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The Current Transcript for March 28, 2023

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

[Music: Theme]

SOUNDCLIP

[protests]

MALE SPEAKER: This has to be stopped. This prime Minister is not qualified anymore.

MATT GALLOWAY: The scenes from the streets of Israel's biggest cities are stunning. Hundreds of thousands of people protesting Prime Minister Benjamin Netanyahu's plan to give the government more power to pick judges. Airports blocked, diplomats posted abroad resigning. With his government threatened and fears of a civil war looming, Netanyahu yesterday delayed the legislation. In 30 minutes, the roots of this fury and whether a pause will be enough to save his embattled leadership. Also this morning, Canada's toxic drugs emergency has led to thousands of deaths across this country. And now, those caught in the crisis are facing another threat.

SOUNDCLIP

FEMALE SPEAKER: BROWN Dope was like hardly, like you're hardly getting sick from that. That was like nothing. Fentanyl Was a little bit worse. But this tranq is intense. You feel like you're literally going to die.

MG: Xylazine, an animal tranquillizer known as a zombie drug is turning up on the streets and putting those using drugs at even greater risk. In an hour, the rise of tranq dope. We begin, though, with a Canadian breakthrough for treating stroke patients. They come into the hospital in life threatening condition, they walk out days later. Good morning. I'm Matt Galloway and this is The Current.

[Music: Theme]

EVT STROKE TREATMENT

Guests: Marleen Conacher , Dr. Michael Hill

SOUNDCLIP

MEAKA STAR: She was making supper and she was talking really weirdly. I couldn't understand her and her face was really weird. Like one side is dripping, then the other side, and she couldn't move one of her arms. I think it was the right one. I don't remember. So I didn't know what to do. And I called my dad. He told me to call 911, so I did that.

MG: Meaka Star was just 10 years old, staying with her grandmother when she noticed something was wrong. Her grandmother, Marleen Conacher , was having a stroke. Meaka’s fast reaction meant that Marleen got to the hospital quickly and the stroke didn't cause any serious lasting damage. But a week later, Marleen had another stroke.

SOUNDCLIP

MEAKA STAR: She said she couldn't open the pill bottle. That was really strange to me because she usually just does it like that. But then she was also like not speaking as much. And then her arms again, they were all wonky. So I just called my dad the second time like, okay, I know what to do this time.

MG: Marleen was taken two hours away to Saskatoon where doctors performed something called an EVT, endovascular Thrombectomy. This is a procedure that holds a lot of promise for stroke patients. Marleen Conacher joins me now. Marleen, good morning.

MARLEEN CONACHER: Good morning.

MG: Your granddaughter sounds like a real star.

MARLEEN CONACHER: Oh, she is. I wouldn't be here without her. I know that.

MG: Tell me about this second stroke. She was talking about some of the things that were happening. You couldn't open a pill bottle and what have you. What was going on then?

MARLEEN CONACHER: Well, I'd gotten up to take my medication first thing in the morning and I went to open up the pill bottle. And my mind at this point isn't working properly because I can't figure out how to open the pill bottles. Well, you know, they're simple pill bottles, but I wasn't aware of what was going on. You know, I just couldn't open the pill bottle, but Meaka knew right away what to do. So. And within, you know, 35 minutes or so, I was on my way to Saskatoon. And with that, that action, I'm sure she saved my life.

MG: So you get to the hospital in Saskatoon. What do you remember about what happened when you arrived there?

MARLEEN CONACHER: When we arrived, in Saskatchewan, they have a, it's called a stroke response I think. So when somebody has a stroke and they're being brought here, a team is assembled. So they're standing there waiting for you when you come in from the ambulance. And so there was a neurologist there, the doctor that did the EVT. You know, there is three or four doctors standing around there, and they took me in for a CAT scan, and then they took me right into the room where they did the EVT.

MG: And all this happened really quickly.

MARLEEN CONACHER: Yeah. Well, to me, yeah, I think it was very quickly. Yep.

MG: And so when you go in, we're going to speak with a doctor in just a moment about all the medical details of how this works. But as a patient, the EVT, the thing about this is that essentially it gets the blood clot out so that the blood can continue to flow, right?

MARLEEN CONACHER: Yes. Yes.

MG: And you're awake for this?

MARLEEN CONACHER: Yep. Yeah. You know, I don't recall when they put the whatever that little claw-like thing up through my groin and it went up through the artery and into my brain. But I do remember feeling when they had got to it and were pulling it out. It was a great deal of pressure. It did not hurt, but it was a great deal of pressure. And then they, you know, obviously pulled it out and got me ready to go into the recovery room. And I don't recall the time, but it was a short time before I was aware and could talk properly. And, you know, I was whole again.

MG: Okay. So I'm going to come back to that. But you just whipped through like the medical miracle part of it. So you're awake and they put in like a catheter into your groin and then they feed this up. Like did you feel? What did you feel as they're doing this?

MARLEEN CONACHER: Yeah. Well, I don't recall feeling anything. The only thing I remember is the pressure of them pulling the clot out.

MG: And where did you feel that pressure?

MARLEEN CONACHER: Right on the side of my temple. I'm not sure. I think that's where the clot was.

MG: Right. And so it just felt like pressure as they're pulling this clot out of your brain.

MARLEEN CONACHER: Yeah. Yeah.

MG: That's amazing.

MARLEEN CONACHER: Yeah. Isn't it?

MG: Did you know what they were doing at the time?

MARLEEN CONACHER: No. I think they explained to my son and to my aunt that had come down in the ambulance with me. They explained it to her, I'm sure, because I wasn't aware, you know, I wouldn't have comprehended what they were doing.

MG: And so they do this, they pull this clot that you feel. You feel this pressure, that's done. And then what do you remember happening then?

MARLEEN CONACHER: Yeah. Well, they did all the stuff that needs to be done after any kind of surgery. And then they moved me to a recovery room. And there wasn't a bed in the stroke unit upstairs for me. So I stayed overnight in the recovery room. And I mean, I was, you know, I was great right after.

MG: You were great.

MARLEEN CONACHER: Yeah. I chatted with, because I try and I do a lot of my stuff with a sense of humour.

MG: Mm hmm.

MARLEEN CONACHER: So when I woke, I got in there and was talking. The nurses had to stay with me that night, of course. And so we created a bond because I visited with him half the night. And then in the morning, they moved me up to the stroke ward.

MG: How long were you in the hospital for?

MARLEEN CONACHER: I was from Monday until Thursday.

MG: From Monday until Thursday. And you walk out of the hospital on Thursday?

MARLEEN CONACHER: Yeah.

MG: And how did you feel?

MARLEEN CONACHER: I felt good. Yeah, I went shopping.

MG: You left the hospital having recovered from a stroke and you went shopping?

MARLEEN CONACHER: Yes.

MG: When you think back at what you went through, I mean, what goes through your mind? For me listening to you tell this story, it seems incredible. But you were there. This happened to you. When you look back at it, what goes through your mind?

