 Hi everyone, we're gonna take a couple of seconds here while people are still trickling in and then we're gonna get started. Okay, good evening everyone. We're going to get started here. I'm Adelina Iften, I'm a professor at the Schulich School of Law and the coordinator of the Criminal Justice Coalition. It is my pleasure to welcome you tonight to the last event of the Criminal Justice Speaker Series. And we are going to end the series with a very topical subject. We are gonna be talking about the opioid crisis and the safe supply. We have three wonderful speakers that will be talking about their work on this issue, both their work separately and their work together. First, we have Matt Bohr, who is the program coordinator with the Canadian Association of People Who Use Drugs. And he will be in conversation with my colleagues, Professor Matt Firder, who is also the director of the Health Law Institute at Delhousey, as well as Professor Sheila Wildman, who is also with the Health Law Institute at Delhousey. And she is a founding fellow with the McCacken Institute for Public Policy. Before I turn it to Matt, I just a couple of things that I want to note. First of all, you're gonna see at the bottom of the screen, there is a Q&A box. So I do want to invite you to use it and to type your questions there during the talk. And I will come back at the end after our three speakers would have presented and filtered the questions for them. Also do note that the session is recorded. You're not gonna appear on the recording, only the speakers will, but you will be able to watch it afterwards on the Shirley Schools of Laws YouTube channel. Okay, and with that said, I'm gonna welcome our three speakers and turn it to Matt. My name is Matthew Bon on the program coordinator with the Canadian Association of People Who Use Drugs. And I just finished my slide, Jack. So I was hoping that Alina would talk a little bit longer but we're good to go. So let me share my screen here and put us in slide show mode, play from the beginning. So as I said, my name is Matthew Bon. You know, I am someone who uses drugs pretty much daily. My drug of choice is fentanyl. And I like to think that I'm a survivor of a overdose crisis because I've known way too many people that haven't made it out a lot. You know, I actually carry a lot of grief and trauma over that because sometimes I think that, you know, why not me and why them, but trying to change that energy into something positive. You know, and last year I had an opportunity. I was doing a lot of freelance writing and they called my friend in Montreal and I said, you know, can we write a letter to an editor to like a medical donor and he's like, sure. And I really didn't know what I was getting myself into. And I knew he was really, really smart and really knew how to kind of navigate that system. And I had no idea. And a fun little fact, the first draft of this was actually written while I was on mushrooms. So just keep that in mind if you ever read this paper. Couple of my national and international affiliations, I was pretty much affiliated with every local harm reduction organization that you could imagine from Directional 180, Mainline, Hand-Up, Halifix. You name it, I probably have worked there if it's over the cold, if it's Coverdale. But now I've been doing more national and international work. So I am the program coordinator with the Canadian Association of People Use Drugs. We do a lot of drug policy work and we're based at Oda Dartmouth. I'm a national board member for the community and students for sensible drug policy. We actually have a Dalhousie chapter so I encourage you to either reach out to me or reach out to some of the chapter, the chapter coordinator with the national board or I can put you in contact with the two local chapter leaders and revive this chapter. I'm one of the leads in this organic group that kind of happened really because of COVID which was the Pan-American Network of Drug User Activists and we're actually looking at creating a Delphi survey right now to look at people in North America, Central America, Latin America and South America. People use drugs and see what are the real issues that people who use drugs are facing and experiencing. And I recently took on an international board seat for the International Network on Health and Hepatitis and Substance User INSU which is out of Australia. I'm hoping I get to go there this year. I know Matt's gonna shake his head that maybe Farmer will pay for me but we'll go to the next slide. So before I do the rest of the presentation I'd like to do, I know it was social land acknowledgement and just an acknowledgement for the acknowledgement is that this is just one very small piece of what we need to do to really build some meaningful and meaningful relationship building with the indigenous tribes of Turtle Island. So I'd like to acknowledge that I'm presenting today for McMoggy, the Ancestral and Unceded Territory of the McMonnell people. This territory is covered by the British Treaty covered by the Treaties of Peace and Friendship which McMack and the Wulass II he signed at the British Crown in 1725. The treaties did not deal with the surrender of lands and resources but in fact recognize McMoggy and the Wulass II we key title and established the rules for what was to be an ongoing relationship between nations. Honoring this treaty relationship through land acknowledgement is just one of the many steps that can be taken towards reconciliation as outlined in the 94 calls to action issued by the Truth and Reconciliation Commission of Canada in 2015. And this is my favorite paragraph to it but I think we all really have to think about what we're gonna do to really become more self-aware with our cultural competency. So every individual in every institution has a role to