We are currently living through a pandemic, but it is pivotal to recognize that COVID-19 is not the only health crisis in Canada. According to the federal government, 12 people die from an opioid overdose every day in the country.
Simply put, opioids include an umbrella of medications used to relieve pain. Why are opioids used? It is not simply due to choice. Usage of opium and its derivatives is not new – they been used for centuries to help with both physical and emotional pain. However, opiates are addictive. Their addiction, when coupled with the role of Big Pharma, is a dangerous combination.
Big Pharma’s advertising blitz to health care professionals have produced an explosion of prescriptions, profits and addiction. The example of Purdue Pharma in the United States is significant. From 1996 to 2002, Purdue more than doubled its sales force and distributed coupons to doctors in order to let patients try 30-day free supplies of a highly addictive drug called OxyContin. The pill is comprised of oxycodone, a semi-synthetic opioid based on elements of the opium poppy and related to morphine. Painkillers of this nature were originally used for cancer pain but starting in the mid 1990s they were aggressively promoted for chronic pain such as manual labour and car accident injuries. This widespread usage led many to become addicted. Eventually, authorities began clamping down on these pills and began warning health professionals and the public that opioids were far from a magic bullet. This resulted in a squeezing of the legal supply. However, this didn’t help patients addicted to or dependent on opioids, instead it made them desperate to obtain them through other means, opening the door to deadly consequences.
Currently in Canada, opioids can be available legally, such as ones prescribed by doctors and other health care professionals to help with injuries, surgeries and chronic pain. On the other hand, opioids are also available illegally on the street drug market. They can be used to alter moods including causing euphoria and are thus open to abuse. While drug abuse itself is not a new problem in Canada, the emergence of strong synthetic opioids such as fentanyl and carfentanil in the illegal drug supply has exacerbated matters.
The opioid crisis has claimed the lives of over 15,000 Canadians between January 2016 and December 2019. The seriousness of the situation can be summed up in a few sobering facts from British Columbia: more people have died this year from illicit drug overdoses in BC than from COVID-19. By mid-June, BC had recorded 186 COVID-19 deaths, while the number from illicit drugs stood almost three times higher at 554 deaths. The province has recorded more than 100 overdose deaths in each of the past four months, with May the deadliest month in the province’s history with 170 deaths, only to be upstaged the very next month with 173 deaths.
In Toronto, the number of opioid deaths has also reached grim milestones. In April 2020, 25 fatal suspected opioid overdose calls were reported by Toronto paramedics – the highest number of suspected deaths since September 2017. In May, another 25 suspected deaths were reported. Alberta has been grappling with its own crisis too. During the last week of May and first week of June, there were 16 opioid deaths. Crews were called to 246 opioid-related emergencies in Edmonton in the month of May 2020. By comparison, in May 2019, they responded to 108 opioid-related emergencies. In Montreal, the regional health board for Centre-Sud-de-l’Île-de-Montréal recorded 15 drug-related deaths in May 2020 and noted that while there is no opioid crisis right now, the situation could change rapidly. This is supported by Montreal-based CACTUS, North America’s oldest needle exchange program, which witnessed more drug overdose interventions than the previous month. The COVID-19 pandemic has intensified the opioid crisis further since many more people are using the drugs alone, due to physical distancing and advice to stay at home as much as possible. In normal circumstances, when it is more likely that others are present, the chances of an overdose being reversed with naloxone and rescue breathing are increased, but when the drugs are taken alone, the risk of dying is increased.
Much like every other crisis, the opioid crisis impacts marginalized communities the most since they lack the resources to deal with it, and are already grappling with multiple other stressors, unlike those in positions of privilege. But highlighting the problem is only one part. The key is finding a solution, and there are solutions to be found.
Two examples stand out – Portugal and Switzerland. In Portugal, illicit drugs were decriminalized in 2001, while dealers and traffickers continued to be subject to criminal prosecution. As things stand currently, Portugal has one of the lowest rates of illicit drug use in Europe. Switzerland dealt with its own heroin-related drug crisis in the 1980s differently. It started a HAT (heroin-assisted treatment) model in 1992, where instead of being given takeaway prescriptions, patients were required to attend a clinic once or twice a day and to use their prescriptions on site under medical supervision. This combined the benefits of prescribed supply (drug strength and purity, free from contaminants and adulterants, and used with clean equipment) with the benefits of regular access to services in a safe and hygienic venue, while also preventing the admission of prescribed heroin in the illicit market. Since Switzerland introduced this program, deaths due to drug use have declined steadily. The model used by Switzerland can be replicated in Canada to tackle the opioid crisis.
In Canada, the North American Opiate Medication Initiative (NAOMI) heroin-assisted treatment trials operated in the Downtown Eastside of Vancouver from 2005 to 2008. It gave heroin users access to a safe supply of heroin. The NAOMI study found that “heroin-assisted therapy proved to be a safe and highly effective treatment for people with chronic, ‘treatment-refractory’ heroin addiction. Marked improvements were observed including decreased use of illicit ‘street’ heroin, decreased criminal activity, decreased money spent on drugs, and improved physical and psychological health.”
These examples support the broad picture of decriminalization, which is an urgent need in Canada. The government has still not abolished the long-failed “War on Drugs,” which claimed to remove drug use through criminal penalties but is really a war on the poor as the rich can always safely get their drugs. Not only has this wasted public funds that could have been used for other purposes, this policy has directly fueled suffering, disease and death that could have been otherwise avoided. Problematic drug use is made worse by the vicious cycle of poverty, trauma, stigma and isolation. It is inhumane to deal with a health and social issue by criminalizing those who suffer. That effort has been a complete failure not just in Canada, but across the world in terms of dealing with drug use.
The key to end this death and suffering is to ensure a clean and safe supply of drugs. This would also cut crime as many addicts obtain money for their drugs through criminalized activities. It is imperative that drug use in Canada be immediately decriminalized and properly regulated. Furthermore, individuals who suffer from these addictions need to be provided proper access to health care, education and employment so they are able to restart their lives. Living under the daily struggle of capitalism should not be compounded by being criminalized for using drugs.
