The federal government has taken plenty of action to try to curb Canada’s opioid-overdose crisis.
It has aggressively expanded supervised injection sites across the country and made naloxone, a life-saving antidote to opioid overdoses, available without a prescription.
It has stepped up enforcement efforts to weed out the import of illegal synthetic opioids and bust drug labs and traffickers on Canadian soil.
But while Ottawa acts, the crisis deepens. Last year, 3,987 Canadians died from apparent opioid-related overdoses. That’s 1,126 more than the year before. The death toll from opioids is now greater than the toll from AIDS at the height of that epidemic.
In the face of this horror, the latest announcement from Health Canada continues a streak of worthwhile but small-bore initiatives from a government that seems to grasp the seriousness of this disaster, but has not yet embraced the dramatic fixes that are really needed.
Health Minister Ginette Petitpas Taylor recently unveiled a new enforcement team to investigate deceptive marketing practices by drug companies, while also calling on those firms to stop promoting opioids. (In the past, the department has only responded to complaints about improper marketing, rather than doing its own oversight.)
There’s nothing wrong with this. Drug companies are certainly known to oversell the benefits and downplay the risks of their products. The notion, peddled by its maker Purdue Pharma, that OxyContin was less addictive than other opioids on the market had a leading role in the current crisis.
But whatever merit the Health Ministry’s new marketing crackdown might have, it is unlikely to make a real dent in Canada’s opioid addiction problem.
It might have made a difference in the mid-1990s, when pharma companies were newly selling opioids as a safe treatment for chronic pain. But that terrible myth took hold and now Canadians consume a shocking quantity of legal opioids – the second most in the world per capita after the United States.
And while the infamously pernicious OxyContin was taken off the market in 2012, the proportion of opioid prescriptions given out in Canada that were for strong opioids such as morphine and fentanyl actually went up in the next five years.
In other words, there is no quick way of putting this genie back in the bottle. Canada is hooked on opioids. Millions of Canadians use the drugs for pain relief and can’t simply have their prescriptions cut off or severely curtailed without crippling withdrawal symptoms and the risk that they will opt for dangerous street drugs instead.
British Columbia’s College of Physicians and Surgeons confronted this reality recently when it revised a 2016 standard of practice that called on doctors to limit opioid dosages to the equivalent of 90 milligrams of morphine a day.
In part because of concerns that patients were being tapered off their meds too quickly, physicians in the province are now being advised to determine appropriate dosages in consultation with their patients.
Of course, when so many people are being prescribed opioids in Canada, some of them are going to become addicted, or abuse the drug, and find their way to street versions – no matter what doctors do to try to prevent it. And today it is street drugs that are doing most of the killing.
Almost three-quarters of the accidental opioid-related deaths in Canada last year involved fentanyl or its analogues. It appears that this is largely because those drugs are being cut into heroin and other illegal opioids. Users who are addicted and recreational users alike are being poisoned by unscrupulous dealers.
Given this literal death spiral, two decades in the making, of easy opioid prescriptions leading to a spike in addiction leading to a spike in fatal poisoning by tainted street drugs, a move to further monitor pharmaceutical marketing practices that have already been tamped down is the definition of too little, too late.
That’s not to say these moves are worthless. But the government needs to show more ambition in rethinking the way Canadians treat pain and addiction – a vast undertaking, requiring political courage and billions in funding – if it hopes to stem the tide of Canada’s worst public-health crisis in generations.