Opioid-related overdoses and deaths have been a significant public health crisis in Canada for some time, with the province of British Columbia (B.C.) having declared a public health emergency in 2016. In B.C. life expectancy fell in 2017, for the second year in a row. Nationally, it is now apparent that life expectancy rates in the country have stropped increasing. This marks a dramatic change from prior patterns, as life expectancies had been increasing for about four decades until 2017, where they did not increase from the prior year. Young men in the 20 to 44 age group have faced a high number of opioid overdose related deaths, which has offset the longer lifespan of older males.
Between January of 2016 and September 2018, Canada’s Public Health Agency stated that more than 10,300 Canadians died from an opioid-related overdose. Fentanyl, a painkiller, has been linked to 73 percent of such deaths that occurred over a nine-month period between January and September 2018.
Besides young men, the crisis has disproportionately affected specific groups. In Vancouver, B.C., the life expectancy differences between young men in the more affluent west side and the poorer Downtown Eastside is about 17 years. First Nations people have been heavily impacted. B.C.’s First Nations Health Authority stated that 193 First Nations people fatally overdosed last year, marking a 21 percent increase from the earlier year. First Nations women are more vulnerable to dying from an overdose, in comparison to their non-First Nations counterparts.
Dr. Keith Ahamad, who works at St. Paul’s Hospital in Vancouver and is also a researcher with the BC Centre on Substance Use, said, “We’re doing a very bad job nationally with drug policy, combined with the fact that we’re not looking after people from the lower socioeconomic groups.” He added, “There’s a traumatic fallout for people who are losing children and siblings and friends and parents. There is health-care-provider burnout at a level I’ve never seen before. My colleagues are absolutely burned out.” The provincial health officer of B.C., Dr. Bonnie Henry, said, “I believe we need to continue to focus on this crisis and there is more to do including decriminalization of people who use drugs and providing people addicted to drugs and at high risk of dying with pharmaceutical alternatives to the poisoned street-drug supply.”
It is apparent that with this ongoing crisis, more comprehensive solutions are needed that can address the various factors that are affecting it. The distribution of opioid pills to patients has been an area that has been greatly scrutinized by regulatory agencies recently. In 2018, B.C. announced a lawsuit against drug companies, accusing them of being partially responsible for the opioid crisis in the province. Widespread allegations that pharmaceutical companies have been freely advertising addictive drugs to physicians while downplaying the risks to patients are a major motivation towards such governmental actions. Regulators taking a more critical stance towards pharmaceutical companies, which have been able to market and sell their products without a sufficient amount of regulatory oversight, is welcome albeit long overdue. Crackdowns on illegal supplies of opioids like fentanyl and carfentanyl, are another step that is already being taken. However, despite these steps, which have their importance, the public health aspect of treating the patients and their multifaceted problems must take priority. The decriminalization of users and allowing for various forms of harm reduction, including safe injection sites, like the example of Vancouver’s Insite program, is important to implement throughout the country, to start to reduce the high number of overdoses and overdose deaths.
In combatting the ongoing opioid crisis, one potential solution has been to emphasize marijuana as an alternative. A councillor in Vancouver, Rebecca Bligh, put forward a motion that would change zoning bylaws and allow cannabis stores to open in the city’s Downtown Eastside, besides four approved locations. Her argument is on the basis that low-cost cannabis sold to vulnerable users may be a part of the solution to the crisis. A growing body of research into marijuana’s properties, including how it can interact with addiction centres of the brain that are implicated in opioid addictions, is highly valuable. Having an accessible and affordable market of cannabis derived products may be an important part of addressing some aspects of the opioid crisis, including pain relief.
It is becoming increasingly evident that the opioid crisis is one of such a great magnitude that its ramifications are being felt throughout the country. British Columbia, Alberta, and Ontario are the provinces in which it has the most effect. The negative effects that it has had on life expectancy, including the significant impact on young men, First Nations communities, and those who are impoverished, suggests that immediate action from the different branches of government in Canada, in a comprehensive and highly coordinated matter, is essential to start to address the many ramifications of this public health emergency. The public health domain must be given precedence over the law enforcement domain, to better assist people who are battling addictions, while not further stigmatizing and marginalizing them.
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