Opioid crisis symptom of society that’s sick

With Ontario Premier Doug Ford threatening to fulfill his campaign promise to close the province’s seven supervised injection sites despite the rising number of overdose deaths, it’s worth stepping back to consider where the endless stream of people willing to risk their lives comes from in the first place. It’s a key question that hasn’t received enough attention as the crisis has grown, and one that needs to be addressed as part of the long-term response to the emergency. Last year, almost 4,000 Canadians died from illicit drug overdoses, federal data released in June showed. That was up 34 per cent from a year earlier, a year that itself had seen a massive increase from the one before that. In Ontario, the increase was even faster. There were 1,125 overdose deaths recorded in the province, a jump of 55 per cent from 2016. A majority of the deaths were from fentanyl, a powerful opioid that is often mixed with other drugs long before they reach the consumer. The producers add fentanyl because it is cheaper to make than other drugs, and therefore, increases their profit. For several years, Western Canada has been at the forefront of the crisis, and the experience there is instructive. In Alberta, the number of fentanyl-related deaths doubled every year between 2011 and 2015, and in recent years, British Columbia has accounted for nearly half the Canadian deaths. B.C.'s chief coroner, Lisa Lapointe, by the end of 2016, was saying publicly that, on some days there wasn’t enough space in the Vancouver morgue for the number of bodies. More people were dying from overdoses in the province than from motor-vehicle incidents, suicides and homicides combined. Distressingly, the crisis has escalated, despite years of effort to slow it. B.C. declared the opioid crisis a public health emergency two years ago and last year, created a new ministry for mental health and addictions. New overdose prevention sites have opened to provide supervised consumption services, a harm-reduction measure to address the fact that many of the people who have died have been using alone. Drug-checking machines are beginning to be introduced, so people can know what’s in the substances they buy illegally, and there are calls to do more to provide people who are addicted with a safe supply. Kits containing naloxone, which can reverse the effects of overdoses, have been made widely available for free. There’s money for new treatment beds and outpatient services. And yet the number of deaths keep rising. All of these efforts are positive, but the best that can be said is that likely even more people would be dying without them. As in B.C., authorities in Ontario have been emphasizing harm reduction. Toronto police announced recently that officers working in the downtown core would begin routinely carrying naloxone. And Eileen de Villa, Toronto's medical officer of health, added her voice to calls to decriminalize small amounts of drugs and to consider regulating all drugs. The approach, which the federal government has in recent years rejected, would be similar to what we do now with alcohol and will do soon with marijuana. Taking a longer view, we need to do more to prevent people from getting to the point where they are at risk of an overdose. Recent moves by provinces and the federal government to change doctors’ prescription practices and to limit advertising by opioid manufacturers are steps in the right direction. Most people who use opioids start with a prescription from their doctor. It’s generally seen as good news that fewer people received such prescriptions last year in every province, except for Newfoundland and Labrador, though there’s reason to worry the drop may mean more people taking their chances on drugs they buy on the black market. To get even further upstream, however, we need to consider how social conditions contribute to addiction. While every person who has died was an individual, each with their own story, common themes arise. When Leslie McBain, the founder of the parents’ group Moms Stop the Harm, talks about the 2014 death of her son Jordan, she traces his addiction back to untreated anxiety when he was a child that led to self-medication. In the words of Gabor Maté, the Vancouver doctor and author: “The drug addict is a particular case of somebody who is trying to soothe themselves from the outside because of internal distress and disturbed brain circuits.” Grand Chief Doug Kelly, the chair of the First Nations Health Council, sees the overdose crisis and its disproportionately large impact on Indigenous people as fitting the devastating pattern of alcoholism and suicide. “It’s unresolved trauma, unresolved grief,” he has said. That thinking lines up with the thesis by Bruce Alexander, who taught psychology at Simon Fraser University. He argued the evidence showed that the presence of an addictive substance matters less than the conditions that make people want it. When a society fragments, addiction increases dramatically as people struggle to cope with dislocation. Through this lens, the opioid overdose deaths are not so much the result of bad choices made by individuals, or a criminal matter, but a sign of a sick society. That perspective also suggests another path of treatment. Along with harm reduction, we need to be doing what we can to heal trauma, as well as avoiding it in the first place. In a country where nearly one out of five children is raised in poverty, we need to provide more support to make sure families and others raising kids have everything they need to create as safe and nurturing a home as possible. We need to intervene early to support people’s mental health, and Ford is on solid ground with his pledge to spend $1.9-billion on mental health and addiction supports over the next decade. But we must also do what we can to build social connections and to improve the working and living conditions that make the lives of many stressful. The problems run deep, but there’s much we can do together to address them. As with many illnesses, it’s time to recognize that we’re in this together and in the long run prevention will be much better for all of us. Andrew MacLeod is the author of All Together Healthy: A Canadian Wellness Revolution, which looks at opportunities to better address the social determinants of health. The Hill Times

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Opioid crisis symptom of society that’s sick

Opioid overdose deaths are not so much the result of bad choices made by individuals, or a criminal matter, but a sign of a sick society, writes author Andrew MacLeod.

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