play in making the need to change this to dismantle systemic racism and oppression against black and indigenous people in Canada. We think one action that anyone can take is raising your own cultural awareness, learning about other cultures, asking questions, reading, listening, becoming more self-aware. It may seem simple enough but we're going into a process and we have to be prepared to be humble at any point because we're entering a lifelong journey and we will make mistakes. As long as we keep an open mind and open heart through this acknowledgement and the harm reduction philosophy we commit ourselves to this lifelong work in creating effective change within our society. So I don't think I read the title of my publication but I have it right here so I will read it because this word is not a really well-known word even among some people that you would think that I would thought may have known it but unless you're an epidemiologist or whatnot you may have not heard it. So the publication was called addressing the syndemic of HIV, hepatitis C, overdose and COVID-19 among people who use drugs, the potential roles for decriminalization and safe supply. So when we're talking about the pandemic and epidemic and overdose crisis, a housing crisis, public health emergencies, for people who use drugs and a lot of other marginalized and racialized communities what we're really talking about is the syndemic. Knowing a syndemic is when two or more social or health diseases or issues negatively impact each other to worsen the disease trajectory so come for each illness. A great example is if somebody is homeless and they have HIV and they're hepatitis C co-infection there's a good chance that they may not be adhering to their hepatitis C medication or even their anti-retroviral medication for their HIV. So that's really gonna impact their co-infection. So I'd like to think of this crisis as a syndemic. So you'll see this word and I'll kind of explain it a little bit more as we go. So first of all, I just wanted to acknowledge some of the people that we lost this year and up in the left-hand corner where you have Jesse Harvey he's from Boston and why do I have somebody from Boston here because we actually got pretty close to the pandemic and he started the first church of safe injection and he was gonna try to apply for a religious exemption to hand out safe syringes and drug testing in the locks on cats. And Maine, Massachusetts only public health authorities can give out safe supplies and it's illegal if you don't otherwise but you can tell he went out in his red car every day and he did it and this was a guy that was going places and every time I hear somebody doesn't matter if I know them or not I really feel something very strong and it goes back to what I said at the beginning and I don't know why them and not me. Jude Bryant is like the mother Teresa of harm reduction advocacy. She's from Australia. Luckily she didn't die of a drug overdose but I thought it was good to acknowledge her and all the work that she has done. I recently wrote a piece for filter on women who are leading the safe supply movement in Canada and I wanted to kind of put her in but it just didn't really fit. So I wanted to acknowledge her today and then this one up in the corner is probably that the hardest one that I put up there but I thought I had to, you know I'm still grieving over Jesse. Jesse's the one on the your left, my right. Well, I guess my left now too but he's this guy here. I've known him for quite some time. This was a day where we had rock the dock come down to calm good solutions. We did some fundraising. You can see we had our disposal bucket as we got all the money and we did actually a really good job Jesse was really getting, he was getting and he was trying his hardest and I really believe that the absence based culture and health acts killed him, right? Like he tried to, he came off his opioid agnes therapy program and then he used again and his tolerance wasn't the same and he didn't make it. So back to the syndemic. So the first syndemic was and it's still going on was the Savva's Syndemic, the Substance Abuse Finance and HIV AIDS Syndemic and this would have been, you know, late 90s. What has I said before, the hallmark of the syndemic is the presence of two or more disease states that adversely interact with each other and negatively effecting the mutual course of each disease trajectory, enhancing vulnerability in which are made more delirious by experience and inequities. So practically people living in poverty, people living with, you know, multiple mental health and social issues, physical issues, they're all in syndemics and you know, really COVID-19 is not a pandemic, it is a syndemic and we should be looking at it as one. So a big part of what I do at Caput is a national drug user group and we are an organization that was formed in 2009, unofficially, officially in 2011. We received funding in 2018 through the Substance Use and Addiction Program with Health Canada. Our whole board is made up of current or former people who use drugs. We don't have any non-drug users on your board and I would say at least 80% of them are current drug users, including myself. We do everything in English and French. This is one of our most infamous documents. I actually would love to do a bibliometric analysis and write a paper on how many times this has been cited in academic literature but I learned a new trick where I can actually get a DOI number for grade literature. So that's what I'll be doing with some of our new material coming out. But if you want the links to them where I can send out the slides and all our material afterwards. But so safe supply is not your traditional form of opioid agnes therapy. It's not methadone. It's not buprenorphine. It's not slow release oral