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People hold a banner during a march to remember those who died during the overdose crisis and to call for a safe supply of illicit drugs on International Overdose Awareness Day, in Vancouver, on Aug. 31, 2021.DARRYL DYCK/The Canadian Press
In Prime Minister Justin Trudeau’s mandate letters to his many ministers, there are lists of dozens upon dozens of priorities, so many that it’s hard to imagine his cabinet will be able tackle every one of them.
Yet despite the Liberal government’s seemingly unending to-do list, there is one pressing matter of public health that is conspicuous for being barely mentioned: the opioid overdose crisis.
Opioid overdoses killed 24,626 people in Canada in the 5½ years from 2016 through mid-2021, according to national data. The death toll is close to that of the 31,082 people killed by COVID-19.
In British Columbia, where the crisis is the worst, overdoses have killed 3,389 people since the pandemic began in March, 2020, while COVID-19 has killed 2,455.
There had been hope that things were getting better in 2019, when opioid deaths fell from the previous year. But with the onset of the pandemic, alongside a suddenly much more toxic supply of drugs on the street, a new record of deaths was set in 2020. Final figures are not yet available for 2021, but Canada was on track for more than 7,000 deaths last year – another record, up 12 per cent from 2020 and almost double the number in 2019.
The outlook remains grim.
The Public Health Agency of Canada, since late 2020, has conducted modelling of potential deaths in the months ahead, weighing factors such as the concentration of fentanyl in street drugs and the potential impact of measures such as supervised drug-consumption sites. The modelling is similar to work done to understand trends in the coronavirus pandemic.
The most recent model, published a month ago, suggests the likeliest outcome in the months ahead is more than 3,000 people will die in the first half of 2022.
Given all of this – the thousands of unnecessary deaths to date and predictions of many more to come – the challenge should be a top-of-the-list priority in Ottawa. But it is not. The words opioids, overdoses, decriminalization and safer supply do not get mentioned at all in the mandate letters. Overdose deaths are entirely absent from the mandate letter for Health Minister Jean-Yves Duclos.
The only place overdoses are signalled is in the mandate for the newly created role of Minister of Mental Health and Addictions – the sixth of 10 priorities. It calls on Minister Carolyn Bennett to “advance a comprehensive strategy to address problematic substance use.” It goes on to say Ottawa aims to help provinces “provide access to a full range of evidence-based treatment and harm reduction, as well as to create standards for substance use treatment programs.”
These are good goals. But there are two problems.
The first is the lack of urgency – to “advance” a strategy does not sound like a result will arrive any time soon. The second problem is the lack of specifics. One example is decriminalization. Health Canada, right now, is considering applications from the City of Vancouver and B.C., yet the mandate letters ignore this.
The letters also seem to in part ignore the Liberals own election platform from last fall, where the “opioid overdose epidemic” was named. While the platform promise of a broad substance-use strategy is in the mandate letters, details such as a pledge for $500-million for treatment are not.
What the Liberals also seem to be ignoring is the expert advice on substance use they commissioned last year. The reports unanimously backed decriminalization of small amounts of drugs and said expansion of a safer supply of drugs, a regulated alternative to deadly street drugs, should be “an urgent priority.” More broadly, the experts wanted an overhaul of Canada’s drugs strategy, from harm reduction to treatment and recovery. Two days before the election, the Liberals said the reports would “inform our next steps in drug policy.”
Yet it does not seem so. Yes, the idea of a broad strategy is there, but without the important details backed by experts. There’s no deadline to complete the work. And it’s ranked as the sixth priority of a new cabinet role that doesn’t have its own department.
This is a recipe for failure. It is the type of slow-motion policy response, common across all governments, that has been typical throughout the opioid crisis. The entirely predictable result, mathematical models or otherwise, will be more needless deaths.
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