Hidden crisis
EXPERTS AND ADVOCATES WARN COVID-19 HAS OVERSHADOWED THE TOLL OF SUBSTANCE USE AND OVERDOSE DEATHS
nineteen-year-old Jacob Bulloch saved three lives when he lost his. he was found unconscious in a calgary group home last November after a suspected fentanyl overdose. It would be three agonizing days in hospital before his mom would know for sure that damage to his brain was fatal.
cheryl Bulloch remembers watching her son all night.
“This is it,” she thought. “I’m not going to see him after this.”
She climbed into his hospital bed and held him.
hours later, he was removed from life support. Jacob’s heart, lungs and liver were used in three life-saving procedures. his kidneys freed two strangers from dialysis.
“he always had a good heart,” says Bulloch. “I would love to meet the person who has it now.”
Jacob is one of more than 4,000 canadians who died from an opioid-related overdose last year. experts say the record-breaking 2020 death toll — yet to be fully calculated — is linked to the COVID-19 pandemic, which has pushed individuals to use in isolation and decreased access to life-saving services.
Bulloch says Jacob’s death came as no surprise.
“It wasn’t a matter of if, but when. I told Jacob all the time. I said, ‘you are going to die from fentanyl.’”
fentanyl is described as being 100 times more potent than morphine. carfentanil, the most powerful analogue, is upwards of 10,000 times stronger.
The purity of already impure street drugs deteriorated when the pandemic fractured supply chains and, experts say, higher concentrations of fentanyl and fentanyl analogs made their way to the streets. These synthetic opioids were linked to about 75 per cent of overdose deaths in canada between January and June 2020, according to the federal government.
Jacob “battled demons” for many years. he faced homelessness. he was in and out of the hospital for threats of suicide, overdoses and other mental health issues.
despite attempts to get help, Bulloch says her son was failed time and time again by a system that discarded him as nothing more than a junkie.
One doctor told her son to “deal with your drug issue, then we’ll deal with your mental health.”
donald Macpherson, executive director of the canadian drug Policy coalition, says the pandemic has overshadowed the overdose crisis, even as opioid-related deaths outpaced COVID-19 fatalities in some jurisdictions.
No government — municipal, provincial or federal — has responded in an emergency fashion to overdoses as they have to the pandemic, he says. The mere threat of COVID-19 ignited action on a national level. When cases, hospitalizations and deaths spiked, public heath measures were enhanced.
“Part of that has to do with framing the issue as an addictions issue as opposed to a poisoning issue,” says Macpherson. “(Officials) are not responding to the actual problem, which is a drug toxicity crisis.”
Many on the frontline of this public health emergency say a legal and regulated supply of drugs — often termed “safe supply” — is urgently needed to address the illicit market.
drug reform advocates say this should happen in conjunction with the decriminalization of illegal substances, which is supported by the canadian Association of chiefs of Police.
B.c. is seeking a federal exemption that would decriminalize illicit drugs. If successful, it would be the first jurisdiction to do so.
“It is absolutely a barbaric approach to withhold pharmaceutical product (from) people when we know thousands of canadians are going to buy from the illegal drug market tonight,” says Macpherson. “That’s why you are seeing the emerging practice of safe supply actually being started by some courageous physicians.”
dr. Mark Tyndall is one of them.
The B.c.-based physician, one of canada’s leading experts on harm reduction and public health, launched the world’s first biometric opioid vending machine in Vancouver’s downtown eastside in december 2019. What makes the Mysafe Project so unique is it offers medication outside of traditional healthcare settings, where strict rules are often in place and stigma lingers.
“The whole thing is about providing people with some autonomy so they have a bit of control over what they do, when they get their drugs and they don’t have to talk to a pharmacist or health-care worker every time they get it,” says Tyndall.
A nearly $3.5-million investment from the federal government in March means the dispensing machines will operate in B.c., Nova Scotia and Ontario.
When it comes to decriminalization, Alberta-based addictions expert dr. Monty Ghosh says canada’s drug policies force victims of overdose to the margins of society and disproportionately impact racialized canadians.
“There’s no other medical disease that we arrest and incarcerate,” Ghosh says.
fear of law enforcement can also prevent people from accessing life-saving services, such as supervised consumption sites, he says. That’s one reason he launched the National Overdose response Service hotline, in collaboration with Grenfell Ministries in Ontario and Brave Technology coop in B.c. to reach canadians coast-to-coast.
“We are basically going into their own homes and monitoring them,” says Ghosh, adding it’s an especially important service for people who are using alone.
evidence suggests supervised consumption sites are most effective at reducing mortality rates within a 500-metre radius. canada’s 37 facilities operate solely in urban centres, leaving rural canadians in the dark.
Six lives have been saved since the hotline’s december launch and more than 430 people have dialed in. If a suspected overdose occurs, local emergency responders are immediately notified.
Prior to the pandemic, opioid toxicity deaths were falling across the country, but that progress was lost almost instantly when provinces went into lockdown in March 2020. April to June 2020 marked canada’s deadliest quarter to date, with 1,628 fatalities — a 54-percent rise from the same quarter in 2019.
experts say harm reduction interventions, such as supervised consumption services, overdose prevention sites and naloxone distribution, are necessities to combat the rising death toll. even so, provincial governments have been apprehensive and, in some cases, dismissive of the need.
The Saskatchewan Party refused to fund the province’s first supervised consumption site. Organizers opened the site in October despite insufficient capital and crowdfunded $50,000 to hire one paramedic.
Manitoba Premier Brian Pallister said an overdose prevention facility in Winnipeg is a “lower-priority.”
In Alberta, the fight for harm reduction services has grown tense. The United conservative government stripped funding from a life-saving opioid dependency program, only to walk back their decision after clients launched a legal battle. It also defunded the sole supervised consumption site in Lethbridge — the busiest site in North American — over allegations of financial misconduct that were later proven to be unfounded.
The province then opened an overdose prevention site, but it can only serve a fraction of the clients.
Lethbridge faced the highest rate of opioid-related deaths in the province last year at 44.1 per 100,000 people, as of November. It was one of the highest rates in the country, in an area in the province where rates of opioid use are highest among first Nations people.
Petra Schulz co-founded national advocacy organization Moms Stop The harm (MSTH) after her son, danny, died in 2014 following an accidental fentanyl overdose.
“you have to make safe supply available everywhere,” she says. “We have two choices: We either change how we think about substance use, or we’re OK with having a generation of young people die.”
As Bulloch says, the opioid crisis is “going to be like cancer. everybody’s family is going be affected” should nothing change.