War on drugs fuelling spike in fentanyl overdoses: expert
Researcher wants policy to focus on treatment, rather than prohibition
As Quebec police chiefs and officers meet Thursday to plan a cohesive attack against fatal opioid use, mounting evidence suggests the criminalization of production, sale, and possession of illicit drugs is driving the fentanyl overdose crisis.
Montreal police are taking a “zero tolerance” stance in targeting drug distributors amid a growing public health crisis. While they’ve recently dismantled several fentanyl drug rings, they acknowledge new gangs quickly move in to take their place to sell toxic heroin-laced fentanyl.
Not only has the “war on drugs” failed to make a dent in global trafficking and consumption of narcotics like fentanyl, it’s actually fuelling the spike in overdose drug deaths, said physician and addiction researcher Eugenia Socias of the University of British Columbia and the B.C. Centre on Substance Use.
“The crisis we are witnessing, although it started as a crisis of overprescribing opioids, has shifted — and actually gotten worse — because of the introduction of illicitly manufactured fentanyl, which is a consequence of law enforcement focusing on the supply side of drugs without adequately addressing the needs of people who have become addicted,” Socias told the Montreal Gazette in an interview this week.
An over-reliance on law enforcement approaches is not likely to curb the fentanyl epidemic, Socias said of a renewed effort by Quebec police to stem drug fatalities.
History has repeatedly shown that prohibition doesn’t work, from the 1920s alcohol prohibition to illegal “street drugs” — opium, cocaine, heroin, marijuana and now fentanyl, Socias said. Punishing the sellers and users of illicit drugs drives the drug trade underground, to crime, violence and death.
Socias’s position echoes a recent call by the United Nations and World Health Organizations for drug decriminalization. Leading medical, public health and human rights groups have also endorsed drug decriminalization, citing health, economic and social benefits in countries like Portugal, which in 2001 decriminalized personal possession of illicit narcotics and invested massively in treatment options.
Representatives from 20 of Quebec’s biggest police departments are expected to hold a closed-door strategy meeting Thursday at the provincial police school in Nicolet, École nationale de police du Québec, following a streak of opioid deaths this summer, mostly in Montreal. The goal is to determine best practices that may be incorporated into police training.
Law enforcement is a difficult political issue, Socias said, one that requires a co-ordinated approach that addresses the supply side on the street so that decriminalization does not leave illicit supplies in the hands of organized crime.
“But we also need to acknowledge that one of the drivers of overdose epidemic is untreated opioid addiction,” she said. “In my opinion, our efforts should transition from the focus on drug prohibition to addiction treatment and recovery.”
A rash of fentanyl overdoses that claimed hundreds of lives last year prompted B.C.’s chief health officer to declare a public health emergency, Socias noted. However, while everyone has acknowledged the problem, the death toll continues to climb.
“It’s a good first step to acknowledge we are in a crisis situation, and progress has been made in B.C. in terms of response once an overdose has occurred,” she said. “But we need to do more on the treatment side to prevent the overdoses from happening.”
Fentanyl overdoses killed more than 2,800 people last year, most of them in Western Canada. Alarmed by the scale of the problem, Socias co-authored an editorial last week in the medical journal, The BMJ, highlighting the serious side-effect of the war on drugs.
The “war on drugs” mindset, she said, treats those who use drugs as criminals rather than as people with a health problem. “There’s lots of evidence showing addiction
The crisis we are witnessing, although it started as a crisis of over-prescribing opioids, has shifted.
is a chronic disease that’s similar to other chronic diseases like diabetes, HIV and hepatitis, and we need to bring those people into care to address the problem rather than just treating them as criminals and putting them in jails.”
Criminalization creates other barriers to health care, she added, as some health providers are not amenable to treating individuals with drug addictions. Also, there’s stigma around medications proven highly effective in reducing crime and illicit drug use, she said, citing expanded access to second and third-line treatments, including methadone, buprenorphine, slow release oral morphine, injectable opiates and hydromorphone.
Because funding is limited, efforts should focus on things that actually work and that would likely have an impact, she said. Proven strategies include expanded treatment and front-line outreach support, to harm reduction like save injection sites, wide access to the antidote Naloxone and drug testing kits so users could verify which drugs they are consuming, she said.