09/30/20 Perry Kendall

Doctor Perry Kendall a Canadian Public health physician who was the first Provincial Health Officer for the Canadian province of British Columbia's health ministry and was awarded the Order of British Columbia for contributions to Public health field and to harm reduction policy and practice.

Cultural Baggage Radio Show
Wednesday, September 30, 2020
Perry Kendall
Health Ministry
Download: Audio icon FDBCB093020.mp3


DEAN BECKER: I live here in America, we're a land of opportunity and, and other, uh, uh, bonuses, supposedly freedoms, et cetera. But we have a drug war that is destroying our nation. As far as I am concerned. Uh, it's creating turmoil around the world is creating more overdose deaths and empowering terrorists, dark Dells gangs. And, uh, we just can't seem to get any traction and, uh, around the world, there are people like Doctor Joao Goulao of Lisbon Portugal who has come up with a plan to decriminalize. And, uh, today we're going to talk to a gentlemen who has spent, uh, 20 plus years, I think trying to find a better way, trying to find a means to protect his citizenry. And, uh, he is the, uh, uh, what was it? Co-director of the British Columbia center for substance use? Um, dr. Perry Kendall.

DOCTOR PERRY KENDALL I was the provincial health officer for 20 years. I retired from that, but I've been doing a number of odd jobs consulting, uh, writing papers. I'm currently an interim part-time coder, actually the BC center on substance use. And I have a longstanding interest in drug policy and drug treatment prevention, harm reduction, et cetera.

DEAN BECKER: Now it's been about 10 years ago, I got a chance. I went to Vancouver, British Columbia. I met up with Mark Emery there, uh, toured his facilities, but, uh, just around the corner was the insight, uh, safe injection facility. And, uh, I found it to be well just marvelous, clean, uh, uh, stair aisle and, and, uh, of great benefit to the people there, a Vancouver. And you had a large part in making that possible, did you not?

DOCTOR PERRY KENDALL Um, yeah, I was privileged enough to be looking at the, the federal provincial territorial, which is the senior levels of government in Canada. Um, and, uh, chairing a number of committees, which looked at the problems, the public health problems associated with injection drug use. And, uh, we looked to Europe, uh, for some of our answers. Well, we had opened up needle exchanges in Canada in the early nineties. Um, but looking at some of the issues with HIV, with hepatitis C, with crying, with overdoses, et cetera, we were really struck with what, um, Switzerland was doing along the spectrum of opioid assisted therapy, maintenance therapy for people who were ready to get off, but needed to stabilize their lives. And there was obviously a fairly high failure rate with the current gold standard, which has methadone maintenance. And they had moved to using heroin assisted treatment for people who could not be maintained satisfactorily or who weren't good for whom methadone did not work. And that was such a key thing that they also had across Europe. Um, we supervised consumption sites where people could bring their drugs and inject them under the, under the oversight, if a nurse or a physician and get primary health care and counseling, as well as a, one of the first steps we thought we might do.
We, we had, um, uh, proposals for heroin assisted treatment in Vancouver, but we wanted to open up, um, see how we could open up supervised consumption sites as a public health measure to deal with the epidemic of hepatitis C and HIV. And I just helped to steer the policy papers that looked at whether this was feasible, how you might do it and led the process that led to the point where the minister of health of the day was convinced that he would conduct conducted clinical trial, give us an exemption from the controlled drugs and stuff. There's his act, which the minister of health can do in Canada and run a, a well evaluated clinical trial to see how that would happen and create the, create the ways in which local municipalities, local health authorities, local police forces and communities could cooperate to establish the criteria and the way such a, a program could be opened up.

And then if it didn't work in Canada, we'd have the evidence to say it didn't work and wait and work. But if it did work, usually the groundwork for, uh, expanding, uh, an evidence based intervention. And so that was the insight and the evaluation of insight. And that was, it was that scientific evaluation that led 13 years later to the Supreme court of Canada decision that the federal government, which had changed to become a very conservative government, was trying to close insight down and that the Supreme court of Canada to say that it was actually a human rights issue, that this was a well-proven, uh, valid, um, effective, uh, health intervention measure and the health Canada and the federal could not shut it.

DEAN BECKER Now, now that has gone on to expand well beyond Vancouver, has it not?

DOCTOR PERRY KENDALL Yeah. In the face of the opioid epidemic crisis, we have probably 30 or 40 supervised consumption sites across Canada now in every, in every place where they have overdose issues, every town, urban connotation, et cetera.

