0:00:00.810,0:00:06.090
I remember the first time that[br]I saw people injecting drugs.

0:00:06.090,0:00:09.640
I had just arrived in Vancouver[br]to lead a research project

0:00:09.640,0:00:15.100
in HIV prevention in the[br]infamous Downtown East Side.

0:00:15.100,0:00:17.650
It was in the lobby[br]of the Portland Hotel,

0:00:17.650,0:00:20.560
a supportive housing[br]project that gave rooms

0:00:20.560,0:00:22.960
to the most marginalized[br]people in the city,

0:00:22.960,0:00:26.800
the so-called[br]difficult to house.

0:00:26.800,0:00:29.200
I'll never forget the[br]young woman standing

0:00:29.200,0:00:32.950
on the stairs repeatedly[br]jabbing herself with a needle

0:00:32.950,0:00:35.770
and screaming I can't find a vein,

0:00:35.770,0:00:40.140
as blood splattered on the wall.

0:00:40.140,0:00:44.100
In response to the desperate[br]state of affairs, the drug use,

0:00:44.100,0:00:48.780
the poverty, the violence,[br]the soaring rates of HIV,

0:00:48.780,0:00:53.430
Vancouver declared a public[br]health emergency in 1997.

0:00:53.430,0:00:56.010
This opened the door to[br]expanding harm reduction

0:00:56.010,0:00:58.530
services, distributing more needles,

0:00:58.530,0:01:01.860
increasing access[br]to methadone, and, finally,

0:01:01.860,0:01:04.080
opening a supervised injection site.

0:01:04.080,0:01:08.910
Things that make injecting[br]drugs less hazardous.

0:01:08.910,0:01:12.240
But today, 20 years[br]later, harm reduction

0:01:12.240,0:01:15.810
is still viewed as some[br]sort of radical concept.

0:01:15.810,0:01:18.540
In some places it's[br]still illegal to carry

0:01:18.540,0:01:19.740
a clean needle.

0:01:19.740,0:01:21.870
Drug users are far[br]more likely to be

0:01:21.870,0:01:25.440
arrested than to be[br]offered methadone therapy.

0:01:25.440,0:01:28.260
Recent proposals for[br]supervised injection sites

0:01:28.260,0:01:31.680
in cities like Seattle,[br]Baltimore, and New York

0:01:31.680,0:01:34.800
have been met with[br]stiff opposition.

0:01:34.800,0:01:37.560
Opposition that goes[br]against everything

0:01:37.560,0:01:40.300
we know about addiction.

0:01:40.300,0:01:41.740
Why is that?

0:01:41.740,0:01:44.190
Why are we still[br]stuck on the idea

0:01:44.190,0:01:48.540
that the only option is to stop[br]using that any drug use will

0:01:48.540,0:01:51.060
not be tolerated?

0:01:51.060,0:01:54.780
Why do we ignore[br]countless personal stories

0:01:54.780,0:01:57.300
and overwhelming[br]scientific evidence

0:01:57.300,0:02:00.980
that harm reduction works?

0:02:00.980,0:02:04.790
Critics say that harm[br]reduction doesn't stop people

0:02:04.790,0:02:07.080
from using illegal drugs.

0:02:07.080,0:02:09.770
Well, actually, that[br]is the whole point.

0:02:09.770,0:02:12.650
After every criminal[br]and societal sanction

0:02:12.650,0:02:15.800
that we can come up with[br]people still use drugs,

0:02:15.800,0:02:19.100
and far too many die.

0:02:19.100,0:02:21.920
Critics also say that we[br]are giving up on people

0:02:21.920,0:02:27.060
by not focusing our attention[br]on treatment and recovery.

0:02:27.060,0:02:28.740
In fact, it is[br]just the opposite.

0:02:28.740,0:02:30.180
We are not giving up on people.

0:02:30.180,0:02:32.540
We know that if recovery[br]is ever going to happen

0:02:32.540,0:02:34.730
we must keep people alive.