MARLEEN CONACHER: Well, I just thank the good Lord that I am here, you know. I guess I don't know how to explain it, but I don't think back on it a lot. Like I tell the story, but I mean, I don't spend a lot of time, you know, thinking about having a stroke or whatever.

MG: Yeah. A stroke is a scary thing for a number of reasons. And you know this very well because of what happened to your dad, right?

MARLEEN CONACHER: Yeah, he was. If they'd had things like this, I think he would have been just as fine as I was. But he was home by himself and he had this stroke. And a relative of my husband's had been phoning there because there was supposed to be a birthday party for my nephew and they couldn't reach my brother and his wife. And so they phoned to my dad's place and he picked up the phone and all he said was help, help. And so they came and got him, took him up to the hospital and that's where he spent the rest of his life. You know, he went into the nursing home but it affected him. He was paralyzed on his left hand side, so he was in a wheelchair. And yeah, he was like that for two years before he passed on.

MG: Hmm. And you think had they had this kind of thing back then that they could have saved his life.

MARLEEN CONACHER: Oh, I'm sure they would have. I'm sure it would have. Yeah. Because we aren't sure how long he laid at home having had this stroke.

MG: Because so much of this is about, I mean, with a stroke just generally, but with this kind of treatment, time Is everything, right?

MARLEEN CONACHER: Oh yeah, yeah, yeah. Fast as you get there, you know, your chances of being okay are they're way better.

MG: How are you doing now? You sound great.

MARLEEN CONACHER: I'm doing really good. I, you know, don't let anything really get me down. Yeah, I'm doing great. I have a bit of a memory problem, and I don't know if that's because I'm, you know, getting old or if it's because of the stroke.

MG: Yeah. I think in all of us, as we get old, the memory starts to slip away and we wonder what it is.

MARLEEN CONACHER: Yeah. It's frustrating.

MG: What about your granddaughter? I mean, what does she think of all of this?

MARLEEN CONACHER: Well, she's pretty proud of herself, which she should be.

MG: She should be, yeah.

MARLEEN CONACHER: Yeah. And she takes it one day at a time too.

MG: You're really quite something. And you've been through just a remarkable thing. It's a real pleasure to talk to you, Marleen.

MARLEEN CONACHER: Well, thank you. It's a pleasure to talk to you too.

MG: Marleen Conacher was treated using EVT for a stroke in 2021. Dr. Michael Hill is a stroke physician at Foothills Medical Centre. He was a key player on research on EVT. He's in Calgary. Dr. Hill, good morning to you.

DR. MICHAEL HILL: Good morning.

MG: What goes through your mind when you listen to Marleen talk about what she went through and how she is now at the other side of this?

DR. MICHAEL HILL: Well, lots of character, doesn't she have? That's great. Nice to hear. We see cases like this now. Terrific that she got fast attention and fast treatment. And as you pointed out in your interview, speed is critical.

MG: What does that mean? I mean, from a layperson's perspective, we understand that. From your perspective, what does time mean when you are treating somebody who's had a stroke?

DR. MICHAEL HILL: Well, 10 or 15 minutes makes a difference. When we're alerted to a suspected stroke syndrome and we're meeting somebody in the emergency room, we're hustling to get there and be there before the patient or just after the patient arrives. So, you know, you run from the car.

MG: We heard the description from Marlene about what happens in this procedure. Once you run from the car and you meet the patient at the hospital, walk us through quickly kind of what goes on.

DR. MICHAEL HILL: Well, can I start a little before that? I mean, I think a really key perspective that we didn't hear about and Marleen doesn't know about is the infrastructure required to get patients to help. And that involves the, you know, EMS services and their ambulance services. The paramedics are identifying cases. They call ahead so we know they're coming. We meet them at the door, right? So we have a team that meets them there. And then we have to make a very quick assessment about whether the patient is likely going to be, you know, an endovascular candidate or a treatment candidate. And then if the patient has a blocked artery, a clot in any artery in a location which is amenable to endovascular treatment, then we will offer them endovascular therapy. We may do it with or without giving intravenous thrombolysis. So that's a clot busting drug which has been used for, you know, over a couple of decades. So we'll move them into what we call the angio suite. And as described, you know, you heard Marleen say it, Typically you enter the arterial system through the groin. You puncture the femoral artery and then you pass a catheter up the femoral artery into the iliac artery into the aorta. And then from the aortic arch, you can pass it up into the carotid or vertebral arteries to access the intracranial circulation, and that's where the clot is. And then you will use devices to remove the clot. And there are two different types of devices. And typically, actually, they're used now in combination. Basically, one is called a stent retriever. It's a small, I guess you could think of it like a snare, right? It's a way of grabbing a thrombus. And then the other is an aspiration catheter. And if you use them together, you sort of snare the thrombus and then you turn on the vacuum and suck it out.

MG: How big will the thrombus, that's the clot, how big would that be?

DR. MICHAEL HILL: It depends on, you know, which artery is affected. But for example, a typical diameter of the middle cerebral might be three millimetres or so in terms of the thickness of the clot. And then it could be anywhere from, you know, one centimetre to four centimetres long.

MG: The patients are generally awake when this happens? She said that she felt the pressure of this thing being taken out.

DR. MICHAEL HILL: Sometimes patients are completely cooperative and we can do it completely awake. Sometimes they require some degree of sedation to keep them still. You can imagine it's important to do this procedure with your head relatively still. You can't have them thrashing around. And sometimes people need general anesthesia. So it varies according to how the patient is. Some patients when you're actually in the artery, it does either hurt or you feel a bit of pressure. It varies. I would say most people get some degree of minor sedation. And they also have an effect on memory. So people don't tend to remember much of what happened.

MG: When did you realize that this was a game changer?

DR. MICHAEL HILL: Well, you know, we were one of the groups in Calgary. We led the escape trial across Canada. And that was a, you know, it was a contributing thing. It was one of five trials that were done all around the same time. So when we got the results, of course, it was obvious it was a massive treatment effect. But I think, you know, after the fact and seeing what was happening on our own stroke unit where, you know, just like Marleen, right, where people would come in and they were paralyzed on one side, they couldn't speak or, you know, they were severely affected and then they were leaving the hospital in two or three days, just like Marleen said, and going shopping. That was a visible change. It was tangible. You could feel it, right? The flow of patients on the unit was changing. Whereas people would have stayed many weeks for their recovery and rehab if they survived at all. So that's changed. It's just entirely changed the way our service delivery works. So for myself and my colleagues, that was a major evolution and it was obvious to see.

MG: I was going to say, what is that like for you to see somebody who comes in in that distress, knowing that in years past, as you said, with perhaps some of those drugs that they might have been given to break up the clot, that they may not have recovered or that the recovery would have been long, slow, could have halted along the way. When you see them get up and walk out the door a couple of days later, what is that like?

DR. MICHAEL HILL: Yeah. Well, it's amazing, of course. I mean, when I started doing neurology and stuff, it was just at the beginning of the time when we had thrombolysis. And of course when Thrombolysis worked, which is, you know, less frequently, it was great, right? It was obvious then that there was a huge benefit to the patient. So here, the issue is that it works a lot more frequently. And so it's terrific when we get people back to their lives. So it's fantastic.