We also have overdose prevention sites, which are places where you don't actually, you can inject, but, um, you have somebody who's there with Naloxone who could reverse the overdose where it to where it to happen. So we have a about 25, 30 overdose prevention sites in British Columbia. And again, a number of them across the country, the issue of overdose prevention, a supervised consumption. I mean, they're, they're a little blurry in their distinctions, but you are generally offer more services and support services in a supervised consumption site than you would in an overdose prevention site. So an overdose prevention is I could be as simple as attention and Allie and a supervised consumption site. It could be as complex as actually having withdrawal management center assisted living in, in, in, in the context of a supervised consumption sites,

DEAN BECKER which is, uh, the, the expanded options or the treatment assisted living. And all of this are other means to help people walk away from their addiction or their reliance on these substances. Uh, it it's a means to help if I dare say correct to their life, or they had them in the right direction, correct.

DOCTOR PERRY KENDALL and get some stability in their lives. So they're not constantly thinking about how to get, how to, you know, get, get 'em the next fix or evade the police, or have to do some dealing because they that's how they maintain their habit. So providing a safer alternative to injecting on the street, providing a safer alternative to a very toxic drug supply and providing a safe, alternative to sleeping in doorways, or having, having to engage in the sex trade to provide your next, your next source of drug. So people get their lives together. They get stabilized. It actually saves society money, believe it or not to do the right thing. Um, every evaluation from Spain, Germany, Switzerland, Holland, and British Columbia are shown that there's really significant return on investment from these programs.

DEAN BECKER; Wonderful. Now I'm sure you're well aware the situation in the U S where we had, uh, Ithaca, New York or Seattle San Francisco, and even some, uh, uh,
Barely touching on the idea in the city of Houston to open up a safe injection site. This is a quashed. It is, it is put down by governors and judges. And, uh, I don't know, I guess they consider it immoral or what exactly. I'm not sure, but it is, uh, quashed at every, uh, instance so far. And I, I guess, uh, and you may not even be aware that in many States, uh, there is not even, uh, an allowance for a needle exchange that is considered forbidden as well. And this leads, I'm sure you would agree to more complications, more diseases, more death, more lives ruined because of this fear that people will, I don't know, will want to do drugs more because they have a chance to share needles. I mean, to exchange needles, I'm just not sure what the fear is, but it certainly has some strength. How would you respond to those down here who are so afraid of taking this chance?

DOCTOR PERRY KENDALL I think one of the main fears is that it was quotes, send the wrong message that somehow drug use is acceptable and okay. And that more people get into it. Um, it clearly doesn't from the Swiss experience. Um, and the Dutch experience that people that they are with are getting older and older and older. They're not getting younger. It's not that younger people are coming in to become drug addicts because they can now inject somewhere safely. That just doesn't happen. We've seen the HIV rates drop to very low in the city of Vancouver because those folk are in some form of care and they can receive, um, HIV drugs, and they're not giving each other HIV anymore in terms of sending the wrong message. People who use insight when you compare them with people who don't use insight, or about 30 to 40% more likely to enroll in addictions management program, the people aren't using insight.
So we also see less needle paraphernalia around those places. And, uh, the police in Vancouver, uh, now are actually, they refer people to insight because it's safer people don't die with the toxic drug supply, and they are actually calling for treatment on demand. And they're calling for safe supply. And they're asking that people who have small amounts of drugs on them to be decriminalized. So they would like to see the Portuguese model coming into Canada. In fact, the Canadian association of chief of police have recommended decriminalization of possession of small amounts drugs, because they recognize that it's a health problem. So it's very hard to combat the mindset that you're talking about, um, because it plays well with certain conservative politicians, I think, but it's, it's, um, it's really so fallacious because, um, if you want to talk about safe consumption sites, that's what those are.

We do that all the time for people who have anything from a social alcohol use to, uh, you know, a managed alcohol problem, a functioning alcoholic, or even unfunctioning alcoholic. Interestingly in Canada, I mean, bars were opened up as an essential service, um, before schools were in the context of COVID and probably the United States. So if we have a completely, um, non rational approach to the psychotropic substances that we choose to use and legalize, and obviously there are financial interests in that, I mean, there are financial interests in keeping some drugs illegal. I mean, the whole drug war could be fought on that. Billions of dollars could be spent on it, both on the law enforcement side and on providing the drugs that people want. And on punishing the people who are using those drugs, um, it's ridiculous.

DEAN BECKER Now you, to my understanding, you are going to take another rather bold step, um, given that the government will allow it to happen.
As I understand it, you're going to grow opium poppies. You're going to harvest that opium, turn it into heroin and sell it cheaply to the, uh, the users there in Canada. Is that true, sir?

DOCTOR PERRY KENDALL Uh, that's, that's an idea that was put forward by a user group of heroin compassion club group. That's not exactly what, um, that's not really what we are working on. Heroin is available in Canada for a small number of people with opioid addiction who have failed the treatments elsewhere. It's an expensive drug, at least as manufactured by big pharma. It has to be imported and the various constraints around it would mean that only about 150 people in British Columbia can actually be stabilized on heroin and live normal lives. Switzerland on the contrary has about 1500 people who are stabilized on heroin. We have, I'm working with a professor at the university of British Columbia to see if we can start a company called fair price pharma, which would make diacetyl morphine domestically.

