Pubdate: Fri, 20 Oct 2017
Source: Winnipeg Free Press (CN MB)
Copyright: 2017 Winnipeg Free Press
Authors: Gabriela Novotna and Tom McIntosh
Page: A9


ACCORDING to the Canadian Institute for Health Information, the rate
of opioid poisoning hospitalizations has been steadily on the rise,
with approximately 13 Canadians a day hospitalized for an opioid
overdose in 2014-15. What began with the over-prescription of opioids
such as OxyContin, a painkiller previously thought to have a low
potential for addiction, led first to the diversion of legal drugs to
the illegal market, and later to the dramatic expansion of the illegal
production of fentanyl.

As the horror stories of addiction and death have multiplied, it is
now clear that what was once a medical issue is now a population
health crisis.

To date, we have had little success in dealing with this crisis
because we continue to focus on it in terms that fail to understand it
as something other than a problem with illegal drugs. Seizing fentanyl
shipments as they arrive in Canada has done little to interrupt the
supply on the street. Current harm-reduction methods, while moderately
effective, still operate within a framework that places the illegality
of the drug at the centre of our understanding of the issue.

We supply police and other first responders with the opioid antidote
naloxone and ask it be used to keep the addict/offender alive so that
they can, in all likelihood, be processed into the criminal justice
system. Supervised-consumption sites continue to rely on the police to
"turn a blind eye" to those entering or leaving the facility likely in
possession of illegal drugs. The success of both Ottawa and Toronto's
"pop-up" supervised-consumption sites in city parks came entirely from
the willingness of the police to pretend they are not there.

As a first step, this is fine. But it is not a long-term solution.
Situating our harm-reduction activities within a criminal justice
framework puts the focus on those populations already more likely to
interact with the criminal justice system - the poor and racialized
groups (especially Indigenous peoples).

Harm reduction's success requires police to let "criminal activity"
such as possession of narcotics slide in certain areas and at certain
times in order for people not to die.

We need to see addiction first as a health issue, not a criminal issue
- - and, second, as a health issue that primarily preys on those
subpopulations that are already economically or socially

Decades of a "war on drugs" have done nothing to reduce the supply or
the demand for substances that, to some extent, are arbitrarily deemed
illegal. We learned this lesson quickly with the failed prohibitions
of alcohol and, increasingly, we seem to be coming to terms with it
with marijuana. And we know we can "denormalize" harmful substances
because we have done it with tobacco.

In 2001, Portugal decriminalized possession of all drugs in amounts
deemed for personal use. Drug use and addiction (not the same thing)
are a public health issue, it asserted, not a criminal matter. This
freed up resources on the criminal justice side to focus on more
important criminal activity. It also allowed harm reduction methods to
integrate preventative messaging more effectively.

Portugal now averages three overdose deaths per one million people
every year. The European Union average is 17.3 and the U.K. average is
44.6. Canada has had 2,458 opioid-related deaths in the past year.

However squeamish it might make us feel, however much we want to cling
to the notion that "drugs are bad" and people should "just say no," it
is time that we try something new. The criminal justice system is not
the place to deal with addiction. It is a social and economic problem
that requires more than a patchwork of public health interventions and
treatment services based on local advocacy efforts.

With the scale of this opioid crisis reaching the middle class and
young recreational drug users, many are being missed. Naloxone peer
distribution programs aimed at street-entrenched chronic drug users are
unlikely to reach suburban neighbourhoods. Strategies to reduce harms
of drug use without criminalizing it first need to be embedded within
a wider health and social policy reform.

We recognize that this is calling for a major policy shift in how we
discuss addiction. But as the fentanyl deaths continue to claim more
and more lives, we cannot continue to pretend that we are on the path
to solving this problem when every indicator says otherwise. The
evidence is strong. It is our mindset that needs changing.

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Gabriela Novotna and Tom McIntosh are expert advisers with and researchers with the Saskatchewan Population 
Health and Evaluation Research Unit at the University of Regina.
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