MG: Not everybody is the best candidate for this, right?

DR. MICHAEL HILL: No, I would say. So the statistics in Alberta, we treat about 10% of all strokes with endovascular thrombectomy. And there are a number of technical considerations. What co-morbid illnesses do you have and various things. So it's not for everybody for sure. But this particular procedure addresses the patients with the most severe types of a skimming stroke. And in that way, you know, we're dealing with a very high morbidity and mortality condition. So it's dramatic when you see a great result.

MG: How available is it across the country?

DR. MICHAEL HILL: Well, it’s pretty good now. This is a great advantage of, you know, doing the primary research in the country. So when we started, we had 11 sites across the country in the escape trial. And all of them, when the trial was shown to be positive, were able to just sort of turn around and continue to offer the treatment. And I think we've got about 25 or 30 sites now in Canada offering this treatment there. And it's most of the major hospitals in the country. You know, it's a tertiary level procedure, right? You're not going to see it in a small rural hospital.

MG: And so would you want to see it I mean, more widespread? Is that possible? Is that likely?

DR. MICHAEL HILL: There's a balance here between volume and volume of procedures and availability. So in an ideal world, of course it's available everywhere. But like many procedural based or team based operations and care, you need expertise. And in order to have that expertise and maintain it in the team, you've got to do a certain number of cases per year. So, you know, if you're just doing one a year, you're more likely to have complications than you are to be successful, right? Whereas if you're doing 150 a year, every second day basically, then, you know, the team is ready. Essentially the wheel is greased too, right? And everyone's ready for these things to occur because you're doing it so frequently. So there's a balance there. We certainly all agree around the world really, that the more this could be available, you know, the better. But there is a balance between team readiness, skill and expertise and managing availability.

MG: How many of these do you do a year, do you think?

DR. MICHAEL HILL: Oh, in Calgary, we do about 180, 200 a year. And it's about the same in Edmonton.

MG: It really must be something. I mean, as you said, you give somebody their life back.

DR. MICHAEL HILL: Yeah, it's fantastic to see, right? It's lovely to see people walking out of hospital.

MG: Thank you for telling us about this. This is really quite, quite something and feels like a bit of good news at a time when particularly when it comes to strokes, there often is not a lot of good news. Dr. Hill, thank you very much.

DR. MICHAEL HILL: You're welcome. Thank you.

MG: Dr. Michael Hill is a stroke physician in Calgary at the Foothills Medical Centre. He was a key player in research on EVT and appointed officer of the Order of Canada for that work on improving stroke care. Your CBC News is up next. And then.

SOUNDCLIP

[protests]

FEMALE SPEAKER: Everyone here served in the Army and they are serving too. And we are going to protect the democracy. We are here for the democracy. He's not here for the democracy. Thank you very much.

MG: For weeks, tens of thousands of protesters have been calling on Israeli Prime Minister Benjamin Netanyahu to stop his plans to overhaul the justice system. Now he's fired his defence minister after he spoke out against the plan. We will talk further about Netanyahu putting a pause on this initiative, but whether that will answer the concerns of the many people on the streets of Israel who fear that that country's democracy is at stake. My name is Matt Galloway. You're listening to The Current on CBC Radio and the CBC Listen app. We're back in six minutes. Stay with us.

[Music: Theme]

ISRAELI UNREST

Guests: Steve Hendrix, Ronen Bergman, Michael Koplow

MG: Good morning. I'm Matt Galloway and you're listening to The Current.

[Music: Theme]

MG: Still to come, a new deadly turn in the opioid epidemic. How an animal tranquillizer is entering Canada's drug supply. That story in just under 30 minutes. But first, is Israel's democracy on the brink?

[Music: Theme]

SOUNDCLIP

[orchestra, protests]

MG: Those are members of the Israel Philharmonic Orchestra accompanying protesters singing the Israeli national anthem on the streets of Tel Aviv on Sunday night. They were among 600,000 people voicing their opposition to Israeli Prime Minister Benjamin Netanyahu's plan to overhaul the judiciary. The overhaul would make it easier for politicians to appoint judges and to overrule those judges. And when Netanyahu sacked his defence minister for siding with the opposition, it sparked new outrage.

SOUNDCLIP

[protests]

MALE SPEAKER: We’re here to protest. We feel that we have no other way. This has to be stopped. This Prime Minister is not qualified anymore.

MG: If you do the math, about six and a half percent of the entire population of Israel took to the streets over the past couple of days. And in the end, Benjamin Netanyahu relented sort of.

SOUNDCLIP

[Benjamin Netanyahu speaking in his language]

MG: From a national responsibility, from the will to avoid a rift within the people, last night, Netanyahu announced he was delaying the judicial overhaul for now. Steve Hendrix is a reporter with The Washington Post. He's in Jerusalem. Steve, hello.

STEVE HENDRIX: Hi, Matt.

MG: How would you characterize what the last few days have been like in Israel?

STEVE HENDRIX: Boy, the tumultuous climax of a very, very tumultuous three months. You know, this is a place where the Israelis and we observers here are used to a lot of upheaval. It's almost a way of life here. But even with that as a starting point, few people have seen anything quite like the outpouring of opposition. The sheer numbers, as you said, are pretty unprecedented here. And then just sort of the grappling with basically two sides of society has just felt like a very profound conflict. And they all kind of came to a head the last 48, 72 hours.

MG: Who are the people who are out protesting saying that the prime minister has essentially lost, you know, the moral authority to govern?

STEVE HENDRIX: Well, it's different than the sort of longstanding centre left sort of standing opposition to Netanyahu and his right wing government. This controversy brought in a whole new category of Israelis. A lot of the middle class and people outside of Tel Aviv and Jerusalem, outside of the coastal tech corridor as it were, got involved. And then the most remarkable twist was in the recent weeks when we began to see military members, reservists who play a very important role in Israel's overall military readiness. They openly began opposing the judicial reform project and even more pledging not to participate in training missions. They were careful to say, of course, if there's an emergency, we will respond. But they made their opposition very clear and very public, which was not only unprecedented, it was quite the turning point.

MG: And then he fired his defence minister and more people came out onto the streets and there is this pause that is announced in this overhaul. Do you believe that pause will be enough to mollify those who have been out on the streets?

STEVE HENDRIX: I mean, it was certainly a relief to many people when it happened. And last night, it had become kind of expected given the course of events. But no, I think there's plenty of protesters have said they will continue to keep pressure up. And even the prime minister himself had said that, you know, this issue is not going to go away. This kind of judicial overhaul is quite the priority for particularly his most hardline partners in the governing coalition. They have a lot of leverage. If they were to pull out of his coalition, the government would fall. So we know it'll be back. Probably there'll be some talks over the Passover Knesset recess. But after that, I don't know if it will unfold quite the same way. But the potential is there for, you know, a return to real turmoil.

