Chief Coroner’s Report of the Task Force into Illicit Narcotic Overdose Deaths

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In June of 1993 the Minister of Health and the Attorney General of British Columbia announced that the Chief Coroner of BC, Vince Cain, had been assigned to head a task force to inquire into the high number of deaths associated with the use of heroin. Vince Cain held a number of meetings to determine the exact terms of reference for the task force, and after seven months of such meetings and other governmental rigamarole, the task force was ready to begin its inquiries in earnest by January of 1994.

Cain spent January and February travelling the province with two assistants, holding private meetings with people directly involved in or affected by the problems caused by illegal narcotics. From March until the beginning of June the task force returned to the same locations and held public meetings to receive input from anyone who felt they had something to offer to the inquiry. The final meeting was held at Carnegie Centre (Hastings & Main) on June 9th. During the months of June, July and August the task force conducted research in order to bridge the gap between anecdotal tales and statistical information.

Although the report was originally due to be released in September, it was held up for unspecified reasons by the Attorney General’s office until mid-January 1995, when it was finally released to the public.

The full title of the Coroner’s Report is: Report of the Task Force into Illicit Narcotic Overdose Deaths in British Columbia. The report is divided into eight chapters, as follows:


THE ADDICT

The first chapter of the report concerns itself with the users of illegal drugs. The Chief Coroner writes that: all kinds of people, from all walks of life, can get caught up in substance abuse, and that drug users come in all sizes and shapes: all colours, sexes, professions, and socioeconomic backgrounds. Nevertheless, the media portrays the most visible, most overtly controversial, most socially and economically depressed people as addicts.

Despite this, Cain seems to have discovered a “common thread” which was present in each addict: a lack of self-esteem. He writes that: they indicated they had been told consistently that they were `low-life’, for want of translation, nothing more than a piece of `feces’, and that they would never amount to anything in life.

Cain concludes the chapter with the thought that, because there is so much variation between addicts, we must accept the fact that there is no single `magic bullet’ solution… Instead, solutions must be multi-faceted and must fit within the social, psychological, and philosophical context of the individual user. These solutions must also fit within a hierarchy of goals ranging from facilitating safe use of illicit drugs to facilitating detox and addiction treatment for those motivated to discontinue their drug use.

THE EPIDEMIOLOGY OF OVERDOSE DEATHS IN BC

The second chapter of the Chief Coroner’s Report looks at the statistics surrounding overdose deaths in British Columbia. Cain writes that:
over the past few years, there has been a dramatic increase in the prevalence of intravenous drug abuse of heroin and cocaine as the preferred route of administration.

In 1993, death attributed to illicit drug abuse became the leading cause of death among both males and females between 30 and 44 years of age, the ratio of male to female deaths being about 4.5 to 1. The number of such deaths in British Columbia has increased from 39 in 1988 to 331 in 1993, an eightfold increase over six years.

About 60% of these deaths occurred in Metro Vancouver, with the remainder being scattered across the province. In terms of the number of deaths per capita, Vancouver is still far ahead with almost 50 deaths per 100,000 population, as compared to the provincial average of 14.

The report makes it clear that it is heroin and heroin in combination with alcohol that is responsible for most deaths. Heroin was present in 90% of drug-related deaths, followed by alcohol which was present in almost half of all such deaths. Cocaine by itself accounted for a very small proportion of deaths, although cocaine used with heroin seems to be a more lethal combination.

An addendum to the report which provides information from 1994 indicated that the level of purity of street heroin dropped from a high of about 80% purity in early 1994 to 54% by mid-year, with the indication that it would continue to drop. Drug deaths seem to have levelled off during the months of April to July of 1994, with the hope that this trend will continue.

PUBLIC HEALTH / TREATMENT

Emergency Services
The chapter on Public Health and Treatment deals with the different aspects of the health care system as it relates to drug users. Cain begins with a look at emergency medical services and those that provide them.

He briefly discusses the “miracle drug” naloxone, a narcotic antagonist which displaces heroin from its binding sites in the brain and thus can reverse the effects of a heroin overdose almost immediately. Naloxone, known by the brand name Narcan, was not widely available in ambulances prior to mid 1992, but now all 40 ambulances in the lower mainland carry it.

Although the Chief Coroner recommends that naloxone be made even more widely available, he does relate the difficulty faced by paramedics who administer Narcan to a comatose patient who then wakes up and does not want any further help, even though the effects of the Narcan wear off after an hour and the user can possibly face a further relapse into unconsciousness.

