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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 on the stairs

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repeatedly jabbing herself with a needle,
and screaming,

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"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 services,

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distributing more needles,

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increasing access to methadone,

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and, finally, 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,

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harm reduction is still viewed
as some sort of radical concept.

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In some places, it's still illegal
to carry a clean needle.

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Drug users are far more likely
to be arrested

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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 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 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,

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people still use drugs,
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 while 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,

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surrounded by people who care

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is a lot better than
injecting in a dingy alley,

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sharing contaminated needles
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 was at 327 Carol Street,

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a narrow room with a concrete floor,
a few chairs and a box of clean needles.

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The police would often lock it down,

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but somehow it always
mysteriously reopened,

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often 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 who were injecting drugs.

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I was always struck with the
commitment and compassion

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of the people who operated
and used the 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,

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that everyone there thought
that things would get better.

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Most were convinced that, someday,
they'd 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 site, called INSITE.

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It opened in September of 2003
as a three-year research project.

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The conservative government was intent on
closing it down 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:

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Dean Wilson and Shelley Tomic.

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The court ruled in favor
of keeping INSITE open by nine to zero.

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The justices were scathing in
their response to the government's case.

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And I quote:

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"The effect of denying the services
of INSITE to the population that it serves

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and the correlative increase in the risk
of death and disease

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to injection drug users
is grossly disproportionate to any benefit

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that Canada might derive

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from presenting a uniform stance
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,

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impossible to open up
any new sites in Canada.

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There was one interesting thing
that happened in December of 2016,

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when due to the overdose crisis,

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the government of British Columbia 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 of these de facto illegal

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supervised injection sites
across the province.

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Virtually overnight,

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thousands of people could
use drugs under supervision.

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Hundreds of overdoses were reversed
by Naloxone, and nobody died.

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

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75,000 different individuals
have injected illegal drugs

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more than three and a half 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 from needle exchanges

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methadone and supervised injection sites.

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These are common-sense,
compassionate approaches to drug use

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that improve health, bring connection

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and greatly reduce suffering and death.

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So why haven't harm reduction
programs taken 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 drug dealers.

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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 and poverty

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that has been created by our drug laws
and not the drugs themselves.

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How do I explain to people
that drug users deserve care and support

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and the freedom to live their lives

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

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Let's be clear:

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criminalization is just a way
to institutionalize stigma.

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Making drugs illegal does nothing
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

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are irresponsible people who just
want to get high,

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and then 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 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 and Michael Jackson,

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the majority of the suffering

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happens to people who are
living on the margins,

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the poor 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 meth

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will be interrupted.

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On top of that, they will be asked
a barrage of questions

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that only serve
to expose their losses 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 is upside down.

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For some reason,

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we have decided that abstinence
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 need to survive:

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a safe prescription for opioids.

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Starting with abstinence is
like asking a new diabetic to quit sugar

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or a severe asthmatic
to start running marathons

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or a depressed person to just be happy.

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For any other medical condition,

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we 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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While 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

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that 64,000 Americans died
of a drug overdose in 2016,

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far exceeding car crashes or homicides.

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Drug-related mortality is now
the leading cause of death

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among men and women between
20 and 50 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 for all kinds of pain.

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It is estimated that two million
Americans are daily opioid users,

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and over 60 million people

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received at least one prescription
for opioids last year.

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This massive dump of
prescription drugs into communities

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has provided a steady source
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 reduced the street supply

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The unintended but predictable consequence

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is an overdose epidemic.

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Many people who were reliant on
a steady supply of prescription drugs

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turned to heroin.

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And now the illegal drug market
has tragically switched

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to synthetic drugs, 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 of poisoning epidemic?

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What if thousands of people started dying

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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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We continue to demonize the drugs
and the people who use them

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and blindly pour even more resources
into law enforcement.

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So where should we go from here?

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First, we should fully embrace,
fund and scale up

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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 a public health issue

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and turn to comprehensive social
and 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 possession.

246
00:15:04,830 --> 00:15:07,266
Money that was spent on drug enforcement

247
00:15:07,290 --> 00:15:10,583
was redirected to health
and rehabilitation programs.

248
00:15:11,060 --> 00:15:12,369
The results are in.

249
00:15:13,050 --> 00:15:16,280
Overall drug use is down dramatically.

250
00:15:17,240 --> 00:15:19,812
Overdoses are uncommon.

251
00:15:19,836 --> 00:15:22,542
Many more people are in treatment.

252
00:15:24,115 --> 00:15:26,782
And people have been
given their lives back.

253
00:15:29,330 --> 00:15:35,131
We have come so far down the road
of prohibition, punishment and prejudice

254
00:15:35,155 --> 00:15:37,744
that we have become
indifferent to the suffering

255
00:15:37,768 --> 00:15:41,926
that we have inflicted on the
most vulnerable people in our society.

256
00:15:42,320 --> 00:15:45,896
This year even more
people will get caught up

257
00:15:45,920 --> 00:15:47,542
in the illegal drug trade.

258
00:15:48,620 --> 00:15:52,916
Thousands of children will learn
that their mother or father

259
00:15:52,940 --> 00:15:56,318
has been sent to jail for using drugs.

260
00:15:57,840 --> 00:16:00,876
And far too many parents will be notified

261
00:16:00,900 --> 00:16:05,542
that their son or daughter
has died of a drug overdose.

262
00:16:06,454 --> 00:16:08,550
It doesn't have to be this way.

263
00:16:10,444 --> 00:16:11,594
Thank you.

264
00:16:11,618 --> 00:16:16,912
(Applause)