0:00:00.810,0:00:05.119
I remember the first time[br]that I saw people injecting drugs.

0:00:06.090,0:00:09.616
I had just arrived in Vancouver[br]to lead a research project

0:00:09.640,0:00:14.472
in HIV prevention in the[br]infamous Downtown East Side.

0:00:15.100,0:00:17.626
It was in the lobby of the Portland Hotel,

0:00:17.650,0:00:20.536
a supportive housing[br]project that gave rooms

0:00:20.560,0:00:22.936
to the most marginalized[br]people in the city,

0:00:22.960,0:00:25.706
the so-called "difficult to house."

0:00:26.800,0:00:30.190
I'll never forget the young woman[br]standing on the stairs

0:00:30.214,0:00:34.269
repeatedly jabbing herself with a needle,[br]and screaming,

0:00:34.293,0:00:35.746
"I can't find a vein,"

0:00:35.770,0:00:38.404
as blood splattered on the wall.

0:00:40.140,0:00:44.076
In response to the desperate[br]state of affairs, the drug use,

0:00:44.100,0:00:48.756
the poverty, the violence,[br]the soaring rates of HIV,

0:00:48.780,0:00:53.406
Vancouver declared a public[br]health emergency in 1997.

0:00:53.430,0:00:56.826
This opened the door to[br]expanding harm reduction services,

0:00:56.850,0:00:58.506
distributing more needles,

0:00:58.530,0:01:00.300
increasing access to methadone,

0:01:00.324,0:01:04.056
and, finally, opening[br]a supervised injection site.

0:01:04.080,0:01:07.841
Things that make injecting[br]drugs less hazardous.

0:01:08.910,0:01:11.449
But today, 20 years later,

0:01:11.473,0:01:15.786
harm reduction is still viewed[br]as some sort of radical concept.

0:01:15.810,0:01:19.716
In some places, it's still illegal[br]to carry a clean needle.

0:01:19.740,0:01:22.477
Drug users are far more likely[br]to be arrested

0:01:22.501,0:01:24.889
than to be offered methadone therapy.

0:01:25.440,0:01:28.236
Recent proposals for[br]supervised injection sites

0:01:28.260,0:01:31.656
in cities like Seattle,[br]Baltimore and New York

0:01:31.680,0:01:34.013
have been met with stiff opposition:

0:01:34.800,0:01:39.633
opposition that goes against[br]everything we know about addiction.

0:01:40.149,0:01:41.609
Why is that?

0:01:41.633,0:01:44.228
Why are we still stuck on the idea

0:01:44.252,0:01:50.132
that the only option is to stop using --[br]that any drug use will not be tolerated?

0:01:51.060,0:01:54.756
Why do we ignore[br]countless personal stories

0:01:54.780,0:01:57.276
and overwhelming scientific evidence

0:01:57.300,0:01:59.303
that harm reduction works?

0:02:00.980,0:02:04.766
Critics say that harm[br]reduction doesn't stop people

0:02:04.790,0:02:06.439
from using illegal drugs.

0:02:07.034,0:02:09.746
Well, actually, that is the whole point.

0:02:09.770,0:02:12.626
After every criminal and societal sanction

0:02:12.650,0:02:13.975
that we can come up with,

0:02:14.396,0:02:17.911
people still use drugs,[br]and far too many die.

0:02:19.100,0:02:21.896
Critics also say that[br]we are giving up on people

0:02:21.920,0:02:26.316
by not focusing our attention[br]on treatment and recovery.

0:02:26.951,0:02:28.716
In fact, it is just the opposite.

0:02:28.740,0:02:30.217
We are not giving up on people.

0:02:30.241,0:02:32.516
We know that if recovery[br]is ever going to happen

0:02:32.540,0:02:34.706
we must keep people alive.

0:02:34.730,0:02:38.306
Offering someone a clean needle[br]or a safe place to inject

0:02:38.330,0:02:40.899
is the first step to[br]treatment and recovery.

0:02:42.950,0:02:45.386
Critics also claim that harm reduction

0:02:45.410,0:02:48.864
gives the wrong message to[br]our children about drug users.

0:02:49.864,0:02:54.244
The last time I looked,[br]these drug users are our children.

0:02:54.268,0:02:58.316
The message of harm reduction[br]is that while drugs can hurt you,

0:02:58.340,0:03:01.226
we still must reach out to[br]people who are addicted.

