Editor’s note: A previous version of this article contained language that is stigmatizing to individuals who are dealing with addictions. The article has been amended.
As COVID-19 continues to ravage the country, a silent epidemic armed with an unregulated poison has been killing Ontarians at a horrifying rate.
Multiple health officials have sounded the alarm about the effect of border closures on the Ontario illicit drug supply, particularly opioids.
Closed borders means drug manufacturers can no longer access smuggled substances, so they’re cutting their supply with what they have on hand — substances such as carfentanil, an elephant tranquilizer, which is far more deadly.
Lockdown and physical distancing also means individuals who use drugs have had to find new, more proximate suppliers, who are selling substances they haven’t used before.
Cue the perfect storm for an accidental overdose.
“The toxicity of the drug supply has changed tremendously due to border closures,” said Adrienne Spafford, CEO of Addictions and Mental Health Ontario. “Since COVID-19 in Ontario, we have seen that deaths due to overdose have increased by between 35 to 40 per cent on a weekly basis.”
A more jarring number? Three-quarters of those people, according to Spafford, were using alone.
Paramedics are trying to keep up with the growing toxicity of opioids.
“If you turn the calendar back five years, we used to administer 0.4 mg, or 2 mg would be the absolute max for naloxone,” said Darryl Wilton, President of the Ontario Paramedic Association.
Now, Wilton says he’s seen up to 20 mg of naloxone being administered to reverse the effects of a strong opioid — 50 times higher than the starting dose.
“Most paramedics in Ontario — where we only used to carry a total of 4 mg in every ambulance — are now carrying, the average across Ontario, is 12 mg of naloxone available at all times in every ambulance, specifically because things like purple heroin are so much more powerful.”
The dire situation is causing more and more people to take a hard look at how things would be different if the government steps in.
“When you have an unregulated product, there’s always a possibility of it being adulterated or contaminated,” said Andy Hathaway, professor of sociology at the University of Guelph.
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“There’s potential benefits to decriminalizing illicit drugs … because of the recognition that harm reduction saves lives.”
Decriminalization means criminal penalties for personal drug use and possession would be eliminated.
That would mean mass incarcerations for possession — which has predominantly affected Black, Indigenous, and people of colour — would be reduced.
It would also mean, according to Spafford, Wilton, and Hathaway, that public perception would shift to viewing addiction as a public health crisis, instead of a criminal one.
‘Under legalization …there is increasing scope to understand the motivation of the user, and why they might be using, other than the fact that they’re a so-called ‘criminal’ or a ‘drug addict’,” said Hathaway.
Instead of focusing on policing and penalizing people who use drugs, Hathaway and Spafford say the government would instead put resources towards treating addictions, and the circumstances that cause them in the first place, such as social inequality, access to education, and precarious jobs and housing.
A popular example of the positive effect of decriminalization is the “Portugal Model.”
According to DrugPolicy.org, Portugal decriminalized its drugs in 2001. Ten years later, the number of lethal opioid overdoses had dropped fivefold.
Within the span of 12 years — two of which were before decriminalization — the number of people who sought treatment for addiction increased by 60 per cent.
What’s more is that the number of individuals using drugs did not increase, despite many believing that decriminalization would spark a surge in drug use.
Advocates for decriminalization also often push for legalization and regulation, meaning the government would produce the substances, keep them under strict regulation, and perform close quality control of their ingredients, potency, and packaging.
This means consumers would know exactly what they’re injecting.
“As long as the market for drugs remains illicit, there’s going to be risk for people,” said Spafford.
But regulation would also means the government is able to gather more data on drugs, and put out factual information on their adverse effects.
“We call it “Black Market” for a reason. It’s black … it’s hard to track, hard to monitor,” said David Hammond, professor of public health at the University of Waterloo.
“I think there needs to be a collective effort to better understand illicit drugs, so that we take care not to de-normalize and stigmatize consumers, because they’re often our best source of information on what’s out there.”
Hammond says regulation also harbours honest conversations with consumers. Canadians have seen that first hand with a substance that was once upon a time illegal — cannabis.
“We’ve been tracking this for many years, and what we see is that Canadians right before and right after legalization were reporting greater information and health knowledge … and you know what? When we talk to consumers of different substances, that is exactly what they want. Most of them want more information, or are curious about what they’re taking and what the effects may be.”
Hathaway, Spafford, and Wilton all agree that the regulation of illicit drugs would mean less poisoned substances, and fewer overdose deaths.
But if many key players in harm reduction want the same thing, what’s the holdup?
According to the experts: stigma.
“If you think about the reasons why people were overestimating the risks of cannabis, it’s because it was illegal,” said Hammond.
“In fact, it’s our legal drugs that cause the most damage in many cases, and tobacco use is a great example … so it has to do with our social norms.”
While Hathaway and Spafford say decriminalization and regulation is a “big part of the puzzle,” it is not a silver bullet to ending the drug epidemic.
Instead, a multifaceted approach needs to be followed, with increased and equal access to mental health services, consumption and treatment sites (CTS), clean equipment like needles, pipes, spoons, case management for addiction concerns, and drop-in programs for peer support.
But none of these things can happen without adequate government funding, which Spafford says has not come through.
“I think I can confidently say that the funding to tackle the opioid overdose crisis has nowhere near met the need of the crisis … We need immediate action on the rollout of an implementation for the government’s Mental Health and Addiction Strategy.”
Until then, Spafford says the war on drugs continues to be a losing battle.
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