Good AFTERNOON Mr. Coroner, Members of the Jury

• This is my first opportunity to address the Jury directly

• Actually it’s also my last such opportunity

• And fair to say the only one

• So I am going to try to make it count

• On behalf of my client the Empowerment Council and our witness, the incomparable Zoë Dodd

• I want to thank you for your service during these last few weeks

• We appreciate how attentive to the evidence you have been and how keenly interested you obviously are in the issues within this inquest

• Members of the Jury, I know that serving on this Jury has been difficult

• Coroner’s Inquests are always terribly sad tragic affairs, by virtue of the fact that they arise from a fellow human being’s death

• But not all Inquests are created equal

• So I also want you to know what an incredible special opportunity you have been given in this case, having been selected to serve on THIS Jury of all Juries

• In this case, while the evidence has of course been difficult to hear and the death of Brad Chapman was an absolute tragedy,

• the fact that we have had a full and fair inquest into an opioid overdose death here in Toronto, is a watershed moment in this public health crisis for this City, this Province and the entire nation

• And you, as the Members of this Jury selected to hear this evidence, have an absolutely unique opportunity, to prevent other needless deaths

• In this particular moment in time, during this unprecedented massive public health crisis, you four Members of this Jury have an unparalleled opportunity to make immediate positive changes that will prevent future overdose deaths

• You can make reasonable and practical recommendations that will save not just dozens, but hundreds, and likely thousands of lives

• And all you have to do is choose to make recommendations to prevent future death in similar circumstances to the tragic death of Brad Chapman

• In that regard, I have every confidence in you all that you WILL choose to make those recommendations that will save lives

• The Coroner’s Motto is that “we speak for the dead to protect the living”

• The only people who can actually do that, are you, Members of this Coroner’s Inquest Jury,

• you are the only people who can speak for those who have tragically overdosed on opioids and died,

• to speak for them to protect the living who continue to use drugs and don’t want to die

• I am going to use my half hour with you in a very practical and I think reasonable way

• You may remember that at the outset of the Inquest when I introduced myself and my client, I told you the Empowerment Council is here as a public interest intervener –

• Our primary interest is in the preventative function of this Inquest

• As a result, we I will focus only on recommendations

• I will not be commenting on the contentious issue in this Inquest, the cause of Mr. Chapman’s death or the manner of death

• Instead:

• What we’re going to do is unpack the top 5 reasons we’ve heard that people are dying in this opioid overdose crisis

• For each reason we are able to identify that people are dying, we are going to identify the solution that would prevent people dying

• Or the multiple solutions that COULD prevent future death in similar circumstances

• When I speak about these solutions, I will be using plain-language broad concepts, not the precise language of the proposed recommendation that corresponds to the idea I am putting to you

• I want you to take note of the concepts and solutions I identify for you that are taken from the evidence you heard so you can make sure you have covered them all in your recommendations at the end of the day

• But as for the language you use, I am only suggesting that you use the language that is being urged upon you by the Coroner’s counsel in the recommendations that we all – or most of us anyway – generally agree you should consider and adopt

• Unless I say otherwise –

• where we depart in the language of certain recommendations, I will let you know

• So we are going to list the contributing causes of these deaths and identify the potential solutions that could stop the deaths

• And just to make things interesting, so you have to stay with me while I speak to you, we are going to save the worst for last

• I am not going to identify the number 1 reason people die in this opioid crisis until the bitter end

• And by then you should be able to anticipate what I am going to say

• Though I suspect you already know

• For now though, just park that thought in the back of your mind

• Keep a blank space for the number 1 spot for why people keep dying

• And let’s move on to what we therefore call Reason #2

• Let’s start with the most obvious reason people are dying in this opioid crisis

• People are being poisoned

• It’s an opioid POISONING CRISIS

• The opioids that people are using are tainted with things they don’t know are there

• People have no idea what they’re taking

• But whatever they think they’re consuming, the fatal dose has been poisoned

• These poisons are almost always fentanyl or an analogue of fentanyl

• Sometimes people are intending to use fentanyl, but even then that supply has been poisoned with other analogues or more potent, extra-powerful versions or strains or other toxins or substances

• What’s the most obvious solution that would prevent deaths caused by the poisoning in the drugs that people are consuming?