0:03:01.250,0:03:05.726
A needle exchange is not an[br]advertisement for drug use.

0:03:05.750,0:03:09.746
Neither is a methadone clinic[br]or a supervised injection site.

0:03:09.770,0:03:12.670
What you see there are[br]people sick and hurting,

0:03:13.160,0:03:16.043
hardly an endorsement for drug use.

0:03:16.876,0:03:19.896
Let's take supervised[br]injection sites, for example.

0:03:19.920,0:03:23.546
Probably the most misunderstood[br]health intervention ever.

0:03:23.570,0:03:26.246
All we are saying is that allowing people

0:03:26.270,0:03:30.107
to inject in a clean, dry space[br]with fresh needles,

0:03:30.131,0:03:32.329
surrounded by people who care

0:03:32.726,0:03:35.868
is a lot better than[br]injecting in a dingy alley,

0:03:35.892,0:03:39.153
sharing contaminated needles[br]and hiding out from police.

0:03:39.470,0:03:41.217
It's better for everybody.

0:03:42.810,0:03:48.278
The first supervised injection site[br]in Vancouver was at 327 Carol Street,

0:03:48.794,0:03:54.126
a narrow room with a concrete floor,[br]a few chairs and a box of clean needles.

0:03:54.150,0:03:56.436
The police would often lock it down,

0:03:56.460,0:04:00.190
but somehow it always[br]mysteriously reopened,

0:04:00.493,0:04:02.594
often with the aid of a crowbar.

0:04:03.720,0:04:05.466
I would go down there some evenings

0:04:05.490,0:04:08.725
to provide medical care[br]for people who were injecting drugs.

0:04:08.749,0:04:11.916
I was always struck with the[br]commitment and compassion

0:04:11.940,0:04:14.796
of the people who operated[br]and used the site.

0:04:15.240,0:04:18.426
No judgment, no hassles, no fear,

0:04:18.450,0:04:20.431
lots of profound conversation.

0:04:20.455,0:04:23.796
I learned that despite[br]unimaginable trauma,

0:04:23.820,0:04:26.899
physical pain and mental illness,

0:04:26.923,0:04:30.034
that everyone there thought[br]that things would get better.

0:04:30.630,0:04:36.574
Most were convinced that, someday,[br]they'd stop using drugs altogether.

0:04:38.580,0:04:41.946
That room was the forerunner[br]to North America's

0:04:41.970,0:04:46.506
first government-sanctioned[br]supervised injection site, called INSITE.

0:04:46.530,0:04:51.456
It opened in September of 2003[br]as a three-year research project.

0:04:51.480,0:04:56.043
The conservative government was intent on[br]closing it down at the end of the study.

0:04:56.580,0:05:00.426
After eight years,[br]the battle to close INSITE

0:05:00.450,0:05:02.946
went all the way up to[br]Canada's Supreme Court.

0:05:02.970,0:05:04.746
It pitted the government of Canada

0:05:04.770,0:05:08.106
against two people with a[br]long history of drug use

0:05:08.130,0:05:10.593
who knew the benefits of INSITE firsthand:

0:05:10.982,0:05:13.140
Dean Wilson and Shelley Tomic.

0:05:14.370,0:05:19.506
The court ruled in favor[br]of keeping INSITE open by nine to zero.

0:05:19.530,0:05:24.347
The justices were scathing in[br]their response to the government's case.

0:05:24.720,0:05:26.005
And I quote:

0:05:26.029,0:05:30.664
"The effect of denying the services[br]of INSITE to the population that it serves

0:05:30.689,0:05:33.895
and the correlative increase in the risk[br]of death and disease

0:05:33.920,0:05:38.878
to injection drug users[br]is grossly disproportionate to any benefit

0:05:38.902,0:05:41.004
that Canada might derive

0:05:41.028,0:05:45.497
from presenting a uniform stance[br]on the possession of narcotics."

0:05:47.540,0:05:49.913
This was a hopeful moment[br]for harm reduction.

0:05:50.390,0:05:53.802
Yet, despite this strong message[br]from the Supreme Court,

0:05:54.290,0:05:57.005
it was, until very recently,

0:05:57.029,0:06:00.209
impossible to open up[br]any new sites in Canada.

0:06:00.800,0:06:05.855
There was one interesting thing[br]that happened in December of 2016,

0:06:05.879,0:06:08.935
when due to the overdose crisis,

0:06:08.960,0:06:14.213
the government of British Columbia allowed[br]the opening of overdose prevention sites.

