Jason Lajoie is the director of the new documentary Harm: Alberta’s Preventable Overdose Epidemic.
I’d never heard the word fentanyl until the night it killed my brother. It was Oct. 26, 2014, days after his 27th birthday, and the same day that Lucus arrived home in Calgary after a gruelling 36-hour drive from our mother’s home in Chatham, Ont. After years of trying to find a sense of belonging in the armed forces, and struggling with the seclusion and tedium of life on an isolated military base in Cold Lake, Alta., he was overjoyed to be moving to a big city with a lucrative job at an energy company as a pipeline repair technician – not bad for a rambunctious kid with dyslexia who had barely made it out of high school. He was determined to save every penny to retire at 50, buy a boat and spend the rest of his years sailing.
By any rational account he should have gone straight to bed after such a long drive, but instead he went out with a friend. They each took a pill his friend had bought from a trusted source. His friend experienced a familiar opioid-induced bliss, while my brother’s opioid receptors were flooded with a lethal dose of fentanyl. He struggled into bed that night and stopped breathing shortly thereafter. Until then I had the luxury of never having encountered the word fentanyl, and I sometimes wonder if he had, too.
I did not know about his drug use. My brother was halfway across the country from me, and, anyways, we never talked about anything serious. He was my big brother; asking him about his vulnerabilities was a non-starter. At his funeral I discovered his roommate had long held concerns about his drug use, and I wonder if I could have known he was struggling with substance use issues if I had asked.
I was so blindsided by his death that I refused to process it for years. He died before we had the official nomenclature of a fentanyl crisis. Before 2014, deaths by fentanyl poisoning were rare compared with other overdose deaths – though Alberta would experience its first major spike in 2014, with 120 deaths – and seldom in the news. My brother was among the first wave of deaths caused by the introduction of fentanyl and its analogues into the street drug supply. These illicit tablets, developed by organized crime, tainted a national drug supply with a powerful painkiller 80 to 100 times more potent than morphine.
Compounding the issue were early failures by then Alberta premier Rachel Notley, who was elected in 2015, to recognize and confront the growing threat of fentanyl abuse and spread in the drug supply, according to Alberta’s main opposition parties. When government leaders did discuss the crisis, they would reach out to police chiefs to seek recommendations on ways to combat fentanyl. These efforts were matched by the Harper government’s renewed call to crack down on illicit drug use. Whereas the federal government had invested $190-million in treatment programs from 2007-2012, they provided more than $200-million during that same period to enforcement punishing illegal drug production, sales and use. While the flooding of the street drug supply with fentanyl was undoubtedly linked to organized crime, the overreliance on law enforcement to handle a medical emergency conflated its victims with criminals, and inadvertently perpetuated a War on Drugs campaign that has proved ineffective at actually reducing harms associated with drug abuse for decades.
It is easy to understand why my brother would fear admitting to a drug problem that could have cost him his reputation, his job and possibly even his freedom. Possession of drugs for personal use is still a crime in Canada, and the prosecution of thousands of individuals each year creates enormous legal and carceral costs that could be better spent on harm-reduction programs. Advocacy groups such as Moms Stop the Harm have pushed for decriminalization for years and, earlier this year, after Vancouver petitioned the federal government to allow the city to locally decriminalize possession, it looked as though the issue might be on the table federally. While the Liberal government just tabled a bill to reduce prosecutions and eliminate mandatory minimum sentences for possession, its failure to pursue decriminalization allows the social stigma and legal consequences to stand.
Deaths from opioid poisoning increased precipitously in Canada after 2013. British Columbia was at the forefront of this crisis, declaring a national emergency in April, 2016 – with nearly 70 per cent of all overdose deaths related to fentanyl, a number that today is more than 80 per cent. By Oct. 16, 2017, almost three years from the day of my brother’s death, the U.S. government would declare the opioid epidemic a public-health emergency, one that by that point had claimed more than 30,000 lives in North America that year alone.
For years I was left to believe that the tragedy of my brother’s death was amplified by being both random and pointless. But as I learned more about the opioid epidemic, I came to see that the tragedy of his death was in how achingly familiar it was becoming for many Canadians. How did we fail to connect the dots for so long, and why did we fail to listen to the pleas of those struggling around us?
