A deadly concoction: opioids and moral outrage
A growing epidemic of mental illness and addiction is quietly ravaging communities in the midst of a pandemic. Isolated and afraid, people are using substances to cope. According to Ipsos, a polling company, 16 percent of Canadians report drinking or drugging at a rate higher than pre-pandemic. Hospitals are beginning to see the results of increased alcohol consumption. Drug use? The opioid overdose statistics were already shocking. We probably won’t know the pandemic’s full impact on addiction and overdose deaths for years.
Between January 2016 and March 2020 more than 16,000 Canadians died from overdose. In Alberta, in the first six months of 2020, 449 lives were lost. Overdose deaths, generally speaking, track younger than Covid deaths. Yet they receive far less attention from the media and governments. Why? Is it because we know Covid could get one of us, whereas opioid overdoses only threaten them?
Admirably, the Government of Alberta has prioritized addiction treatment. Still, treatment beds are lacking and will not meet demand for some time, if ever. Addiction, it should be noted, is not easily overcome. I’ve heard stories of alcohol users who went for treatment five, six or more times before recovering. Opioids seem to be even more resistant to abstinence-based treatment. Estimates for that treatment route— going cold turkey — only succeeds in 3 – 7 percent of opioid addiction cases.
More must be done. To start, the federal government can declare a national health emergency in regards to opioid overdose deaths, to mobilize needed resources across the country.
Decriminalization of drug possession for personal use is also required. Courts and jails don’t treat addiction. Arguably, they perpetuate it.
Regulators, however, must go one step further, into a strategy called safe supply: a medically supervised program where people with hard-to-treat addictions are provided safe, pharmaceutical alternatives. In those experiencing both homelessness and addiction, treatment would go hand-in-hand with supportive housing, ideally.
Safe supply promises first to greatly reduce overdose deaths caused by illicit and dubious concoctions sold on the street. Second, it will give the medical specialists the opportunity to gain the trust of people with addictions — people who are treated like outcasts by society — to allow for more advanced recovery treatment. Third, it will help street-involved, addicted folks steer away from risky and/or criminal behaviours — theft, robbery, street prostitution — they often engage in to raise the money to buy drugs from organized crime.
As it stands today, we’ve allowed criminal gangs to be the de facto prescribers and dispensers of these medications. The system is driven by greed, violence and pathology. Even the routine overdose death of customers, seemingly bad business, hasn’t stopped the supply and sale of toxic drugs like fentanyl.
Yes, the dynamics of safe supply are controversial. As one Alberta Health lackey put it: “We don’t believe in giving drugs to addicts.” Sadly, this is a conscious use of language — “addicts” — to relieve the public of any concern, and to reinforce old myths about “junkies” and “indigents” who simply refuse to get their act together.
Science describes addiction as a complex, yet real illness. I am obviously biased, but my experience as a former alcohol user supports that view.
What I’ve heard a thousand times at 12-Step meetings are stories of how a first drink was an elixir so powerful it promised to solve every underlying problem for the user. Many of these “alcoholics” switched to, or added on, illicit drugs like cocaine when the elixir started to lose its power to treat their inner demons. Many of them were dragged by their addiction from relative comfort to a dystopian underworld of constant threat, violence and societal shaming.
Human beings do not choose to be addicted to drugs or alcohol. Addiction removes that choice. Addiction demands self-abasing loyalty. I’ve heard it too many times to doubt the fact that people, in the throes of addiction, will do anything to drug or drink. Anything. It is so strange to meet such people in recovery. In my experience, they are some of the loveliest people I’ve ever encountered. (A pet theory of mine is that being sensitive is one of the underlying risks for addiction).
But when such folks are addicted and especially when they’re street involved, they are treated as — and sometimes behave as — untouchables, as pariah, as disgusting and dangerous. I suspect a typical person in the throes of addiction, who is also living on the street or in shelters, is told to “fuck off” a dozen times a day — or treated as completely invisible — during their travels.
But that is only one narrative of modern addiction. Another involves so-called “normal” people living in so-called “normal” homes, who die by overdose in their living rooms or bedrooms. Such people were also caught in a vicious cycle of pain, self-medication, withdrawal and shame.
Safe supply, then, is an olive branch of sorts to anyone trapped by unrelenting addiction. It is an offer to remove the constant stress surrounding the illicit drug market and replace it with first-stage, medically-supervised treatment. Safe supply would also help to destigmatize addiction by regarding it and treating it as a health-care challenge, not a crime. Finally, safe supply provides a pathway into even more comprehensive care for people who have been traumatized by years-long experiences as a shamed outcast. Eventually, some or even most of them will be able to recover completely, or at least with an maintenance prescription for medications that mitigate withdrawal symptoms.
If safe supply were to become comprehensive, overdoses and crime would drop. Communities and small-business areas would be liberated from the side effects of illicit drug addiction: the litter, needle debris and roving, predatory drug dealers.
Safe supply, fortunately, is being piloted in various sites in Canada. Sadly, an injectable opioid agonist treatment pilot in Alberta is currently at risk. (See earlier comments about not giving drugs to “addicts”). Ending that program might seem only proper to many Albertans. But is it proper to force desperate folk back into the criminal black market, where death is a roll of the dice? Is it proper to provide powerful medications like opioids to patients with chronic, acute physical pain, as we properly do, but deny them to patients with chronic, acute social, psychological and emotional pain associated with addiction?
Safe supply is treatment, not a party or lifestyle supplement. It is a pathway to further treatment, not the end goal in itself. Recovery is the goal and it is essential, not just for people with addictions, but for cities around the world. As individuals with chronic addictions begin to recover, the side effects of social disorder, crime and urban decay will begin to fade.
Imagine living in a city where overdose deaths drop to zero, or at least very close to zero. Where break-ins, thefts, social disorder, violence and spent needles fade along into the background, along with overdoses. Where the streets are cleaner and safer for everyone.
I can’t speak for you, but I want to live in that city.
By Scott McKeen, City Councillor Ward 6