MG: What is he trying to do in terms of threading that needle and diffusing some of the anger on the streets, but also to your point, keeping that far right coalition on side? How is he managing that?

STEVE HENDRIX: Not very well so far. I mean, you know, we've kind of come to look at Benjamin Netanyahu as this sort of political master strategist. And he certainly has a career where he has come back from, you know, controversy and defeat many, many times. And he could well do that again. But so far, this whole controversy erupted in a way that was very unusual for him according to folks who have been here and watching him for many years. He's quite risk averse in many ways, and he's very careful about presentation. And this was just sort of dropped in the public without any real preparation. It's not an issue they campaigned on, the new government. And there's some questions about how whether he's actually sort of behind on this within his own coalition. It's never been his top priority, but it is the top priority of these very far right parties that he had to go into government with in order to get his majority. So, you know, how he goes from here to appease them, they're quite angry that he caused this, they thought this was their one golden opportunity, is really going to be a fascinating question.

MG: We've heard from Palestinians on this program who say that one of their concerns with this overhaul is that this could further entrench illegal settlements, particularly in the West Bank. What are you hearing from Palestinians about this as this turmoil unfolds?

STEVE HENDRIX: I mean, as with many domestic political disputes in Israel, and they’re frequent, Palestinians I talked to in the West Bank are, you know, I don't want to say they're bemused, but they feel like it doesn't matter to them. Their circumstances don't change dramatically, no matter who's in government or what policies are being debated. I didn't hear a lot of concern about the potential for a weakened Supreme Court. In some ways, it's been quite quiet in terms of security situation. It’s been getting pretty bad in recent months. And there was almost a sense that the Palestinians, including Hamas in Gaza, were sort of like, well, let's just sit back at this point because Israel seems to be battling with itself. And, you know, it's Ramadan now, and that's both often a time of incidents here, but also, you know, a religious holiday where people are with their families. And so far, that's unfolding pretty peacefully, which is nice to say. But all of that is going to come back. You know, all the tensions and all the conflicts will be in play any time now. I think people really expect that. And so, in their view, somehow, some way, it just doesn't make much difference.

MG: Steve, we'll leave it there. And good to talk to you again. Thank you very much.

STEVE HENDRIX: My pleasure, Matt. Thank you.

MG: Steve Hendricks is a reporter for The Washington Post. He was in Jerusalem. As these protests continue, there are concerns for what this civil discontent is meaning for Israel's national security. Ronen Bergman is a staff writer for the New York Times magazine. He covers national security issues. He's in Tel Aviv. Ronen, hello to you.

RONEN BERGMAN: Hi, Matt.

MG: Prime Minister Benjamin Netanyahu announced that he would delay plans to overhaul the judicial system. But he also accused, in his words, an extremist minority of trying to divide the nation. You posted a tweet of a video. You were out on the streets at 2:00 in the morning surrounded by tens of thousands of people. What do you make of that accusation that an extremist minority is trying to divide the nation?

RONEN BERGMAN: As always, I think Benjamin Netanyahu is trying to divert attention to a minority of leftist left wing progressive liberals and trying to portray the opposition against him as either people who are brainwashed to not understand the nature of the so-called judicial reform. And when faced with the fact that many of them, first, the 600,000, the number that you quoted is almost 10% of the population in Israel and almost 8% if you calculate out the children. And when we understand that many of those protesters are people who are serving in the highest position in Israel, in all realms of society, financial industry and the security establishment. He is having a hard time to explain how come this is a minority extremist and they don't understand what he's talking about. He is trying to accuse now the Minister of Defence that he fired and the military commanders that they are not able to stop people from quit. This is the main threat to Israel national security, not to quit the reserve duty. The defence of Israel is dependent on reserve duty soldiers and officers. And many of them have said that when the judicial reform is executed, they will not serve anymore. It's a voluntarily serving task. And if they will not serve, especially pilots, the Israeli operational capability will be significantly diminished. Not just in case of war, but in an ongoing day to day operation.

MG: Is that what you think forced his hand again to… He hasn't said he's going to scrap this review and his policy, that he is going to put it on pause. But he's also said, you know, that we will not surrender. We were elected for certain purposes. But is that what you think led him to this step that we saw in the last 24 hours?

RONEN BERGMAN: I think what led him was a public speech, the first of his own party that rebelled against the so-called judicial reform, the Minister of Defence, Yoav Gallant, who said in a public statement that the continuation of this move is in putting in great jeopardy the Israeli national security. And with the Minister of Defence who represents the military, the rest of the security establishment, the intelligence community and others, when he says this is a great threat to Israel’s national security, the Prime Minister is sort of locked in a tight spot when he cannot say that he is lying. He cannot. So he fired him and he sort of declared a ceasefire with the protesters. His main goal I think is to try and diminish or calm down the protest in the street and the huge wave of reservists who are saying we are not going to serve in the military anymore. If this is contained, he believes he will be able to hold his coalition on one hand. The coalition, much of it are ultraright members of parliament who demands him to continue with the political legislation and maybe hold the government together. And I think the main question of the next few days is what will happen in the streets.

MG: Let me ask you about that coalition. This has been described as an impossible bind that he finds himself in because he has to put these reforms on pause in some ways to defang the protesters on the streets. But you have members of that coalition, including his national security minister, Itamar Ben-Gvir, who is a member of the ultranationalist party Jewish Power who are holding him to account. How are the members of the far right parties responding to what Benjamin Netanyahu has done?

RONEN BERGMAN: So the minister of national security, Itamar Ben-Gvir, who is a convicted terrorist, has been paid for or paid in some kind of a compensation. So Benjamin Netanyahu promised him yesterday that in exchange for him not giving up on the coalition, not withdrawing, he will be giving authority to establish some kind of a private militia under his own command, which is by itself a threat to democracy. And Benjamin Netanyahu is trying to satisfy his parties to the coalition. But I think many of them, if not all of them, would not be keen to quit the coalition because the latest polls indicate that if elections are declared tomorrow, then this coalition is going to lose in a major, major gap to the nowadays opposition. They don't want to start a new round, a sixth round of elections. And so I think that unless something extremely unprecedented and unexpected is happening, he will be able to maintain the coalition. What would happen, and I’m going back to the question of the protest, will he be able to contain the protest? This is something totally different because the protest has other repercussions. The reservist, the military that is in an accelerated process of disintegration, international relations with Israel, what the U.S. will say. All of that contains similar limitations, puts him in a different kind of conditions and threats from all over.

MG: The language that's being used to describe what's going on is extraordinary. People have talked about the possibility that Israel could slip into a civil war. You're seeing ultranationalists who are organizing counter-protests. How real is the prospect of a civil war in Israel?

RONEN BERGMAN: I think if you would take 100 experienced clever Israelis six months ago and ask them or tell them, you take your CBC time machine, go back and ask them six months ago, you tell them what's happened and then you asked them, do you think this is possible? You'll get 100 Israelis telling you this is impossible. No, nothing like this. It’s so unprecedented. It's never happened in the history of the country. So if you would ask me, is it possible to have a civil war in Israel? Six months ago I would say no. Now everything is possible. It can deteriorate. And I think the civil society surprised everybody, especially Benjamin Netanyahu who did not expect this kind of civil unrest that stood on its feet and said this is enough and roared in the streets. It's something that they will do everything they need. You know, in the last protest, the one that I reported from, you mentioned the tweet in the night on the main highway, people said it's either democracy or rebellion.

