Sunday May 21, 2017

Why I'm glad Canada has high rates of opioid use

Dawn Rae Downton says that opioids do a lot of good for people who are in pain.

Dawn Rae Downton says that opioids do a lot of good for people who are in pain. (Elizabeth Chiu/CBC)

Listen 3:50

Across this country, opioid related deaths have been called a crisis, an epidemic and a public health emergency.

And typically somewhere in the media coverage you will read that Canadians are the second highest users of opioids per capita in the world.

But in this essay, Halifax writer Dawn Rae Downton says we need to be careful about how we use that statistic.


I'm looking at two maps.  

They're maps of the world, and they're identical, except for the way the countries are coloured in.  

In the first map, for instance, Canada is coloured red.  In the second map, Canada is green.

The first map is from a United Nations program that tracks opioid use throughout the world.  

This is the map where Canada is red.  

When I look at the UN's colour key, I find that red means we use lots of opioids here, street opioids and therapeutic opioids alike.  

Per capita, our opioid use is second highest in the world.  

The other map, where Canada is green, is from the World Health Organization, the WHO.  

This map tracks who's got the best palliative care in the world.

Green means best.  Canada is among the best.

What you notice from these maps is that, invariably, countries using lots of opioids have advanced palliative care.  

But isn't the media always telling us that opioids are a bad thing?

What you realize from these maps is that the media's wrong.  

Our reliance on opioids is a good thing.

The maps tell me that if I'm fated to die a long, painful death, I want to do it in Canada.

I don't want to die or even hurt in Turkey.  Not Finland either.  

For sure I don't want to be in pain in Russia.  These countries aren't red on the UN's map, and they're not green on the WHO's.  

Opioids are scarce in these places, and so is advanced palliative care.

That's the correlation: not many opioids, not-so-good pain care.  

So in Canada I can die in a little comfort, exactly because we use opioids.   

Here's why I care.  Twenty years ago I lost my closest friend to a brutal cancer.  

She spent her last days shuttling between hospital and home.  

Eventually she chose hospital, a place she hated.  

But only there could she get what she called "drift drugs" opioids that would settle her pain and her dread.

No opioids at home back then and no physician-assisted death either, not then.

It was losses all round, and it was a terrible thing to behold.  

Now, fast forward.  

A couple years ago my sister and my mother died unexpectedly, within six weeks of each other, around Christmastime.

It was another terrible thing to behold except that by then, we'd gone red on the UN's map and green on the WHO's.

By then we had good palliative care, some of the best in the world.

I never worried that either of my loved ones was in pain.

Why should you care?  

Because suddenly Ottawa is starting to withhold therapeutic opioids that you have a right to if you hurt.  

That's government's ersatz way of fixing the so-called "opioid crisis."

But death comes to our addicts courtesy of Chinese smugglers.  

Only rarely do legal, palliative painkillers get to our streets.  

Yet sick people are punished all the same, for a policing failure and a policy failure.

Don't buy into the opioid myth.  Keep your eye on the maps.  Let's stay red, and let's keep going green.


Dawn Rae Downton is a Halifax based writer.