MP, Garnett Genuis writes: Confronting the opioid crisis
In the midst of continuing discussion about COVID-19, it is important that we turn some attention to Canada’s other major public health crisis – the opioid crisis. The opioid crisis has also claimed thousands of Canadian lives. Without effective strategies for managing it, the opioid crisis will lead to a greater level of death and misery over the long term.
To understand what to do about the opioid crisis, we must first understand why we have an opioid crisis. Most people who struggle with opioid dependency started by access prescription opioids. Such opioids are prescribed by doctors to address physical pain, but they also generally cause a person to ‘get high’ and can lead to painful withdrawal for those who try to stop. Opioids have a tolerance-inducing effect, meaning that a person generally needs higher and higher doses in order to maintain the same level of pain-control and ‘high’.
Based on these properties, we can see a common pattern of opioid addiction. A person experiencing pain is prescribed opioids. They seek higher and higher doses to manage that pain, potentially feeding an emerging substance use disorder. Eventually they supplement or replacing prescription opioids with other opioids, as they find themselves on an escalator that they cannot get off.
For some, the solution to the opioid crisis is legalization, removing the stigma associated with opioid use, and so-called “safe supply” policies that see the government liberally supplying opioids to those who would otherwise seek them on the black market. These proposals ignore the properties of opioids and the history of the opioid crisis. Recall that prescription opioids, particularly newer synthetic products like OxyContin, were easy to access and did not have any stigma associated with them until quite recently. These drugs became widespread because of easy access and misleading claims made by their pharmaceutical manufacturers, supposedly designed to ‘lower the stigma’. Easy access and an absence of stigma around dangerous substances are the reasons why we have the opioid crisis in the first place.
American authorities today are aggressively pursuing the companies responsible for causing the opioid crisis. These companies used aggressive and misleading marketing to downplay addictions risks. US states and other bodies are seeking payments in order to hold companies accountable and to help fund treatment. Purdue Pharma, responsible for the over-promotion of OxyContin, has pled guilty to various charges already. McKinsey, the consulting firm that advised Purdue on how to super-charge opioid sales and proposed paying bonuses for overdoses, has paid up as well.
Canada has been way behind holding corporate actors accountable. This might have something to do with the fact that Dominic Barton, the guy who ran McKinsey while it was advising Purdue, is close to Prime Minister Trudeau and was also acting as an economic advisor to the Canadian government, before becoming our ambassador to China.
Holding those responsible for the crisis accountable and using those resources to fund treatment should be a no-brainer. More attention also should be paid to the chemistry of opioid alternatives and opioid addiction recovery. How can medicine better manage pain without the use of opioids? How can we provide people with medicines (such as Suboxone) to treat opioid addiction?
Those facing substance use disorders should be treated with compassion and should always be offered treatment as an alternative to legal sanctions. At the same time, making it easier to access dangerous opioids is not compassionate or helpful. An emphasis on accountability for bad actors and on using research and treatment to scientifically reverse the “up” escalator users face will help us move towards a true solution.