Review: OVERDOSE Heartbreak and Hope in Canada’s Opioid Crisis

An opioid crisis is gripping our nation. British Columbia just posted record highs for overdose fatalities in the last few months, but every province is affected. Something needs to change in Canada to help this situation, and Benjamin Perrin has offered up some insight in his book Overdose: Heartbreak and Hope in Canada’s Opioid Crisis. Perrin is a professor at the University of British Columbia, Peter A. Allard School of Law as well as a senior fellow in criminal justice at the Macdonald Laurier Institute for Public Policy. 

In his book Perrin takes a look at all facets of this crisis to help us understand the complexity of the issues involved in addiction and drug overdose. He speaks to multitudes of experts from all sides of the issue, addicts, police officers, drug addiction counselors, judges, lawyers, frontline workers, Indigenous organizations, activists, border agents, and intelligence analysts. Perrin is able to weave together an exceptionally insightful book that helps illuminate the complexity of the issues involved and comes to concrete conclusions about the best way to fight and win this crisis.

Who is using opioids?

Within the book, readers learn that addicts come from all walks of life and come into their addiction for many different reasons. Illicit drug use is not only a problem of the impoverished and homeless, in BC in 2017 59% of illicit drug overdose deaths occurred in private residences. There are those who were given opioids after a surgery or accident and didn’t realize they were being given addictive medication.

“This is not ‘those addicts’ this is your brother, your uncle, your sister, your mother, and father. You think about why people use street drugs and a lot it has to do with pain, whether it’s psychological, emotional, or physical pain that gets people into it”

Dr. Bonnie Henry, BC Chief Medical Officer, p.31

There are also those who become addicts due to horrible trauma undergone as children with no support to help them through. Bill Mollard, president of Union Gospel Mission (UGM) points out “Their life hasn’t worked well. They’ve had, typically some blunt-force trauma early in their life and that blunt-force trauma, while they’re a kid, is physical abuse, sexual abuse, verbal abuse. The drugs, at that point aren’t about partying. They are aren’t about having a good time. It’s about anesthesia. They use these drugs to mitigate those emotional stresses they have (p.38)” Bill’s organization helps with a network of hot meal programs, shelters, and substance use programs in and around downtown Vancouver. 

How do they become addicts?

Understanding how people become addicts is hugely important when it comes to figuring out how to stop the cycle of addiction, and where to put help so that it will reach those who need it. Perrin speaks at length with frontline workers and helpers to give the reader a picture of the paths that can lead to addiction, and they are not always what one might expect.

He writes of the ongoing misconception that it is somehow an addict’s “fault” that they are an addict, due to their own “bad choices”. Perrin talks about where and why this concept came about, with the groundwork being laid out with the early nineties term of “opioid dependence”.  This term carried judgment as Dr. Joe, one of the many physicians Perrin interviews in the book, says on page 40, back then “It related to the weakness of one’s personality and it was a moral issue”. 

Perrin also takes a look at the issues within the system that is trying to fight the street drug problem. One of the main issues he points out is that it is not the kingpins, the ‘high-level’ traffickers, who are being caught (those who import the drugs and organize how they are networked out for selling). It is the low-level sellers who get caught the most due to their high presence within the community, and sadly they are most often also addicts.

Perrin speaks with Haley Hrymak who was researching the opioid crisis at UBS and found that of the 14 street-level fentanyl traffickers sentenced from Jan. 1, 2016 to Nov.1, 2017 only two weren’t current or former drug users. “Addiction motivated nearly all the individuals who were engaging in street-level trafficking. Addiction is a disease that involves engaging in drug use on an ongoing basis despite risk of harm or negative consequences associated with these behaviours. Research shows that the threat of an increased jail term does not dissolve an addiction (p.108).”

How do we fix the problem?

What should our primary goal be in dealing with the opioid crisis? Perrin says “To me, it’s crystal clear: we have to save lives. That means dumping a century of discredited myths and stereotypes about substance use and being willing to consider all options (p.147).”

From all of the information put forth in the book, Perrin makes a hard case that safe consumption sites are the answer. Getting people the support they need, giving them access to safe places to use drugs with people there to help if they need it. These sites are there to connect people to services and support. Perrin puts forth a strong argument to stop criminalizing people who use drugs, and how this would positively impact all levels of society, those who are taking the drugs and those who deal with the fallout from the illicit drug trade. Perrin also takes a hard look at the evidence for and against the decriminalization of all drugs, with Portugal giving some insight into how the strategy can play out. 

This book is a well balanced and highly thorough look at the opioid crisis within Canada. Perrin’s empathetic and systematic breakdown of the realities of the opioid crisis leaves the reader with not only a greater understanding of the crisis but also a personal view of what it is like to be caught up in it. You can buy Benjamin Perrin’s book here

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