Harm Reduction

Cain continues the chapter with a look at the concept of harm reduction. He writes that:
while terms like legalization, deregulation, decriminalization and free market- phrases with different meanings for different folks- are bandied about, there is one term that actually captures the essence of what most seem to be aiming for: harm reduction.

He quotes some different groups’ definitions of what harm reduction means, and he also quotes the Provincial Health Officer as follows: In short, too much emphasis has been placed on abstinence and not enough emphasis on other strategies that concentrate on reducing the level of harm experienced by users that continue to inject.

Cain introduces the statistic that for every dollar spent on prevention, another eleven dollars is saved on the other side of the scale. He therefore recommends that: the Ministry of Health should assure core funding for needle exchange facilities and programs, undertake strategic planning for the expansion of needle exchange services to provide 24 hour availability as required and mobile units where necessary.


The Ministry of Health should also consider expanding its additional harm reduction services provided from needle exchanges and street clinics to include health care, disease control instruction and supplies, vein care and safe injection information, as well as street drug testing and analysis.

I believe there is a need to conduct several pilot studies on the trial issue of supplying maintenance methadone for appropriate clients from needle exchange and street clinic sites.

Detox

Cain next draws his attention to the issue of detox. He begins the section with a quote which states:
We have to look at the external and internal motivation for addicts. There is a window of opportunity with them which is critically vital…

He explains that there are nine detox facilities in British Columbia, of which four are in Vancouver and two are in Victoria. The others are in New Westminster, Prince George, and Maple Ridge. All but the Maple Ridge and one of the Vancouver detox centres are run by non-profit organizations which receive funding from the Ministry of Health. Cain describes the two main functions of these facilities as being “initial detox and motivating the client to seek further treatment.

Cain reports that: the demand for detox services is high and that most clients stay between two and eight days in full service detox centres, even though longer stays are common. He also explains how he was advised of the variation in treatment protocols, which included: intensive treatment in a residential setting, supportive recovery, intensive treatment in a non-residential setting, out-patient counselling and day programming.

In terms of the drugs used by those in detox, alcohol continues to be the most commonly abused substance. There has however been a dramatic increase in those patients listing heroin as their first drug of choice, up from 229 in 1990-91 to 1,914 in 1992-93. This represents an eight-fold increase in three years. Cocaine saw a rise from 596 to 2,843 over the same period of time, while alcohol hovered around 10,000 and cannabis rose from 206 to 264. The Chief Coroner does offer the explanation that there may be a growing willingness on the part of users to admit to their usage of illegal drugs.

Cain also shows support for the concept of having Detox Centres being closely affiliated with a Residential Supportive Recovery facility. He explains that it is easier for a patient to make the transition between the two if there is already: a familiarity with the environment, the staff, and other patients.

He also underlined the idea that long-term treatment facilities need to accommodates children, otherwise they will continue to lose women who leave treatment at the earliest possible opportunity so as not to lose their children to Social Services.

Methadone

After making these recommendations, Cain looks at the Methadone Maintenance Program. He cites complaints about the “cumbersome and time consuming” federal administration system, specifically: urinalysis having to go through federal labs, frequent bureaucratic delays, and a lack of responsiveness to local concerns. He recommends that since more than half of all Canadian methadone patients are to be found in British Columbia, the provincial government should pursue having responsibility for the methadone dispensing program transferred to the provincial Ministry of Health.

While discussing the success of the Methadone Maintenance Program, Cain describes programs that are being explored in Europe, such as a project in Switzerland which provides for the prescription of heroin, morphine, injectable methadone, and in some cases cocaine.

The committee of the College of Physicians and Surgeons which monitors the Methadone Maintenance Program stated that they felt that heroin and morphine did not fit into the medical treatment model. Despite this, the Chief Coroner reported that the feeling on the street was that users of these drugs are both competent enough to inject their own heroin and responsible enough to ration their own dosages.

Supportive Recovery

The final part of the chapter on Public Health / Treatment deals with supportive recovery. Here the Chief Coroner looks at the concept of “Continuum of Care”, which describes a treatment process which moves: from acute intervention through rehabilitation to maintenance. This is contrasted with the current system which is described as suffering from revolving door syndrome.

To help solve this problem, the Chief Coroner recommends that supportive recovery programs are expanded to provide longer term assistance, that more focus is placed upon community-based, home-type environments, and that recovering addicts be used in a consultant/aide capacity to the staff of detox, treatment and needle exchange programs.

