Fentanyl crisis must be met with better drug policy in Manitoba, researcher says

The increasing number of fentanyl-related deaths in Manitoba must be met with a response that uses research and evidence to produce life-saving results, Ellen Smirl writes.

Simply controlling supply or criminalizing drug users doesn’t address complex causes of multifaceted problem

Even the smallest amount of fentanyl and carfentanil can be fatal, Winnipeg firefighter-paramedics say. (UFFW)

The increasing number of fentanyl-related deaths in Manitoba must be met with a response that uses research and evidence to produce life-saving results.

Policies that focus solely on controlling supply or criminalizing drug users doesn't address the complex causes of addictions. People with addictions need both harm reduction and treatment to address the multifaceted problem. 

Federal Health Minister Jane Philpott committed to an evidence-based health care approach at a November government summit about the opioid crisis in Canada.

This is promising; the previous Conservative government had a history of rooting drug policy primarily in criminalizing drugs and drug users rather than investing in treatment or bolstering harm reduction.

In 2015, the Stephen Harper government passed the Respect for Communities Act, which made it much more difficult to open safe-injection sites, demonstrating the incredible gap that can occur between evidence and public policy.

Focusing too heavily on drug law enforcement at the expense of public health and regulatory approaches has been associated with an increase in violence and homicide.

Effective drug policy must support individuals and their families to address the underlying risk factors of addiction, such as the distress that drives the individual to use in the first place.

Much of the responsibility for implementing programming lies in the hands of the provinces. Addiction supports in the province remain insufficient and disconcertingly, Manitoba Health Minister Kelvin Goertzen is not increasing resources for addictions services to deal with the crisis.

Federal Health Minister Jane Philpott says legislative changes are coming within the next few months to help address this country's deadly opioid crisis. (Christopher Katsarov/Canadian Press)

From hospitals to the streets

The issue of opiate misuse first grabbed the attention of the public in the early 2000s, when OxyContin became a household name. Until the mid-90s, prescription opioids were largely reserved for debilitating illness or end-of-life care.

But in 1996, Health Canada approved Purdue Pharmaceutical's OxyContin, which could deliver pain relief over many hours. Doctors began prescribing it for everything from backaches to fibromyalgia. OxyContin was billed as a revolutionary new way to treat chronic pain. 

The drug quickly became a favourite of those hooked on opiates, who could get it legally if it was prescribed or easily on the street if it was not.

It is also easy to abuse. Crushing the tablets allows users to snort or inject the drug, resulting in a more immediate high.

In response to increasing reports of abuse of the drug, OxyContin was pulled from the market in 2012 and replaced with OxyNeo, a patented formula that prevents those abusing the drug from snorting or injecting the pills.

It was an attempt to address what was already becoming clear: Canada had an opiate problem.

Unfortunately, discontinuing OxyContin and replacing it with a drug that was considered less prone to abuse failed to address the underlying problem of addictions. 

Today, fentanyl fills the void left by the tighter regulation and reformulation of OxyContin. A synthetic opioid 100 times more powerful than heroin, far too many people have become addicted to this deadly drug, and many have died.

While some have knowingly switched to using fentanyl, many are unaware they are taking it. This deadly drug has even been laced into non-opiates such as cocaine and methamphetamine.

Opioids include prescription painkillers such as oxycodone, fentanyl and morphine, as well as illegal street drugs like heroin. (Toby Talbot/Associated Press)

Criminalizing opioids won't beat addiction

It is increasingly evident that criminalizing opioids doesn't reduce drug addiction. Since the 1960s, the U.S. has spent an estimated $2.5 trillion on "War on Drug" strategies, with the results having the opposite effect of what was intended: drug prices have actually declined while purity has risen.

Further, there is a racializing component to this approach: In the U.S., one in nine African American men aged 25-29 are incarcerated primarily as a result of drug law violations, even though ethnic minorities use drugs at the same rate as other U.S. populations.

While much rhetoric about drug use claims that controlling the access to drugs is the most important approach, research on opioid dependence suggests the reasons why people become addicted are complicated. Treatment options need to reflect these complexities.

Further, fentanyl is such a deadly addiction that people are dying while waiting to get into treatment. The number of treatment beds and community addictions supports needs to be increased. 

In the last two years, the number of deaths in Manitoba related to fentanyl has nearly doubled. Many suspect this is a vast underestimation. The government of Manitoba recently convened a task force to examine this epidemic with recommendations expected in early 2017.

As we saw with the removal of OxyContin, simply trying to control the supply without increasing treatment options holds the potential to make matters worse. Simply removing one drug, as was done with OxyContin, is not an effective solution.

Instead, we need a public health strategy that helps people with addictions address the multiple risk factors that can lead to drug misuse. 

Government needs to learn from past policy missteps. It remains paramount that any policies that emerge from the fentanyl task force be rooted in evidence-based research, bolster harm reduction efforts and, most importantly, invest in treatment options for those who struggle with addictions. 

Ellen Smirl is a research affiliate with the Canadian Centre for Policy Alternatives Manitoba.