Category: Harm Reduction

[vc_row][vc_column width=”1/1″][vc_column_text]With the onset of winter, I’ve been reminiscing about the summer. Like many young Canadians, I spent the summer adventuring around my province, hiking, camping and enjoying the extra freedom the warm weather offers. This summer I was also lucky enough to attend a number of music festivals. I love festivals. Spending a weekend away, great music, camping with your friends, dancing until the wee hours under starry skies… there’s something magical and ethereal about the festival community that draws in so many attendees every year.

And yet, these festivals have a darker underbelly. “Party drugs” like ecstasy, ketamine and cocaine are common at music festivals, and their uncontrolled use can lead to serious consequences. This summer alone in Canada, almost 80 people were admitted to hospital after incidents with drugs at festivals. Two of these people died. They were only 20 and 22, respectively. Sadly, this is not an uncommon theme. Every year, kids go to festivals and every year kids die at festivals. The Canadian Centre on Substance Abuse reports that the largest number of ecstasy users are between the ages of 15-24. These are not dangerous criminals. Annie Trong-Le, 20, who died this summer of a recreational drug overdose, was a political science student at York and a regular volunteer in her community. These are normal kids from normal families. So what’s going on?

The popularity of music festivals is on the rise. Shambhala, an electronic music festival near Salmo, British Columbia capped its attendance at 10,000, which represents a tenfold increase since its 1998 inception. The Squamish Valley music festival drew in nearly 100,000 guests this year. The Basscoast music festival, formerly held in Squamish, scaled up two years ago, capping attendance and moving to Merritt, BC.

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This rise is, at least in part, due to the dramatic increase in popularity of Electronic Dance Music (or EDM) in the past several years. According to the International Music Summer Consumer report in 2012, $6.4 billion EDM industry is the fastest growing music genre in the US, with similar growth in Canada. Festivals that used to attract large rock acts are now drawing huge DJs like Skrillex and Deadmau5.

Synonymous with the EDM scene is MDMA, aka “molly” or ecstasy. MDMA is everywhere in popular culture. In Miley Cyrus’ hit song “We Can’t Stop”, she sings “la-di-da-da-d/We like to party/Dancing with molly/Doin’ whatever we want”. Madonna made waves this year, titling her new album the cheeky “MDNA”, and asking concert-goers at the Ultra music festival “Has anyone seen molly?” Having attended 3 festivals myself this summer, increased MDMA use was impossible to ignore. Festival dance floors that used to be littered with beer cups are now full of young people in neon taking pills. With the surge in EDM popularity, rave culture has come back in a big way, and despite a lack of data collection, my sense is that MDMA and recreational party drug use is on the rise.

The problem with this, ironically, is not that kids are taking MDMA, but rather that they are NOT taking MDMA. In it’s pure, non-contaminated form, MDMA increases release of the neurotransmitter serotonin in your brain leading to a feeling of ecstasy, trust and connectedness and, though hotly contested, evidence suggest that the effects of pure MDMA are unlikely to lead to death (and actually, some labs are even looking at the potential to use MDMA for therapeutic use). The problem is that MDMA, usually purchased as capsules or pressed tabs, is often laced with dangerous substances like speed, cocaine, or other MDMA derivatives, like the dangerous PMMA. These substances, especially when ingested unknowingly, can lead to heart attacks, hyperthermia, seizures and many other symptoms. Most lethal cases of party drug use are actually a result of users unknowingly ingesting dangerous unknown substances.

Most users of party drugs have no way of knowing what they’re taking. Even after many successful uses, a single dose of contaminated drugs can lead to unexpected and sudden death. Maintaining a staunch “anti-drug” approach is not preventing kids from taking drugs. And simply accepting that deaths are a consequence of festival culture is not suitable. We need better options to keep users safe – otherwise things are only going to get worse.

Some groups have already started taking control. At the Shambhala festival, AIDS Network Kootenay Outreach and Support Society (ANKORS) sets up a booth to provide free drug testing for unidentified substances (And it’s working — see below for their stats). The Trip Project, out of Toronto, and Dance Safe, out of San Francisco, do advocacy education and drug testing for EDM festival-goers to try and increase drug knowledge and safety. Many festivals have “sanctuary” spaces, where drug users feeling overwhelmed or uneasy can relax in a non-judgmental space, staffed by emergency medical professionals. Many festivals, though clearly stating that they don’t promote drug use, are clear about where to find help if something goes wrong. Harm reduction is bubbling up all around the edges of the party scene.