MG: Those are quite the stakes. Ronen, we'll leave it there. It's good to talk to you again. Thank you very much.

RONEN BERGMAN: Thank you.

MG: Ronen Bergman is a Tel Aviv based staff writer for the New York Times magazine and the author of “Rise and Kill First: The Secret History of Israel's Targeted Assassinations”. The protests against Prime Minister Netanyahu's judicial overhaul have not been limited to being inside Israel. On Sunday night, hundreds of people protested outside the Israeli embassy in London. And parts of the Jewish community in the United States are speaking out as well. Michael Koplow is chief policy officer of the Israel Policy Forum. It's an NGO based in Washington. Michael, good morning to you.

MICHAEL KOPLOW: Hi, Matt.

MG: Do you think that Prime Minister Netanyahu putting pause on this policy is a sign that he is truly reconsidering what has been proposed, a proposal that has, as we've said, sent thousands of people out onto the streets of Israel and beyond in protest?

MICHAEL KOPLOW: I think he's reconsidering the tactics that he's going to use to get the overhaul passed. I'm not confident that he has rethought the actual legislation itself. I think that what he understands after the upheaval of the last 48 hours when he fired his defence minister and the protesters came out in larger numbers literally in the middle of the night than we've seen so far and as he watches his Likud Party drop in political polls, is that the way in which he approached this was a mistake. But ultimately, if this overhaul doesn't pass, he likely loses some of the parties in his coalition and may even lose his own justice minister who's from the Likud Party. So I think that he's still looking to pass the judicial overhaul, but he needs to do it in a way that makes it seem as if he's the one compromising and not being the one who's obstinate.

MG: What do you think the ultimate political goal of the overhaul is? The ultranationalist members of his cabinet have said that the judiciary has overreached, in their words, when it comes to ruling on issues like the settlements and the West Bank. What's the goal of what he's proposed?

MICHAEL KOPLOW: There are different goals for different parties in the Coalition. And it's important to remember that there are five different parties that make up the Prime Minister's coalition. For Netanyahu himself, he is looking to get out of his three court cases that are still ongoing. And any approach he takes to get out of them is going to run up against opposition from the Supreme Court. From the ultra-Orthodox parties in the coalition, they are looking to make sure that they are exempt from the IDF draft permanently, which is something that the Supreme Court in the past has repeatedly said that they cannot do. And when it comes to the national religious parties in his coalition, the religious Zionism Party and the Jewish Power Party led by Bezalel Smotrich and Itamar Ben-Gvir, they are, as you know, looking to really upend the way in which Israel operates in the West Bank. Everything from being able to build on private Palestinian land to extending civil sovereignty over Israeli settlements in the West Bank. And these are things the Supreme Court has prevented in the past.

MG: Smotrich who is the Israeli finance minister said in a speech last week, there is, in his words, no such thing as a Palestinian people. He’s set to visit the United States. And your organization has said, “We are opposed to him visiting the United States in his capacity as the finance Minister. We oppose this call and we call on pro-Israel Americans to understand that welcoming him here will harm rather than help support for Israel.” What are you most concerned about?

MICHAEL KOPLOW: Smotrich did indeed visit a couple of weeks ago to address an Israel bonds conference in Washington. And he was met with an almost universal wall of condemnation and silence from the Biden administration, from members of Congress, and from American Jewish organizations. From our perspective, Smotrich isn't only the finance minister. He's also a minister in the Defence Ministry. And as of about a month ago, he was granted control over Israeli policies in the West Bank with regard to settlements and with regard to demolitions. Not only for Israelis, but for Palestinians. And what we are concerned about is that Smotrich has been very open about his desire for Israel to annex the West Bank without giving Palestinians who are living there any type of political rights and certainly not giving them citizenship. And as an organization that very much wants to see a two state outcome to the Israeli-Palestinian conflict, Smotrich in many ways represents an existential threat. And that's before we get to his blatant racism and comments such as wanting to wipe out the Village of Huwara or giving that speech that he gave in Paris saying that there's no such thing as a Palestinian, and doing so in front of a map of Israel that included the country of Jordan as part of Israel. So I don't think that anybody should be underestimating just how much damage Smotrich can do and just how inflammatory a figure he is.

MG: How has all of this reverberated within Jewish communities in the United States, this fire storm that's engulfing the country right now?

MICHAEL KOPLOW: I think in many ways, the current Israeli government has united the Jewish community in the United States more than almost any other event in Israel that I can recall. There has been really blanket condemnation of some of the things that the government has done. There is almost complete opposition within American Jewish institutions to the way the judicial overhaul was proposed and was almost carried out. And so I think that American Jews and American Jewish institutions are pro-Israel. They support the state of Israel, and they generally support the government of Israel. But in this case, the Netanyahu government has gone so far and has been so extreme not only in terms of the members of its government, but in terms of the things they’ve proposed and the things they’ve said, that it's been very hard for American Jewish organizations not to come out in opposition. And I think that that is a very new element in the relationship between American Jews and Israel.

MG: We're almost out of time. Do you think that Netanyahu cares about what the American Jewish communities would feel about his government and what his government is doing?

MICHAEL KOPLOW: I'm sad to say that I don't think he does care in particular. I think that while Netanyahu has talked about being the prime minister of Jews everywhere and not only of Israelis, he has long been reluctant to grant North American Jews any type of real role inside of Israel. And I also think that he has long had a political calculus that says Israel's true friends in the United States are folks on the right, and particularly evangelical Christians. And most American Jews are left or centre. And he views that as being problematic and is leading to a situation where he doesn't think American Jews are going to be sufficiently pro-Israel in the long term. So I think that he views this right now certainly as a PR problem and an optics problem, but I'm not sure that he cares all that much what American Jews think one way or the other.

MG: And just very briefly, is this problem anywhere near resolved for him?

MICHAEL KOPLOW: No, I don't think so. I think that what he said yesterday was that he's putting things on pause, but that he's still determined to pass the overhaul. And I think he's going to do whatever he can in the next four to six weeks to construct a new narrative in which he is the one who is compromising and is reasonable and the opposition is not. And I fully expect that he's going to try to pass the overhaul almost in the exact same form come May, June and July.

MG: Michael, glad to talk to you. And perhaps we'll speak again as this continues. Thank you very much.

MICHAEL KOPLOW: Thanks, Matt.

MG: Michael Koplow is chief policy officer of the Israel Policy Forum. It's an NGO that is based in Washington, D.C. Well, coming up after your regional update, there is a new and deadly mixture entering Canada's drug supply. It's known as tranq dope, a mixture of opioids with a powerful animal tranquillizer. In 90 seconds, we'll hear what this drug is doing to drug users and why advocates are very, very worried. My name is Matt Galloway. You're listening to The Current on CBC Radio and the CBC Listen app. Back in just a minute. Stay with us.

