Caught in a Public Health Double-Bind

"Service providers where possible are going to online provision of service."

"If you want to have a conversation with your doctor, Zoom is often the first choice. And homeless people don't have access to Zoom."

"The more connection you have with people who care about you, the less likely you are to develop an addiction. And right now, we're disconnecting."

"As people become more involved with the criminal justice system, they become more criminal."

"Jail is crime school n the same way that Harvard Law is upper-crust training school -- you learn some stuff, you're constantly told who you are, and you make connections."

"Ending drug prohibition would stop that process."

Mark Haden, adjunct professor, School of Population and Public Health, University of British Columbia 

"People have been very hurt by seeing how quickly the government can react to a public health emergency when it chooses to do so [as with COVID-19]"

"People who use drugs and their allies have been really devastated to see that comparison."

"Since COVID, we've seen things get much worse. The level of adulteration of the drug supply has increased."

Dr.Alexis Crabtree, resident physician in public health and preventive medicine, University of British Columbia

Front-line workers in Ottawa-Gatineau say more people are using street drugs in an unsupervised environment due to their fears of catching COVID-19. (Brian Stewart/CBC News)

"People have been applying for the government COVID-19 aid, using it to binge on drugs and overdosing. [The Trudeau government introduced a monthly Can$2,000 emergency benefit in March to help Canadians left jobless by the pandemic. Applicants are required only to answer a few questions and certify their veracity.]"

"With Can$2,000 in their pocket, people just went on benders."

"They had access to quick cash and it killed them."

"[It was a] stronger batch of drugs [than he was used to that did him in.] They got me back on my feet and sent me on my way. I rested up and did more drugs."

Luc Laplante, homeless in Ottawa, drug-addicted 37-year-old

Health officials in Canada continue to urge people to remain cautious even as the country approaches the 300,000-case mark of COVID-19. And nor do overall trends strike confidence that the pandemic will end anytime soson. Dr.Theresa Tam, Canada's top public health figure, has warned that Canadians must engage in stopping the spread of COVID-19 to help avoid overwhelming hospitals. Even as Manitoba becomes the new red zone in Canada for cases, Manitobans rallied against mandatory masks and allied lockdown measures.

From Saskatchewan to Nunavut, Ontario to Quebec, Alberta to British Columbia, Canada is witness to growing numbers of COVID cases in an ongoing upward swirl, leading to hospitalizations, emergency treatment and deaths. The call has gone out to the public that increased awareness and appropriate steps in social distancing and mask wearing is not negotiable; it is up to everyone to maintain vigilance. And in all the attention given to the SARS-CoV-2 virus running rampant through the country, another crisis is being short-shrifted.

That would be the pandemic of opioid overdoses which have also seen a sharp rise in tandem with that of COVID infections. Since the March border closure, and limited access to services have both conspired to turn back the slow descent in opioid deaths, directing their rise, leading to the reversal of the 13 percent decline in fatal opioid overdoses between the years 2018 and 2019. "Illicit toxicity deaths" have risen starkly in the months between March and August in British Columbia, the nation's hot-spot for overdoses.

 

On International Overdose Awareness Day in August, people in Vancouver, British Columbia, remembered those who died of overdoses. Photo: DARRYL DYCK/Associated Press

The Public Health Agency of Canada has posted numbers of an alarming rise in deaths, 181 occurring in June alone, representing a 138 percent increase from the 76 fatalities the same period the previous year. And nor is Ontario's situation an improvement on that of British Columbia's, where an estimated 50 to 60 people weekly are now dying of overdoses, according to the chief coroner's office which identifies a 35 to 40 percent year-over-year increase since the pandemic's onset.

"Canadians should be seized with this particular crisis [that is] escalating as we speak", said Dr.Theresa Tam last month. A range of factors have been linked to the virus, leading to the deadly spike of opioid overdoses. The continuing border shutdown disrupts illicit drugs' supply chain, setting the stage for contamination by dealers hoping to stretch their profits, mixing it with toxic additives making them more deadly. Added to which health precautions occasioned by the virus narrow access to services, from doctor visits to supervised injection sites.

Overdose prevention sites can make physical distancing difficult with bottlenecks, a situation that deters people who require immediate access or those who simply cannot see themselves standing in line in cold weather. Pandemic restrictions' social isolation can breed new users as well as heavier substance abuse. At social housing facilities pandemic protocols have the effect of restricting visitors, increasing the risk of an overdose when no one is close by to intervene in a crisis in progress.

While some people may take comfort in the swift and dramatic action undertaken by governments across the country in an effort to control the spread of COVID-19, its example of health-care responsiveness contrasts with the inaction by those same governments where indifference is perceived to the plight of those addicted to substances whose possession is illegal. Experts in the field urge expanded access to prescribed opioids through safer supply programs.

Oxycodone & acetaminophen pills (CP/Graeme Roy)

The Canadian Medical Association Journal published a study in August that showed few overdoses connected to people with prescribed opioids such as methadone and buprenorphine. The lead author of the study felt doctors should feel more relaxed about prescribing those alternatives. Were the overdose crisis to be declared a public health emergency the groundwork would be laid for improved access to treatment and recovery services alongside broader use of overdose-reversing drugs like naloxone, the study suggests.

Contemplating decriminalizing drugs might advantage the situation by deterring users from underground access to drugs, and could at the same time free up resources for public health that by default go to law enforcement. 

 

And nor is Canada's situation unique. In the United States, the deadliest drug overdose epidemic in the country's history is taking place, where 71,000 overdose deaths took place last year, even before the coronavirus arrived. It is likely that the total of such deaths this current COVID year will surpass that of the year before, given preliminary death data from nine states, along with national data on emergency responses to reported drug overdoses as reported by the Associated Press.

Firefighters and paramedics with Anne Arundel County Fire Department wear enhanced PPE as they transport a patient after responding to a call for a cardiac arrest as a result of a drug overdose on May 6, 2020 in Brooklyn, Md.   Alex Edelman / AFP via Getty