Written by: Nancy La, SFU Student
As vaccinations become available for Vancouver, the grim battle against COVID-19 begins to look more hopeful. The days of self-isolation now have a clearer finish line, and normalcy is coming closer and closer. Yet in Vancouver, a part of the normalcy we all wish for contains in itself another health crisis — one that faded from the limelight when cases of COVID-19 surged in B.C.
Lurking in the background of the pandemic is the overdose crisis that was declared a health crisis by the government in 2016, five years before the pandemic made its way into Canada.
My interview with BC’s Health Minister gave insight into the complexity of addiction, along with government actions during the pandemic in response to the overdose crisis during the pandemic.
Additionally, Burnaby’s Overdose Crisis Zoom Town Hall with BC NDP MLAs (and other advocates) in the Burnaby areas provided an even greater understanding of the overdose crisis.
In an attempt to stave off feelings of helplessness, I joined SUCCESS’ Youth Leadership Millenium (YLM) program where workshops on self-improvement and career development take place once every week on Zoom. An important part of YLM is giving back to the community and in order to successfully graduate from the program, members must take part in a capstone project called Community Leadership Initiative (CLI).
A question often asked in our brainstorming groups was “What is one thing that your community is struggling with?” My group identified the overdose crisis as an issue that not only affects the Downtown Eastside (DTES), but also has a ripple effect across communities both urban and suburban. My group then launched an educational platform on social media to spread awareness about the crisis and to reduce the social stigma on addiction.
As a part of the project, we interviewed BC Health Minister Adrain Dix for more details on how the crisis came to be, the actions taken by the government, and the effects of COVID-19 on the crisis, along with the steps taken in response to those effects.
To better understand the overdose crisis as it is today, we need to understand how it all started. The issue began in the early 2000s in Canada with the increase of prescriptions for medical grade opioids for patients whose pain level did not require such a high level of a painkiller (i.e. taking OxyContin for non-chronic pain, such as headaches or post-surgery pain management).
This excess of prescriptions led to a large population of Canadians becoming increasingly opioid reliant. In fact, the BC government recently (along with many other governments) sued pharmaceutical companies for their misleading marketing to doctors and their roles in starting the overdose crisis in North America. The government soon realized that opioids were becoming a health concern and started to cut off the medical (and legal) supply of opioids, but the damage had already been done by that time.
During the City of Burnaby’s Overdose Crisis Zoom Town Hall, Janet Routledge, Burnaby North MLA, shared some personal connections she had with the overdose crisis.
“In thinking about the men that I know in my life [ . . . ] the vast majority of opioid deaths are men who are alone in their homes, who suffered from chronic pain, either from sports or work injuries or botched surgeries.”
The medical supply of opioids was dwindling, yet the number of people who were reliant on opioids was growing, causing a sharp increase in demand in the market for illicit synthetic opioids such as fentanyl and its analogues. Considering that fentanyl is much deadlier than conventional opioids, the health crisis was only going to get worse.
With over 1716 deaths related to illicit drugs in 2020 — a 76% increase from 2019’s 984 deaths — BC has yet to control the overdose crisis.
During the interview, we raised questions about the nature of how BC is coping with the effects of the crisis. Dix responded by commenting on the complex nature of addiction, along with some other barriers the government faces when dealing with the crisis.
“The cumulative effect [of the overdose crisis] on people, the trauma of addiction, and people requiring long term care [after surviving], are all elements of the overdose crisis” said Dix. “At its core, the issue of addiction — which is linked to other issues in society — is one of chronic disease. The overdose crisis, and addiction issues, in many respects, [are] a lifetime issue.”
Dix also commented on one of the most challenging aspects of the overdose crisis saying, “We can get better, but it requires support for long periods of time, and can sometimes get expensive.”
Rehabilitation is amongst the most difficult aspects of the overdose crisis as long term care requires massive amounts of investments — both in time and money — from the federal and provincial government. Throughout the hour-long interview, Dix drew parallels between his diabetic diagnosis to help us understand how, for chronic illnesses such as addiction, mental health problems, and diabetes, recovery is the goal instead of a cure.
With an understanding that addiction (and the overdose crisis) is a complex problem with many social determinants, Dix explained strategies the provincial government is implementing.
These strategies include “significant investments in housing,” as housing spaces during the pandemic (such as hotels) are not a long term solution because they “group people who are dealing with the same issues in the same space.” He added, “there are two temporary modular housing projects in my riding for those who are struggling with addiction [which] provide hundreds of bed spaces for the homeless.”