0:02:34.730,0:02:38.330
Offering someone a clean needle[br]or a safe place to inject

0:02:38.330,0:02:42.950
is the first step to[br]treatment and recovery.

0:02:42.950,0:02:45.410
Critics also claim[br]that harm reduction

0:02:45.410,0:02:49.980
gives the wrong message to[br]our children about drug users.

0:02:49.980,0:02:54.360
The last time I looked, these[br]drug users are our children.

0:02:54.360,0:02:58.340
The message of harm reduction is[br]that well, drugs can hurt you.

0:02:58.340,0:03:01.250
We still must reach out to[br]people who are addicted.

0:03:01.250,0:03:05.750
A needle exchange is not an[br]advertisement for drug use.

0:03:05.750,0:03:09.770
Neither is a methadone clinic[br]or a supervised injection site.

0:03:09.770,0:03:13.160
What you see there are[br]people sick and hurting,

0:03:13.160,0:03:16.980
hardly an endorsement[br]for drug use.

0:03:16.980,0:03:19.920
Let's take supervised[br]injection sites, for example.

0:03:19.920,0:03:23.570
Probably the most misunderstood[br]health intervention ever.

0:03:23.570,0:03:26.270
All we are saying is[br]that allowing people

0:03:26.270,0:03:30.770
to inject in a clean, dry space[br]with fresh needles surrounded

0:03:30.770,0:03:33.770
by people who care[br]is a lot better

0:03:33.770,0:03:37.460
than injecting in a dingy alley[br]sharing contaminated needles

0:03:37.460,0:03:39.470
and hiding out from police.

0:03:39.470,0:03:42.810
It's better for everybody.

0:03:42.810,0:03:45.810
The first supervised[br]injection site in Vancouver

0:03:45.810,0:03:49.710
was at 327 Carol[br]Street, a narrow room

0:03:49.710,0:03:52.860
with a concrete floor,[br]a few chairs and a box

0:03:52.860,0:03:54.150
of clean needles.

0:03:54.150,0:03:56.460
The police would[br]often lock it down,

0:03:56.460,0:04:00.930
but somehow it always[br]mysteriously reopened, often,

0:04:00.930,0:04:03.720
with the aid of a crowbar.

0:04:03.720,0:04:05.490
I would go down[br]there some evenings

0:04:05.490,0:04:07.380
to provide medical[br]care for people

0:04:07.380,0:04:08.670
who were injecting drugs.

0:04:08.670,0:04:11.940
I was always struck with a[br]commitment and compassion

0:04:11.940,0:04:15.240
of the people who operated[br]and used this site.

0:04:15.240,0:04:18.450
No judgment, no[br]hassles, no fear,

0:04:18.450,0:04:20.560
lots of profound conversation.

0:04:20.560,0:04:23.820
I learned that despite[br]unimaginable trauma,

0:04:23.820,0:04:27.480
physical pain, and mental[br]illness that everyone

0:04:27.480,0:04:30.630
there thought that[br]things would get better.

0:04:30.630,0:04:34.050
Most were convinced[br]that some day they'd

0:04:34.050,0:04:38.580
stop using drugs altogether.

0:04:38.580,0:04:41.970
That room was the forerunner[br]to North America's

0:04:41.970,0:04:44.940
first government sanctioned[br]supervised injection

0:04:44.940,0:04:46.530
site called INSITE.

0:04:46.530,0:04:50.670
It opened in September of[br]2003 as a three year research

0:04:50.670,0:04:51.480
project.

0:04:51.480,0:04:54.690
The conservative government[br]was intent on closing it down

0:04:54.690,0:04:56.580
at the end of the study.

0:04:56.580,0:05:00.450
After eight years, the[br]battle to close INSITE

0:05:00.450,0:05:02.970
went all the way up to[br]Canada's Supreme Court.

0:05:02.970,0:05:04.770
It pitted the[br]government of Canada

0:05:04.770,0:05:08.130
against two people with a[br]long history of drug use

0:05:08.130,0:05:11.250
who knew the benefits of[br]INSITE firsthand, Dean

0:05:11.250,0:05:14.370
Wilson and Shelley Tomic.

