The opioid crisis has not only sapped the energy from first responders, it’s hardened us to the continuing tragedy.
The seemingly unending opioid overdose crisis with its litany of deaths and near-deaths has not only sapped the energy if first responders, it’s made something that would have been unthinkable almost normal.
More Canadians now die from drug overdoses than from car accidents. For the first time in decades, average life expectancy has dropped because of the more than 9,000 fatal overdoses across the country.
We need to solve this.
Even if the death toll isn’t enough to convince you, the simple fact is that we can’t afford not to put an end to it.
In addition to those who have died, thousands more have ended up in emergency rooms and hospital beds. In a recent report, the Canadian Institute for Health Information said that 17 Canadians a day were hospitalized in 2017 for opioid-related poisoning. In Vancouver, at the centre of the crisis, it worked out to slightly more than 10 a week.
Opioid-related hospitalizations jumped 29.3 per cent in B.C. Across Canada, they rose 27 per cent.
An estimated 4,700 lives were saved last year in British Columbia, largely because of widespread availability of naloxone. But when someone overdoses on fentanyl, which is at the root of this crisis, they stop breathing and even with the quickest of responses there can be brain damage.
Nobody knows how many British Columbians now suffer from toxic brain injury, let alone how many Canadians. But the estimates range from the hundreds to the thousands.
But those are only the public health costs. The Victoria-based Canadian Institute for Substance Use Research calculated the cost of substance use in 2014 in B.C. was $4.9 billion. In Canada, it was $38.4 billion. But that was before the opioid crisis hit.
The biggest costs for all substance use including alcohol and tobacco are lost productivity at 38 per cent of the total, health-care costs at 33 per cent, plus criminal justice costs. And that doesn’t account for the collateral harms to spouses and children.
Then, there’s a much more complicated economic cost. We’re only now starting to understand the effect of billions of dollars earned in the illicit drug trade being laundered including through government-regulated casinos. It’s linked to the spike in Vancouver house prices, which has made this once most-livable region into an unaffordable one.
With an aging workforce, opioid deaths disproportionately affecting men in their prime and house prices beyond reach for most working people, we have a toxic economic combination.
Clearly, a solution is in everyone’s interest. But what are the answers?
Portugal’s success offers some solutions. Free and easy access to harm reduction, treatment and recovery services are at the core of its drug policy.
Decriminalization of drugs for personal use takes away the risk and the stigma of seeking help, while income supports for families makes it possible for their loved ones to go into treatment.
Because drugs remain illegal, police attention is focused on trafficking and the result has been a reduction in supply, while effective prevention programs have reduced demand.
Of course, there are three key differences.
No. 1 is fentanyl. We have it. They don’t.
The second is that cannabis is legal here. Since legalization, there is growing pressure from drug users and grieving families for a safe supply of drugs. Their influence is evident in the recent from the B.C. Centre on Substance Use recommending compassion clubs run by boards that include addicts, selling pharmaceutical grade heroin to addicts.
There is no country where all drugs are legal. Canada was only the second in the world to legalize cannabis.
Finally, Portugal’s drug laws were enacted only after widespread debate and consultation. Canada’s last public consultation was the 1970s Royal Commission on the Non-Medical Use of Drugs. The resulting recommendations included decriminalization of marijuana for personal use and fines of as little as $100 for personal-use possession of other illicit drugs.
Regardless of what kind of policy would result from a national discussion, Portugal’s drug policy head, Dr. Joao Goulao, underlines that the success of its policies was only possible because the government earned the social licence to proceed.
Initially, there were some large costs associated with expanding its treatment services and facilities (including residential therapeutic communities). But those costs are now balanced out by reductions in addiction rates, HIV/AIDs infection rates, hospitalizations and lost job productivity.
END OPTIONAL CUT
Vancouverites did have a discussion nearly 20 years ago in the midst of a heroin overdose crisis that pales beside what’s happening now. The resulting Four Pillars Plan for prevention, treatment, harm reduction and enforcement had widespread support, but it was never fully implemented. Had it been, we might not be in the mess that we are today.
We need a national conversation about everything from decriminalization to universal access to treatment and recovery services.
To do that, we need evidence and better data. Consider the 4,700 lives saved last year in B.C. after an overdose. Nobody knows whether that represents 4,700 people or 100 people resuscitated 47 times. Nobody knows how many who were saved died in later overdoses? Knowing is essential to determining the appropriate responses.
One possible starting point is to agree that we need to do better than simply keep people alive and then set a goal.
For that we might well look to Portugal. There, the goal is to help people resume their dignity and, to the best of their ability, resume being contributing members of society.