Canada’s response to the opioid crisis has been fragmented and marginally effective at best. We deserve a better approach, and the answers are out there. Other countries are effectively dealing with the issue and Canada should be more open to learning from them. There are several key steps we can take to ensure Canadians with addiction can lead healthier, happier and more productive lives.
First, we need to recognize this is actually a crisis. Do you remember SARS and how it impacted every Canadian with a focused response from our public health teams? Forty-four Canadians died from SARS. How about AIDS at its peak in 1995? We all were aware of the crisis and as Canadians we worked together diligently to help. That year about 1,400 people died from AIDS. Compare this to over 2,400 Canadians dying from opioid overdoses in 2016 and the number likely to double in 2017.
Why are we not treating this as a crisis? Is the life of an opioid addict worth less? Our governments have taken some steps to recognize the seriousness of the issue but we have a long way to go. In the meantime, thousands more of your neighbours, co-workers and family members will die.
Second, we need to accept that addiction is a chronic disease, not a moral failure. Diabetes is also a chronic disease, often brought on by poor choices of diet and lack of exercise as well as genetics. We provide diabetics with the right health care services and education to effectively treat this chronic disease, and we have programs to prevent or postpone the onset of diabetes.
Why is addiction treated differently? Ten per cent of our population has an addictive tendency, 1 per cent of which will become seriously addicted to drugs or alcohol. The good news is that by recognizing that addiction is a chronic disease, we can effectively treat the vast majority of addicts.
Third, we need a concerted and unified effort to effectively treat addicts with a long-term goal of abstinence. We must recognize that to affect change, we need to engage addicts to accept their chronic disease and make the right lifestyle and social choices to live drug or alcohol free. It can be done and abstinence is a very achievable and worthwhile goal.
Our experience suggests that well over 90 per cent of addicts can be abstinent over time, with a mix of outpatient psychological interventions such as cognitive behavioural therapy and in-patient treatment. There are multiple Canadian-made digital tools such as Wagon (www.onthewagon.ca) to help these addicts stay abstinent.
Safe injection sites are an admirable effort, but they do not address the longer term addiction issues. Notably, countries such as Portugal (held up as a world leader in addiction treatment) do not use supervised injection sites, as they prefer to deal with the core issues of addiction. Portugal seamlessly balances harm reduction and abstinence to achieve wellness for all patients and as a result has one of the lowest societal costs of addiction in the world.
Fourth, we need to understand the root cause of the crisis. The recent spike in deaths is widely attributed to the increased availability of fentanyl, which is up to 100 times more potent than heroin and is increasingly mixed with a variety of street drugs. We have programs underway to deal with the importers and distributors of this deadly compound, but that is not enough.
Most health care experts agree that the root cause of most opioid addiction is over-prescription of pain management drugs. For example, in June one of the authors had a cycling accident and suffered a fractured pelvis. He was in some pain but thought it manageable. Without even asking, the attending emergency room physician prescribed a highly addictive opioid.
Think about this happening tens of thousands of times each day, knowing that 10 per cent of us have the tendency to become addicts. Unnecessary exposure to these opioids can lead to addiction and the seeking of higher and higher ‘highs’, ultimately leading to heroin and fentanyl.
To break this cycle is simple — we enforce strict prescription guidelines for any opioid. There is at least one Canadian company that has developed clinical decision support software that can prevent improper prescribing of opioids.
Canada has a terrific health care system and our political leaders all want to do the right thing. With focus on the right areas, we can prevent thousands of deaths.
Isn’t it worth the effort?
https://www.thestar.com/opinion/commentary/2017/11/07/how-canada-can-properly-deal-with-the-opioid-crisis.html November 7, 2017