0:05:14.370,0:05:16.470
The court ruled in[br]favor of keeping

0:05:16.470,0:05:19.530
INSITE open by nine to zero.

0:05:19.530,0:05:22.590
The justices were[br]scathing in their response

0:05:22.590,0:05:24.720
to the government's case.

0:05:24.720,0:05:28.710
And I quote, "The effect of[br]denying the services of INSITE

0:05:28.710,0:05:31.530
to the population that it[br]serves and the correlate have

0:05:31.530,0:05:33.870
increased in their risk[br]of death and disease

0:05:33.870,0:05:36.690
to injection drug[br]users is grossly

0:05:36.690,0:05:39.540
disproportionate to[br]any benefit that Canada

0:05:39.540,0:05:43.470
might derive from[br]presenting a uniform stance

0:05:43.470,0:05:47.540
on the possession of narcotics."

0:05:47.540,0:05:50.390
This was a hopeful moment[br]for harm reduction.

0:05:50.390,0:05:54.290
Yet, despite this strong[br]message from the Supreme Court,

0:05:54.290,0:05:57.770
it was, until very[br]recently, impossible

0:05:57.770,0:06:00.800
to open up any new[br]sites in Canada.

0:06:00.800,0:06:02.690
There was one[br]interesting thing that

0:06:02.690,0:06:06.560
happened in December[br]of 2016 when

0:06:06.560,0:06:10.400
due to the overdose crisis, the[br]government of British Columbia

0:06:10.400,0:06:15.170
allowed the opening of[br]overdose prevention sites.

0:06:15.170,0:06:18.530
Essentially ignoring the[br]federal approval process,

0:06:18.530,0:06:21.110
community groups[br]opened up about 22

0:06:21.110,0:06:24.080
of these de facto illegal[br]supervised injection

0:06:24.080,0:06:26.600
sites across the province.

0:06:26.600,0:06:29.000
Virtually overnight,[br]thousands of people

0:06:29.000,0:06:31.160
could use drugs[br]under supervision.

0:06:31.160,0:06:33.200
Hundreds of overdoses[br]were reversed

0:06:33.200,0:06:36.530
by naloxone and nobody died.

0:06:36.530,0:06:40.370
In fact, this is what's happened[br]at INSITE over the last 14

0:06:40.370,0:06:41.200
years.

0:06:41.200,0:06:46.340
75,000 different individuals[br]have injected illegal drugs,

0:06:46.340,0:06:49.580
more than 3 and[br]1/2 million times,

0:06:49.580,0:06:52.290
and not one person has died.

0:06:52.290,0:06:55.970
Nobody has ever died at INSITE.

0:06:58.950,0:07:00.150
So there you have it.

0:07:00.150,0:07:04.350
We have scientific[br]evidence and successes

0:07:04.350,0:07:08.850
from needle exchanges, methadone[br]and supervised injection sites.

0:07:08.850,0:07:12.300
These are commonsense,[br]compassionate approaches

0:07:12.300,0:07:16.680
to drug use that improve health,[br]bring connection, and greatly

0:07:16.680,0:07:20.540
reduce suffering and death.

0:07:20.540,0:07:23.630
So why haven't harm reduction[br]programs taking off?

0:07:23.630,0:07:30.720
Why do we still think that drug[br]use is law enforcement issue?

0:07:30.720,0:07:34.460
Our disdain for drugs and[br]drug users goes very deep.

0:07:34.460,0:07:37.810
We are bombarded with[br]images and media stories

0:07:37.810,0:07:40.600
about the horrible[br]impacts of drugs.

0:07:40.600,0:07:43.960
We have stigmatized[br]entire communities.

0:07:43.960,0:07:48.550
We applaud military inspired[br]operations that bring down

0:07:48.550,0:07:53.170
drug dealers, and we appear[br]unfazed by building more jails

0:07:53.170,0:07:58.960
to incarcerate people whose[br]only crime is using drugs.