0:06:15.117,0:06:18.506
Essentially ignoring the[br]federal approval process,

0:06:18.530,0:06:22.901
community groups opened up[br]about 22 of these de facto illegal

0:06:22.925,0:06:25.694
supervised injection sites[br]across the province.

0:06:26.600,0:06:27.989
Virtually overnight,

0:06:28.013,0:06:31.136
thousands of people could[br]use drugs under supervision.

0:06:31.160,0:06:36.025
Hundreds of overdoses were reversed[br]by Naloxone, and nobody died.

0:06:36.530,0:06:40.847
In fact, this is what's happened[br]at INSITE over the last 14 years:

0:06:41.363,0:06:46.316
75,000 different individuals[br]have injected illegal drugs

0:06:46.340,0:06:49.556
more than three and a half million times,

0:06:49.580,0:06:52.133
and not one person has died.

0:06:52.157,0:06:56.061
Nobody has ever died at INSITE.

0:06:58.950,0:07:00.126
So there you have it.

0:07:00.150,0:07:05.768
We have scientific evidence[br]and successes from needle exchanges

0:07:05.792,0:07:08.826
methadone and supervised injection sites.

0:07:08.850,0:07:13.143
These are common-sense,[br]compassionate approaches to drug use

0:07:13.167,0:07:15.779
that improve health, bring connection

0:07:15.803,0:07:18.834
and greatly reduce suffering and death.

0:07:20.540,0:07:23.606
So why haven't harm reduction[br]programs taken off?

0:07:23.630,0:07:28.883
Why do we still think[br]that drug use is law enforcement issue?

0:07:30.720,0:07:34.362
Our disdain for drugs and[br]drug users goes very deep.

0:07:34.386,0:07:37.786
We are bombarded with[br]images and media stories

0:07:37.810,0:07:40.254
about the horrible impacts of drugs.

0:07:40.600,0:07:43.936
We have stigmatized entire communities.

0:07:43.960,0:07:49.785
We applaud military-inspired operations[br]that bring down drug dealers.

0:07:49.809,0:07:53.146
And we appear unfazed[br]by building more jails

0:07:53.170,0:07:58.566
to incarcerate people whose[br]only crime is using drugs.

0:07:58.960,0:08:01.881
Virtually millions of people are caught up

0:08:01.905,0:08:06.039
in a hopeless cycle[br]of incarceration, violence and poverty

0:08:06.063,0:08:11.857
that has been created by our drug laws[br]and not the drugs themselves.

0:08:12.900,0:08:17.027
How do I explain to people[br]that drug users deserve care and support

0:08:17.051,0:08:18.726
and the freedom to live their lives

0:08:18.750,0:08:24.289
when all we see are images of guns[br]and handcuffs and jail cells?

0:08:25.710,0:08:27.101
Let's be clear:

0:08:27.736,0:08:32.212
criminalization is just a way[br]to institutionalize stigma.

0:08:33.000,0:08:38.420
Making drugs illegal does nothing[br]to stop people from using them.

0:08:41.888,0:08:45.256
Our paralysis to see things differently

0:08:45.280,0:08:49.816
is also based on an entirely[br]false narrative about drug use.

0:08:49.840,0:08:52.087
We have been led to believe[br]that drug users

0:08:52.111,0:08:55.889
are irresponsible people who just[br]want to get high,

0:08:55.913,0:08:58.428
and then through their[br]own personal failings

0:08:58.452,0:09:02.116
spiral down into a life[br]of crime and poverty,

0:09:02.140,0:09:06.076
losing their jobs, their families[br]and, ultimately, their lives.

0:09:07.190,0:09:10.721
In reality, most drug users have a story,

0:09:10.745,0:09:15.146
whether it's childhood trauma,[br]sexual abuse, mental illness

0:09:15.170,0:09:16.616
or a personal tragedy.

0:09:16.640,0:09:19.455
The drugs are used to numb the pain.

0:09:22.130,0:09:28.241
We must understand that[br]as we approach people with so much trauma.

0:09:29.167,0:09:34.186
At its core, our drug policies[br]are really a social justice issue.

0:09:34.210,0:09:39.297
While the media may focus on overdose[br]deaths like Prince and Michael Jackson,

0:09:39.900,0:09:41.399
the majority of the suffering

0:09:41.423,0:09:44.971
happens to people who are[br]living on the margins,

0:09:44.995,0:09:47.121
the poor and the dispossessed.

