Canada's opiate crisis has taken on many new shapes in 2016. By most accounts, British Columbia is leading the country in its response—from declaring a public health emergency and deregulating the opiate blocker naloxone, to publishing overdose data as close to real-time as the coroner's testing allows.
But BC's response to the overdose epidemic looks quite different from the inside of a nine-by-six-foot jail cell. Clean needles aren't easy to come by. Fentanyl and other drugs are widely available in unknown concentrations and purities. And six months after winning a legal challenge for access to addiction treatment, many are still waiting on medical help to arrive.
BC inmate Jeremy Baker* told VICE he's finally been clean for nearly 30 days—but it's no thanks to jail treatment programs. He says he quit cold turkey, after asking for treatment, and is still feeling symptoms of withdrawal. "I'm still unable to sleep and getting just a bit of chills and cold sweats," he told VICE.
Before April of this year, inmates had to be in jail for three months before BC Corrections would allow opiate replacement therapies like methadone. Four prisoners launched a legal challenge, and Corrections agreed to give inmates the same access to treatment as people on the outside.
Over the summer, the BC College of Physicians made it easier to prescribe the newer opioid replacement drug suboxone. Like methadone, the addiction treatment can be issued on a same-day prescription from a doctor. In theory, according to the settlement, the same should be available to prisoners.
But in BC prisons and remand centres, health care is provided by a private company called Chiron. Because drug availability is limited by Corrections' budget, wait lists to get on suboxone are long, leaving prisoners hanging for as long as three or seven months, with no indication of how patients are being prioritized.
VICE reached out to Chiron to find out how many prisoners are currently accessing treatment, and how many are waiting, but did not receive a response. According to BC Corrections stats from last year, 3,058 inmates participated in programs, out of more than 18,000 admissions.
Baker says he requested suboxone when he was admitted over a month ago, and he was told he was on a waiting list along with about 80 other inmates. Prisoner advocates say incarceration is a perfect time to intervene and treat addiction, but people like Baker aren't getting the skills, tools, and resources to get clean. "You can't come to jail and expect to get anything," he said.
Facing scarce treatment, Baker says a black market for treatment drugs has emerged, where inmates who are already on programs will stash and resell suboxone—something many dopesick inmates rely on. The drug, which comes in the form of a pill that dissolves under the tongue, can be crushed and snorted. "With suboxone, they only watch you for five minutes, it's easier to bring back from the med window," he told VICE. "It does help, it calms people down."
While waiting for treatment (or hustling one of these DIY programs), fentanyl and heroin are readily available, and tempting to a withdrawal sufferer. Baker says fentanyl gets smuggled into the cell block in fake Oxy pill form, as well as in heroin powder. He knows from experience not to do more than one tiny hit, and that the high doesn't last as long. "I could die from doing two ten papers—that's a ridiculously small amount," he said of the difference in potency between fentanyl and heroin. "That's blowing my mind."
As Baker tells it, drugs have been his main source of his trouble with law enforcement since as long as he can remember, and prison has only made his addictions worse. His first stint in jail was for selling to undercover cops. The first time in jail he stayed away from opiates, and stuck to snorting stimulants.
Once released, more than a decade ago, Baker and his friends from jail were maintaining expensive coke habits, which would later land him another sentence in a federal penitentiary in connection with a series of break and enters. That's where he started snorting heroin. "In the pen you saw people injecting with pens sharpened into needles," he recalls. "They'd melt plastic to make a plunger, and I'd just keep six and watch this go down."
Prisoner advocates have pushed for better harm reduction supplies in jails and prisons, to curb transmission of HIV, Hep C, and other blood-born disease, but corrections officials say needles are too great of a security concern.
Then there's the danger of being released. When prisoners leave, they're many times more vulnerable to overdose, because of changing potency and less restrictions. Baker says he's seen too many inmates, including himself, released after business hours on a weekend, with no chance of accessing medical treatment. "It's super common, it happens to everybody." Baker says he's lost three close friends, all of whom he met in jail, to fentanyl.
When Baker was released earlier this year, his plan was to enter a treatment program in Vancouver—one that had helped him stay clean for two years in the past. He says he spent most of his last day making calls, trying to get a prison doctor's script faxed to the centre.
But when he was released from jail at 8:30 PM on a Friday, Baker says his methadone script wasn't waiting for him at the centre, which meant he couldn't check in. With no doctors in the country available to write a new script at that hour, and no money in his pockets, Baker says he felt forced to fend for himself over the weekend. By Monday had been caught stealing from Safeway and was back on dope, which would land him back in jail serving more time.
With only a few weeks left in his sentence, Baker has cleared one of the hardest addiction hurdles—getting clean. He hopes he can keep it that way when he's released again later this month. When that happens, he'll find himself in a province with some of the country's most forward-thinking harm reduction and addiction treatment programs; a different world than the one he experienced behind bars.
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*Name has been changed to protect safety.