SOCIAL ISSUES

Social Services

After examining the health and treatment issues surrounding the use of illegal drugs, the Chief Coroner moves on to look at some of the broader social issues which need to be addressed along with any changes to drug policy.
He begins by looking at the Ministry of Social Services, and the fact that about 23% of drug-related deaths in an average month occur on Welfare Wednesday and the three days which follow it. The media attention given to this issue was one of the factors which originally led to the creation of the Task Force.

To help solve this problem the Chief Coroner recommends that social assistance payments be staggered throughout the month, and that electronic rent payments to welfare landlords be considered. He also suggests that those who work in social assistance are educated so as to achieve a greater understanding of addicts and addiction.

In terms of housing, the Chief Coroner writes:
if the general public were to witness and experience the hovels that some addicts exist in, they would perhaps better understand why some of these people need alcohol and drugs to face the world day to day.
According to the Chief Coroner, “the typical Social Services drug-involved client tends to be a single female parent.”
He cites a Social Services supervisor who describes the usual scenario as being that “the client is an expert at excuses” who is “so full of denial that she never accepts the critical comment or the offer of help.”
The supervisor continued:
…services are seldom accepted until the effects of her addiction are blatantly threatening the safety of her children.
When this happens there is the threat of her children being taken from her, and these crises often enable some services to be accepted by the client. Most often, however, we are allowed only short term participation and ultimately “the client reverts to old behaviours.”

The supervisor seemed to be realistic about the actual success of unwanted interventions, stating that
services are only effective when the client is ready to receive them. What brings this readiness about is a mystery… Seldom can our intervention strategies take any credit.
The Chief Coroner also pointed out that some hotels in Vancouver’s Downtown Eastside offer discounted beer on Welfare Wednesday and that 80% of Vancouver’s licensed drinking seats are to be found in that area. Since alcohol was involved in almost half of drug-related deaths these facts should be of major concern.

The Chief Coroner recommends that the Ministry of Attorney General reduce the number of licensed drinking seats in the Downtown Eastside and review the “legality and propriety” of offering discount beer on Welfare Wednesday.

Poverty/Unemployment

The next section under the heading of Social Issues is Poverty/Unemployment. The following quotes from this short section indicate the Chief Coroner’s conclusions on the subject.

I would submit that long-term unemployment and dead-end low paying jobs contribute to the rate of substance abuse in our province.

I heard from addicts who say that drugs provide them with a sense of structure… often drug use is the only reprieve from their otherwise troubled and chaotic lives. There is no other meaningful purpose, there are no other alternative activities for them.

It doesn’t take a rocket scientist to figure out that if a person does not have meaningful work to go to after treatment, then he/she is at risk to continue the cycle of drug abuse.

…service providers reiterated the need for meaningful jobs. In fact, many of the recovering addicts we spoke to were now looking towards the substance abuse treatment field for meaningful employment.

Women & Children

The last four sections of the Social Issues chapter deal with different groups in society whom the Chief Coroner felt were worthy of special attention. The first of these are women and children, about whom the Chief Coroner writes that “improved treatment options are urgently needed.” He continues on to say that
services specifically for women and children are extremely limited and fragmented… women identified the biggest single problem as the lack of provision for child care.

Although there are twice as many male users of heroin than females, there are four times as many men in treatment. The Chief Coroner speculates that this is because: women who abuse drugs are more likely than men to be caring for children, few residential programs accept children, and not many women addicts can afford high-quality outside care for their children.

Women are also afraid to admit to drug use for fear of losing their children. One woman is quoted as saying:
I did all the things that Social Services and probation wanted me to do… but I confessed to being an addict. I was honest with social services and they apprehended my son for permanent guardianship.

Cain therefore recommends, among other things, that the Ministry of Social Services provide adequate day care, travel, and financial support to mothers attending substance abuse treatment programs. and that it also review ministry policies and practices which remove children from mothers or families suffering from addiction.

Cain also addresses the issue of drug use during pregnancy and possible negative consequences for the child. He writes that
substance use in pregnancy is often confounded by poverty, poor prenatal care, poor nutrition, a history of sexual and physical abuse, and limited access to appropriate parenting role models.
Although he writes that: for some women and families, having a child can lead to a detoxifying experience, the Chief Coroner also provides statistics to the effect that between 36-46% of infants born in the Eastside of Vancouver have been prenatally exposed to alcohol and other drugs, and that among disabled children in northern BC and the Yukon, fetal exposure to alcohol accounted for about 30% of their disabilities.

