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I remember the first time that
I saw people injecting drugs.

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I had just arrived in Vancouver
to lead a research project

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in HIV prevention in the
infamous Downtown East Side.

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It was in the lobby
of the Portland Hotel,

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a supportive housing
project that gave rooms

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to the most marginalized
people in the city,

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the so-called
difficult to house.

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I'll never forget the
young woman standing

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on the stairs repeatedly
jabbing herself with a needle

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and screaming I can't find a vein,

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as blood splattered on the wall.

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In response to the desperate
state of affairs, the drug use,

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the poverty, the violence,
the soaring rates of HIV,

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Vancouver declared a public
health emergency in 1997.

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This opened the door to
expanding harm reduction

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services, distributing more needles,

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increasing access
to methadone, and, finally,

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opening a supervised injection site.

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Things that make injecting
drugs less hazardous.

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But today, 20 years
later, harm reduction

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is still viewed as some
sort of radical concept.

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In some places it's
still illegal to carry

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a clean needle.

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Drug users are far
more likely to be

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arrested than to be
offered methadone therapy.

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Recent proposals for
supervised injection sites

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in cities like Seattle,
Baltimore, and New York

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have been met with
stiff opposition.

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Opposition that goes
against everything

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we know about addiction.

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Why is that?

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Why are we still
stuck on the idea

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that the only option is to stop
using that any drug use will

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not be tolerated?

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Why do we ignore
countless personal stories

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and overwhelming
scientific evidence

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that harm reduction works?

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Critics say that harm
reduction doesn't stop people

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from using illegal drugs.

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Well, actually, that
is the whole point.

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After every criminal
and societal sanction

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that we can come up with
people still use drugs,

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and far too many die.

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Critics also say that we
are giving up on people

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by not focusing our attention
on treatment and recovery.

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In fact, it is
just the opposite.

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We are not giving up on people.

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We know that if recovery
is ever going to happen

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we must keep people alive.

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Offering someone a clean needle
or a safe place to inject

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is the first step to
treatment and recovery.

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Critics also claim
that harm reduction

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gives the wrong message to
our children about drug users.

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The last time I looked, these
drug users are our children.

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The message of harm reduction is
that well, drugs can hurt you.

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We still must reach out to
people who are addicted.

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A needle exchange is not an
advertisement for drug use.

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Neither is a methadone clinic
or a supervised injection site.

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What you see there are
people sick and hurting,

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hardly an endorsement
for drug use.

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Let's take supervised
injection sites, for example.

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Probably the most misunderstood
health intervention ever.

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All we are saying is
that allowing people

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to inject in a clean, dry space
with fresh needles surrounded

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by people who care
is a lot better

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than injecting in a dingy alley
sharing contaminated needles

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and hiding out from police.

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It's better for everybody.

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The first supervised
injection site in Vancouver

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was at 327 Carol
Street, a narrow room

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with a concrete floor,
a few chairs and a box

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of clean needles.

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The police would
often lock it down,

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but somehow it always
mysteriously reopened, often,

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with the aid of a crowbar.

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I would go down
there some evenings

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to provide medical
care for people

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who were injecting drugs.

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I was always struck with a
commitment and compassion

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of the people who operated
and used this site.

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No judgment, no
hassles, no fear,

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lots of profound conversation.

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I learned that despite
unimaginable trauma,

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physical pain, and mental
illness that everyone

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there thought that
things would get better.

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Most were convinced
that some day they'd

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stop using drugs altogether.

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That room was the forerunner
to North America's

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first government sanctioned
supervised injection

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site called INSITE.

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It opened in September of
2003 as a three year research

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project.

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The conservative government
was intent on closing it down

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at the end of the study.

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After eight years, the
battle to close INSITE

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went all the way up to
Canada's Supreme Court.

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It pitted the
government of Canada

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against two people with a
long history of drug use

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who knew the benefits of
INSITE firsthand, Dean

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Wilson and Shelley Tomic.

