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Osgoode Health Law Association: Perspectives in Health

Canada’s Fight Against Fentanyl: Will 2018 bring an end in sight?

Canada is currently facing an epidemic of opioid dependency, involving both prescribed and illegal forms of the narcotic substance that, in recent years, has led to an increase in fatal overdoses. This epidemic may ultimately stem from prescribing methods practiced by North American doctors and the dangerous addictive nature of this narcotic. According to the International Narcotic Control Board, Canadians are the second highest consumers per-capita of opioids in the world, with Americans being the highest consumers. Opioids were first introduced in hospitals as a treatment for pain in the early 19th century in the forms of morphine, codeine, laudanum, and heroin. During the 1950s, synthetic opioids, such as oxycodone, became available by prescription, and by the 1990s and early 2000s, the prescription market for the treatment of chronic pain was dominated by slow-release formulations such as the fentanyl patch, hydromorphone, and OxyContin. Efforts have been made by several provincial governments to curb the over-prescribing of oxycodone by restricting coverage under publicly funded drug plans, however the continuation of booming opioid prescription sales reported by Canadian retail pharmacies indicates that these efforts are not solving the problem.

To make matters worse, illicit fentanyl pills have infiltrated the market of street drugs, which has fueled what has been called ‘an epidemic within an epidemic’. Fentanyl can be lethal in even small doses because it is 100 times more potent than morphine and up to 50 times stronger than heroin. Since the emergence of fentanyl pills on our streets, reports of addiction and overdose deaths have skyrocketed. In Ontario, as of 2014, the number of fatalities related to opioid abuse surpassed the number of fatalities caused by motor vehicle accidents. In 2016, there were 2,861 apparent opioid-related deaths, while according to early 2017 reporting from the Public Health Agency of Canada, there were 1,460 apparent opioid-related deaths in the months of January to June, indicating that 2017 will exceed 2016 in total number of overdose deaths. Vancouver’s Downtown Eastside is the epicentre of the crisis, with over half of Canada’s reported overdose deaths in 2017 happening in British Columbia. Reports have compared this crisis to that of the heroin epidemic that hit Vancouver hard in the early 90s and, because of the increased potency of fentanyl, the rates at which people are dying are considerably higher. Authorities have been forced to lease space from funeral homes in order to store bodies, as the city morgues have been filled to capacity. Since the heroin crisis of the early 90s, Vancouver had been at the forefront of advocacy efforts to incorporate harm reduction legislation in our nation’s drug policies, which eventually led to federal approval of supervised injection sites. But are these efforts enough?

As we enter into another year of this epidemic, which shows no signs of slowing down, what are the possible solutions? Experts and survivors have all weighed in on the conversation, and the consensus appears to be that there is no one solution to fix the problem, but rather a multidisciplinary approach needs to be adopted with greater collaboration across disciplines. There are 3 general segments of people to consider in the battle against this epidemic: those currently addicted to opioids; people currently taking opioids to treat chronic pain, but who do not have problems with substance abuse; and people suffering from chronic pain who are not currently taking opioids. For people currently at risk for addiction to opioids, leading healthcare professionals advocate for preventative measures via non-drug therapy to alleviate pain, reducing the number of pills prescribed in one prescription, and using anti-inflammatory medications as an alternative to opioids. Public health officials have been calling for better coordination and surveillance of the epidemic and specifically overdoses, to improve the accuracy of the data and to better target interventions. This can be done through the implementation of routine reporting policies and a nation-wide data surveillance system, in coordination with more training for medical staff, and more efficient rapid identification within emergency departments of overdoses as they occur. Other approaches include expansion of naloxone (a life-saving medication that can block the effects of opioids during an overdose) distribution to include bars and nightclubs, and other places regularly frequented by those at risk for an overdose. Treatment options could also be made more affordable and treatment programs could be designed to be more individualized based on the individual’s circumstance and needs. For example, a more effective treatment program for an individual may run for longer than 21 days because, for many, a 21-day treatment plan is not enough.

The provinces, territories and federal government are committed to working together through the Special Advisory Committee on the Epidemic of Opioid Overdoses to advance efforts to reduce opioid-related deaths and harms. The more that harm-reduction philosophies are incorporated into the interventions and prevention strategies, and the more collaboration across disciplines, the better Canada can tackle and overcome this devastating epidemic.

 

 

Efua Gyan received her Master in Public Health, with a specialization in Sex, Sexuality, Gender and Health from the School of Public Health at Boston University.

This article is part of the Osgoode Health Law Association’s Perspectives in Health column. Keep up to date with the HLA on Facebook (Osgoode Health Law Association, Osgoode Health Law Association Forum) and Twitter (@OsgoodeHLA).

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