Abhimanyu Sud is the director of Safer Opioid Prescribing at the University of Toronto’s Faculty of Medicine.
Last week, Statistics Canada released a report documenting national trends in life expectancy. It is not a good-news story. For the first time in the four decades that the agency has been collecting detailed data, life expectancy did not increase between 2016 and 2017. Gains in life expectancy from fewer and later deaths – from diseases such as cancer and stroke – are being undermined by significant losses from the opioid crisis.
Given that 10,000 Canadians have died in less than three years, the scale of our national response has been meagre.
As a chronic pain physician, medical educator and researcher who has been concerned about the opioid crisis for the better part of a decade, I can frankly say that I didn’t think we would get here. I remember reading the landmark 2015 study that showed the opioid crisis in the United States was the main driver of large increases in mid-life mortality for white non-Hispanics. Life expectancies south of the border have been falling in recent years largely due to drug overdoses and suicides.
Still, I thought Canada was protected from a substantial impact by so-called deaths of despair. Our opioid death rates, though at epidemic levels, were notably lower than those in the U.S. And besides, we have universal health care, more social cohesion and less income inequality. We have many institutions and traditions that were designed to keep us alive and well.
Looking back at data from Statistics Canada, the only periods of extending plateaus or declining life expectancy were around the Great Depression and the Second World War. As we commemorate the 75th anniversary of D-Day, we must now also acknowledge that the opioid crisis is having impacts comparable only to those as a result of major economic collapse and world war. Let that sink in.
Though life expectancy is considered a marker of population health, it is in fact a reflection of much more. Gains in life expectancy over the past century are as much due to improvements in living standards, lifestyles and education as they are to improved health care. In this light, these new figures are telling us not just about health problems or our health care system but our development as a country. For the first time since Canadian soldiers stormed the beaches of Normandy, Canadian social development has stalled.
Some well-intentioned advocates want to characterize the opioid crisis primarily as a health problem. The motivations are clear: A health-based approach could neutralize the debilitating stigma of drug use and chronic pain and open up the possibility of mobilizing science-based approaches to large-scale problems, as we sometimes see for infectious disease epidemics such as SARS or Ebola.
Our collective inaction, combined with the new life-expectancy data, suggests that a health-based response is not sufficient. Indeed, the origins of the crisis are problems inherent in our health care system. The zealous over-prescribing of poorly researched, high-dose opioids for the management of pain exposed wide swaths of our population to danger. Should we have confidence that the health system that created this problem is willing and able to transform itself in order to resolve it?
Another way is an all-hands-on-deck approach: involvement and action from every sector of society. This is no longer only a health problem but a problem of national development. Practically, this would mean considering the impacts on the opioid crisis of all new policies, health or otherwise.
The Ontario government evidently plans to take the opposite of an all-hands-on-deck approach. Alcohol is involved in 20 per cent of opioid deaths in Ontario, yet we have the provincial government bent on reducing the cost and increasing the availability of alcohol. Overdose prevention sites save lives, especially those of the most vulnerable people, yet the government has cut funding. (The Alberta government seems prepared to follow suit.) Public health infrastructure is fundamental to collecting, analyzing and responding to data about the opioid crisis, yet public health is squarely in the Ontario government’s crosshairs. Chronic pain care is key to delivering alternatives to opioids for the 20 per cent of Ontarians living with pain, yet these services continue to be on the chopping block.
The opioid crisis fits the classic definition of a wicked problem – a complex and messy convergence of health, economic, justice and industrial issues. Our response as a nation, so far, has been wicked indeed.