‘A CRISIS OF MASCULINITY’
Vast majority of overdose deaths happen to men
Is it because males are more likely to isolate themselves?
Is it because men, to deal with their suffering, are more inclined to consume alcohol and other drugs?
Is it because men, who do the most dangerous jobs, are much more likely to be seriously injured at work and to take opioids to kill the pain?
Dr. Paul Gross is among those who want to get to the bottom of why 15 of the 60 regular members of Vancouver’s Dudes Club have in the past year died of fentanyl and other opioid overdoses.
Gross is among the relatively few health professionals openly yearning for answers to a startling trend: More than four out of five deaths from opioid overdoses in Canada are males.
“It’s crazy. The members of our club are wondering, ‘Am I next?’ ” says Gross, a downtown Vancouver physician who has, for seven years, worked with elders to run the Dudes Club, which serves mainly Indigenous males.
Even though the Dudes Club is in Vancouver’s Downtown Eastside, the opioid crisis cuts across socio-economic status and ethno-cultural groups. It is striking down poor and middle-class, people old and, especially, young.
“There’s definitely a story to tell about why the male piece of the fentanyl crisis has not been given the attention it deserves,” Gross says.
Despite thousands of news stories about the crisis — in which 81 per cent of last year’s 935 fatal B.C. overdoses were men, a pattern that holds throughout North America — only a handful of health officials and media outlets have explored the perspective of gender.
A significant exception to the cultural silence occurred last week when Ashifa Kassam of The Guardian, one of the world’s most progressive media outlets, published: “Is North America’s opioid epidemic a crisis of masculinity?”
Could the spurt of international attention prod health officials in Canada, the U.S., Britain and elsewhere to begin the research that will explain this fatal trend among males, who consistently die younger than women?
“We don’t have a focus on things that men are at greater risk for. And this is certainly one — dying of an overdose is primarily affecting men, and men in the prime of their life,” Patricia Daly, chief medical health officer for Vancouver Coastal Health, told The Guardian.
For what else are men at greater risk? And why?
One of Gross’s suspicions is that men are more likely than women to be socially isolated, particularly when doing drugs and overdosing.
In addition Gross believes some men subscribe to “stoicism at all costs.” Many Indigenous members of the Dudes Club, he said, for instance, have been “living on the land” since they were kids.
The physician also finds both longtime addicts and male “weekend warriors” go along with a “certain type of masculinity that says, ‘I have a high tolerance for opioids: I can take large doses.’ ”
Dan Bilsker, an associate professor of psychology at the University of B.C. who spent 25 years working in the psychiatric emergency ward at Vancouver General Hospital, has arguably done more than anyone to figure out why it’s mostly men dying of overdoses.
He cites four factors behind the men’s crisis, which he calls a problem “hiding in plain sight.”
He begins with high male suicide rates.
When Bilsker worked in Vancouver’s medical system, and males were accounting for four out of five suicides, he found it bizarre that so few health officials seemed curious about it.
While women attempt suicide more often, typically using pills, an unreliable method, Bilsker said men use more lethal means from which “they are not expecting to be rescued. They do not care if they live or die.”
Bilsker said men, especially Aboriginals, more often go through with suicide — including through overdosing — because they are more inclined to see their suffering as “intolerable, interminable and inescapable.”
Trained by society to do their duty and “just suck it up,” the psychologist said, many men don’t reach out for help.
Quite a few turn to alcohol, at a rate of abuse five times higher than women’s, Bilsker said in a talk at Simon Fraser University, in which he suggested alcohol is a gateway drug to opioids.
The excessive use of opioid painkillers such as fentanyl, whether prescription or illicit, is also related to how men overwhelmingly take on society’s most dangerous jobs.
Whether it is in logging, construction, or the military, he said, most men consider dangerous work a “responsible and honourable” field.
The tragic downside is males are 20 times more likely to die on the job in Canada than women. And they’re 2.5 times more likely to suffer severe injury.
Those workplace injuries can lead to addiction to opioid painkillers.
It’s a mystery why the epidemic of male suicide, workplace fatalities and overdose deaths is not receiving significant attention.
It might relate to the stereotyping of masculinity, which the entertainment industry, media and academia often caricatures as hypercompetitive, privileged and dominating of women.
If those dying of overdoses were predominantly women, Bilsker believes governments’ response would be different.
“I suspect there would be more groups — more people actively involved in raising public awareness — who would speak up and engender a greater sense of this being an important issue.”
Bilsker would like to see North American health experts conduct more research into the workplace and family “trajectories” that lead males to overdose.
He’d also applaud more effort going into strengthening men’s psychological skills, including through wider use of cognitive behavioural therapy and other treatments that can help men overcome their despair.
The Dudes Club, which also has branches throughout the B.C. Interior, offers a glimmer of hope for some men.
As Gross says, it’s dedicated to positive expressions of masculinity: It works on the principle that good men (and women) are always ready to support their brothers.
“The men who come to our meetings,” he said, “have an attitude that we’re going to carry each other through these tough times.”
We don’t have a focus on things that men are at greater risk for. And this is certainly one — dying of an overdose is primarily affecting men, and men in the prime of their life. Patricia Daly, chief medical health officer for Vancouver Coastal Health.
It’s crazy. The members of our club are wondering, ‘Am I next?’
DR. PAUL GROSS, who helps to run the Dudes Club, which serves mainly Indigenous males