Re: An inside look at BC’s illicit drug market. Authors reply

We appreciate Michelle Danda’s letter in response to our case report “An inside look at BC’s illicit drug market during the COVID-19 pandemic” [BCMJ 2021;63:9-13,19].

We wanted to note that a case report describes and interprets the experiences of a single individual. Therefore, the findings from a case report may intrinsically have limited generalizability, and this was stated in our article. However, the merits of a case report are that it presents novel, informative narratives, generates ideas to be examined in future studies, and serves as a valuable educational tool. Case reports are the substrate from which larger, more generalizable studies can be justified. Some of the information may have not been new to people who work extensively in the field of addictions. However, the article was published in a general medical journal for physicians who may not have extensive experience in the field. By engaging with a person with lived experience, we were able to share his unique experiences and perspectives, which may inform areas of future research and strategies to improve health care for vulnerable populations.

We used the name “John Doe” to protect the identity of the individual. We had the information to provide much more context, but given the word count limitations of the article, the need to protect John Doe’s identity, and the fact that we were publishing in a general medical journal, we focused on reporting his observations and opinions of the illicit drug trade rather than more personal characteristics.

As for what qualified John Doe as a reliable source, he was convicted in a court of law for distribution of crystal methamphetamine and fentanyl in the Downtown Eastside during the COVID-19 pandemic. Since this was the topic of the case report, we believe that qualified him to speak about the topic. His account was consistent with external data points, such as court records and collateral sources, where available. Further, there are many examples of the experience of people who use drugs in the medical literature but very few examples of people who sell drugs. The goal of the article was to highlight the lived experience of someone who sold drugs, not people who use drugs, during a unique time in history such as the COVID-19 pandemic.

There was no pre-existing relationship between the physician interviewer and John Doe. In a forensic evaluation, the forensic psychiatrist is to maintain neutrality and objectivity in their assessment of all patients. The forensic evaluation is done voluntarily, and before the evaluation can begin, it must be determined that the patient has the capacity to consent. During the forensic evaluation, John Doe raised the topic of illicit drug trade in the Downtown Eastside during the COVID-19 pandemic. He was then asked whether he wanted to share his insights for a case report. His participation was completely voluntary, and he was assessed to have the capacity to consent to the case report. As reported in our article, written informed consent was obtained from him. He voluntarily agreed to share his information because, in his words, “I want to provide information that hopefully can prevent overdoses and save someone’s life. I think it’ll be useful for the medical community.”
—Nickie Mathew, MD, MSc, ABPN, FRCPC, ABPM
—James S.H. Wong, BSc
—Reinhard M. Krausz, MD, PhD, FRCPC

This letter was submitted in response to “Re: An inside look at BC’s illicit drug market.”