Daphne Bramham: When it comes to drug policy, politicians aren’t following the evidence

Opinion: Why are our politicians ignoring experts on booze and drugs?

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Every day since COVID-19 struck, we’ve been told that evidence matters, that we need to listen to the scientists and researchers.

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Yet, when it comes to drugs, our provincial and municipal governments figure they know better and pay little or no attention. It seems they’d rather give people what they want and damn the consequences.

The B.C. government’s announcements last week that cocktails can now be delivered along with meals and that cannabis stores can now legally do dial-a-dope were greeted enthusiastically. The same has been true of announcements by various municipalities that they are expanding their zones where people can openly drink alcohol.

Cannabis remains mostly a no-go for parks since it falls under the prohibition against smoking — one of the few legal vices deemed worthy of strictly regulating.

But is this good public policy?

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The Canadian Institute for Substance Use Research suggests that it’s not and especially not considering that its December research indicated that private liquor store sales in British Columbia rose 18.5 per cent between March and June 2020, while government liquor stores had an eight-per-cent increase.

At the time, lead researcher Tim Stockwell said, “We suspect part of this increase at private stores has to do with the fact they have been making alcohol more convenient to buy, by offering home delivery with a minimum order or listing its products on third-party delivery apps.”

On Tuesday, institute researchers led by Tim Naimi released Not a Walk in the Park: Alcohol Consumption on Municipal Properties in B.C. It makes recommendations to local governments for assessing and mitigating the risks of unsupervised consumption in public places.

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“This approach carries significant public health and safety risks, may add costs to governments and may divert sales away from regulated, licensed establishments,” they wrote. “Furthermore, this approach may not support the social connection goals of everyone in the community, as not everyone welcomes increased opportunities for alcohol consumption.”

Among the “second-hand harms” cited are increases in assaults, gender-based violence, vandalism and impaired driving. The report also cites an increased risk of drowning and potentially marring the enjoyment of others (including families) sharing public spaces and the higher risk of COVID-19 transmission.

Even before the COVID and the liberalization of liquor laws, the institute noted that B.C. consumption was already higher than the national average, steadily rising since 2013 along with the public costs.

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Those costs are substantial. There is a causal link between alcohol use and 200 types of chronic diseases and acute injuries.

The institute estimated the 2017 economic cost in B.C. of alcohol was $2.38 billion, or $483.10 per capita, surpassing tobacco ($277.80) and opioids ($257.04).

Coincidentally, on Tuesday when institute research was released, the Globe and Mail reported that later this week the B.C. government will be expanding its unprecedented experiment with providing pharmaceutical alternatives as replacements for street drugs.

The program was originally aimed at supporting people with addictions physically distance, self-isolate or quarantine in order to prevent the spread of COVID-19.

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Now, with widespread vaccinations and the reopening of the economy, British Columbia will require all health authorities and their clinicians to provide pharmaceutical grade opioids (including fentanyl), stimulants and other addictive substances to illicit drug users.

Out of hospital drug costs will be paid by Pharmacare, the provincial drug plan.

The expansion is coming even though the number of overdose deaths has continued to rise and is on track to hit a record this year.

But that’s no reason to stop, according to the draft update to the B.C. Centre on Substance Use’s safe-supply guidelines.

“The risk of overdose remains high due to the contaminated drug supply,” says the draft document. “(And) it may be appropriate to continue this prescribing for patients who have shown clear indication of benefit.”

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For evidence, the draft notes that it’s “challenging” to compare mortality rates to opioid-user-only data because safe-supply data mixes opioids, stimulants and alcohol.

Between March 27, 2020 and Feb. 28, 2021, there were 6,498 people in the program including 1,431 who were given alcohol withdrawal medication and 3,771 who were given opioid alternatives.

Of the 82 people in the program who died, the cause of death for 37 was not available “because of a delay in vital statistics data.”

Among the findings was that the urine samples of “many” who were prescribed oral hydromorphone (a narcotic) were laced with fentanyl, suggesting that those “many” were at very least topping up their safe supply with illicit drugs.

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According to the Globe and Mail, the final report notes that “health system partners” expressed “significant reservations” about the approach because their training does not include prescribing potentially fatal substances for other than their medically regulated use.

Still, the document’s unnamed authors concluded, “We recognize that we have been unable to address all concerns, but we also recognize that we have to start somewhere.”

Meantime, Addictions Minister Sheila Malcolmson is still sitting on an evidence-based proposal that would provide housing, addiction and mental health treatment for 1,500 people and whose $37-million cost would be offset by the reduction in hospitalizations and interactions with the police.

Following the evidence worked with COVID. So, maybe with these other longer term and wickedly expensive problems, politicians should give it a try — even if drinking wine and beer from glasses rather than paper bags in parks seems like a good idea.

dbramham@postmedia.com

Twitter: @bramham_daphne

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