Canada's big-city mayors, who see the carnage caused by the opioid crisis on their streets every day, are speaking out. While their political views span a broad spectrum, they have a unified voice, and we owe it to ourselves to listen to them.
In their no-nonsense report, the opioid task force of the Federation of Canadian Municipalities makes several recommendations, calling on federal, provincial and municipal governments to:
- Adopt a comprehensive and co-ordinated pan-Canadian action plan that addresses the root causes of the opioid crisis;
- Establish comprehensive timelines and targets for specific outcomes, and;
- Create standardized surveillance, data collection and reporting guidelines.
Canada has a "four-pillars" drugs and substances strategy and the new report reminds us that urgent action is needed in all four areas:
1. Harm reduction: Canada needs to increase the number of supervised-consumption sites, where intravenous drug users can inject without fear of prosecution, with nurses on hand should they overdose. There are currently nine federally sanctioned sites in three cities and 14 requests pending in seven other cities. Cities also need to ensure that naloxone, an overdose-reversal drug, is freely available and facilitate access to drug-checking/testing equipment, which allows users to know if street drugs are tainted or spiked;
2. Treatment: The mayors say that it is an "urgent priority" to expand access to substitution therapies such as methadone, buprenorphine and heroin-assisted treatment. The latter consists of giving drug users controlled doses of pharmaceutical-grade heroin rather than having them rely on street drugs. Crosstown Clinic in Vancouver has done this successfully for years (as do many clinics across Europe). But Crosstown has only 95 patients, and a waiting list of 600 more.
3. Prevention: There is a lot of education to be done to warn potential users (especially youth) about the potential risks of opioid drugs such as fentanyl. At the same time, physicians need to change their (over)prescribing practices;
4. Enforcement: As the Vancouver Police Department said sagely, "We cannot arrest our way out of the opioid crisis." But law-enforcement can take practical measures, such as trying to slow the importation of non-prescription opioids and pill presses.
The big-city mayors have set aside their prejudices about drug users and embraced a pragmatic public-health approach to tackling the opioid crisis.
They have also understood the importance of data. Last year, an estimated 2,300 people died of overdoses in Canada – 931 of those deaths in British Columbia alone. But the numbers are incomplete at best.
What we do know, anecdotally at least, is that one of the principal reasons so many people are dying of opioid overdoses is that they are consuming alone.
Addiction can be as isolating as it is unhealthy, but stigma and criminalization make it more so. That's why supervised-consumption sites (and the more informal overdose-prevention sites that activists have created in B.C.) are so important for slowing the death rate.
What the mayors' report doesn't elaborate on, but only hints at, is that there isn't a single opioid crisis; rather, there are a number of overlapping crises.
In the West – B.C. and Alberta, in particular – street drugs are contaminated with fentanyl, meaning users have trouble judging potency. In the East, there tends to be diversion of prescription drugs to the streets, so the product is more pure, but users still don't necessarily understand its potency.
And "illicit" use of opioids, which occurs everywhere from Vancouver's East Hastings Street to Toronto's Bay Street, is only one piece of the puzzle.
Around the country, there is also a problem of overprescription and inappropriate prescription. Seniors are overdosing on powerful pain meds and so are young people who swipe them from their parents' medicine cabinets. People with chronic pain are becoming hooked on opioids as surely as the stereotypical addict on the street.
As a backdrop to all this, there are a lot of people who are not getting the help they need, and far too little discussion of the root causes of the pain, physical and psychological, that pushes so many people to self-medicate.
A comprehensive, compassionate response to the opioid crisis is needed, and it requires a commitment from all levels of government, including specific goals and targets.
The big-city mayors have issued a timely call to action. Now, let's see a vigorous response to this public-health emergency.
Simply counting bodies is not enough.