Opioids have killed more than 8,000 people in Canada since January 2016, a devastating tragedy that is the worst public health crisis since the HIV epidemic of the 1980s.

To fight this crisis, police in Toronto’s downtown core were equipped with naloxone, a drug that can reverse an opioid overdose and save lives.

But some health care workers and harm reduction advocates say that combining law enforcement with overdose intervention can do more harm than good.

‘Police aren’t medical professionals’

Jeff is a paramedic who has worked in Ontario for 10 years. His real name has been withheld due to fear of repercussions at his job. He said the dangers of involving police in overdose calls should not be underestimated.

“Police aren’t medical professionals. They don’t know the physiology or the pharmacology around how naloxone works. At every call I’ve responded to where police had already given naloxone, they didn’t know the dose they administered.”

Jeff said he responded to one call in which police kicked down a door and administered naloxone to an unconscious woman without any medical assessment, before EMS arrived.

“She could have been unconscious for myriad other reasons,” he said, adding that the 911 call had been made by her boyfriend, who was conscious and would have been able to open the door.

“Performing zero assessment, not even a basic breathing/pulse check, is dangerous,” said Jeff.

“Naloxone forces a person into withdrawal. In long-term opioid users, the brain stops producing certain neurochemicals. Naloxone rips opiates from the brain’s opiate receptors. When you remove that a person is in immense pain.”

Jeff added that the preferred intervention for opioid overdose is ventilation with a bag-valve mask.

“I rarely give naloxone, because I don’t have to.”

‘You need to touch them to do CPR’

Naloxone can be fatal to an overdose patient who has high levels of both amphetamines and opioids in their system.

“Opiates allow your body to have a much higher tolerance for amphetamines than usual,” said Jeff.

“Remove the opiates from the equation and you get ventricular tachycardia [a form of elevated heart rate]. Someone with no medical training does not know how to recognize or respond to that. When you give naloxone without CPR in that situation, you can just kill the person.”

According to Leigh Chapman, a registered nurse and harm reduction activist, the flood of hysteria and misinformation regarding fentanyl exposure could make matters worse for overdose patients who come into contact with police.

“To intervene in an overdose, you need to touch the person. You need to touch them to do CPR, you need to touch them to put them into the recovery position.”

Chapman’s brother, Bradley, became brain-dead and later died in the hospital after losing vital signs while under the supervision of Toronto police. He had been left on the ground in a slumped position, which is dangerous in an overdose situation.

Chapman has become vocal about the need for adequate safe drug-use spaces.

“The evidence is there. We know at this point that safe opioids and safe places to use are what can stop the deaths.”

Criminalization

A lack of medical training is not the only issue when it comes to police involvement in overdose interventions.

Police “can’t remove the criminality from it,” Jeff stated.

He said that he has seen police “blatantly ignore” the Good Samaritan Drug Overdose Act, passed in 2017 to protect people at an overdose scene from arrest for drug possession, thus reducing fears of calling 911.

“At one overdose call, police found residue in a patient’s needle and threatened to arrest him for it. At another call, they threatened a woman with arrest if she didn’t go with us to the hospital,” said Jeff.

Data from 394 reports written by the Toronto Police Service for overdoses they attended in 2016, obtained through a freedom of information request by The Local, reveal police often follow overdose patients to the hospital and question them about the source of their drugs.

“People are much less likely to call an ambulance for an overdose if they know that police will be there, and they are much less likely to be truthful with me if police are present,” said Jeff.

‘This legislation does not protect them’

The Good Samaritan Act is too narrow to encourage people to call 911, according to Gillian Kolla of the Toronto Overdose Prevention Society.

“All it says is that you can’t be arrested for possession. If people have probation or parole conditions, or if they have outstanding warrants, this legislation does not protect them.”

Possession for the purposes of trafficking is also not covered by the Act, meaning that people with larger quantities of drugs can still be arrested.

Arrest after receiving a naloxone dose means that patients can be forced to go through withdrawal in jail, cut off from support and basic comforts during the extremely painful process.

While medically assisted detox programs can help people who wish to stop using do so safely, forced withdrawal in jail means that people are likely to start using again upon release. In addition, a lowered tolerance increases the likelihood of overdose, especially in the first weeks following release.

When Bradley Chapman died, he had been out of jail for less than one month.

For street-involved people and those who use or are in proximity to recreational opioid use, the negative impacts of increasing police involvement are no surprise.

Kate, who wished to be identified only by her first name, said that she watched two police officers mock the friends of a man who was overdosing at her home on New Year’s Eve in 2013. According to Kate, the officers told a 17-year-old girl who was present to administer naloxone because she should be used to injections.

“The girl was at the point of tears when the paramedics arrived,” Kate said. “A man was dying and the police were bullying a distraught teenager for kicks.”

‘Responders and enforcers’

Equipping all emergency responders with naloxone and appropriate medical training is common sense in rural and remote areas, said Kolla.

But “in an urban centre like Toronto where the average EMS response is within eight to 10 minutes, there is an argument that it’s a bit redundant.”

Chapman said that as long as there is a chance of police arriving before paramedics, naloxone should be available.

“It’s complex and nuanced. Police are both responders and enforcers, so they are confused about their role and clearly need more training.”

Police often arrive at the site of an overdose before paramedics do, said Jeff, but that’s because there are more of them.

“Before, they would be there sometimes. But now it’s like they’re at every overdose. Why not put more ambulances on the road, rather than funding police having access to a drug which they don’t understand and haven’t been trained to use?”

When Jeff filed a complaint against a police officer after seeing the officer violate the Good Samaritan Act during an overdose call, Jeff’s colleague, who had been present, was reluctant to give a statement.

“There’s this culture in Emergency Services that we’re all in this together, that we have to have each other’s backs,” said Jeff.

“But our interests may be at odds with those of the police. I had to ask the other paramedic what he was more obligated to protect, the patient’s well-being or a police officer’s feelings and reputation. When I put it that way, he agreed.”

Harm reduction in the community

As overdose prevention sites (OPS) face threats to their existence under the Ford government, it is more vital than ever that harm reduction stays in the hands of the community, according to advocates.

“Getting funding for the OPS is like pulling teeth,” Kolla said. “While there has been significant success with creating OPS inside community health centres in recent years, this is still just the tip of the iceberg when it comes to taking on the enormity of the opioid crisis.”

“We need better hours, we need more low-threshold services.”

According to Chapman, the lack of response to the opioid crisis is tied to the criminality of drug use, and ideological fear-mongering under the Ford government has fanned the flames of animosity towards drug users.

“We just have to keep putting out stories and hope that people will care eventually,” said Chapman. “In a lot of ways, the narratives are shifting. People are talking about evidence more. The experts say that the crisis will only get worse, and that’s with the existing programs.”

“What happens from here is a matter of what we, of what Toronto, will tolerate as acceptable.”