WEBVTT

00:00:00.000 --> 00:00:00.810


00:00:00.810 --> 00:00:06.090
I remember the first time that
I saw people injecting drugs.

00:00:06.090 --> 00:00:09.640
I had just arrived in Vancouver
to lead a research project

00:00:09.640 --> 00:00:15.100
in HIV prevention in the
infamous Downtown East Side.

00:00:15.100 --> 00:00:17.650
It was in the lobby
of the Portland Hotel,

00:00:17.650 --> 00:00:20.560
a supportive housing
project that gave rooms

00:00:20.560 --> 00:00:22.960
to the most marginalized
people in the city,

00:00:22.960 --> 00:00:26.800
the so-called
difficult to house.

00:00:26.800 --> 00:00:29.200
I'll never forget the
young woman standing

00:00:29.200 --> 00:00:32.950
on the stairs repeatedly
jabbing herself with a needle

00:00:32.950 --> 00:00:35.770
and screaming I
can't find a vein,

00:00:35.770 --> 00:00:40.140
as blood splattered on the wall.

00:00:40.140 --> 00:00:44.100
In response to the desperate
state of affairs, the drug use,

00:00:44.100 --> 00:00:48.780
the poverty, the violence
, the soaring rates of HIV,

00:00:48.780 --> 00:00:53.430
Vancouver declared a public
health emergency in 1997.

00:00:53.430 --> 00:00:56.010
This opened the door to
expanding harm reduction

00:00:56.010 --> 00:00:58.530
services, distributing
more needles,

00:00:58.530 --> 00:01:01.860
increasing access to methadone,
and, finally, opening

00:01:01.860 --> 00:01:04.080
a supervised injection site.

00:01:04.080 --> 00:01:08.910
Things that make injecting
drugs less hazardous.

00:01:08.910 --> 00:01:12.240
But today, 20 years
later, harm reduction

00:01:12.240 --> 00:01:15.810
is still viewed as some
sort of radical concept.

00:01:15.810 --> 00:01:18.540
In some places it's
still illegal to carry

00:01:18.540 --> 00:01:19.740
a clean needle.

00:01:19.740 --> 00:01:21.870
Drug users are far
more likely to be

00:01:21.870 --> 00:01:25.440
arrested than to be
offered methadone therapy.

00:01:25.440 --> 00:01:28.260
Recent proposals for
supervised injection sites

00:01:28.260 --> 00:01:31.680
in cities like Seattle,
Baltimore, and New York

00:01:31.680 --> 00:01:34.800
have been met with
stiff opposition.

00:01:34.800 --> 00:01:37.560
Opposition that goes
against everything

00:01:37.560 --> 00:01:40.300
we know about addiction.

00:01:40.300 --> 00:01:41.740
Why is that?

00:01:41.740 --> 00:01:44.190
Why are we still
stuck on the idea

00:01:44.190 --> 00:01:48.540
that the only option is to stop
using that any drug use will

00:01:48.540 --> 00:01:51.060
not be tolerated?

00:01:51.060 --> 00:01:54.780
Why do we ignore
countless personal stories

00:01:54.780 --> 00:01:57.300
and overwhelming
scientific evidence

00:01:57.300 --> 00:02:00.980
that harm reduction works?

00:02:00.980 --> 00:02:04.790
Critics say that harm
reduction doesn't stop people

00:02:04.790 --> 00:02:07.080
from using illegal drugs.

00:02:07.080 --> 00:02:09.770
Well, actually, that
is the whole point.

00:02:09.770 --> 00:02:12.650
After every criminal
and societal sanction

00:02:12.650 --> 00:02:15.800
that we can come up with
people still use drugs,

00:02:15.800 --> 00:02:19.100
and far too many die.

00:02:19.100 --> 00:02:21.920
Critics also say that we
are giving up on people

00:02:21.920 --> 00:02:27.060
by not focusing our attention
on treatment and recovery.

00:02:27.060 --> 00:02:28.740
In fact, it is
just the opposite.

00:02:28.740 --> 00:02:30.180
We are not giving up on people.

00:02:30.180 --> 00:02:32.540
We know that if recovery
is ever going to happen

00:02:32.540 --> 00:02:34.730
we must keep people alive.

