By Dr David Laing Dawson
Many years ago I attended a presentation on an illicit drug ban conducted in an Asian country. I think all the opium dens were closed. Over the next ten years, presented in graph form, the dramatic fall in Opium use was an almost perfect mirror image of the rise of heroin use. So, in reality, this intervention pushed people to engage in even riskier behaviour.
During those same years in North America, the rise in the numbers of therapists conducting marital therapy, exactly followed the rising number of (newly more acceptable) divorces. It seemed to me then that marital therapy was not an intervention to help people in their relationships, but rather an industry taking advantage of a social trend.
I recently wondered about Insite, the clean needle, safe injection site in Vancouver. After much controversy in the early 2000’s and battles with the Conservative Government of Canada, it has been funded and fully operational for over a dozen years. I understand the rationale, and it makes perfect sense, along with the fact that, on a survey, 75% of addicts said they would be willing to use a safe injection site. Clean needles will prevent the spread of hepatitis and HIV. Staff on hand can intervene with overdoses. Addicts can be referred to programs. Other health needs can be addressed.
So what has happened at Insite between 2012 and January 2019?
2015 stats show:
263,713 visits by 6532 individuals.
722 visits per day
440 injection room visits per day
768 overdose incidents
No overdose deaths.
175,464 visits by 7,301 individuals
537 visits per day
415 injection room visits per day
2151 overdose incidents
And, overall, deaths by overdose in B.C. have dramatically risen from 270 in 2012 to 1486 in 2017, and then 1510 in 2018.
During this same period death by overdose of prescribed drugs has fallen (and comprises only a small fraction of the total), while illicit fentanyl has flooded the market.
I am not trying to draw any cause and effect conclusion here, but rather to point out that we humans are a puzzling and contrary species. Interventions aimed at bucking trends and changing behaviour, no matter how much they are based on science, numbers, common sense, can be way off the mark, may even produce opposite results and many unintended consequences.
Just looking at the above raw data I would have to wonder A. Without Insite would the deaths by overdose in 2018 have been 2510, a thousand more? B. Has the presence of Insite and all the de- stigmatization/acceptance surrounding it, actually removed psychological barriers that would otherwise prevent people from becoming addicted and engaging in increasingly risky behaviour? and C. Has the tightening of prescription opioid practices simply opened a market for illegal fentanyl and carfentanyl and pushed a whole population toward more dangerous drugs?
Has it been a good intervention broadly speaking or has it actually contributed to or even accelerated a social trend?
Or is it, like marital therapy, good for a few people but absolutely ineffective bucking a complex social evolution?
There has been a bit of a plateau in deaths by overdose in 2018 continuing so far in 2019. So maybe this social trend is peaking, and maybe it has very little to do with any of our well intended interventions.