morphine. Some may even argue it's not heroin-assisted treatment. Safe supply is meant to be safe and it's meant to be taken home, unsupervised. We all know that drugs have consequences to them but they have benefits and they have risks but we speak so much on the harms that it de-abilitates research. It has this social perspective that just doesn't allow us to get to where we need to be to prove and show the evidence even though I would argue there's tons of evidence proving that safe supply is in need and we need it yesterday. The states have 200 people a day dying. We have 14, that's a lot of lives. The definition we have in this booklet is safe supplies. Any substance or drug that is traditionally only found on the illegal market and we wanna see a regulated supply. Now where drugs are still criminalized, the safest and most direct route to assay supplies through medical prescribing but I'm someone who uses fentanyl daily and the lot it's just I'm not gonna cut it. Heroin Compassion Clubs. This is another form of safe supply. This is probably one of my favorite in the great literature documents. It was created by the BCCSU and a Compassion Club. I'm not sure if everybody knows what one is but a Compassion Club is like think about the medical marijuana days where everybody got together and backed each other up, they put all their money in, they pulled it up, they got a cheaper price, they got a better product and we do that with heroin and not surprisingly, it's mainly women who do this with heroin because a woman can't just go into a heroin assisted treatment program and ask for heroin if they have two kids or maybe if they're just not even a parent but unlike the last thing we need is these evidence-based services and then CPS getting in the way and taking away children of mothers that are just trying to stay alive. So a few safe supply initiatives and you may see some names here that are familiar. This is our older one though. So this would have been our first draft of our securing safe supply during COVID-19 and beyond scoping review and knowledge mobilization. We have Matthew Herter and Sheila Wildman. We also have myself Natasha Tuznerd who's the Executive Director of Canadian Association of People Who Use Drugs, Michael Puglies, and Brianna Chang and this project wouldn't have happened without them. Emily Kamal, Claire Botkin, Dr. Claire Botkin, Dr. Tommy Brothers, Dr. Leah Gange, Candace LePage, Dr. Aiden Schien, Dr. Dan Lerner. So we have an international team and we were granted a CIHR Knowledge Synthesis Grant to look at to do a scoping review on safe supply and we knew going into this that there wasn't gonna be a lot of literature on safe supply and we had to get crafty and I'll let Matt speak a little bit more to that. But if you look at the authors, myself and Natasha, the two drug users are the first two and I think our team is the best research experience I ever had and I feel very lucky to be able to have been there, to have been a part of it from day one and I don't wanna jinx anything but we have it under review at the International Journal of Drug Policy and yeah, soon we'll have a publication on this. Another safe supply, I don't know if I'd call it a paper, I'd call it more of a guidance document. I want I think like four national safe supply working groups now but this one was done by Jessica Hales, Dr. Jillian Cola, Thomas Mann, Emmett O'Reilly, Dr. Nankie Ray, Dr. Andrea Serader, Kaput actually was able to do an external review on this and they acknowledged it in the document. This is a policy options piece that actually me and my two panelists got to write and if you see the title, it's the expertise people use drugs must be essential to the design of safe supply and there was a couple of comments kind of like, yeah, wouldn't that be great? And I think we're getting there, takes a long time to change policy and we're trying to give free drugs to people but we will be there and we will get there. I took the picture in the background. Those are the drugs we're fighting for right now. Deloaded eight, the brand name. But if people who use drugs were not mainly involved, the quality of the research and its impact on policy and service delivery is likely to suffer. And Matt really did work his magic and made this to the piece that it was meant to be. And this is another piece that I worked with Sheila Allen and I was in jail in 2018. I just got out of jail in March 15, 2018. Time flies, but it also feels like I don't know how much, I don't know how I got all this done in a short period of time that I'm somebody that's on methadone and been on and off methadone my whole life. And in one way I was very lucky and very blessed because if you go in jail and you don't have a methadone scrub before you go in jail, you don't get methadone. It doesn't matter if you meet all the criteria for opioid use disorder, you just do not get started. And so I was on methadone, luckily, but every day I had to get stripped, strip-circ. So I had to strip down my bare skin. You know, I had to show people my genitals, I had to turn around and squat, cough, do this while other inmates are across the hall and their cells being stripped-circ. And you know, I always think back and I think about how many of those inmates told me that they were at Shelburne, that they were at Waterville and that they did get sexually abused. So they're reliving their trauma every day, but they need it. They need this drug to feel comfortable in their own skin and yet they have to be re-traumatized every time they have to do it. So some knowledge translation products that came from, you know, a lot of the work that we have done lately. This was one, so the policy options piece was a knowledge translation product that came from our CIJ grant. We needed drug users need us doctors to step up with safe