Every few months or so, there is a news report about the number of deaths caused by opioid overdose. Opioids have been in our society for hundreds of years, stemming from opium which was derived from the poppy plant. The common forms of these drugs- such as morphine, codeine, oxycodone and fentanyl- are strong pain killers that have addictive properties due to their ability to create a euphoric state of mind.
Opioid use started to go up in the mid to late 90s, when doctors started to prescribe the drugs for non-cancerous pain. The medical professionals were misinformed of the addictive properties of these drugs and prescription opioids were given out liberally. The United States started to see a rise in opioid misuse by the early 2000s, with Canada following suit not too long after. As death rates due to overdoses started to rise, media attention grew but with little to no help from the government.
The statistics about opioid use can be overwhelming, and though there is a lot of good work being done to calm the crisis, health officials are still struggling to keep up with the rising numbers. In order to get a clear understanding of the opioid crisis in Canada, we must examine how we got here, the current state of the crisis and what the government is doing to help.
A Brief History of Opioids
Opioids are some of the oldest drugs in existence. There is evidence of their use going back thousands of years: the medicinal properties of the poppy plant were known as far back as the 4th Century B.C. The Sumerians and Egyptians both wrote about the plant as being soothing. It was described as “The Plant of Joy”. Both the ancient Greeks and Romans knew of its ability to reduce pain, and it was eventually brought into western medicine by way of a drug called Laudanum. Laudanum was a mixture of alcohol and opium which was widely used by doctors to treat pain all the way up until the 20th Century. It was used to treat soldiers in the American Civil War, and it was prescribed to women for relief from menstrual pain and hysteria. Opium was so popular that trade of the plant became a major commodity, vital to the British economy. The British economy was so tied to the sale of opium that war broke out with China on two separate occasions when the Chinese government tried to ban the drug.
In the 19th Century, both morphine and codeine were developed by scientists, and were widely prescribed for the treatment of coughs and diarrhea. Neither drug was thought to be addictive so prescriptions were plentiful, and research began in creating synthetic forms of the drug. Heroin was created in the mid 1800s and was eventually produced by Bayer (the same company that now sells over-the-counter pain medicine) to treat pain as well as persistent cough due to tuberculosis, bronchitis and asthma.
Unlike morphine and codeine, however, heroin was considered highly addictive, and production ceased in 1915. For a while opioids fell out of favour with the medical industry as addiction became a prevalent concern, but laws around the drugs began to loosen in the 1960s and 70s. By the 1980s, opioids were back in full swing, as it was thought that people with chronic pain would not become addicted. The use of opioids grew rapidly and when oxycodone was released in 1996, it was aggressively marketed as an effective pain reliever for non-cancer pain. At this time, it was thought that opioids were safe for people to use if their pain stemmed from non-cancer related issues, and doctors were prescribing opioid medications liberally.
As time went on, however, society started to realize that these drugs were addictive, and restraints were added to the ability to prescribe them. This shift caused a rise in heroin use, and as that began to be seen as a problem, fentanyl was produced as a way of replacing the illegal drug. We now know the dangers of fentanyl, but by the time it was on the market, the opioid crisis had already begun.
Statistics About Opioid Use in Canada
To really understand why opioid use in Canada can be considered a crisis, a look at the statistics surrounding it is needed.
The following are some of the findings put out in June 2019 by Public Health Canada:
- More than 11,500 opioid related deaths happened in Canada between January 2016 through December 2018
- 4460 deaths occurred in 2018 alone; of these deaths, 1525 happened in British Columbia and 1471 happened in Ontario
- Death rates have gone up from 8.4 per population of 100,000 in 2016 to 12.0 per population of 100,000 in 2018
- 70% of the opioid related deaths involved fentanyl or a fentanyl analogue
- Average number of hospitalizations due to opioid overdose in Canada is 16 per day
- 94% of opioid related deaths in 2018 were accidental
These statistics are staggering, as they indicate that the death rate due to opioid overdose is still on the rise. The crisis has various implications ranging from the toll on the heath care system to the overall affect on society. By examining an addict’s story, we can better understand how these numbers relate to actual lives.
Jessica, a middle-class working mother of two, was prescribed codeine and then oxycodone after her abdominal surgery in 2011. Her doctors encouraged her to stay ahead of the pain and to take the medication whenever needed, even before she felt it starting to wear off. Jessica reports that she was on codeine and then oxycodone for about six months, and that getting a refill was not particularly difficult. After surgery, she developed an infection which needed antibiotics, and with that prescription came more codeine. Not too long after that, she developed a cough, which they treated with codeine syrup. She knew the “right language” to use with the doctors in order to get her prescriptions refilled, saying that she could easily pick an excuse and the doctors would refill her prescription right away.
