going on where people are exposed to higher potency forms of cannabis, but we don't fully understand what the short- or long-term risks are," he said.

Prof Wayne Hall, director of the Centre for Youth Substance Abuse Research at the University of Queensland, said that while most people can use cannabis without putting themselves at risk of psychosis, there is still a need for public education:

"We want public health messages because, for those who develop the illness, it can be devastating. It can transform people's lives for the worse. People are not going to develop psychosis from having a couple of joints at a party. It's getting involved in daily use that seems to be the riskiest pattern of behavior: we're talking about people who smoke every day and throughout the day."

"When you're faced with a situation where you cannot determine causality, my personal opinion is why not take the safer route rather than the riskier one, and then figure out ways to minimize harm?" said Amir Englund, a cannabis researcher at King's College London.

A UK government spokesperson also said its position on cannabis was clear. 

"We must prevent drug use in our communities and help people who are dependent to recover, while ensuring our drugs laws are enforced. There is clear scientific and medical evidence that cannabis is a harmful drug which can damage people's mental and physical health, and harms communities."

These comments underline the need for a global drug policy that prevents drug use, instead of promoting it. Global drug policy should continue to evolve to match the new scientific evidence available, and that includes taking into account the heavy price that increases in drug use entail, particularly in less-developed countries.

Prevent. Don't Promote. ( is a global campaign that more than 300 organizations across the world are launching at UNGASS 2016 to support the 
UN drug conventions.  This consortium of organizations advocates fora global drug policy based on public health and safety through the prevention of drug use and drug problems.
Aligned with the principles of Drug Policy Futures, we believe that drug policies should:
  • Prevent initiation of drug use.
  • Respect human rights (for users and non-users alike) as well as the principle of proportionality.
  • Strike a balance of efforts to reduce the use of drugs and the supply of drugs.
  • Protect children from drug use.
  • Ensure access to medical help, treatment and recovery services.
  • Provide access to controlled drugs for legitimate scientific and medical purposes.
  • Ensure that medical and judicial responses are coordinated with the goal of reducing drug use 

Saturday, April 9, 2016


 And then read Robert Whitaker's landmark powerful book, "Anatomy of an Epidemic."


Doctors’ reckless prescribing of fentanyl largely to blame for deadly overdoses: expert

Sharon Kirkey 

Canada’s doctors have been “mind-boggingly cavalier” in prescribing fentanyl — the most potent narcotic painkiller used outside operating rooms — and much of the responsibility for the country’s
opioid overdose crisis lies with the medical profession, a leading drug safety researcher is charging.
Dr. David Juurlink says a new study showing half of all prescriptions for fentanyl patches are unsafe reflects dangerous prescribing habits and a serious lack of appreciation for the drug’s toxicity.
Fentanyl has a strength 100 times that of morphine. Guidelines say no one should be put on the drug without doctors first trying a less-potent opioid.

But a study published this week of all patients in Manitoba prescribed fentanyl patches over 12 years found while prescribing has improved, half of new prescriptions are still being written for first-time users with no exposure to opioids.

“It’s very difficult for even a seasoned pain physician to justify the de novo initiation of fentanyl,” said Juurlink, head of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre.

“The idea that we’re just starting people on fentanyl is mind-boggling.”

He and others say the study is the latest evidence of a public health catastrophe the profession, and the public, still hasn’t fully grasped.

More people are dying from opioid overdoses than from car accidents. The medical profession has to take some ownership of this menace.

“This is a massive social problem and it is heartbreaking to me the extent of the lack of awareness … that is at least in part a function of some willful blindness,” said Dr. Gus Grant, president of the Federation of Medical Regulatory Authorities of Canada.

He said regulators are seeing loose prescribing, as well as a few malignant doctors “who have somehow fallen into the sway of the criminal element.”

One Nova Scotia doctor is alleged to have prescribed more than 50,000 oxycodone pills to a patient who never received them. On Wednesday, a Toronto family doctor was arrested in a fentanyl trafficking ring.

Grant stressed such doctors are outliers. But he also said opioid prescribing isn’t following the guidelines and, as a result, “we see the ills associated with these drugs.”

Few people should ever be escalated to taking fentanyl, he maintains, “because by the time they get to that stage, it’s more likely than not that they have declared themselves unresponsive to opioids.”
“It’s time to confront the reality of pain management in 2016,” he said. “Opioids don’t work well for a great many patients.”

According to the federal government’s own projections, Canadian sales of opioids could exceed $600 million a  year by 2019, up from $484 million a decade ago.

Fentanyl is making up a growing share of that market, as provinces tighten access to oxycodone — originally known as OxyContin and one of the most abused drugs in history. OxyContin was replaced in 2012 with a “tamper-resistant” version that becomes a gummy gel when turned into liquid, making it harder to inject.

However, generic versions of the original formulation have entered the market. This week, Ottawa announced the government won’t force the generics to make their versions of oxy harder to snort or inject, prompting criticism Canada’s drug-abuse “carnage” will only worsen.

But while the tamper-resistant formulations are an modest improvement over the older drug, most abuse happens through the ingestion of intact pills, Juurlink said.

With fentanyl, it’s through patches — they come in doses of 25 to 100 micrograms.

The most common form provides three-day continuous drug delivery and has become a “popular choice” for chronic pain, researchers report this week in the Canadian Medical Association Journal.
It is also the most potent opioid prescribed outside hospital. According to Juurlink, people not only die from exposure to excess levels of fentanyl, but the combination with many other drugs that are routinely prescribed can increase its level to lethal ranges.

In 2009-14, there were at least 655 deaths in Canada involving fentanyl, and more than 1,000 lethal drug poisonings where post-mortem drug testing detected the presence of fentanyl, says the Canadian Centre on Substance Abuse.

In Alberta alone, more than 270 people died from fentanyl overdoses last year, double the 2014 toll.
People are dying not just from illicit street drugs and lethal bootleg fentanyl from China and other underground markets, but also from legitimate prescriptions.

Juurlink has treated patients who arrive in hospital with multiple fentanyl patches, adding up to 400 micrograms or more. “And it’s almost always the case that they are being made worse rather than better by the drug,” he said.

Calgary emergency physician and toxicologist Scott Lucyk frequently sees unintentional overdoses
from fentanyl.

“It’s one of the big players right now,” he said. “They come in with respiratory depression — they’re not breathing as well. They have drowsiness and altered level of consciousness.”

“We have physicians who are prescribing these drugs who are not totally familiar with the delivery system,” he said, “and so the chance for patients coming with opioid toxicity, or potentially dying, is definitely there.”

Grant said opioids are important for pain and that doctors need to know how to use them judiciously.
“I do believe physicians are becoming more rigorous in their prescribing and I do see that there is an enhanced social awareness of it,” he said.

“But we’re nowhere near where we need to be.”

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