• A clean, legal, non-toxic drug supply

• On this front, think about how much sense it makes, the way things work now in SCSs and OPSs

• We make sure that the person who comes in to use these services is provided with clean needles, clean supplies, to avoid any infection from dirty needles or supplies

• We clean the area of their body into which they will inject, if they’re going to inject, to avoid infection at the site

• We provide a clean sanitized surface to make sure the environment is safe and healthy for the person to consume the drugs

• And yet we permit them to inject or consume dirty drugs that they got on the street, which contain a host of things nobody knows what they are, and likely these days include a big dose of POISON

• You’ll recall the slide that we showed you with more than 18 compounds in one sample tested that the user believed was pure straight Fentanyl

• Turned out to have caffeine and morphine and a host of other things including Ketamine in there!

• At the SCSs and OPSs, we promise the user that we are going to watch over them and should they overdose, we will bring them back from the brink of death!

• And we do – we provide that service

• But, don’t you think, members of the Jury, that it would be better to bypass the overdoses altogether??

• How do we do that?

• There are so many ways of addressing the problem of poisons in the drugs that people use

• But they all hinge on one basic premise

• We must provide a clean, non-toxic drug supply

• First, provide a non-toxic clean drug supply to the user who comes in to the SCS or OPS

• If we remove the poison from the illicit drug supply, we have resolved the problem

• OR, another way to accomplish the same goal: we provide a legal supply through prescription

• Rather than cutting down on prescription of opioids by doctors to their patients, for people who use opioids, we could consider prescribing the pills,

• Zoë Dodd talked about that – to give people the drugs they need legally

• or provide them with pharmaceutical grade heroin or hydromorphone

• or morphine

• or any clean supply of drugs for people to use not just in SCSs or OPSs but to use whenever they would otherwise use opiates

• These are all things we could consider – which is why recommendation 12 suggests that Canada and Ontario engage in discussion to implement strategies geared toward providing a clean, legal, non-toxic drug supply in SCSs, OPSs and other settings that might be appropriate

• Recommendation 12 as provided to you is one of the MOST important recommendations we urge you to adopt

• There are other ways to ensure a clean drug supply as well, however, and those options also need to be explored, made available and expanded where appropriate

• For example, let’s take the harm reduction approach that works for alcohol users and allow for a managed opioid program

• Just like they have at Seaton House for alcohol

• Provide a small amount of opioid on a regular basis in a supervised or monitored setting to avoid overdoses when people use a larger amount or an illicit supply

• This recommendation forms part of Recommendation 14 on the Big Mostly Joint List you’ve been given

• The Empowerment Council is very fond of Recommendation 14 – it is one of our favourites because it is among the most important

• Recommendation 14 is the one that tells Ontario what to do

• And really nobody needs to be told what to do in all this more than Ontario

• Because right now they’re not only not doing enough, but they’re doing literally NOTHING,

• Including, the Ministry of Health chose not to participate in this Inquest

• And what I mean by that is they knew about this Inquest, they had the right to apply for standing and to be present throughout and ask questions and work on recommendations with us,

• It’s a real shame they were not here to help us, or help you, to sort through all that we’ve heard

• And now back to our regularly scheduled programming, Recommendation # 14

• There are a LOT Of good things in Recommenation 14 but we do suggest one change to the recommendation specifically about managed opioid programs

• Recommendation 14 (ii) suggests expediting these programs (but it says ‘consider’ in front of it – we would suggest removing that word though – as we think this is a critically important solution that does work) – so we say cross out the word ‘consider’ – put a big “X” right through it there and just call upon Ontario to “expedite the implementation of managed opioid programs” instead

• Now beyond the actual poison that is the fentanyl in the illicit drug supply, what else contributes to overdosing?

• Let’s call this next one Reason #3

• People use alone

• There is nobody there to help them

• Why do people use alone?