Small steps towards better harm reduction could make a big change. Improved access to testing kits at festivals and parties needs to become a norm. The University of Alberta is already developing quick drug testing kits, aimed for use by law enforcement to keep an eye on street drug makeup. Better drug testing could help weed out crooked dealers that lace their product, keeping users safer. Similarly, improved education about drug use in the home and school between youth and trusted adults can help kids make safer choices.

The truth is that the party scene is changing. Kids are dying. It’s time to start thinking about how we can keep them safer.[/vc_column_text][vc_row_inner][vc_column_inner width=”1/1″][divider line_type=”Small Line” custom_height=”.25em”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]ANKORS compiles statistics every year outlining the results of their drug testing efforts at Shambhala Music Festival. The following are the stats from the 2013 festival:

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This article first appeared as an op-ed in the National Post, August 20, 2014

It’s summertime, so we can count on this unfortunate fact: Young Canadians will die or become seriously ill because of drug use at music festivals. Earlier this month, three deaths and dozens of cases of illness were attributed to drugs at the VELD festival in Ontario and Boonstock in BC. And the resurgence of large-scale, camp-out music events — especially EDM (electronic dance music) festivals — means these incidents will only become more common.

The conventional response to these tragedies is predictable and ineffective. We tend to blame the individuals for making bad choices and trumpet the “just say no to drugs” mantra.

But there’s a better way. For starters, we need to acknowledge that drug use is not going away. Which isn’t to say we should condone it or encourage it. However, it’s naïve to think that we can eliminate drug use at music festivals, or anywhere, for that matter.

So let’s make it safer. The world is full of instructive solutions to the problems we face: Canadian youth are not unique in supplementing their partying with psychoactive substances. In the Netherlands, Switzerland, Portugal, Colombia, Spain and Austria, authorities have developed “safer parties” strategies to help concert-goers determine if the pills they are about to ingest are as advertised.

In Austria, for example, ChEckiT project workers attend large music events and offer professional drug testing for purity and accurate labelling, which provides results within 30 minutes. It’s part of an integrated drug-checking service that includes information, individual counselling, crisis intervention, group discussions, telephone hotlines, and educational videos on drug-related themes. Colombian NGO Accion Tecnica Social has initiated a similar program in that country.

Other countries provide continuously available street-level testing facilities. One example is the Dutch Ministry of Health’s Drug Information Monitoring System (DIMS), which began in 1988 with testing ecstasy at raves. Today, people can drop off their substances for analysis at a DIMS office, and then check on the internet a couple of days later for results. This system also gives authorities a real-time assessment of drug market trends, enabling general warnings to the community at large when warranted. Here in Canada, only police seizures and hospital visits give us that data, at which point it’s usually too late.

None of these programs serve to endorse drug use. But they do send clear messages to young people that society actually cares about their wellbeing. Their fate doesn’t need to be conceded to the vagaries of an unregulated, potentially unsafe black market.

Unfortunately, we don’t send these messages in Canada. Beyond broad platitudes about education and awareness, the concrete measures taken are primarily reactive rather than preventative. Public officials and police will wring their hands, warn people not to take drugs and perhaps step up attempts to go after the dealers. Event promoters will increase screening at the gate, bring in more emergency responders, and establish “chill-out tents” for those who need a break.

All of which is perfectly worthwhile and laudable, but in the meantime, young people will die because no one in authority is willing to consider product safety as a potential solution to music festival deaths.

Product testing isn’t complicated. It wouldn’t require any major legislation overhaul, and public-health workers could partner with existing grassroots organizations active in the space to carry it out. For example, the Toronto Raver Information Project (TRIP) already provides info and supplies around safer drug use for the perpetual cohort of partyers for whom simply “saying no” is not a realistic goal. ANKORS does similar work — including some rudimentary product testing — at B.C.’s Shambhala festival. Outside of the events themselves, police could more regularly disclose Health Canada results of the contents of substances seized at raves. Currently, they only do so in exceptional circumstances when it suits their purposes.

Whatever the test results, however, we know from constant warnings of police and others that no drug is made safer when left in the hands of organized criminals and unregulated dealers. So as part of a product-safety regimen, we should also open a discussion about alternatives to across-the-board prohibition, like experimenting with a legal regulated market for party drugs — as New Zealand has done.