The effects of the use of other drugs on the fetus are not quite so clear. Infants that have been prenatally exposed to heroin or other opiates usually experience symptoms of withdrawal including: irritability, tremulousness, sweating, stuffy nose, difficulty feeding due to uncoordinated and inefficient suck, diarrhea and vomiting.

Cocaine is known to cross the placenta and the blood brain barrier, and the Chief Coroner’s report states that:
studies have shown an association between cocaine use during pregnancy and a decrease in birthweight and head circumference. However, the studies caution that this effect on growth is probably compounded by maternal undernutrition and polydrug abuse.

The Chief Coroner strongly praises groups such as the YWCA, Crabtree Corner, SheWay, Vancouver Native Health, the Needle Exchange, and Children’s Hospital, and he recommends that these types of organizations be given increased funding so they can meet the rapidly growing needs of their community.

Family & Youth

The section on families and youth tends to cross many of the topics covered in other sections, but the focus is on the importance of parental examples and the effects of childhood abuse. The Chief Coroner reports that:
many stories were told of the battering and brutality of parents toward each other and toward the children in advanced stages of intoxication. I was advised that nearly all addicts registered at needle exchanges have reported physical and sexual abuse in their homes as children; they are scarred, often for life…

He also looks at the increase of two-income families and the resulting proliferation of “latch key kids” whose parents are unable to provide appropriate guidance and parenting as they have to spend their time earning money. The Chief Coroner contends that youth are seeing drug use and the drug culture as a very viable alternative. Explanations for this included a desire for instant gratification and the high profits to be made in trading drugs.

In terms of the programs and outreach services available for youths, the Chief Coroner writes the following:
Frustration was expressed over bureaucratic red tape which drives the cost of health care up, resulting in few programs being able to meet the rigorous standards. Often people used the expression `Penny wise and pound foolish’…

Many kids in need of help are falling through the gaps in services; this is especially true in the outlying regions.

…people perceived that there was a lack of detox and residential youth services. In some cases, youths were referred to Alberta…

If programs are not accessible during a time of need, often this means the youth will go back to a pattern of abusing.
Treatment must be more attractive, accessible, and creative to abusers, especially those at high risk of becoming abusers in their natural surroundings.

First Nations

In the beginning of the section about aboriginals the Chief Coroner writes:
When I first began this study, it was pointed out that 37-40 percent of the population of Vancouver’s Downtown Eastside are First Nations people. Approximately 30 percent of those registered at the needle exchange near Main and Hastings are native people. It was also stated that alcohol was a greater problem than drugs within this group. That led to the observation that there are some 7,000 seats in beer parlours within a six block radius of Main and Hastings.

Although the Chief Coroner reports that about 10% of drug overdose deaths were First Nations people, he then clarifies that this figure is probably larger because of some natives not being properly identified as such.

In terms of native drug users, the Chief Coroner explains:
the native addict population appears as a visible minority within a visible minority. They were characterized by their brothers and sisters, by social workers, health care workers and law enforcement personnel alike as residents in a state of despair and hopelessness. The native people themselves expressed an internalized feeling of oppression, prodded by public expressions of racism. Not unlike the vast majority of addicts, they have a very low image of self-worth and esteem, the abnormal and unnatural extension of which ends in self-destructive behaviour.

Many of the First Nations people have been subjected to lifelong indignities… the young child or young adult will self-medicate to ease the environmental pain that he/she is suffering.
I inquired of some… why they would leave their communities for a life in the Downtown Eastside of Vancouver. They indicated to me quite clearly and explicitly that they were escaping the various forms of abuse rampant in their own communities.

Eighty percent of the kids on the reserve are doing upwards of 50 Tylenol (plain) a day. A number of high-school kids are taking 20-30 Tylenol a day. Some take them with wine and beer, others with water.

The lack of services and trained service providers in isolated areas was pointed out time and time again.

…funding issues remain the most pressing concern for agencies providing these services… Problems cited by some of the smaller agencies included a lack of open and sincere consultation, no agency visits, excessive reporting demands, favouritism of some agencies above others, and the creation of brokerage funding processes… One administrator called it Bureaucratic Terrorism.

Some of the native services I encountered and others which were described to me reflect a great richness in culture and strengths drawn from the family and native spirituality. The traditional medicine wheel, a fundamental element of native beliefs which incorporates psychological, spiritual, cultural, and emotional areas, is an important part of the teachings of many.

Amongst the aboriginal community in downtown Vancouver there is little mobility and little desire to venture out of the familiar environment of the Corner (Main and Hastings)… Services which need to be provided to this community… must be easily accessible: that is, within walking distance.

