Another example of “unintended” consequences has to do with the effect of a criminal record upon travel opportunities. Recently, a resident of Victoria, B.C., won a contest to go to the Super Bowl in the United States.[34] When he arrived at Pearson International Airport in Toronto, he was turned back by U.S. Customs because he had been convicted of marijuana possession in 1981 — thirty-two years earlier. Myles Wilkinson said he was nineteen years old at the time of his conviction. He was caught with two grams of marijuana, for which he paid a fifty-dollar fine. He never did get to the Super Bowl.
Crossing the border into the United States gets more perilous by the day if you make any mention of illegal drugs. It is the federal government that controls the border in the United States, so any disclosure a traveller might make about previous drug use or intentions can bar him from entry.[35] If you tell the border agent you are travelling to Washington State to take advantage of the new legal marijuana laws, you can be turned back. If you admit to having used drugs in the past, you can be turned back. You can also be banned permanently from entry. In order to cross the border in such circumstances, you will be required to apply for an expensive, renewable travel waiver. Such travel restrictions impair an individual’s ability to seek employment, maintain contact with family and friends, conduct business, and live an ordinary life.
In order to start the process of reaching rational conclusions about illegal drug policy, it is important to consider the various risks, harms, and benefits provided by the main three plant-based drugs. The next chapter looks into the known characteristics of marijuana, cocaine, and heroin, both positive and negative. It also draws a very important distinction between public health harms caused by the use of the drugs and harms caused by the fact that they are illegal. The tension between these two should help determine our public policy approach to drugs.
Chapter Three
Heroin: Fear and Loathing
Direct Health Effects
Sometimes it takes the death of a celebrity to bring home salient points about drugs, and to dispel the myths that surround them. Cory Monteith, a Canadian actor who made his name on the television series Glee, died in July of 2013 in Vancouver of what was reported as a heroin overdose. Almost immediately, a Calgary Herald editor implied that he would be alive today except for Vancouver’s ready supply of illegal drugs. She took particular aim at the city’s safe injection site (InSite) in the Downtown Eastside neighbourhood.[1]
It was swiftly pointed out that InSite is not in the business of selling drugs of any kind.[2] It also became clear after the coroner had done his work that Cory Monteith did not die of a heroin overdose but of a combination of heroin and alcohol.
As a sidebar to the Monteith story, the day after his death, Abbotsford police sent out a public warning.[3] They reported, in response to a sudden rise in overdoses, that there was a surge of dangerously potent heroin in the area. They had found fentanyl in recent supplies of heroin, which greatly increases the drug’s strength. As it turned out, there was no fentanyl found in Mr. Monteith’s body, but the warning was a cautionary tale to all those in the area who might be using heroin.
More recently, Philip Seymour Hoffman, one of his generation’s finest actors, was found dead in his apartment with a needle in his arm, and a large quantity of heroin in the room. There has been a similar outpouring of grief over Hoffman’s early demise and much soul-searching over the fact that he was an admitted heroin addict who had been clean for years. The relapse was perhaps inevitable, but his death should not have been. Experts have noted that a relapse could have been triggered by prescription drug use.[4] As well, a former addict returning to heroin might overestimate his tolerance for the drug after many years. And even a change as to where the drug is used might be dangerous. For example, if an addict is accustomed to using the drug in his car, injecting in a different environment might trigger an overdose. This is known as “conditioned tolerance.” As it turned out, the toxicology report showed several drugs were present in Mr. Hoffman’s body, specifically heroin, cocaine, benzodiazepines, and amphetamine.
Simon Jenkins, a respected columnist for The Guardian newspaper, talks about the double standard that we have adopted toward drug use.[5] His comments are a direct reference to the classism that determines who gets punished for illegal drug use and who does not. He says, “The law … lumps Hoffman together with thousands found dead and friendless in urban backstreets, also with needles in their arms. It treats them all as outlaws…. Offices, schools, hospitals, prisons, even parliament, are awash in illegal drug use. Their illegality is no deterrent.” Then he concludes: “So what do we do? We turn a blind eye to an unworkable law and assume it does not apply to people like us. We then relieve the implied guilt by taking draconian revenge on those who supply drugs to those who need them, but who lack the friends and resources either to combat them or to avoid the law.” Jenkins expresses the hope that high-profile casualties like Hoffman will lead legislators to re-think their position on illegal drugs and change the law.
What is this drug that took the lives of Monteith and Hoffman? Why is it so feared?
Heroin is derived from the opium poppy, and today most of the world’s supply comes from the Afghanistan, Burma, and Colombia. Opium was first synthesized back in 1874 as an alternative to morphine, after it was discovered that some people were becoming addicted.[6] In 1895, Bayer began producing the substance. The company called their new product “heroin” because soldiers (heroes) who used it would charge into battle in the face of live fire. Bayer promoted heroin as non-addictive and sold it as a substitute for morphine and as a cough suppressant. But as the twentieth century wore on, heroin was eventually prohibited in both the United States and Canada.
Heroin has a blood-brain permeability ten times that of morphine, from which it is derived.[7] This means that the drug causes depression in breathing and increased pleasure, and it can block pain signals from the spinal cord. Injection produces an immediate “rush” like an intense orgasm. Then the user feels four to six hours of a “high,” which might include nodding off or periods of very busy, talkative behaviour. Alternatively, some high-functioning addicts show no abnormal behaviour at all.
As noted, it is possible to overdose on heroin, and to die, although by far most cases of death involve more than the one drug, usually a combination of heroin and alcohol. “While it is theoretically possible to die from an overdose of any of these [illegal] drugs alone, in practical terms this is extremely rare.”[8] With respect to heroin, Dr. Carl Hart says, “In virtually every overdose death involving an opioid … some other substance is present. Most of the time it is alcohol.” He recommends a mass media educational effort to inform people of the dangers of these combinations.
Heroin is a powerful painkiller that sedates the central nervous system.[9] It is addictive both physically and psychologically. Withdrawal symptoms include dysphoria (a combination of anxiety, depression, and restlessness), insomnia, muscle aches, and diarrhea. Some maintain that regular use can cause addiction, but others question this seemingly straightforward assertion. Dr. Bruce K. Alexander, retired professor at Simon Fraser University, for example, rejects the claim that all or most people who use heroin (and cocaine) beyond a certain amount become addicted.[10] He points out that when heroin was being used for therapeutic purposes in the nineteenth century, the incidence of addiction never reached 1 percent of the population, and was declining when the drug was banned.
Withdrawal from heroin is commonly depicted as extremely painful and long-lasting, although some say it is similar to a bad case of the flu. We know that heroin withdrawal can be relatively straightforward if the pressures that led to the addiction are relieved. A favourite example is that of Vietnam veterans returning stateside after the war. Soldiers took drugs to help them through the experiences they were enduring in combat. About 50 percent tried opium and heroin, and half of these showed signs of addiction.[11] Most of them, contrary to the fears of the American government, were able to withdraw from the drugs relatively easily upon returning stateside. The stressors that had led to drug use in the first place had been removed, so users were able to control or eliminate their drug use at home.
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