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The court ruled in
favor of keeping

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INSITE open by nine to zero.

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The justices were
scathing in their response

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to the government's case.

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And I quote, "The effect of
denying the services of INSITE

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to the population that it
serves and the correlate have

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increased in their risk
of death and disease

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to injection drug
users is grossly

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disproportionate to
any benefit that Canada

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might derive from
presenting a uniform stance

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on the possession of narcotics."

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This was a hopeful moment
for harm reduction.

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Yet, despite this strong
message from the Supreme Court,

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it was, until very
recently, impossible

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to open up any new
sites in Canada.

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There was one
interesting thing that

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happened in December
of 2016 when

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due to the overdose crisis, the
government of British Columbia

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allowed the opening of
overdose prevention sites.

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Essentially ignoring the
federal approval process,

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community groups
opened up about 22

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of these de facto illegal
supervised injection

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sites across the province.

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Virtually overnight,
thousands of people

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could use drugs
under supervision.

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Hundreds of overdoses
were reversed

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by naloxone and nobody died.

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In fact, this is what's happened
at INSITE over the last 14

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years.

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75,000 different individuals
have injected illegal drugs,

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more than 3 and
1/2 million times,

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and not one person has died.

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Nobody has ever died at INSITE.

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So there you have it.

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We have scientific
evidence and successes

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from needle exchanges, methadone
and supervised injection sites.

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These are commonsense,
compassionate approaches

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to drug use that improve health,
bring connection, and greatly

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reduce suffering and death.

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So why haven't harm reduction
programs taking off?

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Why do we still think that drug
use is law enforcement issue?

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Our disdain for drugs and
drug users goes very deep.

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We are bombarded with
images and media stories

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about the horrible
impacts of drugs.

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We have stigmatized
entire communities.

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We applaud military inspired
operations that bring down

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drug dealers, and we appear
unfazed by building more jails

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to incarcerate people whose
only crime is using drugs.

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Virtually millions of
people are caught up

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in a hopeless cycle of
incarceration, violence,

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and poverty that has been
created by our drug laws

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and not the drugs themselves.

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How do I explain to people
that drug users deserve

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care and support and the
freedom to live their lives when

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all we see are images of guns
and handcuffs and jail cells?

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Let's be clear,
criminalization is just a way

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to institutionalize stigma.

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Making drugs
illegal does nothing

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to stop people from using them.

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Our paralysis to see
things differently

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is also based on an entirely
false narrative about drug use.

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We have been led to
believe that drug users are

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irresponsible people who just
want to get high, and then

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through their own
personal failings

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spiral down into a life
of crime and poverty,

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losing their jobs their families
and, ultimately, their lives.

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In reality, most drug
users have a story,

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whether it's childhood trauma,
sexual abuse, mental illness,

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or a personal tragedy.

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The drugs are used
to numb the pain.

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We must understand
that as we approach

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people with so much trauma.

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At its core our drug policies
are really a social justice issue.

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While the media may focus on
overdose deaths like Prince

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and Michael Jackson, the
majority of the suffering

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happens to people who are
living on the margins, the poor

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and the dispossessed.

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They don't vote,
they are often alone.

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They are society's
disposable people.

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Even within health care, drug
use is highly stigmatized.

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People using drugs avoid
the health care system.

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They know that once
engaged in clinical care

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or admitted to hospital,
they will be treated poorly,

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and their supply line, be it
heroin, cocaine or crystal

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meth, will be interrupted.

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On top of that,
they will be asked

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a barrage of questions that only
serve to expose their losses

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and shame.

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What drugs do you use?

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How long have you been
living on the street?

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Where are your children?

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When were you last in jail?

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Essentially, why the hell
don't you stop using drugs?

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In fact, our entire medical
approach to drug use

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is upside down.

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For some reason we have
decided that abstinence

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is the best way to treat this.

