The Political Economy of the Overdose Crisis in Western Canada: An Exploratory Case Study

Background: Canada is in the throes of a drug/substance overdose crisis causing unprecedented numbers of overdose and death. Responses to the crisis have been largely reactive and/or medical in nature, highlighting the need for better understanding of its underlying structural determinants. The crisis has emerged in an era of neoliberal capitalism which has deepened health and social inequities and brought changes to the organization of work leading to increased precarity. Such broader economic influences have been identified as among important determinants of substance use and related harms in other contexts. Scant research evidence exists investigating structural determinants in the Western Canadian context and no studies have explored potential links among these confluent dynamics.\nMethodology: The study used a qualitative case study methodology to explore the contextual influences on the overdose crisis in Western Canada. A contextual synthesis and analysis combined different sources of data to better understand economic influences of the crisis in four sites of study (Saskatoon, SK; Fort McMurray, AB; Kelowna, BC; and Nanaimo, BC). The study drew on three sources of data: publicly available crisis-related data and reports from federal, provincial, and First Nations bodies, 45 interviews with 51 key informants from the sites, and publicly available economic data from Statistics Canada. Within-site and across-site analyses were completed to understand both local and broader economic influences of the crisis. Crystallization, a multidimensional enhancement of triangulation, and member checking were used to build trustworthiness of this research.\nFindings: Patterns of deaths in the overdose crisis in Western Canada reveal an inequitable distribution of harms where working-aged men, First Nations people, and those working in blue- collar and service industries are overrepresented in overdose deaths. Thematic analysis of key informant interviews in each site reveals socioeconomic pressures, the illicit drug trade and prescription opioids and pain management as economic influences on overdose deaths within and across sites. Increased precarity due to employment changes inherent to neoliberalization is explored as a potential link to increased substance use for particular populations, reflected in the patterns of death amid the overdose crisis. Observations on data sources and limitations for exploring contextual dynamics of the crisis are noted throughout.\nConclusion: The overdose crisis in Western Canada is evolving within neoliberal capitalist structures that may be creating risk of substance use and related harms for particular populations. Pathways between those structures and risk appear to be numerous, economically driven, and unevenly distributed among different groups. Data limitations and the nature of exploratory study restrict conclusions about the structural drivers of the crisis, yet certain trends are evident. This study provides emerging insight on the economic influences of crisis-related harms in a Western Canadian context, offering a theoretical framework and suggested hypotheses for ongoing inquiry and suggestive of upstream intervention.

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