Welcome to 2018, the year when more people will die from causes related to substance use in Canada than ever. When I wished my family and friends a happy New Year last night it was with a heavy heart. 2018 is the third year that begins without our youngest son Danny, and the first year for over 4000 Canadian families who lost a loved one to an overdose or other causes related to substance use in 2017.
How do I know that 2018 will be worse? I follow provincial (Alberta, British Columbia) and federal overdose surveillance reports on fatal overdoses and the reported trend is sharply upward. The users, advocates and front-line workers in my social media and personal networks have also seen significant increases in deaths. Every day more families join Moms Stop the Harm (MSTH). Most organizations would view growth from 3 founding members (Lorna Thomas, Leslie McBain and I) in May 2016 to over 300 members in December 2017 as a success, but in our case every new submission via our website comes with a story of desperation, fear, and pain. Desperation and fear for those who have a loved one struggling with substance use and the extreme pain of the newly bereaved. Too many times this year we received a cry for help from a family who do not know where to get treatment for a child, or how to deal with the loss of someone who had so much promise and their entire life ahead of them. The stories are so familiar showing bright young faces from all walks of life, backgrounds and regions of the county.
We have seen progress over the past year: more supervised consumption sites have been approved; peer and volunteer lead overdose prevention sites can soon operate legally; and Naloxone (an antidote that can reverse the effect of an overdose) is being distributed more widely in BC, Alberta, and Ontario. Access to treatment is improving and innovative treatment approaches, such as rapid access programs in emergency rooms and the provision of safe drugs, are being implemented. Several provinces and the federal government are developing anti-stigma campaigns, and the federal government has made funding available through its Substance Use and Addictions Program and other initiatives.
Why do people continue to die despite this progress? There is not one clear answer to this complex question, but part of the answer is that the federal government, provincial and territorial health care providers let the crisis get out of hand before taking action and the response has not been commensurate with its magnitude. Have we ever had 4000 people die from a disease or other health condition without a comprehensive national strategy?
Many of the measures taken to date , such as supervised consumption and overdose prevention sites, are most effective for people who are homeless or unstably housed. Data from the BC Coroners Service, released in October 2017, shows that 87% of overdoses occur indoors, often in people’s homes (59%) and presumably when people use alone. These at-risk users include casual users and those who have developed an addiction. Casual users seem to be most at risk, as they have not developed a tolerance for opioids and they may be unaware that other drugs are contaminated with fentanyl (tests at Insite in Vancouver show that around 80% of all street drugs contain a synthetic opioid, such as Fentanyl). Most casual users do not know how to recognize and respond to an overdose. According to a CBC News report from Winnipeg a young man who died when he and his friends shared pills they thought were Oxycontin. His friends and his brother thought he was “sleeping it off” when he was in fact dying from an overdose.
One of the greatest barriers to addressing the problem is the stigma that surrounds substance use, which causes both casual users and those who live with an addiction to hide their use, including by using alone. When people use alone, no one is there to help when they overdose, like our son Danny who we found dead in his apartment in downtown Edmonton, in walking distance to one of the approved supervised injection services.
Distributing Naloxone will not help if people use in secret and alone as they cannot administer Naloxone on themselves. Even effective anti-stigma campaigns will not fully eliminate the misconception of the person who uses substances as someone who lacks willpower and has a problem that is entirely self-inflicted. Problematic substance use is still seen as a moral failing and not as a health issue.
What would it take to prove my dire perdiction wrong and reverse the deadly trend?
Instead of a patchwork of federal and provincial initiatives, a clear and coordinated national strategy with levels of investment at least equal (per person) to those made during the AIDS crisis in the 1980s—when half as many people died in peak years as did in the opioid crisis in 2017 alone —is required. Such a strategy should be guided by people with lived experience, affected families, and be based on the best available evidence. This evidence tells us that we need to stop criminalizing substance use and start investing in prevention, treatment, and harm reduction as Portugal has done and Norway plans to do. Portugal has since reduced its overdose rate to 6 deaths per million of population, while the US is at 185. Canadian data from March 2017 shows 78 per million nationally, however, the hardest hit provinces and territories are much higher: BC's rate is 200 per million, the Yukon at 160 and Alberta at 138. These rates are not adjusted for year end numbers.
As the experience of European countries shows, decriminalizing the possession of drugs for personal use will help end the stigmatization of substance use and allow users to come forward and seek help through harm reduction measures and treatment. Decriminalization will also permit an open discussion about substance use that will lead to truly innovative approaches and more research findings.
Decriminalization is a bold step that our current government has been unwilling to take. In our most recent campaign we have asked Prime Minister Justin Trudeau to “Do Something”, starting with acknowledging the magnitude of the opioid crisis and initiating a national strategy. So far, he has not responded to hundreds of Canadian families who have sent photos of loved ones who have died or purple hearts for individuals who are struggling. His silence is deafening and a slap in the face of those who have suffered so much.
As a society we should not accept the deaths of thousands of Canadians in the prime of their lives as the new normal. As families we will not be silent and stand by while our loved ones die from preventable causes. We should not have to start the New Year without our sons, daughters, brothers, fathers, mothers, relatives, and friends.
Individuals struggling with substances use have a right to access appropriate medical services and deserve the same level of support and care offered to those with other health conditions. We call on the Prime Minister, and all levels of government, to “Do Something”, to match investment in this crisis to its magnitude and to take the bold step of decriminalizing the possession of drugs for personal use.
Petra Schulz, Co-founder of Moms Stop The Harm, Edmonton, AB January 1, 2018