'They talk. We die.'
This was the stark message written across dozens of protest signs held aloft by drug users and their allies at the opening ceremony of Harm Reduction International's 25th Conference in Montreal in May. The target for the message was Canadian Minister of Heath, Dr Jane Philpott, who was a keynote speaker at our event. With almost 2,500 recorded deaths in Canada in 2016 linked to overdose - a figure thought to be conservative given existing gaps in data - the protesters called on the Minister to declare a national public health emergency that would enable swift action to save lives. Indeed the Canadian overdose crisis is escalating in intensity, with estimates that the province of British Columbia alone might see 1,400 overdose deaths in 2017. Nationwide, overdose deaths have jumped 327% since 2008. With the memories and pain of lost friends and loved ones so close to the surface, the outpouring of grief, anger and demand for action at our conference opening was understandable, and set the tone for the following three days.
The overdose crisis is not solely a Canadian phenomenon. In the United States, the rate of fatal drug overdose has increased by 137% since 2000, with more people now dying from drug overdoses than from road traffic accidents or - shockingly - firearms incidents. Here in the UK the alarm bells are also sounding. Deaths involving heroin and morphine increased by 109% in the England and Wales between 2012 and 2016. Last year, there were 3,744 drug-related deaths in the UK, the highest since records began in 1993.
The overdose crisis is a global crisis, with frighteningly high or rapidly increasing levels of overdose death documented in Russia, Estonia, Sweden, Kenya, Australia, and a host of other countries. It is also an entirely avoidable crisis - one driven by the deadly intersection of repressive drug laws, bad drug policies and the intense stigma and criminalisation of people who use drugs. For this reason, so many of the 1,000 delegates at our conference instinctively understood and supported the demands of our Canadian colleagues. Yet for many delegates from outside Canada, solidarity was intertwined with the appreciation that, when it comes to the issue of overdose and access to harm reduction, Minister Philpott is doing more than just talking. Under her leadership, the Canadian federal government has embarked on an unparalleled harm reduction scale up programme, expanding access to safe injecting facilities in cities across the country, making the life-saving overdose reversal drug naloxone more easily accessible and reducing barriers to the prescribing of pharmaceutical heroin. For our delegates from the seventy other countries present at our conference, the kinds of actions being taken by Minister Philpott remain the realm of fantasy rather than government policy back home.
This is certainly true here in the UK, where despite the alarming rate of preventable deaths, the government's new drug strategy published last month does nothing to stem the tide. Here, the kinds of bold initiatives seen in Canada remain not only off the table, but are not even part of the discussion.
While acknowledging as 'dramatic and tragic' the rise in drug-related deaths, the strategy proposes no concrete action plan to reduce them, focussing instead on initiatives to promote abstinence from drug use. Life-saving harm reduction programmes are barely mentioned. This silence extends not only to sometimes 'controversial' interventions like the safe injecting facilities currently being expanded in Canada (and already operating in eight European countries), but also includes long established interventions such as needle exchange and opioid substitution treatment, programmes that the UK helped pioneer in the 1980s. Needle exchange programmes for example receive a single mention, stating only that current availability should be maintained, even when Public Health England has raised concerns that existing availability is insufficient. Although the overdose reversal medication naloxone is mentioned in the strategy, access remains a serious problem with 10% of local authorities not supplying it to high-risk opioid users in their areas.
'They Talk, We Die' is a powerful message and call for action. Yet for too many countries with staggering rates of overdose deaths - including the UK - the talking isn't even happening. Only the dying. August 31st - International Overdose Awareness Day - offers a stark reminder of the collective failure to act decisively to end this global crisis.
Around the world, we are witnessing rates of death from overdoses that in some cases surpass the levels of HIV-related deaths among people who use drugs seen at the height of the AIDS epidemic. As we commemorate International Overdose Awareness Day, I am also reminded of the rallying cry of the early AIDS movement, 'Silence = Death'.
When it comes to the global overdose crisis, silence still equals death.