0:07:58.960,0:08:01.930
Virtually millions of[br]people are caught up

0:08:01.930,0:08:04.900
in a hopeless cycle of[br]incarceration, violence,

0:08:04.900,0:08:09.730
and poverty that has been[br]created by our drug laws

0:08:09.730,0:08:12.900
and not the drugs themselves.

0:08:12.900,0:08:15.750
How do I explain to people[br]that drug users deserve

0:08:15.750,0:08:18.960
care and support and the[br]freedom to live their lives when

0:08:18.960,0:08:25.710
all we see are images of guns[br]and handcuffs and jail cells?

0:08:25.710,0:08:29.640
Let's be clear,[br]criminalization is just a way

0:08:29.640,0:08:33.000
to institutionalize stigma.

0:08:33.000,0:08:36.539
Making drugs[br]illegal does nothing

0:08:36.539,0:08:38.220
to stop people from using them.

0:08:41.950,0:08:45.280
Our paralysis to see[br]things differently

0:08:45.280,0:08:49.840
is also based on an entirely[br]false narrative about drug use.

0:08:49.840,0:08:52.360
We have been led to[br]believe that drug users are

0:08:52.360,0:08:56.110
irresponsible people who just[br]want to get high, and then

0:08:56.110,0:08:58.250
through their own[br]personal failings

0:08:58.250,0:09:02.140
spiral down into a life[br]of crime and poverty,

0:09:02.140,0:09:07.190
losing their jobs their families[br]and, ultimately, their lives.

0:09:07.190,0:09:10.860
In reality, most drug[br]users have a story,

0:09:10.860,0:09:15.170
whether it's childhood trauma,[br]sexual abuse, mental illness,

0:09:15.170,0:09:16.640
or a personal tragedy.

0:09:16.640,0:09:18.935
The drugs are used[br]to numb the pain.

0:09:22.130,0:09:25.940
We must understand[br]that as we approach

0:09:25.940,0:09:29.210
people with so much trauma.

0:09:29.210,0:09:33.710
At its core our drug policies[br]are really a social justice issue.

0:09:34.210,0:09:37.970
While the media may focus on[br]overdose deaths like Prince

0:09:37.970,0:09:41.360
and Michael Jackson, the[br]majority of the suffering

0:09:41.360,0:09:45.710
happens to people who are[br]living on the margins, the poor

0:09:45.710,0:09:47.570
and the dispossessed.

0:09:47.570,0:09:50.920
They don't vote,[br]they are often alone.

0:09:50.920,0:09:55.040
They are society's[br]disposable people.

0:09:55.040,0:09:59.970
Even within health care, drug[br]use is highly stigmatized.

0:09:59.970,0:10:03.080
People using drugs avoid[br]the health care system.

0:10:03.080,0:10:05.670
They know that once[br]engaged in clinical care

0:10:05.670,0:10:08.820
or admitted to hospital,[br]they will be treated poorly,

0:10:08.820,0:10:11.970
and their supply line, be it[br]heroin, cocaine or crystal

0:10:11.970,0:10:14.700
meth, will be interrupted.

0:10:14.700,0:10:16.650
On top of that,[br]they will be asked

0:10:16.650,0:10:21.030
a barrage of questions that only[br]serve to expose their losses

0:10:21.030,0:10:22.350
and shame.

0:10:22.350,0:10:23.757
What drugs do you use?

0:10:23.757,0:10:25.590
How long have you been[br]living on the street?

0:10:25.590,0:10:28.320
Where are your children?

0:10:28.320,0:10:30.580
When were you last in jail?

0:10:30.580,0:10:35.950
Essentially, why the hell[br]don't you stop using drugs?

0:10:35.950,0:10:39.570
In fact, our entire medical[br]approach to drug use

0:10:39.570,0:10:40.890
is upside down.

0:10:40.890,0:10:45.060
For some reason we have[br]decided that abstinence

0:10:45.060,0:10:47.970
is the best way to treat this.