The Vancouver Native Health Society clinic cites how
the HIV-positive native faces double discrimination. They are often not welcome in any other environment, even downtown foodbanks.

The Chief Coroner continues that
the much lower life expectancy of an average Downtown Eastside AIDS victim is set at approximately two years. This compares with an average of 12 years for an `uptown’ AIDS case.

Other Disadvantaged Groups

The Chief Coroner used this final section of the Social Issues chapter to explore other groups of people that are at a disadvantage under the current system. Specifically trans-gendered people, people belonging to a racial minority, and those with a dual diagnosis of drug dependency and a psychiatric illness.

The Report deals with the last group first, stating:
…the downtown core has a high concentration of individuals with mental health and behaviour problems, with approximately 200 seriously mentally ill in the downtown core who are not receiving mental health services.

There is a pressing need for the continued priority of [the Ministry of Health’s]housing program, improved and better-funded drop-in centres, and continued training for service providers in all areas of alcohol and drug treatment.

The Chief Corner defines trans-gendered as:
usually a person born as male but who is emotionally and psychologically female
He explains that:
these people are often confused or generically mixed in with transvestites. Many of them may be illiterate, homeless, malnourished, and victimized.

In terms of cultural minorities, the Chief Coroner reports that:
concerns included lack of understanding of different cultural views of addiction and treatment, inability of counselors to serve clients in their own language, insufficient cultural sensitivity on the part of mainstream workers, and lack of substance abuse expertise among ethno-cultural groups and serving agencies.

THE JUSTICE SYSTEM

Police

The Chief Coroner begins his look at the Justice System with the police, and he begins the section on the police with the following quote:
It’s not so much an enforcement issue as it is a larger social issue… If enforcement worked, the US would be drug-free.
This reflects the tone of this section, which is that locking them up and throwing away the key is “not necessarily the answer.”

Cain writes that:
police estimate that 60 percent of non-drug crime in British Columbia is motivated by illicit drug use, or committed in the course of illicit drug activity.

Cain quotes a police officer who compares users of cocaine and heroin. The officer states that cocaine users are generally: high achievers, educated professionals who can afford the drug and use cocaine in the morning to achieve and heroin at night to unwind“.
Heroin-only users, on the other hand, tend to be down-and-outers, lower class, downtown skid road types.

In terms of large-scale traffickers and importers, the Chief Coroner writes:
intelligence indicates that some offshore refugees, of unknown background save for race, find their way into British Columbia and, with previous connections in their homeland, not only obtain and import these drugs, but establish themselves and others in the local distribution of them.

This observation prompted him to recommend that the Ministry of Attorney General:
enter into discussions with the federal Minister of Immigration respecting the need to review and determine the status of non-Canadians who import and traffic in large quantities of narcotics.

Near the end of the section on police Vince Cain makes the telling comment:
one day, society may come to acknowledge that drug users generally don’t fit into the enforcement or criminalization model.

Courts

The next section which the Chief Coroner’s Report deals with under the Justice System is the courts. He explains the: sense of frustration and anger on the part of law enforcement officials towards the courts, and writes that: the reference point in many instances was detention vs. bail, [as] “police see the trafficker making bail and going back into business within 24 hours“.

The fact that many of these individuals are receiving legal aid seemed to make the situation more galling. The Chief Coroner writes that the application of the legal aid program to offenders with previous drug charges is viewed by many as making a mockery of the program.

In explaining how provincial courts deal with the sentencing of drug law criminals, cain writes that:
drug offenders, like all offenders, are subject to four guiding principles of sentencing following conviction. They are:


  1. Rehabilitation
  2. Protection of the public
  3. General deterrence

  4. Specific deterrence

The courts do not recognize punishment as a guiding principle of sentencing.

In further discussing the situation, he makes mention of:
a case in Provincial Court where the judge wondered aloud whether sentencing drug dealers to a large number of years in jail would, in fact, deter others from getting involved in the sale or distribution of large quantities of drugs.

He also discusses the fact that: the British Columbia Court of Appeal has not imposed the maximum sentence of life imprisonment since 1984… When compared with the Alberta and Ontario Appellate Courts, the overall drug sentences in British Columbia appear less severe.

The Chief Coroner ends the section on the court system in a rather odd and contradictory manner. He summarizes in a long paragraph where he states that:
…jail appears to be neither a general deterrent nor a specific deterrent within the corrections system. The only principle remaining is “protection of the public,” and I am frankly unable to find any substantive evidence in support of that. British Columbia has more heroin and cocaine, more traffickers selling at bargain basement prices, more addicts, and more deaths. So, whatever we are doing in this province vis-a-vis the criminalization model, it is not working.

