Overdose crisis could have one benefit
Buried within a tragic litany of data describing the dead, there is a grain of hope in the coroner’s analysis of 872 investigations into British Columbia’s illicit drug overdose deaths during 2016 and 2017.
It’s hidden within the particularly discouraging statistic that four of every five victims had been in contact with the healthcare system within a year before dying. When they sought help, the system clearly failed them.
But what if we had bettertrained doctors, and substance users had better access to treatment? Some — if not many — of those 872 might not only be alive, but on a path to recovery.
And, there is the grain of hope. If the system is improved in B.C. and across Canada, this fentanylfuelled epidemic can be stopped. As importantly, a comprehensive treatment system would begin to address the deeply entrenched problem of addictions to both legal and illegal substances.
That was the key to Portugal’s much-lauded success in ending its 1990s overdose crisis, not its decriminalization of drugs. What decriminalization did was provide a pathway for connecting drug users with the health-care system.
There, drug users are identified by police, outreach workers, doctors and nurses. They are assessed as early as possible by specialists, who recommend a course of treatment. Then, users get the best care possible, as quickly as possible.
It initially meant spending more money to treat addictions. But within two years, a costbenefit analysis showed that it resulted in long-term savings in other areas (including fewer visits to emergency rooms).
The B.C. coroner’s data suggests the at-risk are already in contact with the health system, suggesting a pathway to care already exists. But when users seek help, the system fails them by not providing what they need, or not providing the services they need when they need them.
Creating a better system to address the opioid overdose crisis is helped by the fact that this is a very specific epidemic.
Its victims are overwhelmingly men who are single, divorced or separated. They are regular or chronic drug users who live and die in private residences.
If their drug use began as a social thing, it is no longer. They use at home, alone.
A surprising 44 per cent of the men whose deaths were investigated had jobs, usually in the trades or transportation. It’s frightening to think that at least some of them were driving buses, taxis and maybe even flying planes. Others were operating heavy machinery.
They sought medical help for pain-related complaints. The coroner’s analysis doesn’t say whether those pain-related complaints were justified or whether they were attempts to get prescription opioids rather than street drugs.
Still, this suggests the need for physicians to be better trained in treating chronic pain, and the need for more and better treatment options. For years, advocates for chronic pain sufferers have called for both, including last week in Vienna at the United Nations Commission on Narcotic Drugs.
More than two years after British Columbia’s medical health officer declared opioid-related overdose deaths a public health emergency, it’s far from over.
Millions of dollars have been poured into the crisis response that has been focused mainly on harm reduction that has included making naloxone readily available to users. But it’s barely made a dent in the problem.
In the first eight months this year, 972 people have died. That’s down from its peak of 1,058 in the same period last year. But it’s still three times the number in 2015 and more than seven times the number of overdose deaths a decade ago.
Earlier this month, the B.C. government reaffirmed its three-year, $170.6-million commitment to enhance treatment services, training and outreach as well as more money for opioid replacement therapy. The federal government committed a similar amount.
While the loss of loved ones can’t be quantified in dollars and cents, there is a strong economic argument for improving the access and pathway to treatment.
Addictions cost the Canadian economy $38.4 billion in 2014, according to the Canadian Centre on Substance Use. That included costs related to health care, law enforcement, motor vehicle accidents, workplace accidents, as well as the cost of lost production and lost wages. Opioids (this was before fentanyl) contributed $3.5 billion to the total costs, while the economic cost of alcohol and tobacco use was $26.6 billion, or 70 per cent of that $38.4 billion. The two legal drugs were responsible for 90 per cent of the health costs.
It’s not yet clear exactly how the money committed to addictions by the federal and provincial governments will be allocated.
But a recent report from the B.C. Centre on Substance Use urged the government to change the focus from its crisis response of harm reduction to long-term treatment and recovery.
Four working groups were established to make recommendations, including on how to eliminate barriers to treatment and best treatment practices.
What is clear is that building a better, more comprehensive treatment system that includes harm reduction, early intervention, long-term recovery treatment, education and prevention is desperately needed.
The initial targets should be boys and men who are at greatest risk during this fentanyl-fuelled crisis. But it must be quickly expanded to respond to those who are also suffering from addictions to both illicit and legal substances.