00:02:34.730 --> 00:02:38.330
Offering someone a clean needle
or a safe place to inject

00:02:38.330 --> 00:02:42.950
is the first step to
treatment and recovery.

00:02:42.950 --> 00:02:45.410
Critics also claim
that harm reduction

00:02:45.410 --> 00:02:49.980
gives the wrong message to
our children about drug users.

00:02:49.980 --> 00:02:54.360
The last time I looked, these
drug users are our children.

00:02:54.360 --> 00:02:58.340
The message of harm reduction is
that well, drugs can hurt you.

00:02:58.340 --> 00:03:01.250
We still must reach out to
people who are addicted.

00:03:01.250 --> 00:03:05.750
A needle exchange is not an
advertisement for drug use.

00:03:05.750 --> 00:03:09.770
Neither is a methadone clinic
or a supervised injection site.

00:03:09.770 --> 00:03:13.160
What you see there are
people sick and hurting,

00:03:13.160 --> 00:03:16.980
hardly an endorsement
for drug use.

00:03:16.980 --> 00:03:19.920
Let's take supervised
injection sites, for example.

00:03:19.920 --> 00:03:23.570
Probably the most misunderstood
health intervention ever.

00:03:23.570 --> 00:03:26.270
All we are saying is
that allowing people

00:03:26.270 --> 00:03:30.770
to inject in a clean, dry space
with fresh needles surrounded

00:03:30.770 --> 00:03:33.770
by people who care
is a lot better

00:03:33.770 --> 00:03:37.460
than injecting in a dingy alley
sharing contaminated needles

00:03:37.460 --> 00:03:39.470
and hiding out from police.

00:03:39.470 --> 00:03:42.810
It's better for everybody.

00:03:42.810 --> 00:03:45.810
The first supervised
injection site in Vancouver

00:03:45.810 --> 00:03:49.710
was at 327 Carol
Street, a narrow room

00:03:49.710 --> 00:03:52.860
with a concrete floor,
a few chairs and a box

00:03:52.860 --> 00:03:54.150
of clean needles.

00:03:54.150 --> 00:03:56.460
The police would
often lock it down,

00:03:56.460 --> 00:04:00.930
but somehow it always
mysteriously reopened, often,

00:04:00.930 --> 00:04:03.720
with the aid of a crowbar.

00:04:03.720 --> 00:04:05.490
I would go down
there some evenings

00:04:05.490 --> 00:04:07.380
to provide medical
care for people

00:04:07.380 --> 00:04:08.670
who were injecting drugs.

00:04:08.670 --> 00:04:11.940
I was always struck with a
commitment and compassion

00:04:11.940 --> 00:04:15.240
of the people who operated
and used this site.

00:04:15.240 --> 00:04:18.450
No judgment, no
hassles, no fear,

00:04:18.450 --> 00:04:20.560
lots of profound conversation.

00:04:20.560 --> 00:04:23.820
I learned that despite
unimaginable trauma,

00:04:23.820 --> 00:04:27.480
physical pain, and mental
illness that everyone

00:04:27.480 --> 00:04:30.630
there thought that
things would get better.

00:04:30.630 --> 00:04:34.050
Most were convinced
that some day they'd

00:04:34.050 --> 00:04:38.580
stop using drugs altogether.

00:04:38.580 --> 00:04:41.970
That room was the forerunner
to North America's

00:04:41.970 --> 00:04:44.940
first government sanctioned
supervised injection

00:04:44.940 --> 00:04:46.530
site called INSITE.

00:04:46.530 --> 00:04:50.670
It opened in September of
2003 as a three year research

00:04:50.670 --> 00:04:51.480
project.

00:04:51.480 --> 00:04:54.690
The conservative government
was intent on closing it down

00:04:54.690 --> 00:04:56.580
at the end of the study.

00:04:56.580 --> 00:05:00.450
After eight years, the
battle to close INSITE

00:05:00.450 --> 00:05:02.970
went all the way up to
Canada's Supreme Court.

00:05:02.970 --> 00:05:04.770
It pitted the
government of Canada

00:05:04.770 --> 00:05:08.130
against two people with a
long history of drug use

00:05:08.130 --> 00:05:11.250
who knew the benefits of
INSITE firsthand, Dean

00:05:11.250 --> 00:05:14.370
Wilson and Shelley Tomic.