• One reason may be that they don’t have enough information about the risks of using alone

• They may not know of the dangers lurking in the current drug supply

• It’s possible they do not know about fentanyl in the drug supply

• They may not know that fentanyl is crossing over into other drug supplies beyond heroin or fentanyl itself

• Or they just don’t appreciate the risks of not knowing what is in the drugs they are about to consume

• The recommendation that arises from these points is that people who use drugs need information

• We must have a public education campaign that informs the person who uses drugs about the risks and

• To warn them not to use alone

• Among other things

• We cannot leave harm reduction workers to do all of the public education on their own without funding or supports for them to do this important work

• We have heard there was a previous public education campaign by the Province but it was stopped

• Nobody knows why

• There are no known plans to restart it

• But we MUST educate the public and in this EMERGENCY and CRISIS situation, this recommendation to launch a public education campaign is absolutely critical

• This is RECOMMENDATION 8

• Recommendation 8 also has lots of other good stuff in it – including the suggestion that callers request AMBULANCE rather than police in cases of overdose, which we will talk about later

• Recommendation 8 directs Ontario to conduct a public awareness campaign but also directs CONSULTATION with People with Lived Experience who have used drugs – this is really important – because you heard for eg that Ontario previously convened a Methadone Task force for doctors and nurses to consult with each other, without ANY representation from users

• That kind of Committee structure, in our respectful submission, is, at the end of the day, basically useless

• Without input from people who use drugs, you have a bunch of people who have no idea what the users’ experiences and challenges are in real life, talking to each other with no clue whether they’re making the slightest sense, really

• What’s the point in that?

• So in your recommendations, we do encourage you to keep in mind the crucial role that individuals with lived experience of drug use must play in every step of the processes we envision to address this crisis

• NOW:

• What are some other reasons why a person might be using alone, even if they are aware of the risks, for example?

• They may not have anyone to use with

• Our solution to that is to provide safe spaces for people to use where they are not alone

• Harm Reduction Models like the Supervised Consumption Sites and Overdose Prevention Sites provide a place for people to use where they’re not alone and they will be watched and supervised and they won’t be allowed to die

• Continuing the SCSs and OPSs is a vital recommendation

• The CTS model is flawed and unnecessary

• There is no suggestion the SCS and OPS models we have in place are not meeting current needs of users

• There is no evidence before you to support CTS as a preferred model or what would be gained by implementing it

• There is some evidence of what could be lost

• Matt Johnson told us for example that some people would not attend at a CTS because they are afraid they’d be forced to discuss treatment

• We therefore urge you to adopt the joint recommendation (#6) to suspend the transition to CTSs

• Now, do people die when they’re not alone but also are not in the safe haven of an SCS or OPS?

• When they use with a friend or someone is there to observe them overdosing?

• Yes, people do die even when they’re not alone but with another person who’s there

• Even when people are not using alone, or if they are observed while overdosing, the person who is with them or comes upon them may not call for help or provide help

• Why not?

• They may not know what to do

• They may not have naloxone

• They may be afraid to call 911

• Let’s call why this happens our Reason #4

• The FEAR of CALLING FOR HELP

• Why are people afraid to call 911 ?

• Because they’re afraid of the Police

• They’re afraid the police will show up first

• Or that they’ll show up at all

• Why?

• Because they may have outstanding charges

• Or because they’ll be charged if they have drugs on them

• It would be so much Better just to have EMS come

• To be assured when you call 911 that only EMS will attend

• Or even Fire, but not the police

• EMS, as you saw, are medical people

• They know what to do

• They can’t charge the user with a criminal offence

• Or arrest a bystander or friend who has outstanding charges

• Usually for fail to complies or something minor like that

• It’s important to review whether or why police have to come to overdose calls at all

• IF they do, people do die, if the officer can’t assist properly during an overdose

• Why might an officer be unable to reverse an overdose even if he or she witnesses one or attends on one?

• They may be Unable to appreciate what’s happening

• They may have difficulty Recognizing signs of an overdose

• They may not have Naloxone

• They may not know what to do, or when to, or how to, administer Naloxone

• They may not have the Necessary or the BEST Training

• Online training did not help Officer Mackrell

• He could not quite recall some key aspects of Naloxone training he received online

• Which is why Police Must be trained hands-on

• Reversing an Opioid Overdose

• And the administration of Naloxone

• Must Be Part of basic CPR training

• Next – What other reason can we identify for why these overdoses continue?

