Speer: Is Canadian politics shaped by “the revenge of places that don’t matter”?
Bridging the urban-rural divide in CanadaSaturday October 12, 2019
The past several years have seen dramatic increases in the problematic use of opioids and opioid overdoses in Canada. Health Canada estimates “there were more than 8,000 apparent opioid-related deaths between January 2016 and March 2018.” Most of them are accidental – although Health Canada notes limitations in tracking the full extent of the epidemic, which results in overestimations in some provinces, underestimations in others, and an altogether lack of data in some cases. A joint report from the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institute for Health Information (CIHI) found that “the rate of hospitalizations due to opioid poisoning in Canada increased more than 30% between 2007-08 and 2014-15”.
Over the last two years, Canada implemented important initiatives including the updating of opioid prescribing guidelines for non-cancer pain, research into better treatments, and a community-led push for safe-injection sites to break down barriers to treatment. Despite these efforts, challenges remain in addressing stigma and ensuring equitable, effective access to treatment care pathways. With every new effort towards reducing opioid-related harm in Canada, it becomes more and more clear that solutions lie at the intersections of sectors. The need to facilitate collaboration and innovation is pressing, as vulnerable populations – especially young men and people in rural and remote communities – continue to suffer the brunt of the epidemic.
The 2016 Opioid Summit resulted in the release of the Joint Statement of Action to Address the Opioid Crisis: A Collective Response, in which over 30 partners committed to individual and collective action to address the crisis. In the first year, partners worked to collect, disseminate and exchange knowledge amongst first responders, physicians, First Nations communities and policy makers. A set of principles emerged to guide responses from this collective knowledge, and the principles have been validated by the research literature:
In the two years since the Joint Statement, concrete actions have been taken that embody these principles. Further action will need to take place on multiple fronts simultaneously – on legal mechanisms of enforcement and public safety, stigma reduction, medical research and innovation, social policy and education.
The Public Policy Forum (PPF) hosted a roundtable discussion, in November 2018, on the way forward to address Canada’s ongoing – and developing – opioid addiction problem. Through discussion, the participants created recommendations for government, health care providers, industry and caregivers on how access to treatment can be improved. The conversation stressed the need to break down barriers, increase awareness, and collaborate across sectors – with the support of meaningful policy changes – in order to tackle the opioid crisis in Canada. This is arguably the most pressing public health issue in the country and through action, treatment can be improved and overdoses substantially reduced.
Opioid misuse is a national issue. Addiction transcends socio-economic divisions – some say we can assume there as many prescription opioid users on Bay Street, Toronto as in Downtown Eastside, Vancouver – but outcomes between individuals aren’t experienced equitably. Not only are there distinct regional and community nuances, the causes of opioid addiction are varied (and often inter-related) and include poverty, trauma, the long-term effects of colonialism on Indigenous people and communities.
An individual’s journey into addiction is personal and painful. The path to recovery requires stripping away treatment barriers and making access to treatment a seamless, patient-oriented process. The barriers to service access and effective treatment are varied and range from common systemic factors to deeply ingrained attitudes and tendencies. There is no single fix, but there are strategies that adhere to the principles of the 2016 Joint Statement of Action.
Today we see enormous collective action in Canada. All quarters are making calls for rapid access to effective opioid addiction treatment and policy action that lowers barriers to treatment. Treatment providers, patient groups and policy makers recognize that the positive, long-term outcomes they strive to achieve can’t be anchored to abstinence-only principles and models of service provision. Not everyone is going to get better, but they can have better lives.
‘The opposite of addiction isn’t sobriety. It’s connectedness.’
Government is starting to address the knowledge gap in the public has about opioids. The medical community and other service providers will similarly need more general education about addictions, particularly opioid addiction, in order to build more effective treatment pathways and services.
Government, to its credit, has done a great deal to push ahead harm reduction practices and address opioid addiction – for instance enabling a prescription heroine pilot project, providing more rapid action treatment sites, providing overdose treatments free of charge at some locations and beginning to address enforcement policies. More can be done to develop smarter enforcement, address opioid analogues distributed through the mail, and convene a national discussion about the place of decriminalization.
Recognizing how opioid misuse is a societal issue, roundtable participants emphasized the need for a society-wide response. They discussed that stakeholders, decision-makers, and allies from different sectors needed to get involved in meaningful, interconnected ways. They highlighted opportunities for more inter-sectoral engagement as well as certain promising practices.
There is a profound sense of hope in the possibility of better opioid addiction treatment, better pathways to care and better collaboration. When we talk about the future of opioid addiction treatment in Canada, people don’t turn to despair. They think of inspiration, ingenuity and equity. They see the profound impacts of colonialism and inequitable services and commit to doing better. They see systems defined by collaboration, integration, learning, leading practices and access. They are ready to listen, and they are ready for swift action. Most of all, they have hope.
“The opposite of addiction is connection. Call someone.”
Hope comes from people with lived experience. It is carried by families and caregivers who anchor treatment and other services in the contextual expertise of community. They have the strongest voices, able to identify obstructions to care and are capable of articulating what a coherent system of treatment pathways should be. In 2019, Canada can do better and be better by hastening access to treatments that work, learning from and scaling up best practices, and continuing coordinated efforts between all stakeholders – all to stem the tide of the crisis.