supply. That was another knowledge translation product. Safe supply doesn't just have to be opioids. We need stimulants as well. One of our national CSSDP board members wrote that. I wrote this piece on meth adults and it's called, you know, if you listen to crackdown and if you don't, you should because it's like the best podcast ever. But essentially they uncovered wrongdoing and from the BC government, the BC College of Pharmacists and Malmuff Pharmaceutical that they did a switch change where they said, you know, we'll give you meth dose, but we want everybody that's on the provincial framework here, that's on methadone. We want every single one of those clients. And this was back in like 2015, 2014, 2015 and it's spread across Canada, of course. And I remember like 2016, 2017. Now we're struggling. You know, I ended up in jail on 2017. You know, it was because my methadone wasn't working. You know, I couldn't, it didn't last me a whole none. And now I'm starting to realize, you know, some of the things I did were my fault. You know, that should never happen. I overdosed last July. I think the pandemic affected me a lot more than I thought it did. I think I held a lot in for a while. And you finally wrote about it and made me feel a lot better. And you know, ironically, I don't know, a month later, I responded to an overdose. And I'll stop touching my most. I responded to an overdose. And if anybody knows me and you see me in my book bag, I always have naloxone dangling from my bag. And this, this evening, this guy never had access to a kit ever. We have no social take home naloxone program. He had no idea what that is. You know, like, why is that, you know, what's the no social health authority doing? Like, you know, we have somebody who uses drugs daily and they have no idea what to take home naloxone program. It's a, it's a joke. I gave him my last kit and I walked up to score some notes. And I was like, I don't know what to do with that. And all with my friend. And I gave him a little bit of extra and he overdosed in seconds. I never seen someone go down so fast. I didn't have an ox on kit. I, you know, remembering all my harm reduction methods. I put them down on his back. It was kind of surreal. Somebody is probably about seven us there. I'd say four people left for you away. The owner of the host was looking for naloxone. Some guys, they do me. And, you know, like, it was, I didn't think he was going to make it. You know, I really didn't think he was going to make it. I don't know what to do with naloxone. I just, I don't know what he would have done if he didn't make it. But, you know, luckily we don't need to test compressions. That's a last resort. When you drive from an opioid overdose. It's oxygen being cut off your brain. Not. You know, we don't, you know, so. The test compressions could be the very, very, very last resort. So if you don't have naloxone, you just do rescue breathing, you know, you put the neck back. You hold your nose, blow in your mouth. And you can even kind of hear them breathe a little bit more each time. And I say to life doing that. I was a little bit surprised by the publication. I'm probably over time, so I'll try to speed it up. A little bit of background. Information. It was just supposed to be an editor to the editor or an editor, a letter to the editor. Got turned down at the Lancet. Got a dream big. journal of drug policy led us down really smoothly. And I wrote this other piece for the conversation just a little bit before. And I remember the journal of studies on alcohol and drugs. They retweeted it and said how much they liked it. And I kind of said, oh, I'd love to publish in your journal or whatever. I didn't even know what kind of journal it was at the time. And they said, oh, what's your email? We'll reach out. We'd love to have you. And I thought it might have been like a predatory journal, but it turns out it's through Rutgers. Rutgers University. It's the oldest. Academic journal and focused on alcohol and drugs. The editor in chief said, can you take this letter to the editor, which was focused on safe supply and combine it with your decolonization. Article and expanded into 2000 words. And I said, we sure can. And so it really happened very organically. We got Dr. Mark Tindall as our senior author, which is really cool. And we also put a land acknowledgement in there, which you don't always see every day. So I won't get into too much of, you know, the piece I will share it. But you know, essentially we argued that. We're in a, we're in a syndemic. We're not in an overdose crisis. And we need decriminalization and safe supply, or this is continued. It's going to get worse, you know, 81,000 people in the States died in 2020. They're projecting a hundred thousand and like, one is enough enough, right? Decriminalization is always possible. If there's political will. And we just need to push for it. And a safe supply of drugs, you know, the landscape in the States is a little different where the, the DEA actually controls all what doctors can prescribe and things like that. They're kind of like our health Canada in a way, which is absolutely insane. I think we should sue the DEA. Maybe Matt, Sheila, I want to take that on, but, you know, like I really think they probably played more role in this overdose crisis than anybody else. I don't know. Did I take out? I must. Oh, so we had, we had three. Commentaries written on our piece. One was from Stanford. One was from. Brown low. In the University of California. And one was from Yale and Kathleen Carroll. Rest in peace. She passed away suddenly this. This year. And she did a lot, you know, like, they didn't all agree with what we were saying, but I looked at her body and she did a lot of work through this field, you know, and. I respect that regardless if they're. Thinking