Federal response may worsen overdose crisis

Monitoring could boost street markets, says Jordan Westfall.

Federal Health Minister Jane Philpott unveiled new details of Canada’s national drug strategy at the Charting New Futures in Drug Policy conference last Friday in Toronto. Health Canada pledged $40 million to create a national prescription drug monitoring program (PDMP) that will increase surveillance on physicians and patients alike. The program is purported to reduce rates of problematic opioid use.

However, PDMPs can have the unintended consequence of transitioning prescription opioid patients to illicit street drugs. Their $40-million pledge could mean that rates of overdose deaths for persons who use drugs in some regions of Canada (particularly in B.C.) might actually increase. How? With increased surveillance of prescribing practices will come increased pressure for physicians to stop prescribing opioids to their patients. Patients are cut off, and as a result, seek opioids in an unpredictable street market where fentanyl, a drug 100 times more powerful than heroin, is needlessly killing people every day.

Street markets are saturated with fentanyl these days. In B.C., it’s responsible for a 75 per cent increase in overdose deaths that led the provincial government to declare a public health emergency. In Alberta, fentanyl overdose deaths have soared 4,500 per cent since 2011.

But Health Canada doesn’t measure the impact of their PDMP policy on rates of overdose death.

Health Canada uses a narrow, exclusionary measurement of successful policy (reduced consumption of prescription opioids). It doesn’t even consider overdose death as an unintended consequence, despite research indicating that this has occurred in other jurisdictions.

Decision making of this sort occurs frequently, and exposes systemic issues in our nation’s drug policy.

It contributes to the overdose epidemic that is devastating thousands of Canadian families.

The health outcomes of people impacted in the most acute way are excluded from the very definition of policy success. Heath Canada must measure how their new policies will reduce overdose deaths; reduce stigma and marginalization; and how it will impact the health outcomes of people who use drugs. Otherwise, we’ve already been written off. Now for a hopeful prayer. In an absolute reverse image of the evidence for Health Canada’s PDMP program, research showing that supervised consumption facilities reduce overdose deaths is near unanimous (ergo, reductions in overdose deaths are actually measured).

Unfortunately, the government’s Respect for Communities Act makes legally opening a supervised injection site in Canada exceedingly difficult. The Health Minister held steadfast that Health Canada would not repeal the Respect for Communities Act, despite the barrier it presents to reducing overdose deaths.

Instead, Philpott has given her promise that the agency will work with applicants through the section 56 exemption process required to open a supervised consumption site in Canada. How’s that for a leap of faith? There is a public health emergency in Canada. We need an emergency response. Our lives will not wait.

We need to include current and former drug users as the primary stakeholders when policy is written. Otherwise, more death will be a result. How?

For proof, consider the impact on Ontario’s overdose death rate after the OxyContin reformulation in 2012. OxyContin was replaced by a tamper-resistant version called OxyNEO, in hopes of reducing diversion of the drug to illicit marketplaces. However, in the absence of OxyContin, former patients transitioned to more harmful substances like fentanyl and heroin. The next year, Ontario experienced its worst year in provincial history for overdose deaths.

People who use drugs know better than any other stakeholder how damaging it can be when the government gets it wrong.

We pay for their mistakes with our lives.

It doesn’t even consider overdose death as an unintended consequence.