Yet despite these statements he then makes a recommendation that the Ministry of Attorney General:
examine and discuss with the federal Minister of Justice and the Solicitor General of Canada the merits of mandatory maximum life sentences, without parole, for people importing and trafficking in large quantities of narcotic substances.

Corrections

The section on correctional institutions is the final one in the chapter on the Justice System. Cain begins the section with a quote which says: Jail is not the best social institution to deal with our social problems.

In this section the Chief Coroner looks at the situation surrounding dug use in prison, and finds that there are definite differences of opinion when it comes to the effects of incarceration. Some people told him that “jail allowed me to clean up and take a new look,” while others informed him that “I didn’t get started on drugs until I went to jail.”


Regardless, the Chief Coroner reports that:
it is virtually impossible to prevent drugs from coming into correctional facilities, no matter what the security classification…
and that some prison administrators testified that “sometimes drug use can be helpful in `keeping the lid on.'”

The Chief Coroner explains that although needles remain classified as contraband;
the BC Corrections Branch has implemented a policy which makes bleach available to inmates for the cleaning of needles.
Yet despite this acknowledgement of the prevalence of drug use in prison, the Chief Coroner reports that: substance abuse services are lacking in correctional centres, and describes the difficulty of getting onto the Methadone Maintenance Program after having been in prison.
Since the rule is that you have to be using heroin before you can get onto the program, those fresh out of prison are typically denied access to the program until they are able to provide a few samples of “dirty” urine. If a user’s system is clean this means that street drugs must be used before being eligible for the program.

In summarizing the problems of the correctional system, the Chief Coroner writes that:
the institutions are full of individuals who [are]consumers… serving sentences for crimes related to obtaining drugs or for crimes committed under the influence of drugs.
He continues to say that:
we must begin to see those individuals at the bottom of the drug chain as victims of society rather than criminals… we must look at establishing model medical treatment, social engineering and, assistance, rather than criminalization, punishment and incarceration.

COSTS

The chapter on costs is the shortest in the report, covering only one and a half pages. The Chief Coroner begins the chapter by explaining that:
studies abound internationally and nationally in the field of substance abuse. There is a wealth of written materials in this area. Yet, from researchers, policy analysts and bureaucrats alike, I have heard the call for more data, more information, more information, and more research, if government is to make rational effective decisions. To that I respond: `Balderdash!’ The time has come to make decisions…

In 1989 Health and Welfare Canada reported that more British Columbians reported having used marijuana, cocaine, heroin and other drugs than people in any other province. BC also had the highest per capita rate of convictions for possession offenses and the second highest rate for trafficking offenses.

The Chief Coroner “guesstimates” the financial costs of provincial and federal drug policies and drug use in British Columbia for 1989 as follows:

  • $68 million for drug law enforcement (policing, federal prosecutions, corrections, legal aid).
  • $151 million for policing non-drug crimes related to drug use (thefts, B&E, weapons offences, violent crimes).
  • $13.6 million for federal & provincial substance abuse prevention programs.
  • $17 million in treatment services and employee assistance programs.
  • $3.1 million for health care programs for methadone maintenance, needle exchanges and infants of substance abuse mothers.
  • $20.6 million in social assistance for drug users.
  • $39 million in injury claims connected with automobile accidents.

  • $48.3 million reduced workplace productivity and workplace accidents.

This totals $360 million dollars. Adjusted for inflation, the total for 1991 can be estimated at $388 million, and for 1994 at around $500 million. However, this depends on the formula used, as the Chief Coroner cites another formula which estimated the 1989 costs at $653 million. This is compared to about $2 billion in Ontario (1986-87) and $1.2 billion in Quebec (1988).

The Chief Coroner explains that:
the costs seems to be more directly related to maintaining the symptoms and status quo, rather than diverting and redirecting the monies to the root causes and ultimate solutions for these personal and social problems.

The Chief Coroner concludes this short section by describing how:
the majority of those with whom I spoke talked mostly of what it costs to operate and maintain their treatment programs… I didn’t hear much on the costs referred to in this part of the report. Not too many spoke in terms of the millions of dollars being spent on the front end of the system and little was said on what is expended at the back end, except to say that not enough is being provided for the treatment of substance abusers. This usually came out in terms of the human costs. They need help: it is costly and that is where the money should be provided, but is not.