“I would say that I only wanted the refill just in case I needed it or that I lost some pills on a trip,” she says.
She describes the prescriptions as being “generous” and says that they were so large that the pharmacy wouldn’t have enough medication in stock and would often split the prescription in two. This would allow Jessica to have more time between renewals and she became increasingly casual with use, often mixing them with wine. After six months of use, she was given a prescription for Benzodiazepine (also known as Valium), as a way of stopping her pain medication.
At first, Jessica simply used them to decrease the number of opioids she was consuming each day. She describes taking a number of different combinations in order to get the desired effect: “Pain pills and wine, then when that started to wear off, benzos and wine.” As long as she could “numb out”, it didn’t really matter what pills she used.
Eventually, Jessica’s addiction was transferred to Benzodiazepine completely, but this is not the case for all addicts. In total, Jessica took either opioids, benzos or a combination of the two, for five years. She was a lucky one though, as she was able to get the professional help needed and has been in sobriety for over three years now.
What is being done?
Due to the increasing numbers of deaths, both Canada and the United States have changed their policies around the prescription of these medications and doctors are less likely to recommend the prolonged use of opioids. When dealing with pain, doctors now tell patients to wait to use the drugs until they are really needed, and they recommend lower strength painkillers such as Acetaminophen and Ibuprofen more often.
Getting a renewal for prescriptions is also more difficult as doctors now understand the risks of addiction. This has caused another issue in the crisis, however, and that is the illegal trade of legal drugs. In other words, patients are selling their left-over prescriptions or not disposing of them properly, which allows for others to obtain the drugs for recreational use.
To combat this phenomenon, both the United States and Canada have created media campaigns to inform the risk taken when prescription drugs are not disposed of properly. By bringing leftover medications to the pharmacy to be disposed of, people can make sure these drugs do not find their way to the black market which reduces the access people have to these highly addictive drugs.
The government of Canada has also adopted a system for safe injection sites, where addicts can use drugs such as heroin without being prosecuted by the law. The idea behind this system is that if an addict can take their drugs while being supervised, there is less risk of overdose. The sites are also able to test the drugs being taken, so that trace amounts of fentanyl (which can be lethal) are not mixed in, as well as provide clean needles so that there is less risk of infection from HIV, Hepatitis C and other infections that can be passed through shared needles. The main goal of the sites is to prevent overdose, but also to help reduce the impact of drug overdoses on Emergency Services.
Unfortunately, these sites are under public scrutiny, as many people do not think that they are a good way for governments to spend their money. People worry about the gathering of addicts in one area, and protests against these sites have sprung up in communities throughout the country.
Also, legalization and funding for safe injection sites is a provincial matter, and not all provinces have implemented them. So far only British Columbia, Alberta, Saskatchewan, Ontario and Quebec have legal injection sites, which means a large portion of Canada does not have this life saving system in place.
Advocates for those suffering from addiction also speak of the importance of decreased stigmatization of those addicted to opioids and drugs in general. There is a general perception of drug addicts as being the lowest of the low in our society, often depicted as being uneducated, unemployed and homeless.
Drug addiction does not discriminate, however, and as we saw in Jessica’s story, it can hit stable functioning adults too. The shame associated with being addicted to drugs makes it harder for people to seek help and the problem of addiction is often swept under the rug. As a society, there needs to be more compassion when talking about drug abuse and addiction issues, so that those who need help can get it without worrying about what others might think.
Since opioids are legal, people can become addicted to them without others noticing, since the type of medication people take is never really discussed in public. This can make the addiction rate harder to pin down, as people are able to function in their everyday lives while still relying on the calming effects of opioids. By bringing light to these issues, we can begin to battle the opioid crisis going on in our own backyards.
The opioid crisis in Canada is far from over and there is a lot of work that needs to be done in order to stop the number of deaths from continuing to rise. Educating the public about the crisis seems to be a big component of how we might be able to curtail the issue.
That being said, how can society be expected to stop an issue that has actually been going on for hundreds of years? There is no easy answer to this question, but the efforts of both the American and Canadian governments have at least begun to address the issue.
The most important thing to know when looking at opioid use in Canada is that recovery is possible. The crisis will not be solved overnight, but by supporting recovery programs and educating the public about the risks of addiction, we might be able to help the problem.
Photo credit: Ajay Suresh. This picture has a Creative Commons attribution license.