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If you're lucky enough, you
may get into a detox program.

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If you live in a community
with suboxone or methadone,

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you may get on a
substitution program.

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Hardly ever would we offer
people what they desperately

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need to survive, a safe
prescription for opioids.

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Starting with abstinence is
like asking a new diabetic

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to quit sugar or
a severe asthmatic

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to start running marathons
or a depressed person

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to just be happy.

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For any other
medical condition, we

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would never start with
the most extreme option.

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What makes us
think that strategy

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would work for something
as complex as addiction?

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Well, unintentional
overdoses are not new.

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The scale of the current
crisis is unprecedented.

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The Center for Disease Control
estimated that 64,000 Americans

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died of a drug overdose in
2016, far exceeding car crashes

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or homicides.

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Drug related mortality
is now the leading cause

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of death among men and
women between 20 and 50

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years old in North America.

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Think about that.

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How did we get to this
point, and why now?

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There is a kind of perfect
storm around opioids.

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Drugs like OxyContin,
Percocet, and Dilaudid

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have been liberally
distributed for decades

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for all kinds of pain.

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It is estimated that two
million Americans are daily

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opioid users, and
over 60 million people

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received at least one
prescription for opioids

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last year.

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This massive dump of
prescription drugs

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into communities has
provided a steady source

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for people wanting
to self-medicate.

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In response to this
prescription epidemic,

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people have been cut
off, and this has greatly

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reduced the street supply.

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The unintended but
predictable consequences

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is an overdose epidemic.

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Many people who were reliant on
a steady supply of prescription

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drugs turned to heroin and,
now, the illegal drug market

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has tragically switched
to synthetic drugs,

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mainly fentanyl.

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These new drugs are cheap,
potent, and extremely hard to dose.

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People are literally
being poisoned.

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Can you imagine if
this was any other kind

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of poisoning epidemic?

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What if thousands
of people started

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dying from poisoned meat
or baby formula or coffee?

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We would be treating
this as a true emergency.

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We would immediately be
supplying safer alternatives.

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There would be changes
in legislation,

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and we would be supporting the
victims and their families.

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But for the drug
overdose epidemic

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we have done none of that.

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00:13:38,430 --> 00:13:41,730
We continue to demonize the
drugs and the people who

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use them, and blindly
pour even more resources

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into law enforcement.

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So where should we go from here?

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First, we should
fully embrace, fund,

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and scale up harm reduction
programs across North America.

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I know that in places
like Vancouver,

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harm reduction has been a
lifeline to care and treatment.

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I know that the number
of overdose deaths

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would be far higher
without harm reduction,

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and I personally know hundreds
of people who are alive today

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because of harm reduction.

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But harm reduction
is just the start.

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If we truly want to make an
impact on this drug crisis,

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we need to have a serious
conversation about prohibition

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and criminal punishment.

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We need to recognize that drug
use is, first and foremost,

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a public health issue and turn
to comprehensive social and

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health solutions.

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We already have a model
for how this can work.

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In 2001 Portugal was
having its own drug crisis.

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Lots of people using
drugs, high crime rates,

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and an overdose epidemic.

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They defied global conventions
and decriminalized all drug

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possession.

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Money that was spent
on drug enforcement

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was redirected to health
and rehabilitation programs.

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The results are in.

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Overall drug use is
down dramatically.

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Overdoses are uncommon.

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Many more people
are in treatment,

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and people have been
given their lives back.

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We have come so
far down the road

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of prohibition, punishment, and
prejudice that we have become

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indifferent to the
suffering that we

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have inflicted on the
most vulnerable people

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in our society.

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This year even more
people will get caught up

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in the illegal drug trade.

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Thousands of children will learn
that their mother or father

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has been sent to
jail for using drugs.

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And far too many
parents will be notified

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that their son or daughter
has died of a drug overdose.

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It doesn't have to be this way.

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Thank you.