00:05:14.370 --> 00:05:16.470
The court ruled in
favor of keeping

00:05:16.470 --> 00:05:19.530
INSITE open by nine to zero.

00:05:19.530 --> 00:05:22.590
The justices were
scathing in their response

00:05:22.590 --> 00:05:24.720
to the government's case.

00:05:24.720 --> 00:05:28.710
And I quote, "The effect of
denying the services of INSITE

00:05:28.710 --> 00:05:31.530
to the population that it
serves and the correlate have

00:05:31.530 --> 00:05:33.870
increased in their risk
of death and disease

00:05:33.870 --> 00:05:36.690
to injection drug
users is grossly

00:05:36.690 --> 00:05:39.540
disproportionate to
any benefit that Canada

00:05:39.540 --> 00:05:43.470
might derive from
presenting a uniform stance

00:05:43.470 --> 00:05:47.540
on the possession of narcotics."

00:05:47.540 --> 00:05:50.390
This was a hopeful moment
for harm reduction.

00:05:50.390 --> 00:05:54.290
Yet, despite this strong
message from the Supreme Court,

00:05:54.290 --> 00:05:57.770
it was, until very
recently, impossible

00:05:57.770 --> 00:06:00.800
to open up any new
sites in Canada.

00:06:00.800 --> 00:06:02.690
There was one
interesting thing that

00:06:02.690 --> 00:06:06.560
happened in December
of 2016 when

00:06:06.560 --> 00:06:10.400
due to the overdose crisis, the
government of British Columbia

00:06:10.400 --> 00:06:15.170
allowed the opening of
overdose prevention sites.

00:06:15.170 --> 00:06:18.530
Essentially ignoring the
federal approval process,

00:06:18.530 --> 00:06:21.110
community groups
opened up about 22

00:06:21.110 --> 00:06:24.080
of these de facto illegal
supervised injection

00:06:24.080 --> 00:06:26.600
sites across the province.

00:06:26.600 --> 00:06:29.000
Virtually overnight,
thousands of people

00:06:29.000 --> 00:06:31.160
could use drugs
under supervision.

00:06:31.160 --> 00:06:33.200
Hundreds of overdoses
were reversed

00:06:33.200 --> 00:06:36.530
by naloxone and nobody died.

00:06:36.530 --> 00:06:40.370
In fact, this is what's happened
at INSITE over the last 14

00:06:40.370 --> 00:06:41.200
years.

00:06:41.200 --> 00:06:46.340
75,000 different individuals
have injected illegal drugs,

00:06:46.340 --> 00:06:49.580
more than 3 and
1/2 million times,

00:06:49.580 --> 00:06:52.290
and not one person has died.

00:06:52.290 --> 00:06:55.970
Nobody has ever died at INSITE.

00:06:55.970 --> 00:06:58.950


00:06:58.950 --> 00:07:00.150
So there you have it.

00:07:00.150 --> 00:07:04.350
We have scientific
evidence and successes

00:07:04.350 --> 00:07:08.850
from needle exchanges, methadone
and supervised injection sites.

00:07:08.850 --> 00:07:12.300
These are commonsense,
compassionate approaches

00:07:12.300 --> 00:07:16.680
to drug use that improve health,
bring connection, and greatly

00:07:16.680 --> 00:07:20.540
reduce suffering and death.

00:07:20.540 --> 00:07:23.630
So why haven't harm reduction
programs taking off?

00:07:23.630 --> 00:07:30.720
Why do we still think that drug
use is law enforcement issue?

00:07:30.720 --> 00:07:34.460
Our disdain for drugs and
drug users goes very deep.

00:07:34.460 --> 00:07:37.810
We are bombarded with
images and media stories

00:07:37.810 --> 00:07:40.600
about the horrible
impacts of drugs.

00:07:40.600 --> 00:07:43.960
We have stigmatized
entire communities.

00:07:43.960 --> 00:07:48.550
We applaud military inspired
operations that bring down

00:07:48.550 --> 00:07:53.170
drug dealers, and we appear
unfazed by building more jails

00:07:53.170 --> 00:07:58.960
to incarcerate people whose
only crime is using drugs.