0:10:47.970,0:10:51.420
If you're lucky enough, you[br]may get into a detox program.

0:10:51.420,0:10:54.510
If you live in a community[br]with suboxone or methadone,

0:10:54.510,0:10:57.480
you may get on a[br]substitution program.

0:10:57.480,0:11:00.480
Hardly ever would we offer[br]people what they desperately

0:11:00.480,0:11:06.040
need to survive, a safe[br]prescription for opioids.

0:11:06.040,0:11:09.880
Starting with abstinence is[br]like asking a new diabetic

0:11:09.880,0:11:12.700
to quit sugar or[br]a severe asthmatic

0:11:12.700,0:11:15.250
to start running marathons[br]or a depressed person

0:11:15.250,0:11:16.480
to just be happy.

0:11:16.480,0:11:18.190
For any other[br]medical condition, we

0:11:18.190,0:11:21.400
would never start with[br]the most extreme option.

0:11:21.400,0:11:23.710
What makes us[br]think that strategy

0:11:23.710,0:11:28.570
would work for something[br]as complex as addiction?

0:11:28.570,0:11:31.030
Well, unintentional[br]overdoses are not new.

0:11:31.030,0:11:34.150
The scale of the current[br]crisis is unprecedented.

0:11:34.150,0:11:39.460
The Center for Disease Control[br]estimated that 64,000 Americans

0:11:39.460,0:11:43.810
died of a drug overdose in[br]2016, far exceeding car crashes

0:11:43.810,0:11:45.700
or homicides.

0:11:45.700,0:11:49.270
Drug related mortality[br]is now the leading cause

0:11:49.270,0:11:52.600
of death among men and[br]women between 20 and 50

0:11:52.600,0:11:55.150
years old in North America.

0:11:55.150,0:11:57.260
Think about that.

0:11:57.260,0:12:02.290
How did we get to this[br]point, and why now?

0:12:02.290,0:12:04.960
There is a kind of perfect[br]storm around opioids.

0:12:04.960,0:12:08.650
Drugs like OxyContin,[br]Percocet, and Dilaudid

0:12:08.650,0:12:12.160
have been liberally[br]distributed for decades

0:12:12.160,0:12:14.890
for all kinds of pain.

0:12:14.890,0:12:17.650
It is estimated that two[br]million Americans are daily

0:12:17.650,0:12:21.700
opioid users, and[br]over 60 million people

0:12:21.700,0:12:24.550
received at least one[br]prescription for opioids

0:12:24.550,0:12:26.140
last year.

0:12:26.140,0:12:28.870
This massive dump of[br]prescription drugs

0:12:28.870,0:12:31.690
into communities has[br]provided a steady source

0:12:31.690,0:12:35.160
for people wanting[br]to self-medicate.

0:12:35.160,0:12:38.490
In response to this[br]prescription epidemic,

0:12:38.490,0:12:41.400
people have been cut[br]off, and this has greatly

0:12:41.400,0:12:43.860
reduced the street supply.

0:12:43.860,0:12:46.460
The unintended but[br]predictable consequences

0:12:46.460,0:12:48.360
is an overdose epidemic.

0:12:48.360,0:12:52.170
Many people who were reliant on[br]a steady supply of prescription

0:12:52.170,0:12:56.460
drugs turned to heroin and,[br]now, the illegal drug market

0:12:56.460,0:12:58.890
has tragically switched[br]to synthetic drugs,

0:12:58.890,0:13:01.140
mainly fentanyl.

0:13:01.140,0:13:05.370
These new drugs are cheap,[br]potent, and extremely hard to dose.

0:13:06.450,0:13:08.585
People are literally[br]being poisoned.

0:13:11.470,0:13:14.260
Can you imagine if[br]this was any other kind

0:13:14.260,0:13:15.830
of poisoning epidemic?

0:13:15.830,0:13:17.590
What if thousands[br]of people started

0:13:17.590,0:13:22.060
dying from poisoned meat[br]or baby formula or coffee?

