It’s been seven months since COVID-19 was declared a global health emergency, and since Canada’s provinces and territories declared their own public health emergencies or states of emergency. Since then, almost 10,000 people have died of COVID in Canada. Globally, deaths have surpassed the sombre million marker. The devastation is unparalleled; it demands a pause for reflection.
Ontario is now ramping up its COVID response in some regions to meet the demands of an escalating second wave. But in the wake of the devastation left by COVID, another crisis is unfolding: 15,000 people have died of opioid overdoses in Canada since 2016. It is a crisis that is affecting communities everywhere and COVID is exacerbating it.
The opioid crisis is driven by a toxic drug supply. The criminalization of drugs and the people who use them force already stigmatized groups further into the margins. People who use drugs must access them on unregulated markets, where the risk of accessing tainted or toxic substances is higher. COVID has exacerbated an already difficult situation by disrupting pathways to support and care for people who use drugs. Border closures due to COVID have also led to increased toxicity in drugs at a time when access to harm reduction and overdose prevention services is severely curtailed.
The severity of the crisis is especially evident in Ontario, which has now surpassed British Columbia to become the province with the most opioid overdose-related deaths. Between March and May 2020, Ontario experienced a 25 per cent increase in overdose deaths compared with the same period last year. According to the Office of the Chief Coroner of Ontario, an estimated 50 to 80 people per week are dying of overdoses.
Despite this, Ontario has yet to declare the overdose crisis a public health emergency. An emergency declaration does more than draw attention to the crisis: It is galvanizing. It triggers action and moves resources. Ideally, it also creates pathways to make sure protective protocols are in place. In the best-case scenario, pandemic or emergency declarations also inspire bold leadership and innovative policy-making.
Ontario’s failure to declare the opioid crisis an emergency is nothing short of catastrophic. In simple terms, this means that communities are not receiving the resources they need to address what they are seeing on the ground. A generous reading of this situation might say the policy hasn’t caught up with what’s happening on the ground. An alternate reading is that we are prepared to let people who use drugs die in the thousands because of the stigma toward drugs and the people who use them. A calculus has been made and people are dying every day because of it.
The situation unfolding now is a product of the war on drugs and the criminalization of people who use drugs. Advocates and affected communities are calling for an end to the war on drugs and for policy-makers to change how they understand this crisis and the responses needed. The opioid crisis is a health crisis and the responses to it must prioritize health-based solutions.
There are a few things policy-makers in Ontario can do now to change the trajectory of this crisis:
1. Declare the overdose crisis a public health emergency
The overdose crisis is one of the most severe crises facing this generation. To effectively address it, policy-makers in Ontario must declare it a public health crisis. A declaration lays the groundwork for the paradigm shift we need. Ontario needs health responses, not criminalization. Declaring a public health emergency will also ensure that the crisis is monitored in real time and that health system resources are re-directed appropriately.
2. Expand access to safer supply programs and ensure they are funded
In August, the Federal Minister of Health sent a letter to all provincial and territorial health ministers urging them to work with stakeholders in their jurisdictions to make regulated pharmaceutical options available for people who use drugs. Safer supply programs fall under this banner. These are low-barrier health programs that reach people who face tremendous challenges in accessing health care. Criminalization forces people who use drugs into illegal markets, where the risks of consuming toxic substances are high. Safer supply programs prevent this while linking people to health care. The evidence is strong: safer supply programs improve health outcomes for people who use drugs. Until safer supply is more widely available in Ontario, we will continue to see the high number of overdoses and deaths we are seeing now. Policy-makers must advance safer supply now.
3. Bring the right people to the policy-making table
In 2018, Ontario stopped convening meetings of the Opioid Emergency Task Force, an advisory group guiding the provinces’ response to the overdose crisis. A range of stakeholders sat at the table, including people who use drugs, health-care providers, researchers, policy-makers and clinicians. The absence of these voices is acutely felt. Ontario’s policy response to this crisis is neither bold nor responsive. The voices of the most impacted are not sitting at the tables where decisions are being made. Until this is addressed, policy solutions to the ongoing crisis will be inadequate.
4. Implement the Chapman inquest recommendations
Bradley Chapman died of a fatal overdose in Toronto 2015. His death was followed by an inquest which looked at the emergency response to his death. Ontario’s chief coroner released a report in 2018 with critical recommendations at provincial and federal levels. The Chapman inquest was distinct in its recognition of the urgency of the opioid crisis. Despite its importance, many of the recommendations have not been implemented in Ontario. The province must act urgently to implement these calls to action.
Both the COVID pandemic and the opioid crisis have been seasons of death and grief. Many are thinking about the people who have died over this period and the role policies have played in their early deaths. We are watching people die in Ontario due to decision making that refuses to catch up. In a 2001 essay, the novelist Toni Morrison wrote: “Speaking to the broken and the dead is too difficult for a mouth full of blood.” The dead she was talking about didn’t die in global pandemics that have left devastation in their wake, yet there are lessons in Morrison’s words for us, too. About 15,000 people in Canada have died of overdoses. We are speaking of their deaths and our mouths are full of blood. Their deaths could have been prevented. The dead are people who used drugs; they were highly stigmatized and marginalized. The governing paradigm of the day says these deaths are somehow acceptable.
We must re-make this world. In speaking about the dead, we must empty our mouths of carnage and speak about the limitations of our heath-policy infrastructure to reduce the devastation caused by one of the most pressing health crises of our time. We must speak truth about the failures and limitations of the current policies in place. Perhaps in this way, in re-imagining effective health policy, we can stem the devastation before us.
Sané Dube is a policy analyst and story teller based in Toronto. Her people are the Ndebele of what is now called Zimbabwe.
