Media coverage of what is being dubbed the "fentanyl crisis" has created a small window into the reality that I deal with every day. As a frontline worker with a social-service agency in Downtown Victoria, I have been witness to the epidemic of overdoses taking place in our streets.

Although it is encouraging that the frequency of overdose deaths is finally receiving media attention, discussing it as a "fentanyl crisis" is an oversimplification. It avoids more complicated conversations about poverty, mental health, and affordable housing that our community needs to have.

The title of "fentanyl crisis" frames the overdose epidemic according to the familiar "war on drugs" narrative. This narrative is a comfortable one because it provides convenient villains. It directs scorn at the manufacturers and traffickers; the monsters who put these drugs on the street in the first place.

The deeper reality is that for an overdose crisis to occur, there needs to be an addiction crisis. Social stigma, legal implications, and problems accessing health care make addiction illnesses difficult to quantify. However, a short visit to any of Victoria’s packed homeless shelters describes the situation with a gravity that no numbers can achieve. During the past two years, there has been an undeniable increase in the problematic use of street drugs and the suite of problems that go along with them.

Over the same time period, while the rate of addictions and overdose deaths has been skyrocketing, Victoria has also developed an affordable-housing crisis. The Canadian Mortgage and Housing Corporation reports that the rental-vacancy rate in Victoria has dropped from 2.7 percent in 2014 to 0.5 percent at the end of 2016. With that vacancy rate, there has been a corresponding increase in rents, and the average cost of a one-bedroom apartment is now $912.

The consequence has been a drastic increase in the number of homeless or underhoused people. 

There is an undeniable correlation between homelessness and addiction. Although debates can be had about which is the causative factor, across North America and Europe the highest rates of problematic substance use are consistently found among underhoused and homeless people. It follows, then, that the correlation between Victoria’s housing crisis and its addiction epidemic is no coincidence.

Another contributing phenomenon to the addiction crisis is mental illness. Many care providers consider addiction itself a mental illness, and addictions are generally associated with other co-occurring mental-health issues or brain injuries.

The reality is that there is a frightening lack of funding for mental-health care. I have worked with dozens of clients who are far too sick to manage day-to-day functions such as bathing and feeding themselves, and it is almost impossible for them to access the support they need to lead stable lives.

People struggling with mental illness are also disproportionately likely to experience poverty and homelessness. Welfare rates in British Columbia have been stuck at $610 per month for 10 years. In that time, housing and the cost of food have risen dramatically. As the cost of living rises with each passing year, opportunities for people to escape homelessness and construct a degree of stability required to deal with addiction and mental illness disappear.

This suggestion of how poverty, mental health, and homelessness compound to create the current addiction crisis has been established in countless academic papers, but the clearest explanation I have heard came to me from one of my clients. “When you live on the street, you can’t not go insane and get high all the time.”