[Music: Theme]

TRANQ DOPE

Guests: Dayn Kent, Dr. Aamir Bharmal

MG: Hello again. I'm Matt Galloway and you're listening to The Current.

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SARAH LAUREL: It's pretty terrifying, largely because we don't know much about it and we don't have a reversal drug for it.

MG: That terrifying drug is Xylazine. It is an animal tranquillizer that is increasingly being added to the opioid supply. It's called a zombie drug or tranq dope. It can leave people in a near lifeless state for hours. It also causes wounds to fester and can lead to sepsis and amputations. Sarah Laurel is a frontline aid worker in Philadelphia where Xylazine is being found in upwards of 90% of that city's drug supply.

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SARAH LAUREL: We have to begin testing why it is causing these wounds within humans. And currently, we are in a place where the only thing that stops the wounds from progressing is discontinuing use, which is not a realistic expectation to put on a community that is chemically dependent on it.

MG: Now, Health Canada is warning that tranq is being found more in Canada as well. In 2018, five samples of xylazine were found out of the tens of thousands of drugs tested each year. In 2019, that number jumped to 205. By last year, it had jumped again over 1000 positive samples. Dayn Kent is the coordinator of Bevel Up. It's the Consumption and Treatment Service at the Regent Park Community Health Centre in Toronto, and he's with me in studio. Dayn, good morning.

DAYN KENT: Hi, Matt.

MG: This sounds terrifying.

DAYN KENT: Yeah, it's not a great time. We're seeing at our site the proliferation of benzo related substances as adulterants in samples being tested for fentanyl. Ultimately, this is an outcome of an illicit and unsafe street supply of drugs. Have we or had we moved towards a model of drug use where it's in the legalized regulated environment, we would be seeing much less of these types of adulterants in this substances and the litany of side effects that come with people using them.

MG: How much of this xylazine are you seeing in Toronto?

DAYN KENT: So in Toronto, xylazine shows up, it's the fifth most common adulterant in fentanyl samples. Six of the top nine adulterants found in fentanyl are benzo related. We generally see more flualprazolam and things like that. And ultimately, like because of the illicit supply, we only really check samples when they are associated with an atypical or severe overdose.

MG: So if the alarm goes up, then you start to test those samples.

DAYN KENT: Yeah, because the drug testing pilot in Toronto doesn't have the capacity to check every sample. And so the sites need to kind of decide what samples to send. And so therefore, people may be consuming vastly larger amounts of etizolam or xylazine than we're really capturing. Because of the numbers, we're just not able to check enough of the substances.

MG: I mean, we gave kind of the thumbnail sketch of it, but how potent is this?

DAYN KENT: It's really potent. Part of the issue is that as people are intravenously using these substances, they're loading their body up with large amounts of fairly potent benzodiazepine related drugs. And people will be unarousable for stretches of time, three, four or five hours.

MG: Explain what that means and explain what you see.

DAYN KENT: So typically in an overdose situation, you know, if it's fentanyl related, people are going to overdose or show signs of overdose within the first three or four minutes. And fentanyl is a short acting opiate. So, you know, if we intervene within 25, 30 minutes, their body is metabolizing that fentanyl and they're able to kind of come out of it and move along with their day. The issue is with the benzos because they're so long acting and they're wholly unaffected by naloxone. People are just pushed to unconsciousness.

MG: Because this is an animal tranquillizer.

DAYN KENT: Well, because it's a benzo, right? So the mechanism of action for naloxone is on opiates. It's on the opiate receptors in the brain. It's not on the receptors in the brain or the body that receive and process the benzo drugs, right? So people become unconscious, but it's not fentanyl related. So therefore, all we can do is just keep them safe and comfortable and allow them to sleep it off. And we've had cases in the site where people are asleep for six or seven or eight hours because of this load of benzos that are in their system.

MG: What happens when they wake up if they have taken xylazine?

DAYN KENT: So generally, if people are in a long nod and they’re asleep for six or seven hours, they're coming to and they're in withdrawal because the fentanyl is so short acting that they're now showing symptoms of withdrawal. The other thing is that because of the potentiation of the fentanyl and the opiates with the benzos, people come back very, very confused. They don't remember if they've taken their drugs, if they’ve taken their shot.

MG: That’s why people would call it like a zombie drug.

DAYN KENT: Yeah. Like they come out of it, they don't remember anything that's happened. They’ve missed days of their lives. And ultimately, you know, people can come up and think, I've been robbed, right? But they actually took their shot. They just forgot about it because of the amount of benzos in it. And so they wake up agitated, aggressive, potentially just frustrated, right? Because they think that they've lost all their stuff. So for us as a service provider, the issue can be managing these kind of behaviours that are chemically induced through really no fault of the person themselves. Like they're buying and they want to use that. They kind of know what to expect with that. And then it comes with all these other drugs that really can kind of throw the whole process sideways.

MG: I’ve heard stories as well of people waking up and being incredibly disoriented and that that has been a concern because people walk into traffic, for example, that that's something that happens because of the severity of this drug.

DAYN KENT: Yeah, absolutely. I mean, it's a tranquillizer. It's a sedative. People are able to function, perhaps, or remain conscious, but are not very present in their lives. And so yeah, we see people who can become extremely agitated or, you know, decide, I need to go outside, I have to go do this thing. And we think it's totally not safe for you to leave right now. But off they go out into traffic, right? Like we've seen people, I used to work near Queen where I’ve seen people hit by cars down there, you know, falling off a street car, like all manner of things as a result of this kind of confusion that's associated with the benzo use.

MG: What about these serious skin infections, the ones that we're hearing about in Philadelphia, for example? There was a New York Times piece that documented this that people might have seen as well. How serious can those be?

DAYN KENT: Very serious. Part of the benefit of the model of a consumption treatment service is that because we have nurses on site, we're able to offer primary care and addressing those kind of infectious issues like much earlier on in the lifecycle of someone's situation. So for us, you know, we do a lot of abscess management, wound dressing, irrigation, that sort of stuff, giving people some education on how to care for the wounds themselves and supplies so that they can go and do those things offsite at home, wherever they're kind of staying. But ultimately, the fact that people are injecting an illicit substance, there's all manner of other things in there. And so, you know, some of them are quite caustic and can cause real, real issues for the tissue around the injection site.

MG: Can you just help people understand how something like this, an animal tranquillizer ends up in these drugs?

DAYN KENT: It ends up in these drugs because the drugs are illegal. The criminalize model we have right now incentivizes the creation of increasingly potent and increasingly diverse substances to be mixed in with the illicit street supply. So people are getting away with it. There's a lot of money to be made in the drug industry.

MG: Are people seeking this drug out?

