Donald MacPherson and Scott Bernstein: We can stop the overdose epidemic—why aren’t we?

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      By Donald MacPherson and Scott Bernstein

      The numbers are in, and they are shockingly tragic: 11,577 Canadians—your friends, your families, your loved ones—died from apparent opioid-related overdoses between January 2016 and December 2018. The latest grim report from the Public Health Agency of Canada brings the gravity and scale of this national crisis into sharper relief. Last year, one person died every two hours from an opioid-related overdose.

      Our good friend and fierce harm-reduction activist, poet, and humanitarian, the late Bud Osborn, called it “genocide” when thousands died of overdoses during the epidemic in British Columbia in the 1990s. Many of us who lived through those dark times recognized that the crisis resulted from policies that helped create a new potent drug supply in the unregulated illegal market and forced people who use drugs into dangerous, life-threatening situations.

      Now, 25 years later, the same dynamics are happening again. Only this time it’s much worse.

      More than 85 percent of heroin tested on the streets of B.C. contained fentanyl or its analogues, potent opioids that are the primary cause of this unfolding disaster. In 2018, 75 percent of overdose deaths in Ontario were attributed to fentanyl, and in Alberta, 88 percent of a record high 744 accidental-overdose deaths were fentanyl-related. The illegal drug supply in Canada is now a toxic soup of lethal contaminants.

      The numbers hide the people and can never adequately reflect the faces, the hopes and aspirations, the lives of friends and colleagues, the hundreds of orphans and grieving families affected by this disaster: thousands of Canadians sacrificed to a collective stubborn and blinkered belief that more of the same will produce a better result.

      In response to the latest crisis, there has been tremendous mobilization of groundbreaking and innovative harm-reduction services. In spite of these efforts, the one intervention that may turn the tide on this crisis has not been attempted or even seriously considered on a broad scale: access to a safe supply of opioids.

      To get there, we must first acknowledge that traditional approaches such as harm reduction, treatment, recovery, and prevention have little impact on a contaminated drug market. Treatment providers, recovery advocates, and prevention professionals must call for radical change rather than clinging to the belief that the tide will turn if we only do more of what they offer. Second, it is long overdue that law-enforcement agencies call for a new approach that might eliminate the toxic market and take back control of drugs from organized criminals.

      Distribution of safe drugs is not an insurmountable task. In B.C., for example, government could mount a truly robust public health-oriented response that draws together expertise from its ministries; the B.C. Centre for Disease Control; the B.C. Centre on Substance Use; the colleges of physicians, pharmacists, and nurses; first responders; the public-health community; civil-society organizations; and hundreds of people with lived experience working the frontlines of this epidemic.

      With more than 1,200 pharmacies, harm-reduction programs, community-action teams, peer organizations, and community-based health clinics in B.C., there is a vast distribution system for safer drugs waiting to be harnessed. Funding should not be a barrier to action. This is an emergency. If this were a wildfire, governments would spend until the fire is out, and in terms of lives lost in 2018, the overdose catastrophe is 1,489 times more serious than the wildfire crisis was last year.

      Today, if our friend Bud were here, he would argue that the continued intentional refusal to supply pharmaceutical-grade drugs to people who desperately need them and whose supply is poisoned amounts to a second genocide. The same system that diagnoses people with a “chronic relapsing brain disease”, or addiction, sends them to the toxic drug market every day by denying access to a safe supply of drugs.

      The overdose crisis presents an opportunity to address one aspect of our policy by crafting a lifesaving response to a toxic drug market. To accomplish this, we need all parties working together.

      We can stop the overdose crisis, so why aren’t we?


      Donald MacPherson is executive director of the Canadian Drug Policy Coalition at Simon Fraser University and recent recipient of the B.C. Centre on Substance Use’s first lifetime achievement award. Scott Bernstein is director of policy  at the Canadian Drug Policy Coalition.