In the years since Lucus died, the situation has only grown more critical, and affects Canadians from coast to coast. While provincial reporting of opioid related deaths in 2020 is not yet complete, we know from the available data that more than 5,200 Canadians died from opioid toxicity last year, more than double the number of deaths from motor vehicle collisions. Without swift and deliberative action from government, the health care community and the public, more lives will be lost and more families devastated.
Despite my growing realization that my brother’s death was part of a fast-growing epidemic, I, like many Canadians, still had no interest in addressing the systemic problems. I lack the temperament for activism, and felt no interest in joining an advocacy network. Besides, what did I have to contribute to this discussion?
I told myself that I knew too little about his circumstances to advocate for anything meaningful. What could have prevented this? He was a typical middle-class white male in his late twenties and a closeted drug user. Prior to his death, he had never experienced an overdose or intervention, nor had he ever sought help for his substance use. Prior to the introduction of counterfeit fentanyl into the drug supply chain, I might never have needed to write an article like this. But fentanyl has supercharged the stages of addiction, or in my brother’s case, short-circuited things entirely.
After his death, it would be five years before I felt ready to confront the opioid situation in Canada. Because of an improbable set of circumstances, I found myself living in Calgary in the fall of 2019 while waiting for my PhD defence date, and wondering what I would do after I had my degree in hand. More importantly, I was dealing with what I would realize in hindsight, through therapy, was a nervous breakdown – driven in part by the stress of my PhD program but also from my unwillingness to confront the circumstances of my brother’s death, exacerbated by my move to Calgary and the painful realization that I was now older than my brother had ever been.
Some days I would stop myself mid-reverie imagining if I might have lived near him, and whether I would have gone to visit him on this day or that, had circumstances permitted. Other days included waking dreams where I would run into him on a sidewalk, and we would catch up on simple things such as whatever TV shows we were watching.
By that point, the death rate from opioid poisoning in Alberta was about two people a day. I was unnerved by how disconnected I felt from those statistics, despite my personal connection. They could say nothing about the lives of those lost, nor the effects of the tragedy on those who knew them. I knew that I would never find peace with my brother’s death so long as I avoided understanding it.
Focusing on the overdose epidemic in Alberta, I wanted to bring much-needed awareness to the social and political issues that were compounding this crisis. At the urging of my partner, who was completing a critical care medicine fellowship in Calgary, I considered returning to my long-abandoned passion for filmmaking, and especially video essays. I assumed that all those years of higher education should have given me some ability to translate complex ideas into digestible stories, which I could further supplement with my partner’s facility with medical knowledge and his invaluable connections to health care practitioners in the area. I realized that I was in a privileged position to apply our unique combination of academic backgrounds to ask some serious questions to people in the Calgary health care community about his death, and to share these insights in a way that I wish could have been available to me all those years ago. More importantly for me, I felt I owed it to my brother.
Outwardly my plan was driven by overarching research questions that I hoped would shed light on how Canada had found itself in this current opioid situation, but privately, I simply wanted to know how someone like Lucus could have died, and what could be done to prevent deaths from fentanyl in the future.
An epidemic of drug overdoses has claimed more than 20,000 Canadians since 2016 — about the same number of victims as the coronavirus. In this interactive feature, Andrea Woo and Marcus Gee puts names and faces to those we lost.
Several theories have already been advanced that suggest how the problems fuelling the current epidemic were pervasive before the arrival of counterfeit fentanyl and could be traced primarily to the heightened medical use of opioids for pain management in the 1980s and 90s, and the proliferation of illegal narcotics in the early 2010s, including and especially counterfeit fentanyl. Chris McGreal’s American Overdose: The Opioid Tragedy in Three Acts and Lloyd I. Sederer’s The Addiction Solution: Treating our Dependence on Opioids and Other Drugs describe how pain activists in the 1980s pushed doctors to adopt opioids based on a small set of thinly researched sources that underplayed the risk of addiction, driven by media in the late 1990s heralding opioids as a low-risk solution to pain management. This frenzy led to innumerable substance abuse disorders in patients, ensnaring them in a debilitating cycle of drug-seeking behaviour that, while destructive, was not immediately lethal in the way fentanyl would later become. While overprescription may have precipitated the epidemic, overdoses today are almost entirely owing to a contaminated drug supply. Yet it remains important to be reminded of the dangers that come from relying on quick-fix solutions with promises that seem too good to be true.
