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Ivey International Centre for Health Innovation

The politics surrounding the Canadian opioid crisis

  • Shannon Loveless
  • |
  • Feb 13, 2019
The politics surrounding the Canadian opioid crisis

With the recent election of a Conservative provincial government, leader Doug Ford’s persistent and controversial reforms have been hard to overlook. Among a long list, cutting the Ontario Student Assistance Program, rolling back the progressive 2015 sex-education curriculum and stalling safe-injection sites are a few of his infamous pursuits. With last year seeing opioid overdose fatalities exceeding 4,000 Canadian citizens, with 1,200 of those in Ontario alone, the halting of safe-injection sites has created a public panic surrounding the urgency to prioritize the opioid epidemic. The shocking truth is that three to four Ontarians die of opioid overdoses daily, with that number of deaths increasing by 16 per cent in the span of one year. Of the estimated 9,000 total opioid related deaths across Canada from 2016 to 2018, 94 per cent of those fatalities were deemed accidental. The epidemic is predicted to continue accelerating along the same trajectory, enhanced by its low standing on the political agenda. With Ontario citizens urging the government to declare a state of public emergency for what has been dubbed the “defining health crisis of our time”, the Conservatives have been under immense pressure to act.

With the election of a Conservative government “dead-against” safe-injection sites, it was predicted that the necessity of Liberally established overdose-prevention sites would be challenged. New sites to open in Thunder Bay, St. Catharines and Toronto were put on hold to conduct an extensive evidence review with the mission of determining their value. However, the evaluation lasted a dangerously prolonged three months considering that Thunder Bay had the highest rates of opioid deaths in the province and Parkdale, Toronto, was losing people monthly, if not weekly. While many questioned the ethics of doing further research on an extensively reviewed and clearly vital healthcare service at the cost of losing lives, the Conservative’s lengthy deliberation was overlooked amongst the wave of alleviation when they reached the same conclusion of months prior— that communities need these life-saving services.

While many addiction experts and the Registered Nurses' Association of Ontario had a sigh of relief, it was too early for them to exhale completely. Existing sites are only allowed to stay open if they reapply to operate under the newly named model “Consumption and Treatment Services”. With a new name comes new provisions to strictly focus on rehabilitation. While this appears to make sense, upon further examination it creates the obstacle of how to treat those who do not want rehabilitation at the present moment but are still entitled to services. Ultimately, people need to seek rehabilitation when they are ready to accept it, with over-dose prevention being a step in the process to keep people alive until that time. In the words of Dr. Juurlink, head of clinical pharmacology and toxicology at the University of Toronto, “You can’t rehabilitate someone who is dead.”

It is unclear whether the funding promised for these sites will be enough to cover the extensive treatment services requested, especially given the fact that numerous rehabilitation services are currently not publicly funded.Further, the province is prohibiting tents or pop-ups in high need areas and limiting the total number of permanent sites where people can access services to 21. This arbitrary restriction can do harm to underserviced communities by restricting services and forcing competition for sites.With 18 locations already in operation and the 3 locations in Thunder Bay, St. Catharines and Toronto, the spots are accounted for. Given the pressing extent of the opioid crisis and the fact that overdose deaths are steadily rising, the number of sites should be based on need and not preference. The practicality of enforcing a 21-site limit in addition to the restrictions to reform services to new guidelines seems paling when what should be prioritized is getting these services out, period.

Health Canada has intervened federally, saying it no longer requires applicants to provide formal letters of support from provinces, theoretically providing a way around Ontario's cap of 21. Health Canada have approved over 25 supervised consumption sitesand provided emergency treatment funding to provinces hardest hit by the crisis.In addition, the federal Liberals now allow other funding models, including from third-party and private organizations. However, the federal government's move to open the door to more sites doesn't come with more funding for would-be operators. It has been critiqued with only offering opportunities for those who are already well-resourced.

The inconsistency of provincial control combined with sporadic federal authority has created a geographic disparity in overdose prevention services. Where one lives across Canada, or even Ontario, impacts greatly their chance of survival upon the event of an opioid overdose.While funding is allocated based on opioid crisis severity and population size, in the current financial bind this means only high-need areas are receiving services and less high-profile sites are receiving minimal assistance. As Rebecca Jesseman, policy director for the Canadian Centre on Substance Use and Addiction states, "We wouldn't accept this variation in service quality and availability for health conditions like cancer, diabetes and heart disease, so why is it the norm for substance use?”.

With months passing since the Conservative’s initially proposed their safe-consumption model, progress has remained minimal. Truthfully, there has been a dangerous lack of co-ordination between various government agencies since the opioid crisis began in 2015. This disorganization is only further exacerbated by the lack of progress at the hands of the Conservatives. In fact, the province's existing opioid task force has not even met since Conservatives took office in the summer.

Among recommendations to assign a provincial co-ordinator for the opioid crisis and resume regular meetings of Ontario's opioid task force, is to engage in discussions with the federal government to make a clean, legal and non-toxic supply of opiates available at safe-injection sites. Currently, methadone is the only opioid authorized for long-term outpatient pharmacological treatment of opioid addiction in Canada. When Portugal acknowledged their opioid problem in 1997, they initiated a multifaceted strategythat included street teams to inform people who use heroin about the option of exchanging heroin for methadone for free in special centres. 17 years later Portugal has rectified a crisis similar to Canada’s current state.

When France was dealing with a similar opioid epidemic, they increased access to buprenorphine, a similar substance to methadone in reducing withdrawal and craving for people with opioid addiction without itself becoming addictive. France allowed any doctor to prescribe buprenorphinewith no special licensing or training.  The British Columbia Centre on Substance Abuseeven recommends that buprenorphine should be the first line pharmacotherapy option for addiction given its superior safety profile. Incontrast to methadone, buprenorphine carries a lower risk of abuse, addiction and side-effects. However, given patient individuality, namely dependency and regular dosage of opioids consumed, some people respond better to buprenorphine and others to methadone. Overall, the next progression in Ontario’s harm reduction strategy should be toward providing a safe drug supply to users, since so many deaths appear related to drugs contaminated with fentanyl.

The opioid epidemic is a complex, pervasive and growing public health concern in Canada. While some marvel at how quickly Canadian society has adapted to harm-reduction strategies such as safe-consumption sites, even forcing Conservatives to accept them, this adaption principally points to how serious our opioid problem is. Safe-consumption sites are a vital resource, but just having them present is not a solution in itself. It is vital that advances continue to be made to provide access to quality opioid addiction services for all citizens. Canada still has a long journey ahead in the pursuit of universal healthcare.

 

Shannon Loveless is a practicum student working as a Research Analyst at the Ivey International Centre for Health Innovation. She is in her fourth year pursuing her Honours Specialization in Health Sciences at Western University.