what I'm thinking, you know, I think change happens when. You know, people have different perspectives. And have an open mind. And they're willing to listen to each other. So the journal let us write another piece. They had all these crazy names like unsafe supply. Why I say so why won't help. One was called. Use without consequence. And then there was another one like. Let's put the. The unicorn before the horse or something or. So we use a famous Bob Dylan quote. The times are a change in. Addressing misconceptions. North America's. Over those crisis. Over those crisis. And. Yeah. That was kind of like my. I stole this from Mark Tindall. I've seen him do it. I didn't do. But it is like one of my, my favorite. Banksy photos. So keep your coins. I want change. I'd argue we need change. And thank you for listening. Thank you so much, Matt, for sharing all of that with us. And thank you for the work that you are doing. And you continue to do. To trigger change. Thank you. We're now going to turn it to, to Matt. To hear more about the work that. That the three of you are doing. And thank you so much for your time. Thank you so much. Thank you. And thanks Matt for. Really setting the conversation up. I'll be brief just to give more time for discussion. For folks after Sheila has a turn as well. So just. Just a couple of points I wanted to share with the group. The first thing is. That. You know, this was a, so we started working together. Matt and I had met. A lot of my work's been in drug policy, but I've tended to focus on drugs that have been approved for prescription purposes. And, you know, how well the regulatory system is working. Do we really know if they're safe or not. And raising questions about, you know, some of the drugs that contributed to the overdose crisis, like oxycodone. And the way the poor decisions that I think health Canada, the U.S. regulator has made in licensing those drugs. And so to sort of come at this differently, to think where are we now. And what is actually the safest thing to do and actually think about making some of these drugs that. At least in earlier work that I've done. I have great raised questions about why they were let on the marketplace, but to shift and think through, well, you know, there's a serious harm and a lot of that harm. If you really understand what's happening on the ground through talking to people like Matt and Natasha Kaput and many others. You see that if you don't know what's in the drug or the conditions in which you consume it are so deeply unsafe that making sure that you can at least remove one of those risks from the equation, right? Knowing the contents or composition of the drug, what its dosage really is that it's not laced with something that you're not anticipating is so critical, or at least one piece of the puzzle and reducing the overall incidence of harm. But for me, it was a shift in my work because, because of what I had done before and being critical about how some of these drugs had entered the market in the first place. So it was a really incredibly important opportunity for me to learn if I can just put it in those selfish terms from experts like Matt, you know, and so it's been an incredible journey to be on. So I just wanted to say a tiny bit more about the research that Matt highlighted there when he sort of talked about us getting crafty. So we got one of these, you know, COVID grants, thinking about people who use drugs and how to reduce harm. And this idea of trying to pull together all of the research that's out there around safe supply, which is this kind of emerging concept you saw in that document that Matt had up in his slides around safe supply that could put the Canadian Association of People Who Use Drugs, you know, they created this sort of groundbreaking document to sort of articulate what that means from a perspective of people who use drugs in its full scope, right? And it's a concept that physicians or people like me, who have been studying the regulatory system in certain ways struggle to understand the way because we're thinking about risks without necessarily attention to what's happening on the ground at times. And so we got one of these grants to sort of say, well, what's the state of the knowledge? We're in COVID. It's harder to see physicians. It's harder to source drugs that you may need to use. And so, you know, what could we learn from previous disasters or public health emergencies when people need medicines, need drugs, but there are all these barriers for public health reasons, natural disasters. Those kinds of real world events that can shape things up. And so we pulled together none of us had ever worked before. And it's really a credit to Matt and Natasha Caput and other people who through the research process we involved in the research that really brought us together, I think, and pulled together because we saw the importance of the issues. But we were worried about this. So I know there's at least a few academics in the participants list, but others might be quite interested in this as well, at least I hope you will be. We did something called a scoping review. And for a legal academic like myself, a scoping review, if I'm being honest, is kind of a fancy way of saying I'm doing a lit review. You just sort of make exactly what you did in the process of doing the research more transparent. You say, I looked at this many papers. Here are the terms I used to search the literature. But to me, it seemed like a bit of a game, right? You're sort of making a big deal about your methodology, but it's actually about doing a really good literature review at the end of the day. So that was the method we adopted because we figured we could pull together and see if there's important insights in the literature. But of course, we were worried about that too. We