Relating this history to my mother one evening, she mentioned that my brother had been prescribed opioids while recovering from a broken jaw a few years before. Could that prescription have contributed to his death? This is the sort of brooding conjecture that occurs between grieving family when no truth can ever be disclosed.
Nor was this the first time North America had faced extreme rates of substance-use disorders. At the end of the 19th century, there were an estimated 300,000 people addicted to morphine in the United States alone, many of whom were Civil War veterans recovering from war-related injuries or illnesses. At that time, care for these patients was typically provided by religious organizations, which set the virtuous tone that established the ideological frameworks for recovery such as all-or-nothing abstinence-based programs and the language of “getting clean” – both spiritually and physically. This history is echoed in contemporary language, policies and programs that treat substance use disorders as a moral failing, a mindset that distances and compartmentalizes people according to their capacity to behave and model a “normal” member of society.
The persistence of this ideology makes it easy to marginalize those that fall outside the norm and continues to allow the most sanctimonious rhetoric to frame the ways we engage with this epidemic. People are reduced to the dimensions of their addictions, seen as nothing more than their labels – drug user, addict, or simply “other.” For many, this language remains an effective tool to shame and silence. It certainly influenced how I dealt with my brother’s death. I rarely would talk about him with others, not because I was ashamed of him, but because I was afraid that to mention the cause of his death would restrict the scope of his life in their eyes. My brother became my secret. I was so fearful that I would posthumously stigmatize him, and retroactively overwrite his identity, that I ultimately dishonoured his memory.
Braiding these narratives together – the personal, the political and the historical – we can see how the current overdose epidemic is neither an isolated nor an unanticipated phenomenon. It is instead the result of a chronic failure to address historical, cyclical patterns of systemic neglect, abuse and mismanagement.
Moreover, these problems have been disastrously amplified by the COVID-19 pandemic, as people struggle with greater isolation, mental distress and pandemic-induced mental-health issues, especially Indigenous people and people of colour of low socioeconomic status. And despite greater awareness about the crises than ever, deaths from accidental opioid poisoning have continued to increase, with nearly 11 people dying each day in Canada since 2016.
The more I learned about this tragic history, the more I became convinced that unless something is done to overcome this complacency, the cycle of trauma will endure and more lives will be destroyed along with it. Indeed, the more I learned about the North American context of the epidemic, the more I came to understand how the tragedy of my brother’s death happened because of a compounding of systemic failures.
The situation today has worsened. In the years since my brother’s death, the Government of Alberta’s response to the drug crisis has been problematic. Despite a once-earnest push for supervised consumption sites (SCS) in Alberta and wraparound supports for those dealing with drug disorders, these programs, and the harm-reduction philosophy that underpins them, are being cut and undermined, even as opioid deaths soar.
Whereas I was interested in the overarching questions about the opioid epidemic, interviewees for my documentary would consistently return to the more practical considerations of how the Government of Alberta’s response to addictions was costing the lives of Albertans. They would describe how political inaction, driven in part by complacency and largely by moral arguments, was not only making it impossible for them to do their jobs protecting the health of Albertans, but it also wasted time, money and the goodwill of the people they were seeking to help.
It is into this maelstrom of rhetoric, ideology and self-righteous grandstanding that we continue to sacrifice the lives and well-being of Canadians. An overdose claims more than one life – its destructive potential reaches families, friends and colleagues, whose lives are forever diminished each passing day. We must ignore the social, cultural and political forces that keep us atomized into factions, arguing moralisms and platitudes while people continue to die every day.