0:09:47.570,0:09:50.479
They don't vote; they are often alone.

0:09:50.920,0:09:53.812
They are society's disposable people.

0:09:55.040,0:09:59.946
Even within health care,[br]drug use is highly stigmatized.

0:09:59.970,0:10:03.056
People using drugs avoid[br]the health care system.

0:10:03.080,0:10:05.646
They know that once[br]engaged in clinical care

0:10:05.670,0:10:08.780
or admitted to hospital,[br]they will be treated poorly.

0:10:08.804,0:10:12.327
And their supply line, be it heroin,[br]cocaine or crystal meth

0:10:12.351,0:10:13.866
will be interrupted.

0:10:14.700,0:10:18.136
On top of that, they will be asked[br]a barrage of questions

0:10:18.160,0:10:22.326
that only serve[br]to expose their losses and shame.

0:10:22.350,0:10:23.733
"What drugs do you use?"

0:10:23.757,0:10:25.924
"How long have you been[br]living on the street?"

0:10:25.948,0:10:27.638
"Where are your children?"

0:10:28.320,0:10:30.066
"When were you last in jail?"

0:10:30.580,0:10:34.865
Essentially: "Why the hell[br]don't you stop using drugs?"

0:10:35.826,0:10:40.866
In fact, our entire medical[br]approach to drug use is upside down.

0:10:40.890,0:10:42.041
For some reason,

0:10:42.065,0:10:47.318
we have decided that abstinence[br]is the best way to treat this.

0:10:47.970,0:10:51.396
If you're lucky enough,[br]you may get into a detox program.

0:10:51.420,0:10:54.486
If you live in a community[br]with Suboxone or methadone,

0:10:54.510,0:10:56.914
you may get on a substitution program.

0:10:57.480,0:11:01.448
Hardly ever would we offer people[br]what they desperately need to survive:

0:11:01.472,0:11:04.892
a safe prescription for opioids.

0:11:06.040,0:11:10.873
Starting with abstinence is[br]like asking a new diabetic to quit sugar

0:11:10.897,0:11:14.128
or a severe asthmatic[br]to start running marathons

0:11:14.152,0:11:16.456
or a depressed person to just be happy.

0:11:16.480,0:11:18.043
For any other medical condition,

0:11:18.067,0:11:21.090
we would never start with[br]the most extreme option.

0:11:21.400,0:11:23.686
What makes us think that strategy

0:11:23.710,0:11:27.257
would work for something[br]as complex as addiction?

0:11:28.570,0:11:31.006
While unintentional overdoses are not new,

0:11:31.030,0:11:34.126
the scale of the current[br]crisis is unprecedented.

0:11:34.150,0:11:36.944
The Center for Disease Control estimated

0:11:36.968,0:11:42.111
that 64,000 Americans died[br]of a drug overdose in 2016,

0:11:42.135,0:11:44.817
far exceeding car crashes or homicides.

0:11:45.700,0:11:49.771
Drug-related mortality is now[br]the leading cause of death

0:11:49.795,0:11:54.310
among men and women between[br]20 and 50 years old in North America

0:11:55.199,0:11:56.382
Think about that.

0:11:57.133,0:12:01.617
How did we get to this point, and why now?

0:12:02.290,0:12:04.936
There is a kind of perfect[br]storm around opioids.

0:12:04.960,0:12:08.716
Drugs like Oxycontin,[br]Percocet and Dilaudid

0:12:08.740,0:12:14.073
have been liberally distributed[br]for decades for all kinds of pain.

0:12:14.890,0:12:18.763
It is estimated that two million[br]Americans are daily opioid users,

0:12:19.159,0:12:21.676
and over 60 million people

0:12:21.700,0:12:25.446
received at least one prescription[br]for opioids last year.

0:12:26.140,0:12:29.727
This massive dump of[br]prescription drugs into communities

0:12:29.751,0:12:34.314
has provided a steady source[br]for people wanting to self-medicate.

0:12:35.160,0:12:38.092
In response to this prescription epidemic,

0:12:38.490,0:12:42.982
people have been cut off, and this[br]has greatly reduced the street supply

0:12:43.860,0:12:46.502
The unintended but predictable consequence

0:12:46.526,0:12:48.336
is an overdose epidemic.

0:12:48.360,0:12:52.685
Many people who were reliant on[br]a steady supply of prescription drugs

0:12:53.010,0:12:54.161
turned to heroin.

