Fentanyl can't be fixed by reducing the supply
Expert says fentanyl is just the latest drug to generate ‘a period of chaos and moral panic’
The drug overdose crisis in British Columbia continues to deepen despite the extraordinary response of people living in the affected neighborhoods, community-based organizations, first responders, and health care workers.
To truly fix the problem, we need to recognize that the root of the crisis is our national drug policy that continues to criminalize the most vulnerable in our society and puts people who use drugs at the mercy of an underground and unscrupulous drug manufacturing and distribution system.
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Despite public statements by politicians, community leaders and academics that the "war on drugs" is a complete and utter failure, our day-to-day approach to drug users has remained largely unchanged.
Demonize and marginalize
We demonize and marginalize people who use drugs, fill our jails with non-violent drug offenders, and spend unlimited resources on drug interdiction activities while failing to provide the social supports, housing, and health care for those who are habitual drug users.
There are a myriad of reasons and events that launch people into a life of drug use – trauma, personal tragedy, injuries, sexual abuse, racism, mental illness to name a few.
But one thing is consistent: no one started using drugs to become isolated, stigmatized, destitute and criminalized.
These devastating consequences of drug addiction are directly related to entrenched drug policies and a societal indifference to the pain, suffering and even death of people who buy drugs from the illicit market.
It is far easier to be indifferent and to place blame on the victims if the activities that are killing them are illegal.
The current overdose crisis is based on the demand to self-medicate and the use of opioids and other drugs will continue no matter how high the risk.
The more pressure exerted on reducing the supply of drugs, the worse the problem gets and the more vulnerable people become.
One more drug in long line
The more people that are busted for fentanyl importation and dealing, the more fentanyl and other more potent opioids become available.
The more that physicians reduce opioid prescribing, the more people will turn to the illicit market. These are the simple rules of supply and demand and the introduction of fentanyl into the street-drug market is a direct result of prohibition.
In fact, fentanyl is just another drug in a long line of substances that have generated a period of chaos and moral panic.
If we just acknowledge that people will continue to use drugs — both prescription and non-prescription — a whole new conversation can emerge that supports a range of interventions that will reduce overdose deaths along with the serious harms associated with other drugs.
These generally fall under harm reduction — a supervised and respectful place to inject drugs without fear of arrest, real-time drug testing, low-barrier housing, and community support programs.
All are designed to engage, support, empower and give people hope. When these are in place, other medical interventions will be much more successful including suboxone and methadone substitution treatments, prescription opioid programs, and evidence-based long-term treatment interventions.
New approach needed
The mounting death toll due to drug overdose is beyond tragic. Despite a progressive set of actions taken by the provincial government and an unprecedented response by front-line workers, the response has been greatly hampered by drug policies that view the people who use drugs as criminals and undermine proven harm reduction interventions.
We must acknowledge that drug policies based on criminalization and prohibition are driving the overdose crisis and a new approach is urgently needed that reflects the realities of drug addiction in Canada.
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Mark Tyndall is the executive medical director of the B.C. Centre for Disease Control and the deputy provincial health officer.