were worried about what the literature didn't show for a very specific reason, which is if we're trying to pull together the knowledge about how do you make drugs available to people who need them in the context of a public health emergency like COVID, well, if there actually isn't very much relevant literature, even drawing analogies to natural disasters or other kinds of medicines, then there's a real risk that we sort of reproduce the status quo, right? We generate this scoping review, this fancy literature review, which essentially says there isn't very much evidence about how to do this well. And that could feed into folks who have a hesitation or aren't yet persuaded that safe supply is the way to reduce harm. They might say, conservatively, there's not enough evidence for us to act, so we need to study it rather than act. And so we actually messed with the methodology in our process because of anticipating that problem that a scoping review might actually just kind of feed into those conservative perspectives from our point of view. And so we structured our research process to try and account for that, to account for the fact that the literature might be really thin and not help us that much. We did find literature, we searched a hell of it, a hell of a lot of it. But we also built in an advisory committee that acted like a consultant. So when we developed search strategies or we started to find relevant literature or things that we thought might be relevant, we would consult through Matt and Natasha in particular a group of people with living experience or lived experience, people who use drugs, about what we were seeing in the literature, what was missing, what was not there. Because if we didn't write, the kind of things that rise to the level of a publication in a medical journal may not actually match the insights, knowledge and expertise of people who know what's happening on the ground. And so we were kind of messing with the method with a very clear understanding that the methodology might end up producing a document that doesn't tell us really much about what to do, given the scope of the syndemic that Matt talked about. So one of the things that I think we hope to do in the future is actually write about our process, that we didn't just do a scoping review or lit review as such, but we did it in this more inclusive way. And that was one of the central things for us, like there's lots of research that happens in the university where people who have insights and expertise but they're not part of the university are sort of tokenistically engaged rather than meaningfully engaged. And so it was really critical for us to try and counter that in our process and in the knowledge we actually produced and we have to keep attending to that, right? We're sort of in the middle of this in some ways. And so that's really important for us moving forward. So I just wanted to highlight that kind of process piece, but I'll turn it over to Sheila to say some more. Thanks. Thanks, Matt. Both Matt. That was wonderful. And I'm just so pleased to have been able to be part of the research project that Matt Herter has just described in that bond before him. And also a little bit of other writing that the three of us did in a policy options piece and that Matt, I'm going to turn it over to you now in a piece published in the conversation, which I want to talk a little bit about because for the few minutes that I'm going to take, I'd like to talk about some of the learnings or the insights that have come out of the work that we've done together. So across lines and in that, I mean the lines between conventional learnings and the work that we've done together and the work that Matt Herters and folks with lived experience or street level expertise in the way that we've worked in the projects that were just described. So that kind of work, that kind of working across lines really affects the kinds of questions that you ask. The kinds of insights that Herters just described and also thereby the kinds of policy solutions that you're likely to work toward. So we all come to research with bases of experiences and of values that affect the questions that we ask and the kind of learnings that we have toward interpretation of the data that we see but as was just described this was a very intentional way of bringing together different perspectives and experiences in order to arrive at something that we hoped would shake up in some sense the sorts of policy stasis that we've seen for so long. So two things that I want to talk about briefly. One goes to the harms of criminalization and incarceration. So I think we all recognize that there are many ways to criminalization and incarceration of people who use drugs and we're living in a time right now Bill C 22 is something that was in the background here. We're living in a time where decriminalization of at least simple possession of drugs is very close at hand at least a form of decriminalization but it's so important to keep our eye on those things that we can't really develop this tonight but I'd go further in light of the research we've done together and also recommend that we think very carefully about the harms of controlling forms of treatment so controlling forms of putative alternatives to criminalization and incarceration of people who use drugs. That's very central learning for people with both mats. The first insight comes out of the piece that Matt one of the pieces that Matt Bond showed and it was written about a year ago as I said it was published in the conversation it was called fueling a crisis and was a comment on the opioid syndemic as Matt has described and there were three things that came out of that that were really memorable to me and this was the first thing that we started with a physician in Ontario so first thing