EDUCATION

The Chapter on education begins with the quote that “we should build the fence at the top of the cliff, instead of at the bottom.” Essentially, the Chief Coroner argues that “children copy the adults in their lives,” and that therefore:
without the fundamental value of responsibility instilled at a very young age, it is difficult, but not impossible, for society to retroactively program this value.

Although Cain does admit that:
there is research to demonstrate a resiliency factor among some youths from disadvantaged homes, or from families where there were poor or abusive situations. Some of these children will rise above their background.

In terms of how best to educate people, especially youths, about drug use, Cain states that:
“Just say No”messages are simplistic and no longer relevant in our society… US “drug war” literature was evaluated by many as “too negative and not very helpful.”
He continues to write that:
most people agree that scare tactics don’t work. In my travels I heard many stories of individuals who became curious after listening to anti-drug propaganda at school.
The Chief Coroner concludes that:
youth will experiment. If they discover that the message that they have been given is blatantly wrong, they will be less likely to listen to the very real cautions and messages concerning the more addictive and dangerous drugs.

The Chief Coroner also looks at the two groups whose education could save lives, users in prison and on the street. For the first group, Cain stresses the need for increased education, but cites:
the higher risk behaviours and lower literacy levels of inmates, combined with their general mistrust of information provided by the system, mitigate against standard education programs.
He does not offer any innovative solutions, instead simply stating that: there is a challenge to develop new methods to convey existing and expanding knowledge.

As for street users, the Chief Coroner writes that:
the value of the needle exchange and the outreach workers as the vanguards in the educational process is underlined.

LEGALIZATION / DECRIMINALIZATION

According to the Chief Coroner, the terms legalization and decriminalization: are frustratingly vague and confusing and have different interpretations according to the interpreter. He explains that they: were often used interchangeably as I travelled the province. However, he concludes that: the basic idea is that people shouldn’t get a criminal record for merely using drugs… law enforcement should concentrate on those heavy duty traffickers who import, and sell for profit and greed, and, in so doing, wreak so much misery on the less fortunate users: the `Merchants of misery,’ as I heard them called.

The Chief Coroner also describes another approach to drug use, which is: legalizing and decriminalizing them through a medical treatment plan. He explains that the current BC Methadone program would fall into this category, with strict controls and guidelines.

The Chief Coroner explains that: legalization of illicit drugs has not yet occurred in any country, not even in Holland, where the practice is believed by many to be a legalization of the drugs, but is in fact actually a policy of not enforcing laws which remain on the books. However, the Chief Coroner states that it seems to be generally recognized that decriminalization would: …ameliorate many negative personal, family, and social consequences arising from the punitive criminal effort and therefore he suggests that: society must now reject negative criminal sanctions as the source of social control in drug abuse and turn rather to some other methods of control.

It is clear that the Chief Coroner does support control over at least some drugs, as he writes that: the majority consensus was adverse to… total deregulation of the production, sale and use of narcotics.

In terms of the argument that if British Columbia adopted a “legalized” position, we would have an influx of addicts, the Chief Coroner simply replies: Who is to say? I think it is more important to weigh the social, economic, and public health consequences… and to reflect on the quality of life and the kind of society we wish to build for our children… Continuing on in this vein, the Chief Coroner writes that: the drug problem here cannot be altered through the criminal justice system, the police, the courts, or the corrections system… we have to establish alternatives to imprisonment.

These concepts do not seem to extend to the “Merchants of Misery”, elsewhere referred to as “Distributors of Death”, these being those that: import and distribute drugs for profit and greed. Cain argues that society would benefit:
financially and socially by having the police concentrate specifically on these Merchants and Distributors… The courts would also do well to ensure the incapacitation of these people to the full extent allowed under the law.

The Chief Coroner looks briefly at: the European experience around controlled legalization of certain drugs and reports it as being “positive”. He cites that:
the Merseyside region [in England] has recorded a decrease in drug-related crime since authorizing the prescribing and dispensing of a wide range of previously-illicit drugs, including heroin.

However, he continues that: legalization should not be considered the panacea [as]it would not solve all the anti-social and criminal acts committed by confirmed addicts. The Chief Coroner does add that he doesn’t believe: legalization would increase the incidence of these acts. Instead, what it would do is: create that necessary “window of opportunity” for the addicts and give them a: sensible, reasonable way of dealing with their existence.

