Tackling the opioid crisis
Pandemics are remembered, not just for the problems they create, but for the ones they reveal. The COVID-19 pandemic highlighted systemic failures in long-term care, for example, and now it’s revealing our mishandling of problematic drug use.
The Public Health Agency of Canada reports that during the first two years of the pandemic, opioid-related deaths increased 91 per cent compared to the two years before. By way of explanation, PHAC states:
“A number of factors may have contributed to a worsening of the overdose crisis over the course of the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety, and changes in the availability and accessibility of services for people who use drugs.”
These factors have exacerbated the crisis, but they all existed long before the pandemic. It’s just that we failed to see, or at least closed our eyes, to them. And now that the pandemic has revealed them to us, it’s time to act.
To begin with, fentanyl began making its way into the illicit drug supply about a decade ago, and now, in 2022, it’s involved in 85 per cent of opioid toxicity deaths. And of all such deaths, 81 per cent involved exclusively non-pharmaceutical (black market) opioids.
These two statistics point us to two solutions: first, we need to regulate, rather than criminalize, all psychoactive drugs, and second, we ought to provide a safe supply of drugs to users. Those two solutions were, respectively, the “core” and “urgent” priorities identified by an expert task force last year, but so far, Ottawa has done relatively little toward making them a reality.
The feds did approve British Columbia’s application for an exemption from the Controlled Drugs and Substances Act, and personal possession of small amounts of drugs will become legal in the province next year. There’s no word yet, however, on whether Ottawa will approve Toronto’s or Edmonton’s applications for similar exemptions.
But even if approved, this piecemeal decriminalization approach hardly meets the task force’s core recommendation to regulate all psychoactive substances. The Liberals voted against an NDP decriminalization bill, and illicit drugs will therefore remain illegal in most of Canada for the foreseeable future.
As for safe supply, Ottawa has created and funded a number of pilot projects, but their strict protocols and limited enrolment result in many people still relying on the illicit drug trade. And Ottawa’s efforts here too hardly meet the task force’s recommendation for a national scaling-up of safe supply.
That said, Mental Health and Addictions Minister Carolyn Bennett did recently say “we want to be able to get to a place where there is a pharmaceutical-grade, regulated supply of drugs,” so perhaps Ottawa is finally ready to act on the task force recommendations.
The PHAC statement also stresses the importance of improving the availability and accessibility of services for drug users. But to be successful, these services, including treatment, need to address all the factors that result in problematic drug use.
This leads us to the final element of PHAC’s statement: the significant role social and psychological factors like isolation, stress and anxiety play in the opioid crisis.
Unfortunately, people often conceive of addiction as just like any other illness or injury. If that were true, then users could just attend rehab for a week or a month or a year, and they’d be healed. But this isn’t about treating a broken hip; it’s about treating a broken spirit.
As a 2018 Statistics Canada study detailed, problematic opioid use is higher among those whose lives are stressful and those who suffer from poor mental or physical health, especially if their mental health needs are unmet. And the accessibility of mental health care has been uneven at best.
In addition to these psychological factors, social factors play a major role: Statistics Canada found higher rates of opioid abuse among people who are unattached and those whose sense of community belonging is low.
One’s economic status within the community is also critical, as a 2022 PHAC study found that the opioid-related mortality rate was much higher among those in the lowest socioeconomic strata compared to those in the highest.
Indeed, people here more frequently experience housing and food insecurity, and nothing increases stress and anxiety more than wondering where your next meal is going to come from, or if you’ll have a home to eat it in.
Consequently, treating — and preventing — opioid addiction means ensuring the availability and accessibility of affordable housing, food and supportive communities along with physical and mental health care.
If we didn’t know that before, we do now, since the pandemic has revealed it to us. Now it’s up to us to act.