Opinion: New government can take immediate steps to address province’s drug crisis

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Ambulances criss-cross urban areas responding to overdose calls. City morgues are unable to accommodate the number of citizens lost to toxic drugs. A prominent journalist who covers the gangsters in control of the lucrative illicit drug trade is threatened with death.

While this description might sound like a lawless Latin American failed state, this is the current reality in B.C. The province’s new government has an urgent task ahead.

As director of the province’s new B.C. Centre on Substance Use, I’ve been honoured to work with some of the province’s brightest and most dedicated in helping to craft the initial response to the current crisis. I have no doubt the death toll would be much higher if emergency actions undertaken to date had not been implemented, including the widespread distribution of the overdose-reversal drug naloxone alongside a range of other efforts.

However, the death toll continues to rise at an unfathomable pace. Each monthly report on new deaths to overdose makes it abundantly clear: the new government must be willing act in a manner consistent with the scale of the crisis. In this context, there are a number of concrete steps that must be pursued in order to address the structural reasons for the province’s longstanding drug crisis.

First, an addiction treatment system urgently needs to be developed. The absence of an existing system is explained by the longstanding lack of governance and accountability for creating a functioning substance use system of care. Even the most basic elements, such as data on rates of disease and treatment capacity, are largely non-existent. The system has been without functioning governance for so long that even in 2017, in the midst of the crisis, Vancouver Coastal Health provides withdrawal management services in the city’s old animal shelter. Recovery from addiction is possible, but only if a functioning treatment and recovery system is developed.

Second, the province must focus on the toxic drug supply that is the fundamental cause of overdose deaths. While providing naloxone and developing addiction treatment services is critical, the driver of the overdose epidemic is the emergence of toxic synthetic opioids, including fentanyl and related analogues, in the drug supply. Just as alcohol prohibition created the emergence of toxic alcohol in the 1920s, drug prohibition has created the toxic drug market that we have today.

In response, the province needs to immediately implement a provincial drug-testing service to allow consumers to test for and avoid toxic drugs like fentanyl. The intention to create a drug-testing service was included in the July 2016 announcement that outlined the province’s plans for the joint task force on overdose response, yet the service has still not been created.

While technically a required element of building an effective treatment system, another way to address the toxic drug supply is through the rapid expansion of opioid substitution therapies from methadone through to prescription heroin. These treatments have proven to save lives and health care dollars, and provide the added benefit of waging economic war on organized crime by removing consumers from the illicit opioid market.

Third, unlike other areas of health care, the province has failed to fully invest in a provincial system for training health care providers in evidence-based substance use care. This means that we do not have the skilled workforce required to offer effective substance use prevention, treatment and recovery services. As a result, the majority of health care expenditures are on the consequences of untreated addiction, rather than intervening early with cost-effective and lifesaving services.

Lastly, persons with lived experience must be fully engaged in the response to the crisis. Rather than marginalizing those who use drugs and those in recovery, the system should seek to embrace those with the experience and knowledge to be part of the solution. Supporting peer navigators and empowering those affected has been a cornerstone of the successful response to HIV/AIDS, and the province needs to provide adequate resources to those who can help build and extend the reach of the response to the current epidemic.

All British Columbians will benefit from implementing these changes. The U.S. National Institutes of Health estimates that for every $1 spent on addiction treatment, the taxpayers benefit from $12 in savings to the public purse. However, investment is required on the order of hundreds of millions of dollars to create the needed system, which will ultimately reduce the untold public expenditures on avoidable downstream costs.

One provocative proposal, which was suggested during the recent election campaign by family advocacy groups, is to have 100 per cent of revenue from the taxation and regulation of cannabis go to substance use prevention and treatment. I fully support this recommendation and ask that our elected officials agree to this course of action immediately.

Strong leadership has the potential to dramatically improve public health and safety. With the province’s drug problems resembling those of a drug-ravaged failed state, the time for action is now.

Evan Wood is the director of the B.C. Centre on Substance Use and a professor of medicine and Canada Research Chair at the University of B.C.

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