0:13:22.060,0:13:24.340
We would be treating[br]this as a true emergency.

0:13:24.340,0:13:28.000
We would immediately be[br]supplying safer alternatives.

0:13:28.000,0:13:30.020
There would be changes[br]in legislation,

0:13:30.020,0:13:34.420
and we would be supporting the[br]victims and their families.

0:13:34.420,0:13:36.390
But for the drug[br]overdose epidemic

0:13:36.390,0:13:38.430
we have done none of that.

0:13:38.430,0:13:41.730
We continue to demonize the[br]drugs and the people who

0:13:41.730,0:13:46.500
use them, and blindly[br]pour even more resources

0:13:46.500,0:13:48.120
into law enforcement.

0:13:50.890,0:13:53.560
So where should we go from here?

0:13:53.560,0:13:57.070
First, we should[br]fully embrace, fund,

0:13:57.070,0:14:00.490
and scale up harm reduction[br]programs across North America.

0:14:00.490,0:14:03.340
I know that in places[br]like Vancouver,

0:14:03.340,0:14:07.450
harm reduction has been a[br]lifeline to care and treatment.

0:14:07.450,0:14:09.820
I know that the number[br]of overdose deaths

0:14:09.820,0:14:13.180
would be far higher[br]without harm reduction,

0:14:13.180,0:14:18.810
and I personally know hundreds[br]of people who are alive today

0:14:18.810,0:14:21.810
because of harm reduction.

0:14:21.810,0:14:23.750
But harm reduction[br]is just the start.

0:14:23.750,0:14:28.070
If we truly want to make an[br]impact on this drug crisis,

0:14:28.070,0:14:31.940
we need to have a serious[br]conversation about prohibition

0:14:31.940,0:14:34.490
and criminal punishment.

0:14:34.490,0:14:38.660
We need to recognize that drug[br]use is, first and foremost,

0:14:38.660,0:14:46.280
a public health issue and turn[br]to comprehensive social and

0:14:46.280,0:14:48.900
health solutions.

0:14:48.900,0:14:50.880
We already have a model[br]for how this can work.

0:14:50.880,0:14:54.390
In 2001 Portugal was[br]having its own drug crisis.

0:14:54.390,0:14:57.600
Lots of people using[br]drugs, high crime rates,

0:14:57.600,0:14:59.490
and an overdose epidemic.

0:14:59.490,0:15:03.390
They defied global conventions[br]and decriminalized all drug

0:15:03.390,0:15:04.830
possession.

0:15:04.830,0:15:07.290
Money that was spent[br]on drug enforcement

0:15:07.290,0:15:11.100
was redirected to health[br]and rehabilitation programs.

0:15:11.100,0:15:13.050
The results are in.

0:15:13.050,0:15:17.240
Overall drug use is[br]down dramatically.

0:15:17.240,0:15:19.950
Overdoses are uncommon.

0:15:19.950,0:15:24.140
Many more people[br]are in treatment,

0:15:24.140,0:15:26.760
and people have been[br]given their lives back.

0:15:29.330,0:15:32.000
We have come so[br]far down the road

0:15:32.000,0:15:36.110
of prohibition, punishment, and[br]prejudice that we have become

0:15:36.110,0:15:38.120
indifferent to the[br]suffering that we

0:15:38.120,0:15:40.850
have inflicted on the[br]most vulnerable people

0:15:40.850,0:15:42.320
in our society.

0:15:42.320,0:15:45.920
This year even more[br]people will get caught up

0:15:45.920,0:15:48.620
in the illegal drug trade.

0:15:48.620,0:15:52.940
Thousands of children will learn[br]that their mother or father

0:15:52.940,0:15:57.840
has been sent to[br]jail for using drugs.

0:15:57.840,0:16:00.900
And far too many[br]parents will be notified

0:16:00.900,0:16:06.470
that their son or daughter[br]has died of a drug overdose.

0:16:06.470,0:16:10.580
It doesn't have to be this way.

0:16:10.580,0:16:12.430
Thank you.