By Alison Sandstrom
After a long day of panel discussions on Canada’s opioid crisis, Ontario health minister Eric Hoskins reintroduced his federal counterpart Jane Philpott to the audience with warm words.
“On this issue, and so many others, I feel like I can breathe again,” he told the room filled with doctors, scientists, politicians and bureaucrats. “After a decade where quite truthfully we had a government here in Ottawa that did not understand, we have a government that does.”
Applause erupted from the crowd.
Six to seven Canadians are dying daily from opioid overdose. In the face of this mounting death toll, Philpott and Hoskins co-hosted an Opioid Conference on Nov. 18, which was followed by an Opioid Summit the next day.
“We are fighting against a very worrisome trend and we’re not going to get to zero deaths immediately. What we’re going to need to do is flatten that curve as quickly as possible and move it down so people are not dying at the rate they are now,” Philpott said at the summit’s closing news conference.
She cited the conference and summit, which produced a joint statement of action, as examples of the kind of collaborative work that will be needed to combat the crisis.
But not everyone is happy with Philpott’s response to the escalating emergency. Marilou Gagnon is the founder of the Coalition of Nurses and Nursing Students for Supervised Injection Services. During the last federal election her organization mobilized nurses to vote for parties like the Liberals who were supportive of supervised injection. A year later, she said she’s disappointed by what she sees as the Minister’s lack of action on the file.
“There’s enough talk, for more than a year now she’s been repeating similar responses,” said Gagnon.
Gagnon points to volunteer operated “pop-up” supervised injection sites that have sprung up in Vancouver’s downtown eastside. The neighborhood is at the epicenter of the crisis’ hardest hit province. British Columbia is expected to see 800 deaths from illicit drug overdoses by the end of the year. Fentanyl, an opioid 100 times more powerful than morphine, has been implicated in more than half of these deaths recorded so far.
The improvised sites are not sanctioned by the government and are funded through online donations.
“How is that justifiable to have volunteers and people who use drugs in that situation, where the only health care that’s being provided to them is through crowd funded initiatives? It’s really hard to justify for a developed country to be in that position,” said Gagnon.
For her, the commitments in the joint action plan “missed the mark.” Despite Philpott being a vocal supporter of supervised injection services, the majority of the document focused on prescribing guidelines and limiting access to opioids, as opposed to treatment and harm reduction for those currently living with addiction.
“It’s very much focused on how can we prevent this from happening instead of focusing on, okay, it’s already happening so what are we doing to really address the needs of people who use drugs,” said Gagnon. “It reflects the same process that we’re used to seeing in terms of policy; people making decisions who are not really well connected to the ground.”
Dr. Mark Ujjainwalla runs a methadone clinic called Recovery Ottawa. He has little faith in the government’s ability to combat the opioid crisis.
“The government has come up some minor changes that it thinks will solve the issue, which is ridiculous, it shows how far away they are from the reality of the problem,” he said.
Ujjainwalla said more money is urgently needed for treatment facilities. He said the six months to year it takes to get into a government funded medical treatment facility is too long for most of the patients he sees at his clinic.
“They’ll die before they get treatment,” he said.
Sean Leblanc is the founder of the Drug Users Advocacy League in Ottawa. Having overcome an opioid addiction himself, he wants current and former drug users to have more of a voice in shaping government policy related to the opioid crisis. Only two people who had lived experience with opioid use or addiction spoke at the conference.
“There’s a saying we use in CAPUD [the Canadian Association of People who use Drugs]: ‘nothing for us, without us.’ Anything that is a decision that’s going to affect people who use drugs, we have to be a part of that decision,” he said.
Leblanc and others are worried that the government’s emphasis on limiting access to prescription opioids and monitoring their prescribing by physicians will push people into the illegal markets where drug quality and strength is unknown.
“A lot of this crisis started because of the Oxy crisis five years ago,” said Leblanc. “There were a lot of overdoses with OxyContin and that was an issue, but they didn’t talk to people who used drugs, they basically pulled all Oxys and what happened? People replaced it with heroine and fentanyl.”
Rob Boyd runs an outreach and treatment program for drug users at Sandy Hill Community Health Centre in Ottawa.
“I think that the initial information around the opioid crisis in Canada is really around drug safety measures that are being put in place,” said Boyd. “These will have the unintended consequence of limiting access to pharmaceutical opioids at a time when we’re beginning to see the illicit opioids taking on the market.”
Canadians are the second highest consumers of prescription opioids in the world. Many experts trace the roots of the current crisis back to aggressive and successful marketing of OxyContin to doctors beginning in the 1990s.
