Canada’s dual public health crisis
COVID-19 and opioid overdoses are dualling crises that need public policy leadership
In many communities across Canada, the opioid overdose crisis is outstripping deaths from COVID-19.
Yet criminalization of drug use and people who use drugs continues to displace compassion and evidence-informed policies and supports that health workers and social services need to address this crisis.
Criminalizing a public health emergency while responding to health needs with ideology and stigma instead of science and evidence has failed for decades. The difference now? The glaring inequities laid bare by the pandemic.
The opioid overdose crisis, which was declared a public health emergency in British Columbia in April 2016, has proven even more challenging since COVID-19 lockdowns and restrictions were first put in place back in March 2020, as a Public Health Agency of Canada study reported. These necessary measures affected a range of critical health and social services, from elective surgeries, to mental health services, to supervised consumption sites.
During that time, the already toxic and unpredictable illegal drug supply worsened, just when fewer supports were available to reduce harm and save people’s lives.
In Montreal, Toronto, Sudbury, Lethbridge, Manitoba, the Yukon, B.C., several Indigenous communities and countless others in between, overdose deaths continue to rise sharply. In British Columbia alone, the death toll from the overdose crisis was 74 per cent higher in the 2020 compared to 2019, with higher figures projected in 2021.
Throughout the pandemic, the primary message regarding drug use conveyed by Dr. David Williams, Ontario’s former Chief Medical Officer of Health, was to “never consume alone.” Yet one of the main public health refrains during the pandemic was to remain distanced from other people.
Giving advice that’s difficult or impossible to follow is where the inequitable response to COVID-19 has met the inequitable and inadequate responses to the overdose crisis.
These intersections, combined with higher risks for racialized people and people living on low income, demand coordinated local action and interventions, such as the recently announced City of Toronto’s Integrated Prevention and Harm Reduction initiative.
Community-based services, such as safe spaces that provide opportunities for hygiene, meals, social connectedness, internet access and other practical supports are lifelines for people who use drugs, but delicate ones due to the isolation created by the pandemic to socially distance.
The fragility of supports and the new barriers of the pandemic have led to record high rates of overdoses and deaths seen across Canada over the past 15 months. The situation has called for bold action for months, and organizations that provide harm reduction services are still waiting.
In Canada, that meant a life lost to an opioid overdose every 49 minutes last summer.
A key successful intervention to reduce harm was the creation of supervised consumption sites in B.C., which spawned similar programs elsewhere, such as the Consumption and Treatment Services (CTS) program in Ontario. Canadian supervised consumption sites have attended to approximately 15,000 overdoses between 2017 and 2019, with no reported fatalities on site.
The pandemic has created significant barriers for people who need to access these types of services, with some having stayed away due to COVID-19 concerns or turned away through screening processes.
Additional community resources and policy changes are needed to address the compounding challenges faced by people who use drugs.
The crisis isn’t a static one; our responses cannot be either.
Safer supply programs and opioid agonist therapy (OAT) are the kinds of evidence-informed interventions that people urgently need access to. In the last few years, a study on the effectiveness of OAT showed that 590 lives were saved over the 19-month period.
“Safer supply” provides hydromorphone tablets and other regulated pharmaceutical alternatives of known potency and quality from a licensed prescriber to people with opioid use disorder, reducing reliance on poisoned illegal drug supplies, and lowering risk of overdoses.
New guidelines issued after the COVID-19 outbreak allow clinicians and nurse practitioners to more readily prescribe opioids and other substances to those living with addiction. Safer supply has been expanded by the federal government through pilot projects in Ontario, but without any policy or dedicated sustained funding support from the provincial government.
Communities such as London, Ontario, have piloted safer supply since 2016, and much more could be done in other communities across the province—with the necessary funding and shifts in policy approach.
We now need governments at every level to set aside stigma, misunderstanding of drug use, and mindsets focused on failed enforcement policies. The overdose crisis, like COVID-19, is a public health crisis that demands communities come together to support each other. We need collective compassion not divisive judgment.
We need science, not stigma.
Across Canada, there are at least seven chief public health officers who endorse decriminalization of all drugs for personal use. This would alleviate the complications in life generated by criminal records for drug users and prevent jail sentences, during which they will likely suffer withdrawal.
Vancouver’s city council has asked the federal government to approve decriminalization of drug use in that city and the momentum for change continues to build across Canada. More police chiefs and departments are demanding change and a shift towards the harm reduction approaches.
Decriminalizing the use of drugs and ending reliance on a poisoned illegal supply can help us dramatically lower the number of overdoses and overdose deaths.
It has been a positive signal that federal parties in this election are acknowledging the severity of the overdose crisis. The Liberals, NDP and Conservatives have incorporated the issue into their platforms explicitly stating that this epidemic is a medical issue, not a legal one.
The Conservative Party of Canada has promised to build drug recovery centres, increase Canada’s capacity for treatment beds, and not opposing safe-injection sites.
The federal NDP has committed to end the criminalization of users, support overdose prevention sites, expand addiction treatment, and declare the crisis a public health emergency.
The Liberal Party of Canada is focused on continuing the programs it has already implemented as the sitting government around safer supply pilot projects and supervised consumptions sites, and allocating funds towards treatment, recovery, and prevention.
While these platform ideas help build on a changing narrative around drug use, whichever federal party is elected cannot tackle this crisis on its own. This requires a multi-level government approach, supported by other public institutions.
“You talk and we die” has never seemed as stark as now, not least of all because people and families affected by the overdose crisis are seeing what’s possible when communities and health providers are supported by governments to take urgent action to save lives.
We are counting on provincial and federal leaders’ capacity to be open-minded and collaborative to address one of the most significant public health emergencies in recent history. We need inventive, rigorous, community-focused solutions to deal with the overdose crisis as much as we need the same supports for COVID-19.
Arman Hamidian is a Program Manager at SE Health, and the Board Chair at Access Alliance Multicultural Health and Community Services. He continues to conduct research and policy analysis on matters of health equity and the social determinants of health.