Regarding the community acceptance of these projects, Dix said,“A lot of people want housing for people suffering from addiction and mental health issues to be self-contained [ . . . ] but to be successful, it has to be integrated into the neighbourhood.”
The City of Vancouver also recently purchased the Days Inn Motel to provide 65 housing units for homeless people, including wraparound services and other support. They anticipate people moving in this November before the worst of winter arrives.
However, it does not end with just housing support.
“If people are dealing with genuine addiction issues and are unbelievably vulnerable, you have to have support and care that isn’t just housing. That’s why we have primary care networks to provide those services,” said Dix.
Primary care networks are health service centres spanning across the province that provide team-based health care for the community that it is located in. The networks currently include Burnaby, Fraser Northwest, Ridge-Meadows, Prince George, Comox, South Okanagan-Similkameen, Kootenay-Boundary, Vancouver, Richmond, and South Island.
“It’s not just doctors,” Dix explained regarding the team-based approach needed to address mental health and addiction issues. “You also need people who are professionals in addiction and mental health, nurse practitioners, nurses, health science professionals, social workers, the whole team in the community to provide help.”
COVID-19 and the Overdose Crisis
One of the most devastating aspects about the COVID-19 pandemic is its effect on health care systems worldwide, such as with surgeries being delayed. This brings up one of the main points of my interview with Dix: how did the pandemic affect the ongoing overdose crisis?
“We’re in two public health emergencies. The steps taken to deal with COVID-19 involves some form of social isolation, and that has been catastrophic for the overdose crisis. We were making progress [with the overdose crisis] back in February 2019, and then the COVID-19 crisis hit, and then we got one of the highest numbers of overdose deaths in May and June. This is not an ‘either or’ question, but an ‘and’ situation, where we have to deal with COVID-19 and the overdose crisis.”
Dix also elaborated on how social isolation, a crucial aspect of COVID-19 prevention, is a deadly thing when it comes to the overdose crisis.
“You have people in isolation, people can’t get access to care, and [are] also using alone more — the most dangerous thing you can do — and the drug supply [is] becoming increasingly toxic. The consequences have been serious.”
Along with challenges, however, come solutions. Dix pointed out some of the strategies the provincial government has put into action since March to mitigate the effects of COVID-19 on the overdose crisis. These include “access to prescription alternatives like hydromorphone” and “changes to allow nurse practitioners under specific circumstances to prescribe alternatives to illicit drugs.”
On the topic of prescription substitutes, Mae Burrows, advocate for worker’s rights and mental health and addiction reform, elaborated on what should be included in the safe supply for people who use drugs.
“The black market is far more deadly than any of these drugs could ever be [ . . . ] we can eliminate a lot of those social ills with a safe supply. We also need to include the drugs that people need [ . . . ] As of right now, heroin is not on the list, and yet a lot of people need it, especially after all the fentanyl, they cannot manage with the drugs that Pharmacare lists.”
This interview happened in November last year and since then, there have been further actions and news regarding the overdose crisis from the government. Days after the interview with Dix, the city of Vancouver unanimously voted for the motion to seek decriminalization of drug possessions.
If approved by the federal government, Vancouver will become the first city to decriminalize drug possession in Canada. Decriminalization was also a heavily emphasized point of discussion for the Overdose Crisis Town Hall, as panelists called for involvement of federal actions regarding the decriminalization and de-stigmatization for drug users.
As Russell Maynard, former Senior Manager for Vancouver’s Insite, North America’s first supervised injection site, put it, “Our problem is the drug policies that are based on stigma and not science. We cannot address stigma when personal drug use is illegal. They are a huge barrier and a driver of stigma.”
At the time of this article, registered and psychiatric nurses now have authorization from the Ministry of Health to prescribe prescription alternatives to illicit street drugs in an effort to broaden the scope of care for those who need it.
The Path to Recovery
The pandemic is a difficult time for all of us, especially those who are already struggling with addiction and mental health issues. The question now becomes “what can I do to help?”
Well, if you’re an individual who has been self-isolating and following provincial health guidelines, just keep going. The only way to really reduce the effect of COVID-19 on the overdose crisis is to prevent cases from climbing, and we can only do that by staying at home and following health guidelines.
We cannot expect things to go back to normal if we do not work together to get there.