To address overdoses, we need a much broader view
The most recent B.C. coroners report on illicit drug overdose deaths confirmed, tragically, that deaths from overdose and drug poisoning continue to take an unprecedented human toll in this province.
So far, laudable responses have rightly focused on immediate health outcomes given the contaminated drug supply. Supervised consumption and overdose facilities, drug testing, the distribution of overdose-reversing Naloxone and access to injection and non-injection opioid assisted treatment are all expanding. All are critical in reducing overdose deaths.
It is important to remember, though, that most of our current efforts do not stop overdoses — they only prevent them from becoming fatal. If we hope to create long-term, meaningful reductions in overdose deaths, a question that requires considerable attention is how to prevent overdoses from occurring.
As we look deeper into the coroners’ data, we get a clearer picture of what lies behind these grim statistics and, perhaps, some ideas about additional paths we can take to reduce fatalities. Included in the report was this: Fatal overdoses occurred during the days following income-assistance payments at a rate nearly double that of those that happen at other times. There was an average of nearly six overdoses per day on the Wednesday to Sunday following income-assistance payments compared to 3.6 for all other days in 2017.
We can and should understand trends like this as signals that identify opportunities where change could have an impact.
The link between income-assistance payments and overdoses is consistent with research and what people working on the issue have known for years: income assistance importantly reduces some of the health harms of poverty and is a critical component of our social safety net, but the synchronized influx of money to all recipients on the same day is linked to increases in drug use and overdose risk.
People on income assistance have incomes generally considered insufficient to live on. The impossibility of financial security has considerable impacts for drug use, drug-related harm and overdose risk. We need to look more broadly at the social and socio-economic conditions that put people at risk of overdose to identify areas where we can target response and prevention efforts.
Socio-economic marginalization is a key driver of illicit drug use and drug-related harm. In the context of the overdose crisis, socio-economic marginalization could be relevant in many different ways. It might be someone who loses their housing and along with it the space, routines and social interactions that allow them to use opioids more safely.
It could look like someone who experiences severe chronic pain but doesn’t have the resources to consistently access care and resorts to street drugs to self-medicate. It could look like someone who goes through a family rupture, doesn’t have the resources to set themselves up properly and ends up in places where they’re using drugs in high-risk ways. Or it could look like someone being released from prison and not having the resources to land gently or access treatment, resulting in relapse.
As this public-health emergency deepens, we must think about how to incorporate broader understandings of overdose risk into our response and prevention efforts. Strategies to reduce marginalization and associated health harms and illicit drug use of vulnerable people who use drugs will be critical in this regard.
This includes examining our income-assistance system to ensure it does not exacerbate conditions that lead to overdose. It also includes addressing socio-economic factors with documented linkages to increased risk of overdose: homelessness and housing insecurity, food insecurity, insufficient support following release from prison, poverty severity and lower educational attainment.
Developing a comprehensive system of care is critically important to building an effective substance use and overdose response. These efforts will be strengthened if they are undertaken in conjunction with measures to address the social and economic conditions that affect both immediate and long-term overdose risk.
Lindsey Richardson is a research scientist at the B.C. Centre on Substance Use and an assistant professor in UBC’s department of sociology. Jenna van Draanen is a post-doctoral fellow at the centre and the department.