Canada’s opioid crisis may be less reported than that in the US, but the effects have been devastating. Is this where we are headed, asks Jussi Grut, and if so what can we learn from the country’s response?
British Columbia, the province in which Vancouver is the largest city, totalled 1,155 opioid related overdose deaths in 2018. This was the highest in Canada despite having a population less than half the size of Ontario, Canada’s most populated province. Almost 400 of the British Columbia deaths occurred in the City of Vancouver, with most of these people residing in an area called the Downtown Eastside.
The Downtown Eastside of Vancouver is a place that can seem intimidating to outsiders, with people openly taking illicit drugs alongside makeshift markets where residents lay out their few possessions on blankets to sell for a bit of extra cash. These misconceptions about this relatively small community could not be further from the truth, but before I go into further detail some context needs to be provided about North America’s battle with drug addiction as a whole.
While the opioid problem in the US continues to make headlines across the world, a similar but contrasting crisis is taking place above its northern border. Canada, a country that for many conjures images of snow-capped mountains, never-ending forests and a history of peace and inclusiveness, is the last place many outsiders would expect to have a drug problem comparable to that of the United States, but the country is struggling to deal with serious problems of addiction. The origins of the situations are different, despite having a very similar outcome.
The USA’s problem started with the over-prescription of opiates such as OxyContin – with doctors reassured by pharmaceutical companies and medical societies that the risk of addiction with these pain drugs was very low – and was exacerbated by pharma companies promoting use of these drugs for non-cancer patients. After attempts by government to limit the amount of prescription opiates being distributed, without putting in place proper infrastructure to help those now addicted, the amount of readily available drugs accessible through diversion decreased. This effectively forced those who developed an addiction to turn to illicit sources such as street heroin, and deaths due to heroin-related overdose went up by 286 per cent between 2002 and 2013.
While Canada had the second highest consumption of prescription opiates per head of population after the US, according to the 2015 Canadian tobacco, alcohol and drugs survey, only 2 per cent of those who used prescription opioids reported misusing them – this can be attributed to a universal healthcare system not geared to shareholder profits. Canada’s problem is one that is much more complicated, with a range of factors which date back to the days of colonialism.
Extensive research carried out by psychologist Bruce Alexander of Simon Frasier University for his book The Globalisation of Addiction showed that a major cause of opioid addiction among the indigenous populations of Canada was the westernisation of communities through forced disconnection from land, culture and community in order for them to assimilate. This disconnection from their heritage, along with growing social and economic inequality between settlers and natives, created a catalyst for opioid addiction among Canada’s indigenous communities.
Canada’s problem, however, goes far wider than the indigenous population. Rising house prices in big cities are adding to a growing number of homeless who turn to drugs to try to find an escape from their difficult circumstances, and Canada’s sub-zero winter temperatures mean many people move to the country’s most western city, Vancouver, where it rarely snows and winters are comparatively mild.
The book Fighting for Space by journalist Travis Lupik, who has covered Vancouver’s opioid crisis since its inception, tells the story of the activists who fought and broke the law by being the first to hand out clean syringes, unofficially open safe injection sites and form a drug users’ union which later led to the creation of Insite, Vancouver’s first government sanctioned supervised consumption site.
Made possible through an exemption from Canada’s Controlled Drugs and Substances Act, Insite receives on average 700-800 visitors a day – since 2003 there have been more than 3.6m clients and 6,440 lives saved through overdose intervention on site. Insite serves not only as a metaphorical pillar of the Downtown Eastside community but also as part of the four-pillar drug strategy the City of Vancouver has put into place, the four pillars being harm reduction, prevention, treatment and enforcement.
Alongside offering safe spaces for people to take their drugs, Insite acts as a community space where people can socialise. There is no limit to how long clients can stay despite the high numbers of people using the service, many of whom may be homeless. Chill out rooms with complimentary juice and coffee allow clients to relax in what for many will be their only opportunity during the day to be in a comfortable indoor space, and this community-focused atmosphere is vital to the success of Insite and second-generation supervised injection sites which opened after the declaration of a public health emergency by the BC Centre for Disease Control in 2016.
This was in response to rising rates of drug overdose and deaths, partly caused by increasing use of fentanyl. The rise of fentanyl in North America points to a huge incoming problem for us in Europe. As was the case in the US, opioid prescriptions in the UK rose sharply between 1998 and 2016, which could potentially trigger a chain of events that could lead to more people reverting to illicit opioids, and increased fentanyl imports.
Lack of safe injection sites in the UK means we have a gaping hole in the services we provide for people struggling with addiction, leaving many with no choice but to consume illicit substances unsafely. The current system is designed to help those who are actively seeking to rehabilitate themselves, with counselling and needle exchange available to users alongside methadone treatment. However these services are only available as part of a recovery process, leaving many people trying to score outside of the system to prevent withdrawal symptoms.
The desire for immediate change is not shared among the whole community of people struggling with drug problems – safety nets need to be available to those who are not quite ready to seek the help of an establishment that has previously demonised and criminalised them for a problem that is out of their control, often stemming from the need for a coping mechanism to help deal with internalised trauma.
Without fast action, we will see a continuous upwards trajectory in deaths related to fentanyl all over the UK, especially in areas with growing economic inequality. By the time politicians act, the problem will already be out of control.
Photos by Jussi Grut and Insite, www.phs.ca