“We saw OxyContin—a drug that is 1.5 to two times more potent than morphine—prescribed very liberally for chronic back pain, hip pain, osteoarthritis, fibromyalgia, and you name it. It was even doled out for minor ankle injuries. This happened because physicians were taught that it was safe and effective to use opioids for chronic pain,” Dr. David Juurlink, a drug safety researcher at Toronto’s Sunnybrook Hospital, told the parliamentary committee on health in a series of hearing that led up to the Opioid Conference.
Gagnon said the recommendations that came out of the Opioid Conference fail to acknowledge “addiction is not created by a prescription or by taking a pill.” She said unless the government examines the root causes of why people use drugs, including isolation, marginalization and mental health issues, they won’t be able to create effective strategies for combatting the crisis.
“If you don’t dig a little deeper it’s a bit of an oversimplification of the problem and I don’t think we’re necessarily going to address the issue,” she said.
The day before the Opioid Conference began, Philpott told reporters outside the House of Commons that she had been very moved by her meetings with people with lived experiences of opioid abuse, and that the human cost of the crisis was not lost on her.
“It’s very important that we keep those human stories at the forefront of our minds,” she said. “We have been extremely active on this file from the very beginning of our mandate.”
She listed off the actions the government has taken to combat rising overdose deaths, including removing the prescription requirement for naloxone, a drug used to reverse the effects of overdose, and approving Canada’s second supervised injection site, the Dr. Peter Centre in Vancouver.
Conservative health critic Colin Carrie accused the Liberals of being “obsessed” with supervised injection during parliamentary health committee meetings.
“The Liberals seem to be focusing on safe injection sites and the truth is they’re only putting resources into that,” he said.
Ujjainwalla calls supervised injection a “smokescreen.” He wants to see health care money spent on treatment.
“It’s like saying we’ve got this amazing cure for blindness, we’re going to give people white canes and we’re going to shut down every eye institute in Canada,” he said.
Proponents of the sites argue they actually connect drug-users with health care and treatment.
“I think SIS is a really good place to catch and engage those marginalized people in our society, meet them where they’re at,” said Leblanc.
He pointed to the landmark 2011 Supreme Court decision, which ruled that the Conservative government could not close Insite because the service “has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada.”
The Dr. Peter Centre and Insite, both located in Vancouver, are Canada’s only supervised injection sites, although at least ten other Canadian cities are looking into opening their own facilities.
Their biggest barrier, according to proponents of the sites, is a Harper-era piece of legislation, known as Bill C-2. The bill, a series of amendments to the Controlled Drugs and Substances Act, placed new barriers in the way of those wishing to open supervised injection services, including mandatory consultation with various groups such as police forces, municipal and provincial governments, as well as requiring detailed reports on everything from infectious disease rates to potential for litter.
Carrie said C-2 doesn’t stop safe injection sites, it just makes sure the surrounding community is properly informed about them.
The application for supervised injection services at Sandy Hill Community Health Centre where Boyd works has been in the works for four years. He said some of the requirements of the application just don’t make sense.
“There is no threshold for the number of overdoses required to open a site or rates of HIV in the community. Essentially you need to have people who inject drugs in your community to justify operating a supervised injection site – that should be it. We shouldn’t have to undertake the types of research studies we’ve had to undertake,” he said.
Boyd attended the conference and said despite hearing “all the right things” during the meeting, the joint action statement that it produced was disappointing.
“Every possible thing that I would have wanted to say was said by someone at that conference,” said Boyd. “But none of that came to fruition the next day in the summit.”
He chalks it up to the announcements that came out of the conference being pre-decided ahead of time. However he remains optimistic about the government’s intentions.
“I think what we need to do as civil society is to hold the decision makers accountable for what they heard on the Friday before the summit. We need to keep pressing, and Minister Philpott encouraged us to keep pushing,” he said.
Philpott promised that there are legislative changes coming to “turn the tide” on the opioid crisis at the conclusion of the summit, and hinted that they may involve Bill C-2.
“In the coming months, there are a number of pieces of legislation that are going to address matters related to the opioid crisis and certainly we will do the work necessary,” she said.
Leblanc is skeptical. “This conference just makes me wonder how liberal this Liberal government really is,” he said.
But for Leblanc and others change can’t come soon enough. He’s lost his partner, his best friend and countless others to opioid abuse.
“I’m just tired of going to funerals all the time.”
Health Canada plans to issue an update on its opioid action plan by February 2017.