North America is in the throes of a drug use and misuse epidemic that began with the overzealous prescribing of pain relieving drugs such as oxycodone and hydrocodone. As of 2018, this health crisis, known as the “opioid epidemic” shows no signs of slowing down. According to the Center for Disease Control and Prevention, to date, there has been a 200% increase in opioid overdose related deaths. Canadians remain the second highest consumers of opioids after Americans, with the numbers continuously rising. Canada’s response to the opioid crisis has been fragmented and marginally effective at best. Physicians are well aware of their role in giving birth to this crisis and are now doing their due diligence in prescribing less opioids when they can. Aside from these efforts, one can’t help but ask: what else is being done to combat this epidemic?
The U.S. Department of Justice launched an opioid fraud and abuse detection unit last year whose mission is to prosecute individuals that commit opioid-related health care fraud. Lawmakers in the U.S. have done little to combat opioid addiction; Congress has only allocated $4.6 billion to fight the nation’s deepening crisis. This amount is pittance compared to what is actually required to fund nationwide clinics that treat opioid addiction (predicted to be at least $6 billion/year for a decade). Setting limits for opioid prescription has been suggested and legislation that imposes limits has been enacted in some U.S states.
In Canada, a network of doctors has developed a new set of guidelines for the management of opioid addiction. The guideline strongly warns against prescribing more opioids than the equivalent of 90 mg of morphine per day. The guideline also recommends that Suboxone (buprenorphine-naloxone) be used as a first line of treatment in place of the traditionally used methadone since Suboxone has much less severe side effects. Canada has also recognized that offering withdrawal management alone can actually increase overdose rates because the likelihood of relapse is very high due to a lack of long term or ongoing addiction treatment and follow ups. It’s recommended that patients be immediately referred to an in-patient recovery program or an intensive outpatient program instead.
Hospitals in the Canadian province of Ontario now track opioid overdoses and generate weekly reports that are available to every hospital and public health facility. This data provides experts with a comprehensive picture of what’s happening on the ground. In British Columbia (B.C), they’re fighting opioid addiction by providing drugs to addicts. It may sound counter-intuitive, but the idea is that restricting access to the drugs forces addicts to seek them out through illicit means. When sought out illicitly, there’s a higher chance that the drugs will be contaminated and laced with fentanyl (which is a 100 times more potent than morphine), increasing their chances of dying. The idea is to provide access to uncontaminated drugs so that people don’t die, and once they’ve being regulated, they can be moved to substitution therapy and recovery. Providing supervised injections of opioids also already occurs at a small scale in B.C., where there are efforts to implement them province-wide.
Overall North American governments have fallen short of properly treating and preventing opioid addiction. There is no one simple solution to ending this epidemic: it needs to be addressed on three fronts. First, new addictions must be prevented. Secondly, overdose deaths must be prevented. Third, those who are addicted need to be provided with treatment.
There seems to be some success on the first front, with the number of new drug addicts receding every year. The other two fronts are not so promising despite the attention and money flowing into programs. This brings us to the main issue at hand: the crisis isn’t much better than it was when it first began to unfold two years ago.
We also need to be cognizant of the fact that when facing the opioid epidemic, a criminal, judgmental, or moral approach will get us nowhere. Urging people to give up the drugs ostracizes people already suffering from addiction and may even impede them from seeking treatment. We need to treat opioid addiction like the chronic disease that it is and only then can we effectively treat the vast majority of addicts.
Research suggests that 90% of addicts can become abstinent when they are provided with a mixture of psychological therapy, behavioural therapy, and in-patient treatment overtime. What must also be noted is that the recent spikes in overdose- related deaths is due to the increased availability of fentanyl, which, as mentioned prior, is laced into street drugs. The Canadian government should be more rigorous in fighting this crisis by making the acquisition of the drugs even more difficult, and simultaneously making addiction treatment much more accessible. Only then will we hopefully see an end to this epidemic, once and for all.