DAYN KENT: They’re not actively seeking it out, but we do see people presenting with benzo dependency, like an unintended benzo dependency, right? So folks are coming in using their fentanyl. And we've seen people show up at our doors in like advanced stages of benzo withdrawal, sweating, seizures, like shaking, bruxism, like a variety of things. And then they actually get to the point where they no longer have the physical, you know, the fine motor skills to actually inject for themselves because the benzos are withdrawing out of their system and they're showing the physical symptoms of that.

MG: And so what do you want government to do? How would you want them to respond? How would you want it to respond to this?

DAYN KENT: So we need to legalize and regulate substances. We have a safe supply model. It's ubiquitous. It's across the entire country. It's called the LCBO and the alcohol industry. Back in the twenties, when prohibition was a thing, you know, people were going blind. There was a massive proliferation in organized crime. All of these things resulted from the fact that there was something so valuable that people will seek to find within the context and framework of a black market distribution system. If we legalize and regulate these substances, people can get what they're looking for with a consistent dosing and a consistent set of effects. Ultimately, the reason we have overdose prevention sites, the reason we have this massive, you know, issue with the impacts of drug use on society at large is because of the fact that drugs are illegal. Everything is connected to everything else like most things in life. And if people were able to access a safe supply in a consistent low barrier manner, we would help to remove a lot of these other realities of substance use, which is that, you know, people are on a constant treadmill to try and find enough money to be able to buy themselves what they need to get themselves well. If they could access it in a way, they could get off that treadmill, they could then start to look towards the other things in life to build a stable foundation for a jumping off point into whatever they feel like they need to do. So ultimately, the fact that drugs are illegal is what makes them dangerous.

MG: I don't want to go too deep down that path of the debate such as it is over safe supply. But for people who would hear this and might be alarmed when you say legalize drugs, in the context of what we've been talking about, what would you say to them if they're really uncomfortable with that idea?

DAYN KENT: So drugs has won the war on drugs. We've had 60 years of prohibition. What we've tried to reduce the impacts of drug use on society hasn't worked. If you look at Europe, you're seeing an increase in the amount of cocaine being consumed in Europe. This is with all the technology and the massive amount of resources that people are putting towards trying to stop that. Ultimately, you cannot stop bad things from happening to people before they really have the ability to process and integrate those experiences. Trauma will exist. It always has. It always will. Trauma is the root of substance dependency. If we have a society where bad things happen to people and we manage to support them and carry them through it, they will choose not to self-medicate and manage that physical or psychological pain through the use of substances. We will always have people using drugs. Whether or not we support them or we criminalize them, they're still going to do it. The question is as a society, are we looking more towards managing the outcomes of that series of decisions in a way that acknowledges it and supports people and says, yes, we understand why you do these things and here's a way to help you get stable. And so maybe you don't choose drugs because you have other options in terms of how to manage those issues in your life.

MG: We'll leave it there. We'll talk more about this. We're going to speak with a doctor in B.C. who is looking at this as well. In the meantime, it's good to hear what you're dealing with here in Toronto.

DAYN KENT: Thanks, Matt.

MG: Thank you very much, Dayn. Dayn Kent is the coordinator of Bevel Up. It's the Consumption and Treatment Service at the Regent Park Community Health Centre. He was with me in Toronto. Dr. Aamir Bharmal is the medical director of the Public Health Response at the B.C. Centre for Disease Control. Doctor, good morning to you.

DR. AAMIR BHARMAL: Good morning.

MG: What exactly is this drug xylazine that we've been talking about?

DR. AAMIR BHARMAL: Yeah. So xylazine is a sedative that's been used primarily by veterinarians. And it's used as a tranquillizer, especially for large animals, particularly horses and deer. But it's increasingly being found in the illegal drug supply, especially over the past few years.

MG: And how did it end up in that supply as you understand it?

DR. AAMIR BHARMAL: So I think there are a number of reasons. So, you know, as mentioned, one of the reasons why xylazine is showing up in the illegal drug supply is it's being used to bulk up fentanyl. And it also tends to increase those euphoric effects of fentanyl as well. I think one of the other pieces with xylazine is that it's not a controlled substance. And so therefore, it hasn't had this very strict monitoring. And so therefore, you know, if it was diverted, if it was being used in something like humans, it wasn't being monitored in the same way as some of these other illegal drug components were.

MG: What do we know about what it's doing to the body of somebody who would ingest it?

DR. AAMIR BHARMAL: So it's interesting in that it's often been found with fentanyl. So almost 98% of the time when we look at drug samples, that is being found there. And it's also being found with benzodiazepines in the drug supply as well. And so what it does is it actually compounds a number of those effects. And for people who ingest it, it starts to decrease people's breathing rate, people's heart rate and blood pressure. And when taken at a higher enough amount, it causes sedation and potentially some of these what we call amnesic effects, meaning that people sometimes lose memories.

MG: What are you most concerned about when it comes to the increasing prevalence of this drug in the drug supply?

DR. AAMIR BHARMAL: So one of the things I'm really concerned about is the fact that we know that the illegal drug supply is toxic as well as unpredictable. And so we know that, you know, apart from if you were taking a pharmaceutical medication or any other type of legal substance, you know, it would be regulated in terms of the concentration and it would be more predictable. And so the fact that you may see, you know, a hundred fold difference in concentration has huge impacts in terms of the possible risk of overdose or death or poisoning that can happen as a result of that.

MG: Dayn was talking about the situation that he's encountering in the consumption site here in Toronto. What's the situation in British Columbia? How similar is that situation in your province?

DR. AAMIR BHARMAL: So it is different. And that's actually quite, quite striking, especially when we look at drugs that have been seized and that have been tested. Ontario is certainly seeing, you know, the vast majority of xylazine detections across the country. And so here in British Columbia, of those drugs that have been seized, about 3% are of these fentanyl, containing drugs positive for pre xylazine. And, you know, I think we need to look at different ways that drugs may be present in the supply. So we look at those that have been seized, but also those which are tested that are on the street. And even in those, we're finding that it's about 3%. So it's quite striking and quite different than what's being seen within Ontario where, you know, we're seeing probably four to five times higher levels of xylazine detections in the fentanyl drug supply, particularly in Ontario versus those in B.C.

MG: Do we know what the long term effects of this drug would be on users?

DR. AAMIR BHARMAL: We don't really. You know, I mean, certainly it's concerning, especially if people are having multiple poisonings and what their effects in the body may be from that perspective. I think the other thing of note is that with xylazine, people are having some of these complex wounds. And so, you know, these are wounds that are occurring in places where people inject these drugs, but sometimes are showing up in different sites of the body that are away or at a distance from these injection sites. And so some of these wounds are quite complex. And sometimes when they're not treated, they can lead to amputation, which of course is a big concern. But we still don't know a lot about some of these long term effects, especially because they haven't been used in humans.

MG: I guess one of the things that people are trying to wrap their heads around is initially, you know, fentanyl was turning up, then it was carfentanil, which was much more alarming. Now there's this. There are other benzodiazepines that are turning up as well. What does that tell you about, we talk a lot about a toxic drug supply, but what does that tell you about the nature of that toxic drug supply?