that we started with was a statistic in fact a few statistics right as one often does in research and so we pointed out that opioid related deaths were increasing among incarcerated people so inside prisons and jails but also we pointed out a very disturbing statistic around post-release so we know and we're drawing on other research here that in the two weeks after release a prisoner's risk of overdose is more than 50 times higher than in the general population that's in the two weeks after release and that one in ten of all overdose deaths is a prisoner released in the last year so pretty massive indictment of the way that our system of criminalizing and incarcerating people who use drugs harms those people and in this case we're talking about mortality and then second we made a point and this is now at the policy level just to kind of focus in a little bit more we highlighted a policy at one of our local jails here in Nova Scotia Central Correctional Central Nova Scotia Correctional Facility which has a policy that's actually developed by our health authority which looks after the health of folks incarcerated there and one of their policy states that opioid agonist therapy shall not be provided to those who were not in treatment in the community so prior to their incarceration meaning that unless you've been in treatment prior you're not going to get OAT which means you have to withdraw which is a pretty harsh thing and it also means that folks are incentivized to use illicitly inside which is itself harmful it's very risky and the other side of this is that if you're not using inside your tolerance is going down and this contributes to the risk of overdose when you're out so that was kind of a second point that policy is something that has sat kind of a target of lots of criticism for many years and it continues to sit there and then third and this comes out of Matt's contribution to that piece some qualitative development and details about the policy just described and other policies relating to receipt of opioid agonist therapy in jails so Matt wrote a paragraph that was very personal much like he just earlier relate to you about the experience of strip searching the humiliation and the potential triggering of past traumas and he went further and described some of the systems people use to divert medication and so on and just to read it we ended up translating it to third person but we kept those insights and he says I'm just reading from the piece others who want the medication to prevent their own withdrawal symptoms target prisoners receiving OAT people soon start diverting their medication for instance by vomiting it up and straining it through a sock for someone else to use if someone says no to a demand to divert their OAT they may be subject to violence so this piece this insight that's written in the third person it's a piece of research originated in a personal experience that we linked up right through our co-creation of knowledge in that piece that we linked up with the statistics with the policy but that qualitative development is central to the effectiveness of this piece and I guess I'm going to have to stop there but that's meant to be just one illustration of the ways that the connections can be made between you know kind of statistical another relation based or policy based research and the really fine grained insights of street level or in this case is institution level knowledge okay I'm going to stop so that we have a little bit of time for questions thank you so much Eli thank you so much to the two meds for this incredible talk I don't even know where to start with the comments I'd have a lot of questions to ask you but I do we only have about minutes left so I do want to invite the people in the audience to ask if to see if they want to come on and ask questions or type them in the Q&A and maybe in the meanwhile while we wait for a question or two maybe I'm curious how the three of you ended up working together on this like in particular how come that you Sheila and Matt ended up working together with Matt Vaughn do you want me to answer this or do you want them to answer this why don't you answer it um that's a good question so Matt and I met at ATV some I think April 15th and 2019 that Martha Painter put on and I spoke and Dr. Lisa Barrett was there and and we kind of just really clicked and at that time the overdose prevention site was really kind of had a lot of momentum going so Matt agreed to help with that as well so ever since then we kind of been looking at something to work on and Sheila and correct me if I'm wrong but I think um Claire reached out and asked if anybody wanted to write and I think we knew each other just from you know the community but to work together I think Claire reached out and asked if if anybody wanted to write an op-ed on the issue about OAT and JL and Martha connected us all yeah which goes to kind of like this living in Halifax in a small community where there are so many interconnections really among like lots of different work being done by a few people but all really good people so I don't see any question here but I do have one that is more my curiosity from your perspective as people who are not necessarily practicing in criminal law oh we do have a question here actually no it was just a thank you um so the big criminal justice bill that's coming up and Sheila you have mentioned you had mentioned it in passing and there are lots of discussion regarding increasing the police discretion in terms of arresting drug users and making arrests for possession in particular and it has been hailed as being particularly transformative as important as a piece of legislation and I think that a lot of people agree that it is a step forward but then again others might argue that it's just thinking that the margins