00:07:58.960 --> 00:08:01.930
Virtually millions of
people are caught up

00:08:01.930 --> 00:08:04.900
in a hopeless cycle of
incarceration, violence,

00:08:04.900 --> 00:08:09.730
and poverty that has been
created by our drug laws

00:08:09.730 --> 00:08:12.900
and not the drugs themselves.

00:08:12.900 --> 00:08:15.750
How do I explain to people
that drug users deserve

00:08:15.750 --> 00:08:18.960
care and support and the
freedom to live their lives when

00:08:18.960 --> 00:08:25.710
all we see are images of guns
and handcuffs and jail cells?

00:08:25.710 --> 00:08:29.640
Let's be clear,
criminalization is just a way

00:08:29.640 --> 00:08:33.000
to institutionalize stigma.

00:08:33.000 --> 00:08:36.539
Making drugs
illegal does nothing

00:08:36.539 --> 00:08:38.220
to stop people from using them.

00:08:38.220 --> 00:08:41.950


00:08:41.950 --> 00:08:45.280
Our paralysis to see
things differently

00:08:45.280 --> 00:08:49.840
is also based on an entirely
false narrative about drug use.

00:08:49.840 --> 00:08:52.360
We have been led to
believe that drug users are

00:08:52.360 --> 00:08:56.110
irresponsible people who just
want to get high, and then

00:08:56.110 --> 00:08:58.250
through their own
personal failings

00:08:58.250 --> 00:09:02.140
spiral down into a life
of crime and poverty,

00:09:02.140 --> 00:09:07.190
losing their jobs their families
and, ultimately, their lives.

00:09:07.190 --> 00:09:10.860
In reality, most drug
users have a story,

00:09:10.860 --> 00:09:15.170
whether it's childhood trauma,
sexual abuse, mental illness,

00:09:15.170 --> 00:09:16.640
or a personal tragedy.

00:09:16.640 --> 00:09:18.935
The drugs are used
to numb the pain.

00:09:18.935 --> 00:09:22.130


00:09:22.130 --> 00:09:25.940
We must understand
that as we approach

00:09:25.940 --> 00:09:29.210
people with so much trauma.

00:09:29.210 --> 00:09:33.710
At its core our drug policies
are really a social justice

00:09:33.710 --> 00:09:34.210
issue.

00:09:34.210 --> 00:09:37.970
While the media may focus on
overdose deaths like Prince

00:09:37.970 --> 00:09:41.360
and Michael Jackson, the
majority of the suffering

00:09:41.360 --> 00:09:45.710
happens to people who are
living on the margins, the poor

00:09:45.710 --> 00:09:47.570
and the dispossessed.

00:09:47.570 --> 00:09:50.920
They don't vote,
they are often alone.

00:09:50.920 --> 00:09:55.040
They are society's
disposable people.

00:09:55.040 --> 00:09:59.970
Even within health care, drug
use is highly stigmatized.

00:09:59.970 --> 00:10:03.080
People using drugs avoid
the health care system.

00:10:03.080 --> 00:10:05.670
They know that once
engaged in clinical care

00:10:05.670 --> 00:10:08.820
or admitted to hospital,
they will be treated poorly,

00:10:08.820 --> 00:10:11.970
and their supply line, be it
heroin, cocaine or crystal

00:10:11.970 --> 00:10:14.700
meth, will be interrupted.

00:10:14.700 --> 00:10:16.650
On top of that,
they will be asked

00:10:16.650 --> 00:10:21.030
a barrage of questions that only
serve to expose their losses

00:10:21.030 --> 00:10:22.350
and shame.

00:10:22.350 --> 00:10:23.757
What drugs do you use?

00:10:23.757 --> 00:10:25.590
How long have you been
living on the street?

00:10:25.590 --> 00:10:28.320
Where are your children?

00:10:28.320 --> 00:10:30.580
When were you last in jail?

00:10:30.580 --> 00:10:35.950
Essentially, why the hell
don't you stop using drugs?

00:10:35.950 --> 00:10:39.570
In fact, our entire medical
approach to drug use

00:10:39.570 --> 00:10:40.890
is upside down.

00:10:40.890 --> 00:10:45.060
For some reason we have
decided that abstinence

00:10:45.060 --> 00:10:47.970
is the best way to treat this.

00:10:47.970 --> 00:10:51.420
If you're lucky enough, you
may get into a detox program.