• Our Reason # 5 for why people are overdosing IS

• Enforced Abstinence Leading to Lost Tolerance

• People may be overdosing because they’ve lost their tolerance due to a period of enforced abstinence

• Is the person overdosing because they took too strong a dose after not using drugs at all for a period of time

• For eg after a period of forced abstinence in jail

• They’ve lost their tolerance for higher doses or stronger drugs that they built up before going to jail

• or they’re just not used to the new stronger drugs on the street since they’ve been in jail

• What are the solutions to this problem?

• Education for prisoners about the dangers of all this

• Naloxone to be given on release

• Including in Court if released from Court

• Housing to go to when they’re released from jail

• Also we must ensure that SCSs or OPSs are available where there is a concentration or hot spot of deaths

• Including for example perhaps where people end up when released from jail without adequate housing

• Such as in shelters

• Which gives rise to the Recommendation for Shelters to consider having OPSs on site where necessary and practically reasonable

• People will die if they can’t get to an SCS or OPS that is near enough for them to use

• Or WHEN they want to use

• There is a need for 24 hour coverage

• There is a need for local OPS pop-ups

• We’ve heard about the need for one in the Village / Church / Wellesley area, for example

• Which has been identified as a recent ‘hot-spot’

• OPS is the most flexible, nimble, responsive, quickly assembled model of harm reduction that works best

• during this emergency

• It’s a model that is most RESPONSIVE to the Current CRISIS

• It is a model that is REQUIRED while there is a crisis

• Because it is the only model that is responsive sufficiently quickly to save lives where the service is suddenly and urgently required

• But we have heard evidence of the strain the crisis is putting on harm reduction workers

• Harm reduction workers especially in OPSs are stressed and over-wrought

• Overextended, exhausted, depressed, overwhelmed

• They’ve witnessed hundreds of overdoses

• They’ve reversed ALL of those overdoses

• But They’ve Still lost so many friends and colleagues

• They’ve experienced and continue to experience deep trauma

• We urgently need Trauma counselling for them

• Because what they do is save lives

• Without them, these heroes of our communities who work in harm reduction

• Who are out there in the trenches saving lives every day

• The mounting death toll from opioid overdose would be so much greater

• If OPSs and SCSs are saving hundreds of lives a year each, think about how many people would be dead, without them

• And people STILL try to oppose them

• Or some governments create barriers to establishing, continuing or adequately resourcing them

• Which brings us really to the

• Number 1 reason

• That people are dying in this Crisis

• People hate drug users

• They must really hate them

• These ‘others’ who are the ‘users’

• Because why else have we not declared

• a national emergency

• or a national disaster

• while more than 4000 people die each year in Canada?

• SARS took 40 people from us and THAT was perceived as a huge emergency

• Meanwhile in this Inquest we heard that the Province declined to declare a Public Health emergency

• Although the City of Toronto urged them to declare one

• We heard that there is no Provincial Strategy to address this EMERGENCY

• We heard that the Provincial Task Force that was established and was helpful in addressing the crisis has stopped meeting and shows no signs of starting up again

• Tho it must

• There MUST be a Co-ordinated targeted response being spear-headed by experts who include those with lived experience

• Why do people hate drug users?

• Stigma / discrimination

• What’s it all about?

• Presumptions abound about who uses drugs

• That people who use drugs have chosen to do so because they’re lazy or hedons or worthless

• people who are not worthwhile members of society

• Offering a theory of addiction based on the disease model or genetics doesn’t help much –

• It shifts the discussion but not necessarily in a completely helpful way

• Because we should recognize there is no ONE reason that people use drugs

• And also the fact is

• that many people do use without becoming dependent or without any issues that disrupt their lives

• So why do people hate drug users anyway?

• The main reason is that using DRUGS is considered a CRIME

• It is illegal and that makes users CRIMINALS

• We’ve heard this is a policy decision we have made that doesn’t have any real basis

• It is an essentially an arbitrary moral choice

• the effect of which is to criminalize a section of the population who happen to use drugs

• What’s the ultimate answer that will change this and save lives?

• DECRIMINALIZATION (RECOMMENDATION #9) – NOT JUST ‘CONSIDER’ – DO IT

• There are many BENEFITS of Decriminalization

• People won’t hate drug users

• Police won’t be feared

• because they can’t charge drug users

• a regulated legal supply could also result

• safer drugs mean non-toxic drugs

• the end of poisons in the drugs

• The end of the Opioid Overdose Crisis

• And finally the End of the War on Drugs