We're under licensed with Canada and make it available by prescription to people who would benefit from it because they are failing or are not, their needs are not met through the standard methadone or buprenorphine, which is available. So this would be for people who have failed treatment and who form of treatment. Um, so we don't grow in the puppies. We'd be importing the active pharmaceutical ingredient, manufacturing in a government license laboratory, a Diastat morphine, which would then be used for the treatment of opioid addiction.

DEAN BECKER; Well, that's, that's wonderful to hear. And, um, I did have a chance to, in switch on a couple of years back, I got to tour one of their, uh, heroin injection facilities, learn the process and, and see how they handle things that are learned. You have seven minutes with that needle to do your injection, et cetera, that, um, uh, I think it was a as of this point near 20 million injections and zero overdose deaths, which goes totally contrary to the fears, whether you and I were talking about a moment ago of what may happen.
Uh, it's just another example of a right thinking can save lives. Correct. Right.

DOCTOR PERRY KENDALL In fact, there is a big, um, paradox in that people will say, we must make these, these controlled substances illegal because they are dangerous for people by making them illegal. We'll keep them out of people's hands and people will be safer, but you know, the iron law of prohibition, if you don't deal with demand and you still have the conditions which cause deaths of despair and depression and unemployment and child abuse, et cetera, you end up with people wanting to treat their pain, whether it's psychic pain or physical pain. And if you're not having a prescription drug available to you, people will turn to the illicit street drugs. And, um, one of the laws of prohibition is that when you prohibit the importation of a product that people want, then the people who are importing it are going to try and make it more potent so that you get more bang for the buck and it's easier to smuggle in.
Al Capone smuggled in whiskey from Canada and rum from Canada, rather than beer or wine, because it was more concentrated. And this is why opium isn't smuggled, but heroin was smuggled. It's why now we have fentanyl and carfentanil being smuggled because they're hundreds of times more potent and just totally more easy to smuggle him. Yes, sir. The result of that is the law that was extensively put in place to make life safer for people whose actually ended up in Canada and in the United States causing thousands of preventable, tens of thousands are prevented.

DEAN BECKER: I spoke with Dr. Goulao, the drug czar of Portugal a few days ago. He told me that last year they had, uh, less than 200 overdose deaths. Whereas in the United States, we had 70,000 approximate and it just shows that wrong headed, uh, attitude in the United States is truly wrong headed. We, we just can't seem to grasp that our policy is causing no harm. Uh, your, your thought there, sir,

DOCTOR PERRY KENDALL I would agree these policies are harmful. Um, you have to look at a situation where you minimize the harms from the substances are available, but you also minimize the harms from the policies that you've put in place to regulate those substances.

DEAN BECKER Yes, sir. Now give me one second, please. Um, Oh yeah. I, I saw, um, I headline talking about in, in Canada that the, uh, drug overdose deaths up, there were 15 times that of the, uh, COVID-19 and just last month. Um, and I guess what I'm bringing up there is that we need to focus where the problems are. And if these are mostly young people, I think that are dying our kids mostly. And, and yet, uh, we, we just can't seem to see it somehow that, that all of these deaths are just meaningless druggies, undeserving. I, your thoughts, sir?

DOCTOR PERRY KENDALL Um, yeah, I think, unfortunately it comes down to a stigma and discrimination, which is partly due to criminalization. And it's partly due to the fact that we see addiction as a moral failing or a criminal endeavor, um, and some people that people choose to do against the best advice of everybody else. And so letting them get on with it. Um, and it's a shame because it does mean that the politically some lives are worth less than others. Um, and, uh, that's something that we've been fighting and neither the national Institute on drug abuse has been fighting that for many decades now. Um, I think Alicia was the first person to say that addiction is a disease of the brain and it matters because you can fix it, you can understand it. And it's interesting because, um, we don't treat people who have become dependent on nicotine and addicted to nicotine with nearly the same kind of disdain as we treat people who have developed an opioid addiction, the same thing goes for, I mean, we're not terribly good to people who become alcoholic, but governments in North America are in the business of alcohol and promoting alcohol benefiting from the, from the profits of alcohol.
Unfortunately. Yeah. So there's an irrationality rules, this, um, this area of public policy.

DEAN BECKER You got that right, sir. Um, well, the, the special I'm producing, we're calling it seeking the moral high ground. And I, um, you know, there just is no discussion. There is no debate here in these United States. It's just not allowed that, uh, you know, I, I feel that I could win that debate. I wanted to quit funding terrorists, cartels, and gangs, basically reduce overdose deaths, take away children's easy access. It seems like a fine place to put in a platform to run for office if you asked me, but it's just not utilized. It's not discussed. If you could talk to the presidential candidates here in the U S if you could give them some advice to Joe Biden and Donald Trump, what would you tell them, sir?

DOCTOR PERRY KENDALL I don't think I'd want to be giving advice