with the much broader problem right so I'm wondering if you have any thoughts about if you're familiar with and if you have any thoughts regarding the changes that are being proposed and that are going to go before the party I think we have about one minute left I don't know about the other folks but the two things that I would say about that because it removes mandatory minimums for drug offenses and it it doesn't eliminate the potential for prosecution of low level possession as I understand it but it does as you say it mandates consideration of alternatives both on the part of police and prosecutors so one of my questions goes to what those alternatives are likely to be conditional sentence potentially you know one of the critiques that's been raised around that is that the kinds of conditions that are imposed tend to be most likely breached by those who are already most marginalized so you're talking about you know folks in poverty folks who are you know indigenous folks who are racialized most likely to breach those sentences and be back in jail so there is a potential kind of intensification of you know disproportionate representation through that and the other thing that I'd say that's potentially a problem goes to treatment alternatives and I just raised that as a thought so far but I think that it's something we need to think about coercive treatment alternatives are something to be wary of great study 2020 where Vancouver and both mats relied on it in their work that showed no statistical significance to difference in substance use among those who are in coercive treatment versus those who are in non-coercive treatment versus those who are not in treatment at all and that's enough I think for us to really worry about of this kind of widening of the tentacles of whether it be criminal justice or it be health systems to sort of controlling people's lives on the basis of drug use just to piggyback off that you know the only alternative for criminalization is not criminalizing people for using drugs right like it's as simple as that I know it's not as simple as that but you know we don't have to put it into a health system we don't have to wrap it with a bow and put it into like a rehabilitation system we just have to stop criminalizing people you know we're not trying to fix the healthcare system while we're trying to fix the criminal justice system at the same time and if we are then you know that's a whole different you know mandate right you know there is a group that was announced an expert working group task force that's looking at alternatives to criminalization but they're talking a lot about well what are we going to do with them where we got to put them into treatment and you know we continuously hear from people who use drugs no we don't you know but if somebody does want treatment then it should be available Matt can I piggyback on your thought there and just Eileen if we just have another minute or two I know people might file out but so I take your point right like criminalization is such a harm right that to decriminalize is so critical but when we think about access and what a safe supply look like the question becomes how right how are we going to make it available and so I guess I want to just we've had this conversation internally before where I researched and so on but I'm like I know you have lots of thoughts on like well so to decriminalize and making safe supply what is that like taking the model of cannabis and doing that and we've talked about that before or is it like or what's happening with psychedelics you know because they are going very commercial in a different way I don't know if you want to expand and talk about the ways in which people use drugs are actually sidelined from those things yeah so you know I think the cannabis act is a prime example of excluding people who use drugs from their expertise right you know if I want to buy weed from somebody I want to buy weed from somebody who's been selling it forever and they know what they're doing but we can't now because if you have a criminal record I can see safe supply as kind of like a mixture you know because we went we didn't decriminalize marijuana or cannabis we went right to regulation right I could see some kind of like hybrid model of legalized like a regulation or sorry a decriminalization with compassion clubs that are not criminalized or you know the government giving certain drugs pharmacies and you know doing training and you know social enterprises where you could go and buy a drug you know and I think really we should put safe drugs in the hands of drug dealers right I like to call them drug service providers but you know they have probably the most access to people who need some of the most services out there and I guarantee you if someone had an abscess and they're injecting somewhere and all they want to do is get high they're gonna call their drug dealer before they're gonna call Mosh but if there's a drug dealer coming with Mosh maybe there was you know there's an intervention to happen right that answers your question but you know I think yeah I think through community based organizations needle and syringe programs overdose prevention sites like those are places where we could have drug service providers thank you so much I think we're going to have to conclude we're a few minutes after the the announced closing time but we I really appreciate you taking the time to talk to us Matt and thank you Matt and Sheila for your contributions tonight and thank you everyone for attending as I mentioned this is the last event of the criminal justice speaker series if you want to watch some of the other talks feel free to check them out on YouTube on the Shulik School of Law YouTube channel and with that we are going to stop here have a good night everyone thank you