00:10:51.420 --> 00:10:54.510
If you live in a community
with suboxone or methadone,

00:10:54.510 --> 00:10:57.480
you may get on a
substitution program.

00:10:57.480 --> 00:11:00.480
Hardly ever would we offer
people what they desperately

00:11:00.480 --> 00:11:06.040
need to survive, a safe
prescription for opioids.

00:11:06.040 --> 00:11:09.880
Starting with abstinence is
like asking a new diabetic

00:11:09.880 --> 00:11:12.700
to quit sugar or
a severe asthmatic

00:11:12.700 --> 00:11:15.250
to start running marathons
or a depressed person

00:11:15.250 --> 00:11:16.480
to just be happy.

00:11:16.480 --> 00:11:18.190
For any other
medical condition, we

00:11:18.190 --> 00:11:21.400
would never start with
the most extreme option.

00:11:21.400 --> 00:11:23.710
What makes us
think that strategy

00:11:23.710 --> 00:11:28.570
would work for something
as complex as addiction?

00:11:28.570 --> 00:11:31.030
Well, unintentional
overdoses are not new.

00:11:31.030 --> 00:11:34.150
The scale of the current
crisis is unprecedented.

00:11:34.150 --> 00:11:39.460
The Center for Disease Control
estimated that 64,000 Americans

00:11:39.460 --> 00:11:43.810
died of a drug overdose in
2016, far exceeding car crashes

00:11:43.810 --> 00:11:45.700
or homicides.

00:11:45.700 --> 00:11:49.270
Drug related mortality
is now the leading cause

00:11:49.270 --> 00:11:52.600
of death among men and
women between 20 and 50

00:11:52.600 --> 00:11:55.150
years old in North America.

00:11:55.150 --> 00:11:57.260
Think about that.

00:11:57.260 --> 00:12:02.290
How did we get to this
point, and why now?

00:12:02.290 --> 00:12:04.960
There is a kind of perfect
storm around opioids.

00:12:04.960 --> 00:12:08.650
Drugs like OxyContin,
Percocet, and Dilaudid

00:12:08.650 --> 00:12:12.160
have been liberally
distributed for decades

00:12:12.160 --> 00:12:14.890
for all kinds of pain.

00:12:14.890 --> 00:12:17.650
It is estimated that two
million Americans are daily

00:12:17.650 --> 00:12:21.700
opioid users, and
over 60 million people

00:12:21.700 --> 00:12:24.550
received at least one
prescription for opioids

00:12:24.550 --> 00:12:26.140
last year.

00:12:26.140 --> 00:12:28.870
This massive dump of
prescription drugs

00:12:28.870 --> 00:12:31.690
into communities has
provided a steady source

00:12:31.690 --> 00:12:35.160
for people wanting
to self-medicate.

00:12:35.160 --> 00:12:38.490
In response to this
prescription epidemic,

00:12:38.490 --> 00:12:41.400
people have been cut
off, and this has greatly

00:12:41.400 --> 00:12:43.860
reduced the street supply.

00:12:43.860 --> 00:12:46.460
The unintended but
predictable consequences

00:12:46.460 --> 00:12:48.360
is an overdose epidemic.

00:12:48.360 --> 00:12:52.170
Many people who were reliant on
a steady supply of prescription

00:12:52.170 --> 00:12:56.460
drugs turned to heroin and,
now, the illegal drug market

00:12:56.460 --> 00:12:58.890
has tragically switched
to synthetic drugs,

00:12:58.890 --> 00:13:01.140
mainly fentanyl.

00:13:01.140 --> 00:13:05.370
These new drugs are cheap,
potent, and extremely hard

00:13:05.370 --> 00:13:06.450
to dose.

00:13:06.450 --> 00:13:08.585
People are literally
being poisoned.

00:13:08.585 --> 00:13:11.470


00:13:11.470 --> 00:13:14.260
Can you imagine if
this was any other kind

00:13:14.260 --> 00:13:15.830
of poisoning epidemic?

00:13:15.830 --> 00:13:17.590
What if thousands
of people started

00:13:17.590 --> 00:13:22.060
dying from poisoned meat
or baby formula or coffee?

00:13:22.060 --> 00:13:24.340
We would be treating
this as a true emergency.

