In the last five years, there has been an alarming increase in deaths related to opioid overdoses.
More than 22,000 Canadians – the majority of them in the prime of their lives – have succumbed to fatal overdoses since 2016. These numbers are comparable to lives lost in Canada due to COVID-19 infections, yet we are not seeing the same urgency or coordinated action by governments to protect Canadians and prevent loss of life.
Already a public health crisis in its own right, the opioid overdose crisis has been further exacerbated by the COVID-19 pandemic.
With border closures and travel restrictions, the illegal drug supply has grown unpredictable and more toxic and access to vital services such as counselling supports, supervised consumption sites and medical treatment has grown more difficult for people with substance use disorders.
We know that throughout history, people have used substances for a variety of reasons, including recreation, ceremony and overcoming physical and emotional pain. As a society, we need to accept that people will continue to use mind-altering or psychoactive substances, and provide regulations and protections to reduce the harms.
We already accept the use of some psychoactive substances such as alcohol, tobacco and cannabis. Legislation and regulatory frameworks put into place by governments for these substances protect consumers, and reduce harms to individuals and to communities.
But Canada’s drug policies relating to opioids are nearly 100 years old and need to be updated to reflect current evidence and present-day realities. These policies based on prohibition contribute significantly to individual and societal harms.
Prohibition encourages organized crime and illegal activity arising from individuals and groups operating in an unregulated market. It also leads to a more toxic drug supply as drug traffickers find it is easier to hide and import smaller, more potent quantities of opioids.
Law enforcers claim to target high-level production and distribution of drugs, but an analysis of 2016 Canadian statistics on drug arrests showed that 73 per cent of arrests were for simple possession of drugs with youth and people from impoverished or racialized communities – particularly Indigenous communities – being over-represented in the arrests.
Prohibition and criminalization also divert much needed resources from health and social services to fund enforcement and incarceration. The health and social services sectors are better equipped than the criminal justice sector to help people with substance use disorders manage their medical condition and enable them to lead productive and fulfilling lives.
Decriminalizing simple possession and use of drugs can help people with opioid use disorders access the life-changing treatments that they desperately need. With the threat of prosecution removed, they are more likely to seek out services that support their goals in recovery whether that be related to abstinence, reducing harm or avoiding death by overdose.
Through the health service organizations they fund, governments need to provide a full spectrum of proven interventions to help people who use opioids.
Supervised consumption sites are one intervention supported by a wealth of evidence. They have been shown to connect people with the treatments they need, reduce crime in surrounding communities and save money within the public system.
And most importantly, supervised consumption sites save lives. Consider that not a single life has been lost due to drug use within such a facility.
There is also a strong body of research that supports treatment with opioid agonists, such as methadone or Suboxone, to decrease withdrawal symptoms and lower cravings. Making opioid agonist treatment available and accessible to people with opioid use disorder is key to promoting and enabling their recovery.
However, for some people at risk of fatal opioid overdoses, opioid agonist treatments are not effective, or not appropriate. For them, there is evidence from a number of countries including Switzerland, Germany, the United Kingdom and Canada, that providing a pharmaceutical-grade supply of opioids prescribed by a health care practitioner is beneficial.
Safer supply, as this practice is known, lowers the rates of overdose deaths, visits to emergency departments and hospitalizations. Furthermore, safer supply reduces criminal activity and improves connections to medical care, social supports and housing for people with opioid use disorder.
In August 2020, the federal health minister wrote to her provincial and territorial counterparts instructing them to set up access to safer supply of opioids as one option in a spectrum of services for people who use drugs.
In response to this, the UCP government in Alberta recently announced plans to establish a committee to look at “both sides of the issue” of safer supply. The weight of scientific evidence supports one side, but it leaves one wondering what could possibly support the other side.
Finally, it is important to recognize that many with opioid use disorders are suffering from the pain of childhood trauma, homelessness or social exclusion. To reduce opioid overdose deaths, we also need to work upstream to support healthy, well-functioning families; reduce poverty; and build societies based on equity and justice. Because we are all in this together.
Vamini Selvanandan is a family physician and public health practitioner in Alberta. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.