Book Review: Overdose; Heartbreak and Hope in Canada's Opioid Crisis
U.S. readers, this is for you too
This is my first book review for my newsletter. Future book reviews will be for paid subscribers, something I’ll discuss in the next few weeks. This topic is so serious and in need of discussion that I wanted everyone to have access to it.
U.S. readers, please don’t be turned off by the book's title – the content and theme are just as relevant in the United States. Maybe more so.
Overdose was written by Benjamin Perrin, a lawyer, law professor, and former lead justice and public safety advisor to Canadian Prime Minister Stephen Harper from 2012-2013. It was published in 2020 at the start of the pandemic. Just as the book was published, Perrin warned that the opioid crisis would worsen because of the shutdowns and isolation. He was right.
I learned of this book through an online friend I’d never met in person but I’ve known through the magic of the internet for many years. She posted it on her Facebook page because she is one of the many parents who lost a child to fentanyl-laced drugs. It’s a fast read. I completed it in one weekend. It’s well-written and easy to understand.
The writer got me almost right away
When I first started to read Overdose, I was hooked within minutes because of a personal revelation made by the author. As a member of Harper’s conservative government, Perrin had what he said was a front-row seat to Canada’s war on drugs. He bought into the tough-on-crime agenda, which included prison sentences and shutting down any so-called safe injection sites and groups that helped people who were addicts.
A few years later, back in private life, he heard so much about illicit drug overdose deaths and how the punitive and prohibitive approaches to fighting drug use weren’t helping. Perrin decided to learn why.
He wrote in the forward, “By the end of my intensive 100-day investigation, I’d made a complete 180-degree turn. I was convinced: the misguided war on drugs was not only a total failure, it was actually making things worse.”
While I knew the theory behind addiction and drug use and I wasn’t as deep into the punish-and-prohibit approach to illicit drug use as Perrin and his colleagues were, I wasn’t entirely against it. Until I read this book. I now better understand the issues related to drug addiction and have turned away from blaming the victims to wanting to help them. I wish I’d understood sooner before someone I loved who was part of that world died by suicide.
Questions that need answers
Perrin starts the book with several questions that had to be answered before he – or anyone – could begin to understand the depths of illicit drug use and the opioid crisis. Some were:
Why is fentanyl killing so many people?
Why can’t people stop using?
Has criminalizing drugs failed?
Don’t supervised injection sites enable drug use?
To answer the questions, Perrin spoke with many people in British Columbia, including police officers, emergency response personnel, physicians, street workers, people using drugs, and even some mothers who lost their children to the crisis. He also spoke with provincial and federal politicians, as well as experts in the United States.
The crux of the work is not only how fentanyl is killing people, but that addiction to opioids is a chronic disease – one that is ignored, shamed, and treated incorrectly, if at all.
Each chapter answers a question.
The research is deep
As a nurse and health writer, someone who does a lot of reading and research on various health-related topics, I thought I was reasonably well-educated in opioid addiction issues. I wasn’t.
We all have images of someone trying a drug for the first time to get high, be part of a group, or enjoy themselves at a party. But we don’t see that people who are addicted to opioids are actually using them for their original intent – to kill the pain. While opioids were brought to market to numb physical pain, it didn’t take long for people to learn that they also numb mental and psychological pain. And this is what someone who is addicted to opioids is doing, numbing their pain.
At first, it’s to kill pain often related to trauma. It could be childhood trauma, abuse, or being alone and unable to cope. Then, once the addiction sets in, they need the drug to numb the pain that comes from withdrawal whenever it’s been too long since their last dose. It’s too painful; it’s too everything. So they need that dose. And they’ll do anything to get it.
Overdosing deaths and fentanyl
I did know that someone addicted to heroin starts to need stronger and more frequent doses as they begin to tolerate the drug. What I didn’t realize is that our method of “treating” the addicts, by throwing them in jail or putting them in questionably effective rehabilitation centers actually contributes to many deaths. You see, when someone who is addicted comes off the drug for an extended time, their tolerance drops. So when they are released from prison or rehab, if they don’t have follow-up care, their pain is still there and they need relief. With no access to prescription drugs, safe sites, or some other help to manage that pain, they return to what they know. But what they don’t know is they can’t take the doses that they took before. Those doses have become too strong for their body. And they overdose. If they are alone, they die. If they are with others but these people don’t call 911 or have access to naloxone (Narcan), they die.
Fentanyl is another cause of death related to opioid use. Dealers are adding fentanyl to their supplies for various reasons. But if people don’t know that fentanyl is in their product, they can – and often do – die. There are some ways of testing to see if there is fentanyl in the product, but unlike standard manufacturing processes, these powders are being mixed in kitchens, back rooms, basements, and who knows where else. They’re mixed by hand or even with kitchen blenders. But they aren’t mixed consistently. So you have a powder that may have a few grains of fentanyl in one side of the pile, but not in the other. To test for the fentanyl, you’d have to be lucky enough to pick a few grains from where the fentanyl is.
When I was at the AHCJ-CDC fellowship* earlier this year, I learned that some people call this the “chocolate chip cookie effect.” Some cookies have lots of chocolate chips, some have a few, but they’re never equally distributed in all the cookies.
Prohibition and criminalization never work
Perrin dives into how prohibition has never worked. Look back to when the U.S. government tried to stamp out alcohol. That just made it a wonderful way for criminals to make money. He explains how criminalizing drugs makes chemists and others try to find ways to make it easier to get highs with smaller amounts of different chemical combinations. Smaller packets with bigger punches are much harder to detect by law enforcement.
And what about the get-tough stances, throwing everyone in jail for doing drugs? Who is going to jail? The users, the ones who are addicted. The ones who are sick, with a chronic illness. The ones who need help.
Safe injections sites, naloxone, prescription drugs
I admit that one of my issues, as I saw them, was with safe injection sites and needle exchanges. I was in the group that thought, doesn’t that just encourage the behavior? It’s an illegal activity, isn’t it? No, they don’t encourage the behavior. They save lives, I learned. They don’t encourage drug use because people don’t go to these places to try a drug for the first time. Or the second. Or the third. The people who go to these places have nowhere else to go. They know their lives are at risk. They are trying to do what they can with what little they have.
Safe injection sites and similar types of places give people who are addicted a safe place where they can meet the staff and volunteers who can help them. They might not take advantage right away, but if they go back again and again, learn to trust these people, there is hope that a connection might be made and a life turned around. It may not be right away or ever. But at least that possibility is there.
So much more
There is much more to the book than I’m describing here. I’m just touching on some of the points and don’t even know if I’m doing them justice.
I hope you choose to read this book. I hope that it opens others’ eyes as it has mine. I hope I am less judgmental now about an illness that needs to be treated, not criminalized.
What do you think? Have you been touched by the opioid crisis? Will you read this book? Let me know in the comment section. Let’s get a conversation going.
If you think someone else would benefit from reading this book review, it’s free to share. Please do so.
*I was chosen to be part of a 2023 fellowship awarded by the Association of Health Care Journalists, where we spent three days at Centers of Disease Control and Prevention (CDC).