DR. AAMIR BHARMAL: Well, what it really does tell me is that, you know, we have a lot of these types of adulterants. And part of it is right now we're playing a bit of a whack a mole, Right? Because you know what? There are going to be these types of adulterants. And given the illegal nature of and criminalized nature of the supply, we are going to see other things that are being added into the supply because it's not regulated. And as a result of that, there will continue to be other things that are being added in just to either bulk up the supply, trying to increase those effects and potentially have these types of substances that might not necessarily be monitored very closely right now, but that potentially can be added into the drug supply to increase profit.

MG: We heard a little bit from Sara Laurel earlier. She works at the harm reduction facility in Philadelphia where they were seeing, again, upwards of 90% of drugs tested including xylazine. She was speaking on CBC Radio's Day Six on the weekend. Take a listen to her advice for frontline workers in this country.

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SARAH LAUREL: Update your overdose reversal methods for your boots on the ground, harm reduction advocates. Inform the individuals that they're serving of what's to come and what to look for when it comes to those wounds. Hospitals and urgent cares really need to begin testing humans for it, and we need to update withdrawal protocols.

MG: How are officials, health officials in British Columbia responding to this?

DR. AAMIR BHARMAL: Yeah. And actually, that's all very helpful advice because those are things that we have been considering here at the B.C. Centre for Disease Control and starting to act on. That has meant trying to improve just awareness not only among service providers, but also among people who use drugs in the community that xylazine is present, although in lower amounts than other parts of the continent. But in addition to that, what it means in terms of just helping alert a lot of our health care providers as well, especially around these complex wounds or if they're responding to an overdose.

MG: What's the bigger answer here, though? Dayn Kent just a moment ago said you need to legalize drugs. You need to figure out a way to regulate that supply so that adulterants like this aren't ending up into the stream and poisoning people. What is the answer from your perspective?

DR. AAMIR BHARMAL: I absolutely think in terms of the long term goal that it is, but we're thinking a lot more about safe Supply and how we get there. You know, these are big complex questions in terms of how we think about legalizing and regulating these types of drugs. But we have seen that criminalizing people, making the drug supply illegal just creates a toxic and very volatile situation and leads to a lot of people losing their lives unfortunately.

MG: And so the question just in the last minute or so that we have is the question that I asked Dayn, which is for those people across this country, it's not just politicians, but people who are listening who are uncomfortable with that sort of language. In the context of what we've been talking about, what would you say to them?

DR. AAMIR BHARMAL: Yeah. I mean, I acknowledge the discomfort with some of this. You know, I think part of it is starting to think a lot more about, okay, well, what do we need to do then to help people stay safe? And I think as Dayn also mentioned, a lot of this is related to trauma. And so what do we need to do in terms of working upstream to help address some of these issues and help support people along the journey? But then also, what do we do in the short to medium term to make sure that we are addressing this toxic drug crisis that's killing people every single day?

MG: Doctor, glad to talk to you about this. Thank you very much.

DR. AAMIR BHARMAL: Thank you.

MG: Dr. Aamir Bharmal is the medical director of the Public Health Response at the B.C. Centre for Disease Control. Before we go this morning, I want to tell you about something that you'll hear tomorrow on this program where we will be in Nova Scotia. Nova Scotia is a part of the country where it used to be cheaper to live than a lot of places in Canada. The rent there, though, is rising faster than ever. And it's not just happening in Halifax. All over Nova Scotia, even in small towns, the cost of renting a basic apartment is quickly becoming out of reach for many people. You might remember last year on this program, we spoke with Dayle Crouse in Lunenburg. She'd moved out of her rental. She hoped she could find somewhere cheaper to live. She didn't find that space. And when we met her, she was renovating a school bus, trying to turn it into a home for her and her young child. And so we went back to see how she's doing.

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DAYLE CROUSE: The bus is currently still mostly undone. It has a part of a floor and partly insulate it. But when you have to live in a place and renovated at the same time, it's almost impossible. Well, in the last year here in Lunenburg, what I've noticed is that a one bedroom has gone, has doubled. And then I think if you're a family with children, I know what I make an hour. And it's not minimum wage. It's still not a living wage, but it's well above minimum wage. I could never afford to house my son and myself in an apartment plus utilities. But yeah, still working two jobs. So full time and raising a little guy. And I'm really tired this year. Very tired. But I feel like I need to be vocal. But at the same time, I am a little exhausted. So I just think we need to take a people first approach. It's a human right to have housing. It's not a human right to have Jacuzzis and marble countertops and five piece stainless steel appliances. We don't need that. Like we need to think outside the box and think about how to protect a community that is a community of workers. It's not that yes, we love doctors. Yes, we love lawyers, but it's moms working two jobs at a restaurant who support this town, who make this town a place that people want to visit. You don't come here to visit the lawyer. You come here to visit the favourite fish and chip shop or the favourite knitting shop or the favourite… And those are the people you need to house. So the thought of working on the bus is just I'm tired because then I live outside of town. There's no public transportation. So it's a whole kettle of fish. Do you spend money on a taxi that might come or might not come? And it's 15 bucks one way. So you're eating up more of your revenue that you could maybe spend on a rental that you can barely afford. So yeah, it's a whole mixed bag of surviving, not thriving. This spring, my plan is just to keep going. I need to make sure that my son has stability and just keep working so that I can finish the plan. And it's not a 10 year plan. I'd like it to be a done this year plan if the fates align, But it's just to keep going.

MG: Dayle Crouse and her son are house sitting for the winter. Tomorrow we'll hear how other Nova Scotians are coping with rising rents as The Current comes to you from Halifax. That is The Current for this Tuesday. Canada Reads is up next. It's taking the place of Q for this week as the book battle unfolds. When it comes to the cost of living, a lot of people will be looking to the federal budget to try to address that cost of living crisis that so many Canadians are facing. CBC Radio has full coverage of the budget hosted by Catherine Cullen and Tom Harrington. That's at 4 p.m. Eastern. You can listen to it on CBC Radio or the CBC Listen app. And we'll have reaction to that tomorrow as well on the program. We'll leave you this morning with some music from Ethiopia, from a woman who had a remarkable life. Emahoy Tsegue-Maryam Guebrou was a pianist and a nun, died this week at the age of 99. And when I say an incredible life, those words really perhaps undersell what she had accomplished. She grew up in Ethiopia, spent time as a prisoner of war during Italy's invasion of her country. She sang for the emperor Haile Selassie. She became a nun and moved to Jerusalem where she lived for the past 40 years. Throughout her life, donated album proceeds to Ethiopian children orphaned by war, established a foundation to give children in need the opportunity to study her music. Her music came back into the limelight a decade and a bit ago when a solo piano album of hers was rereleased as part of a series called Ethiopiques. It is absolutely beautiful and this is a song from it. This is Emahoy Tsegue-Maryam Guebrou and The Song of the Sea. I'm Matt Galloway. Thanks for listening to The Current and we'll see you from Halifax tomorrow.

[Song: “The Song of the Sea” by Emahoy Tsegue-Maryam Guebrou]

Tuesday March 28, 2023 Episode Transcript