Product testing and drug policy experimentation isn’t the same as creating a free-for-all where all drugs are available in any corner store for whoever wants them. Nor would it minimize the importance of health information and drug education and awareness programs — similar to how we approach tobacco and our favourite party drug, alcohol.

It is simply the recognition that we have the power and knowledge to prevent unnecessary deaths at music festivals and anywhere else drugs are taken. What is holding us back?

This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.

The Supreme Court of Canada’s September 2011 decision allowing Vancouver’s supervised injection site, Insite, to keep operating was a critical milestone for harm reduction in Canada.

One only has to look at the list of interveners in the case in support of this innovative service to see that it has become a valued and mainstream service in Canada. Canadian health organizations including the Canadian Medical Association, Canadian Nurses Association, Canadian Public Health Association and 11 others saw fit to come before the court to support Insite. But even with this high level of support, scaling up harm-reduction services in Canada remains a challenge.

Harm reduction gained traction as a result of the HIV/AIDS crisis in the early 1980s and played a critical role as a strategy to engage injection-drug users in HIV prevention. Harm reduction’s more recent challenges have elevated the critique of policy-related harms – harm caused by policies that criminalize people who use illegal drugs.

Harm reduction acknowledges that there are significant risks associated with illegal drugs and also attempts to work towards mitigating harms within the criminalized environment where drug use occurs. This often puts the public-health goals of engaging people who use drugs in conflict with traditional public-safety strategies that rely on disruption of illegal drug markets, and in turn disruption of the lives of people who use illegal substances.  Harm-reduction approaches balance these realities and focus on creating safer environments as much as possible within a context of criminalization. Some examples include promoting supervision of consumption or discouraging using drugs while alone, promoting rapid response strategies in the form of peer-delivered naloxone programs and strategies that work towards achieving a kind of détente between health efforts and enforcement practices. Given the context of criminalization, a key goal of harm reduction is to maximize the benefits of public-health interventions and minimize the harm of drug use and the enforcement of drug policy.

So what should Canada be doing to facilitate the development of a more robust harm reduction approach as a part of a comprehensive response to drug use? We urge governments to begin with a review of current drug policies to determine the benefits and harms to individuals and communities that accrue from the criminalization of drugs and the people who use them.

Other countries have done such an analysis and have decided to eliminate criminalization as a response to possession of drugs for personal use in an effort to maximize the benefit of a public-health approach to drug problems. Portugal (2001) and the Czech Republic (2009), are two examples of jurisdictions that have taken this step. Both have decriminalized all drugs that are deemed to be for personal use. Portugal decriminalized drugs as part of a response to an HIV epidemic and high rates of drug overdose. The Czech Republic did the same as a result of an extensive evaluation of the previous policy of criminalization. Evaluation of the experience in Portugal has shown that results have been positive overall – HIV incidence and overdose deaths have been reduced, police are supportive of the new law as it has given them more meaningful and helpful involvement in steering individuals towards health services, more people are accessing treatment and other health services which were improved as a part of the decriminalization policy. Additionally no negative trends have been seen in terms of increased harms attributed to this policy change.

Achieving a policy shift as significant as decriminalization will take some time. In the meantime, the Canadian Drug Policy Report, Getting to Tomorrow, outlines some possibilities for improving the development of harm reduction in Canada in the short term:

• Acknowledge that harm reduction is much more than supply distribution and is an essential component of a comprehensive public health response to problematic substance use that offers client-centred strategies with health engagement at their core.
• Acknowledge that harm reduction values the human rights of people who use drugs and affirms that they are the primary agents of change for reducing the harms of their drug use.
• Provincial governments can commit to articulating harm reduction strategies across mental health, addictions and infectious disease policy frameworks.
• Where harm reduction language is present within policy frameworks ensure implementation at the community level.
• Support innovation at all levels. An ethic of experimentation will help create an environment where new ideas and novel approaches can be developed and explored.
• Provide leadership to bring health and policing agencies together to get “on the same page” with regard to harm reduction. Opposition by some in the policing community is unfortunate and an unnecessary barrier to scaling up harm reduction programs.

Developing a robust and equitable harm-reduction approach for Canadians will necessitate new thinking about old strategies — thinking that exposes the harms that flow directly from our current policy frameworks and will open the door to new ideas and approaches that are emerging around the world.