0:12:54.185,0:12:57.717
And now the illegal drug market[br]has tragically switched

0:12:57.741,0:13:00.167
to synthetic drugs, mainly fentanyl.

0:13:01.140,0:13:06.034
These new drugs are cheap,[br]potent and extremely hard to dose.

0:13:06.450,0:13:09.172
People are literally being poisoned.

0:13:11.470,0:13:15.676
Can you imagine if this was[br]any other kind of poisoning epidemic?

0:13:15.700,0:13:18.033
What if thousands of people started dying

0:13:18.057,0:13:21.691
from poisoned meat[br]or baby formula or coffee?

0:13:22.041,0:13:24.316
We would be treating[br]this as a true emergency.

0:13:24.340,0:13:27.976
We would immediately be[br]supplying safer alternatives.

0:13:28.000,0:13:29.996
There would be changes in legislation,

0:13:30.020,0:13:33.266
and we would be supporting[br]the victims and their families.

0:13:34.356,0:13:36.366
But for the drug overdose epidemic,

0:13:36.390,0:13:37.742
we have done none of that.

0:13:38.430,0:13:42.659
We continue to demonize the drugs[br]and the people who use them

0:13:42.683,0:13:48.492
and blindly pour even more resources[br]into law enforcement.

0:13:50.890,0:13:52.818
So where should we go from here?

0:13:53.763,0:13:57.897
First, we should fully embrace,[br]fund and scale up

0:13:57.921,0:14:00.466
harm reduction programs[br]across North America.

0:14:00.490,0:14:03.386
I know that in places like Vancouver,

0:14:03.410,0:14:06.942
harm reduction has been a[br]lifeline to care and treatment.

0:14:07.426,0:14:09.796
I know that the number of overdose deaths

0:14:09.820,0:14:12.796
would be far higher[br]without harm reduction.

0:14:13.180,0:14:18.013
And I personally know hundreds[br]of people who are alive today

0:14:18.810,0:14:20.656
because of harm reduction.

0:14:21.810,0:14:23.726
But harm reduction is just the start.

0:14:23.750,0:14:28.046
If we truly want to make[br]an impact on this drug crisis,

0:14:28.070,0:14:31.916
we need to have a serious[br]conversation about prohibition

0:14:31.940,0:14:33.486
and criminal punishment.

0:14:34.454,0:14:40.271
We need to recognize that drug use is[br]first and foremost a public health issue

0:14:41.358,0:14:47.715
and turn to comprehensive social[br]and health solutions.

0:14:48.900,0:14:51.051
We already have a model[br]for how this can work.

0:14:51.075,0:14:54.366
In 2001, Portugal was[br]having its own drug crisis.

0:14:54.390,0:14:57.576
Lots of people using[br]drugs, high crime rates

0:14:57.600,0:14:59.466
and an overdose epidemic.

0:14:59.490,0:15:04.274
They defied global conventions[br]and decriminalized all drug possession.

0:15:04.830,0:15:07.266
Money that was spent on drug enforcement

0:15:07.290,0:15:10.583
was redirected to health[br]and rehabilitation programs.

0:15:11.060,0:15:12.369
The results are in.

0:15:13.050,0:15:16.280
Overall drug use is down dramatically.

0:15:17.240,0:15:19.812
Overdoses are uncommon.

0:15:19.836,0:15:22.542
Many more people are in treatment.

0:15:24.115,0:15:26.782
And people have been[br]given their lives back.

0:15:29.330,0:15:35.131
We have come so far down the road[br]of prohibition, punishment and prejudice

0:15:35.155,0:15:37.744
that we have become[br]indifferent to the suffering

0:15:37.768,0:15:41.926
that we have inflicted on the[br]most vulnerable people in our society.

0:15:42.320,0:15:45.896
This year even more[br]people will get caught up

0:15:45.920,0:15:47.542
in the illegal drug trade.

0:15:48.620,0:15:52.916
Thousands of children will learn[br]that their mother or father

0:15:52.940,0:15:56.318
has been sent to jail for using drugs.

0:15:57.840,0:16:00.876
And far too many parents will be notified

0:16:00.900,0:16:05.542
that their son or daughter[br]has died of a drug overdose.

0:16:06.454,0:16:08.550
It doesn't have to be this way.

0:16:10.444,0:16:11.594
Thank you.

0:16:11.618,0:16:16.912
(Applause)