00:13:24.340 --> 00:13:28.000
We would immediately be
supplying safer alternatives.

00:13:28.000 --> 00:13:30.020
There would be changes
in legislation,

00:13:30.020 --> 00:13:34.420
and we would be supporting the
victims and their families.

00:13:34.420 --> 00:13:36.390
But for the drug
overdose epidemic

00:13:36.390 --> 00:13:38.430
we have done none of that.

00:13:38.430 --> 00:13:41.730
We continue to demonize the
drugs and the people who

00:13:41.730 --> 00:13:46.500
use them, and blindly
pour even more resources

00:13:46.500 --> 00:13:48.120
into law enforcement.

00:13:48.120 --> 00:13:50.890


00:13:50.890 --> 00:13:53.560
So where should we go from here?

00:13:53.560 --> 00:13:57.070
First, we should
fully embrace, fund,

00:13:57.070 --> 00:14:00.490
and scale up harm reduction
programs across North America.

00:14:00.490 --> 00:14:03.340
I know that in places
like Vancouver,

00:14:03.340 --> 00:14:07.450
harm reduction has been a
lifeline to care and treatment.

00:14:07.450 --> 00:14:09.820
I know that the number
of overdose deaths

00:14:09.820 --> 00:14:13.180
would be far higher
without harm reduction,

00:14:13.180 --> 00:14:18.810
and I personally know hundreds
of people who are alive today

00:14:18.810 --> 00:14:21.810
because of harm reduction.

00:14:21.810 --> 00:14:23.750
But harm reduction
is just the start.

00:14:23.750 --> 00:14:28.070
If we truly want to make an
impact on this drug crisis,

00:14:28.070 --> 00:14:31.940
we need to have a serious
conversation about prohibition

00:14:31.940 --> 00:14:34.490
and criminal punishment.

00:14:34.490 --> 00:14:38.660
We need to recognize that drug
use is, first and foremost,

00:14:38.660 --> 00:14:46.280
a public health issue and turn
to comprehensive social and

00:14:46.280 --> 00:14:48.900
health solutions.

00:14:48.900 --> 00:14:50.880
We already have a model
for how this can work.

00:14:50.880 --> 00:14:54.390
In 2001 Portugal was
having its own drug crisis.

00:14:54.390 --> 00:14:57.600
Lots of people using
drugs, high crime rates,

00:14:57.600 --> 00:14:59.490
and an overdose epidemic.

00:14:59.490 --> 00:15:03.390
They defied global conventions
and decriminalized all drug

00:15:03.390 --> 00:15:04.830
possession.

00:15:04.830 --> 00:15:07.290
Money that was spent
on drug enforcement

00:15:07.290 --> 00:15:11.100
was redirected to health
and rehabilitation programs.

00:15:11.100 --> 00:15:13.050
The results are in.

00:15:13.050 --> 00:15:17.240
Overall drug use is
down dramatically.

00:15:17.240 --> 00:15:19.950
Overdoses are uncommon.

00:15:19.950 --> 00:15:24.140
Many more people
are in treatment,

00:15:24.140 --> 00:15:26.760
and people have been
given their lives back.

00:15:26.760 --> 00:15:29.330


00:15:29.330 --> 00:15:32.000
We have come so
far down the road

00:15:32.000 --> 00:15:36.110
of prohibition, punishment, and
prejudice that we have become

00:15:36.110 --> 00:15:38.120
indifferent to the
suffering that we

00:15:38.120 --> 00:15:40.850
have inflicted on the
most vulnerable people

00:15:40.850 --> 00:15:42.320
in our society.

00:15:42.320 --> 00:15:45.920
This year even more
people will get caught up

00:15:45.920 --> 00:15:48.620
in the illegal drug trade.

00:15:48.620 --> 00:15:52.940
Thousands of children will learn
that their mother or father

00:15:52.940 --> 00:15:57.840
has been sent to
jail for using drugs.

00:15:57.840 --> 00:16:00.900
And far too many
parents will be notified

00:16:00.900 --> 00:16:06.470
that their son or daughter
has died of a drug overdose.

00:16:06.470 --> 00:16:10.580
It doesn't have to be this way.

00:16:10.580 --> 00:16:12.430
Thank you.

00:16:12.430 --> 00:16:18.302