While more than 4,300 overdoses were reversed at SCSs across Alberta from 2017 to 2019, public sentiment remains hostile to their presence. In March, 2020, the Alberta government produced a report highlighting community concerns about SCSs. Following a further report suggesting poor financial controls at the Lethbridge SCS site, the government pulled all funding from the organization last summer. The government similarly declined to extend funding for last-line therapy for people with opioid-use disorder. Funding for injectable opioid-agonist therapy (iOAT) runs out in March, after which people will have to return to the programs that previously proved ineffective for them. (The medical literature on this therapy is evolving, but evidence to date suggests that it can provide benefits. More to the point, people in the iOAT program may not have any other options, owing to the severity of their disease.)
Instead of comprehensive care that meets the specific needs of people who use drugs, the Kenney government calls for specific focus on detox and abstinence-based treatments that have been systematically proven in the medical literature to increase the risk of relapse and death. These plans are disclosed in a rhetoric that conflates all people who use drugs as a monolithic group; a rhetoric that erases the intersections of race, gender, socioeconomic status and circumstance that govern their lives and influence their pathways to recovery. Ignoring these dimensions to insist on a plan for everyone means offering a plan for no one.
As part of my research, I shadowed Bonnie Larson, a Calgary-based family physician, as she treated patients with various substance use disorders. I spent a day with her at the Calgary Alpha House, a non-profit agency that provides a safe environment for those affected by substance use disorders who work tirelessly to restore dignity and balance to their lives, while coping with capricious changes in government policy. After just a single day hearing about their stories of trauma and resilience, it became frustratingly clear how they were mistreated in political discourse that worked to infantilize and brutalize them, especially when they could not meet the standards of recovery based on criteria set without compassion or understanding for their lived experiences. These are people who have undergone extensive trauma that calls for compassionate consideration, particularly because they lack the resources that other members of society might have to deal with addictions. To demand total compliance with abstinence and detox protocols established in the infancy of drug treatment rehabilitation more than a century ago is wildly impractical and demonstrably harmful.
The danger of these approaches is that they are premised on the mistaken belief in a cure that can be administered through various modes of coercion. This sets recovery as an all-or-nothing game: either you are cured, or you lose. Instead of seeking to cure people, we might instead seek ways to minimize harms done to them. Everyone we interviewed emphasized the importance of harm reduction, a means to reduce effects of drug use that also aims to protect the rights and dignity of people who use drugs. Regardless of the questions my partner and I would ask, participants would invariably return to the subject of harm reduction, a term I hadn’t heard of before I started making the documentary. While this admission might disqualify me from speaking seriously on the topic, I think it also points to a more glaring problem in our national culture. I consider myself an educated person, with a personal loss related to opioids, and I was unfamiliar with the term. But then, so were my friends and colleagues when I would mention it in passing. This term and the philosophy it espouses must become part of our cultural lexicon.
As Alex Caudarella, a Toronto-based family physician and substance abuse physician, explained to me, we cannot bully or coerce people into treatment. Instead, we must develop recovery options that work for each patient. There are no one-size-fits-all solutions, and each path to recovery will be personal. As health care practitioners, and as a community, we must recognize that recovery takes time and requires consistent commitment from everyone, including the health care community, government and the public.
In less than three years, nearly 13,000 Canadians have been killed by an opioid overdose, and almost every Canadian has been affected in one way or another by this trauma. So much remains unknown and unaccounted for. Even after I lost my brother, I allowed myself to remain comfortably ignorant about the stakes of this epidemic for years. As a society, we have settled into a complacency that could be charitably read as willful ignorance and perhaps more accurately understood as criminal negligence. We need to remember our bungled response to this tragedy as our national shame, or future generations will continue to suffer its legacy.
We must overcome this complacency and resolve this situation fast. As much as this epidemic destroys the lives of those dealing with substance-use disorders, it also takes away the circumstances that make everyone else’s lives worth living. When I dedicated this documentary to my brother, I realized I had forgotten how to spell his name, my memory tripping over the unusual spelling. I remember Lucus asking my mother about his name when we were children, and my mother’s matter-of-fact reply that she had wanted him to be distinctive. I still dream about all the opportunities that tainted pill stole from him – birthdays, marriage, anniversaries, children – and what it stole from everyone else who knew and loved him.
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