White Coat Black Art·Q&A

Opioid crisis not going away amid pandemic, and will 'kill more Canadians,' says Dr. Daniel Kalla

Dr. Daniel Kalla talks about working in the ER for more than 20 years, how it has shaped his novels and the pandemic’s impact on the opioid crisis.

ER physician's latest novel The Last High tracks the search for a deadly supply of fentanyl

Dr. Daniel Kalla works at St. Paul's Hospital in Vancouver and has authored 10 books, including his latest novel The Last High, which tracks a deadly source of fentanyl. (Michael Bednar Photography)

As the country and the rest of the world grapple with the coronavirus pandemic, the opioid crisis threatens to deepen and "kill more Canadians," says a Vancouver ER doctor.

"[COVID-19] knocked ... opioids right off the front page," Dr. Daniel Kalla told White Coat, Black Art.

"But this is a crisis that we both know isn't going away."

In British Columbia, a total of 113 people died of suspected illicit drug overdoses in March — the highest death toll in a year, according to the B.C. Coroners Service. Experts have warned fentanyl and other contaminants are still present in many illicit drugs.

Kalla says people were afraid to use safe injection sites or join other people because they feared contracting COVID-19.

"So there was an increase in users using alone which ... can be suicidal for opiate users."

In his latest novel The Last High, Kalla chronicles the search for a deadly form of fentanyl in Vancouver. He spoke to White Coat, Black Art host Dr. Brian Goldman about his experience working in the ER for more than 20 years, how it has shaped his books and the pandemic's impact on the opioid crisis.

Here is part of their conversation.

Your latest book The Last High begins with seven teenagers partying. All of them [overdose]. Only two make it to the ICU alive. Eventually we learn that an ultra-powerful form of fentanyl and carfentanil are behind the deaths. It sounds ripped from the headlines. Has anything like that ever happened on your watch?

Not in that scale. I've seen a couple of kids come in — and overdose — who didn't know they were taking fentanyl or opioids. I saw one tragic 21-year-old girl — who ended up brain dead — who is not a regular opioid user.

As much as anything, I meant this book to be a cautionary tale. I have a 19 and 22 -year-old [daughters], and it's the message I wanted to get out there that this stuff is the ultimate Russian roulette that some people are playing with.

Daniel Kalla, shown here with his daughters, says The Last High is a cautionary tale about opioid use. (Submitted by Daniel Kalla)

I want to take you back to that to that 21-year-old. What was that experience like for you?

Most opioid overdoses either die in the field or they get Narcan [brand name], naloxone, an antidote.

And by the time we usually see them in the emergency, they're generally wide awake.

And then there's that slim proportion that's in the middle — whose [hearts] stay alive long enough to get to hospital — but they're effectively brain dead. And I described that in the novel a little bit.

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I had the sense immediately when I saw her that she probably was brain dead.

She was deeply comatose ... but, you know, she had a blood pressure. Her parents were rushing in. 

It was very devastating because even though we were trying to resuscitate her, I [had] this sinking feeling at the pit of my stomach that she's never going to wake up, and sure enough, the CT scan confirmed that the brain damage was already irreversible. 

And she died a couple days later.

Clearly as a fiction author you want to entertain, but I'm getting the sense just listening to you that there's a serious message behind this book. What would you say that is? 

Opioids touch everyone whether you're a direct user or you're a friend or a loved one of a victim and ... when you look at our hardest core street users, homeless addicts ... no one would choose that lifestyle.

They have a genetic predisposition towards addiction.

They make some wrong choices, and they end up where they do. 

I have friends ... non-medical friends [who say], "Well, you know, it's sad about fentanyl, but that's a 'them' kind of thing."

And it's not. It's pervasive, it's everywhere, it can touch you personally. 

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Based on your experience as an emergency physician, but also having conversations with your undercover police officer [Kalla's source of background for his novels], any ideas on how to solve this crisis?

I'm one of those people who … first and foremost, believes in harm reduction at the top of the list and treating substance usage as a disease and getting them help and therapy. 

Second of all, stop treating users as criminals and treat them ... as patients. 

The war … against drugs has never worked in the history [of] any country that's tried it.- Dr. Daniel Kalla

Third of all, I think you need to decriminalize the drug. If we had control over the source, and you weren't bringing in this dynamite that they're using, we could control the death rate for sure.

The war … against drugs has never worked in the history [of] any country that's tried it, and I think we really need to change the attitude. 

We have to stop the criminal supply of fentanyl that's being shipped into the country,

But as long as people don't have an alternative, they're going to turn to the illegal dangerous stuff.

What are the lessons from the COVID-19 pandemic that you think might inform us on how to meet the needs of the patients you see?

Kalla says the opioid crisis is going to kill more Canadians and be with us long after the pandemic. (Submitted by Daniel Kalla)

I've been so generally impressed in the level of our response … the effort that we've put in, the innovativeness. 

We basically rejigged our entire emergency department  … we had, not just money, but thought and effort and dedication, and, you know, we saw a result right away.

I think the same thing can be applied to [not] just the opioid crisis, but the mental health crisis and the homelessness crisis. 

Obviously the pandemic gave us a pretty strong stimulus, but at the end of the day … I think the opioid crisis is going to kill more Canadians, certainly more young Canadians for sure, and be with us long after the pandemic.

You write fiction and sometimes real life is stranger than fiction. So let's end our conversation on this. How do you think COVID-19 ends?

I keep hearing mixed things about how long the vaccine will take and ... if ever they will get one. 

I think until we have that vaccine, or at least a very good treatment, which personally I think will come first — I think it'll be like a cocktail HIV drug kind of treatment that will manage the sickest, and we reduce the death rate. 

Until then, I think we'll see a rolling series of small little waves ... that will lead to all kinds of, you know, social distancing.

We'll move forward in these phases that Canada's proposing now, and then we'll have an outbreak, and we'll all be stuck indoors for a couple of weeks again.

I don't see any way around that because I don't imagine natural herd immunity developing [with] this virus unless it has a horrific death toll across the world.

Q&A edited for length and clarity. 

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