SUMMARY OF RECOMMENDATIONS

The Chief Coroner makes a total of sixty-two separate recommendations to the Ministries of Health, Social Services, Attorney General, Education, Aboriginal Affairs, and the College of Physicians and Surgeons. The first recommendation however, is that the Provincial Government:

establish an independent body under the aegis of the Legislative Assembly of the Province, with powers of inquiry into matters relating to the use and abuse of illicit and harmful substances in the province.

The Chief Coroner’s recommendations cover the whole range of social and drug related policy. His recommendations are based upon the ideas of individuality and a minimum of coercion.
The final two recommendations of the report are bound to be the most controversial. They are that the Ministry of Attorney General:

61. Enter into discussions with the federal Ministers of Justice and Health on the propriety and feasibility of decriminalizing the possession and use of specific substances by people shown to be addicted to those specific substances;

62. In concert with the establishment of a Substance Abuse Commission, seriously inquire into the merits of legalizing the possession of some of the so-called “soft” drugs, such as marijuana.

TALKING TO MR CAIN

I spoke to Vince Cain to discuss some concerns that I had about his report. In the report Cain writes that: an addict might well be 35 years of age, but might act like a 10-12 year-old child. Since the users that I know all seem to be of average maturity, I questioned this statement. Mr. Cain responded that this was what he had been told during his hearings, but that he also strongly supported the idea that all cases are unique, and that blanket statements and solutions simply do not work.

I asked the Chief Coroner if it was possible to use heroin and not be an addict. He responded by telling me that although some people seemed to manage at having a family, a job and a drug habit, almost always the habit eventually became an addiction and destroyed the user’s life.
He also told me that most of the addicts that spoke to him during the hearings did not support legalization, which he defined as being an essentially unrestricted access to the drug, in a similar manner as alcohol and cigarettes.

I suggested to Mr Cain that perhaps humans have a natural desire to intoxicate themselves, and that this is something our drug policies should reflect. He responded that: life is a quest for happiness, and that while some sought that gratification through possessions, others would use intoxicants.
He told me that most of those with whom he spoke were using drugs to escape pain, and that improving their quality of life would have more of an impact upon their pattern of drug usage than any drug policies.

Mr Cain told me that although the provincial government was very supportive of his report, he had received no response from the federal government and did not expect any. He also told me that the overall response to his report had been much greater than he had anticipated, and that he had been asked to speak at a number of different organizations, including an upcoming annual meeting of Canadian and American Drug Enforcement Officers in Portland.

DECRIMINALIZATION IN VANCOUVER

On January 16 a meeting was held to discuss Issues Related to Developing a Pilot Project for the Decriminalization of Restricted Drugs in the Downtown Eastside. This meeting was called by Liz Whynot (Unit Health Officer of the Vancouver Health Department) and Barb Daniel (Executive Director of the Downtown Eastside Residents Association).

The meeting was attended by a wide range of individuals, representing all facets of those involved with or affected by drug policy. Those present included John Turvey (Vancouver Needle Exchange), Dr. Allan W. Askey (Deputy Registrar of the BC College of Physicians and Surgeons), Sergeant Bob Taylor (Vancouver Police Department), a representative from the mayor’s office, Vancouver City Councillors Nancy Chiavario and Lynne Kennedy, many other medical professionals, counselors, social workers, and even some users of the substances in question.

The meeting had been called prior to the release of the Chief Coroner’s Report, but the report was certainly well received by most of those who were in attendance at the meeting. Various models for some form of decriminalization of both heroin and cocaine were discussed, with a general consensus being reached that a prescription model would be the most appropriate way to approach the situation.

Many of the potential obstacles to such a scheme were also discussed, such as public opposition to the idea and the difficulty of gaining support from the federal government. Some potential solutions to these problems were put forward, but no final decisions were reached. Agreements were made to break into various subcommittees to examine the various particular questions involved.

The impact of the Coroner’s Report will be magnified by this groundswell of active bureaucratic reform. Although the nature of the system seems to be that any change must be thoroughly examined and cross-examined before being implemented in small increments, the ball has begun to roll and it must not be allowed to lose momentum.

WHAT CAN YOU DO?

If you would like to have your own copy of the Chief Coroner’s Report, then call his office at (604) 660-7746 and ask him to send you one.

If you live in British Columbia, then write a letter to BC’s Attorney General, Colin Gabelman, and/or the Premier, Michael Harcourt, and tell them what you think about the Coroner’s Report.

You can call Colin Gabelman at (604) 387-5008.

If you live in another Province, then contact your Attorney General and tell him that you think your province should adopt measures like those recommended in the Report.

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