Having had to postpone his trip to the DDN conference, Bill Nelles reflects on the differences in drug policy between the UK and his Canadian home. Bill Nelles is an advocate and activist, now in Canada. He founded The (Methadone) Alliance in the UK Sometimes things happen in life that force us to change our plans, but it’s especially hard to miss a planned journey. I’m writing, of course, about the COVID-19 virus that forced the postponement of the DDN conference, which I was planning to attend in order to talk about the ‘overdose crisis’ in Western Canada where I now live. I was particularly annoyed because I was looking forward to being back home in the UK and seeing dear friends and colleagues. I’m never sure how many UK users and drug workers remember me when I lived and worked in London, but there’s a good chance that if you were working or using from the mid ‘80s to 2004, you heard me training about AIDS, drug treatments, overdoses and user involvement. Here in Canada we don’t have any national publication like DDN that gets to users and professionals alike. DDN’s February editorial, and its article about Vancouver, reminded me how good it is to read sound and unambiguous editorials and articles that say what they mean and don’t pull their punches. The issue had excellent content on the increasing level of danger to users from contaminated supplies. Jussi Grut’s article described the five-fold rise there has been in fatal overdoses in British Columbia (BC) since the street supply has become contaminated by cheap and often poorly made synthetic opioids like fentanyl and carfentanyl. The already high number of overdose deaths here suddenly climbed steeply from just over 400 in 2014 to 1,600 in 2018, in a province with only 3m people. 2016: Vancouver’s Downtown Eastside neighbourhood, a mural highlighting fentanyl-related drug deaths Credit: Gerry Rousseau/Alamy I also wanted to express the same fears that I felt in 1985 that something bad was on the horizon. Something that could, and should, change the balancing trick we cling to when keeping a safe drug supply just out of reach of the people who need it, and who may live or die depending on reaching such services. Nowhere is this more evident than in the cohort of around 500 people in Vancouver who have access to clean pharmaceutical heroin, or hydromorphone. Hydromorphone isn’t used a lot in the UK but it’s kind of like North America’s legal heroin. It’s also much cheaper than importing heroin from Holland. This group has had no direct overdose deaths, because of course they don’t need to use the poison on our streets. Massive publicity and easy availability of naloxone kits have also helped hundreds to reverse their overdose and stay alive. I planned to outline the differences between UK and Canadian services. I remembered DATs and DAATs, which we have never had here, but which are often envied. Then I heard they have gone the way of the dodo, with no ring-fenced drug funds any longer. My reaction was like Charlton Heston’s at the end of Planet of the Apes: ‘You fools, you went ahead and did it!’ One thing that is very evident here is the absence of any arguing about whose treatment is better. Users are much more united here. BC has had comprehensive availability of opioid treatments to rival any European programme for five years now, and peer educators are employed by health providers to educate, encourage trust and provide advocacy. The challenge is to scale these services down for people using in rural settings – including many First Nations people, who were living here when Europeans settled in their lands. There are certainly some shafts of light to mark our progress. Last year saw the first reduction in overdose deaths since 2012, dropping from 1,600 to 1,000. While they remain far above the 400 a year before the crisis, we are getting much better at responding to them.