Canada's overdose crisis: authorities are not acting fast enough

We appreciate the lessons outlined by Benedikt Fischer and colleagues1Fischer B Pang M Tyndall M The opioid death crisis in Canada: crucial lessons for public health.Lancet Public Health. 2019; 4: e81-e82Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar in their Comment on the opioid overdose crisis in Canada. From the frontline perspective, working at an overdose prevention site at the epicentre of the overdose crisis in Canada's largest city, our major lesson is that all levels of government are not acting fast enough, and that the stigma against and criminalisation of people who use drugs are impeding the public health response. In August, 2017, volunteers with the Toronto Overdose Prevention Society opened the Moss Park Overdose Prevention Site—an unsanctioned (without official approval) overdose prevention site in tents in a downtown park—in response to the slow and ineffectual response to more than a decade of rising overdose rates. At that point, not a single overdose prevention site or supervised-consumption service had opened in Ontario, Canada's largest province. In 11 months of operation, Moss Park Overdose Prevention Site supervised 9062 injections, intervened in 251 overdoses, and helped to develop a framework for implementing authorised overdose prevention sites across the province. By July, 2018, Moss Park Overdose Prevention Site was given legal exemption to operate, and was funded along with 20 other sites across Ontario. A change in government has left these sites under renewed threat. Additionally, only four provinces (out of the 13 provinces and territories in Canada) have implemented overdose prevention sites or supervised-consumption services. It is unacceptable that an essential health service is subject to political whims, and is not available equally across the country. While overdose prevention sites and supervised-consumption services are life saving, these facilities do not address the root cause of the current overdose crisis: an increasingly toxic illicit drug supply that is killing 11 Canadians per day.2Special Advisory Committee on the Epidemic of Opioid OverdosesNational report: apparent opioid-related deaths in Canada (January 2016 to June 2018). Public Health Agency of Canada.https://infobase.phac-aspc.gc.ca/datalab/national-surveillance-opioid-mortality.htmlDate: December, 2018Date accessed: February 23, 2019Google Scholar January, 2019, saw a rise in overdoses and atypical adverse reactions. That month, Moss Park Overdose Prevention Site had 2050 visits and intervened in 90 overdoses, an increase from the 26 overdoses treated in December 2018. Testing of a sample of so-called purple fentanyl, responsible for several atypical overdoses, found it contained a dangerous mix of substances, including several fentanyl analogues, various stimulants, and a novel synthetic cannabinoid, AMB-FUBINACA. Safer supply programmes provide alternatives to the illicit drug supply. Despite strong evidence for heroin-assisted treatment,3Ferri M Davoli M Perucci CA Heroin maintenance for chronic heroin dependents.Cochrane Database Syst Rev. 2005; 2 (CD003410.)Crossref Google Scholar and Canadian innovations in injectable opioid agonist treatment,4Oviedo-Joekes E Guh D Brissette S et al.Hydromorphone compared with diacetylmorphine for long-term opioid dependence.JAMA Psychiatry. 2016; 73: 447-479Crossref PubMed Scopus (116) Google Scholar scale-up remains slow. New pilot interventions to divert people from the toxic illicit drug supply continue to be notable exceptions.5Woo A Vancouver to offer opioid pills in latest effort to prevent overdose deaths. The Globe and Mail.https://www.theglobeandmail.com/canada/british-columbia/article-with-opioid-pill-programs-vancouver-inches-toward-addressing-safe/Date: Dec 28, 2018Date accessed: February 23, 2019Google Scholar From the front lines, the reticence of authorities to immediately scale up these critical public health interventions across the entire country—and concurrently explore options and models of decriminalisation and regulation—seems negligent and will result in continued preventable deaths. We declare no competing interests. The opioid death crisis in Canada: crucial lessons for public healthA chief coroner investigation in British Columbia, Canada, identified an “inordinately high number” of drug-related deaths related to a “very real and very serious” drug problem, and recommended unconventional measures to reduce mortality.1 This occurred 25 years ago, in 1993, the number of drug-related deaths in British Columbia peaked at 330.1 Today, the epidemic of primarily opioid-related deaths in Canada is far worse than it was a quarter of a century ago. In 2017, there were 1473 drug-related deaths in British Columbia and 3996 in Canada in total—an increase of more than 400% from 1993—and these deaths now account for substantially greater mortality than motor-vehicle accidents and other leading causes of premature deaths. Full-Text PDF Open Access

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