Too many people are dying. Plenty others are sick.
The root question is how to fix the deadly opioid problem.
The issue is multi-layered and complicated, by all accounts, but some believe the answer is a combination of approaches from around the world and tailoring what could work for Canada.
Easy to say, tougher to implement.
When local MP Alex Nuttall publicized his stance on the opioid crisis in late November, it seemed to start a bigger conversation.
Some observers were stunned that the Conservative politician endorsed the model being used in Portugal to deal with drugs, even though he remained resolutely opposed to a safe injection/consumption site in downtown Barrie, which has one of the worst drug problems in the province.
Possession and consumption of illicit substances was decriminalized in the oceanside nation almost 20 years ago. People found with such substances would instead find themselves before a Dissuasion Commission tribunal, which includes legal and medical professionals as well as a social worker to steer the person toward treatment, if needed. Or there could be a fine or simply a warning. Jail is another option.
And it worked.
Matt Turner, harm reduction co-ordinator at the Gilbert Centre, which is the lead agency applying to the province for a safe injection/consumption site here in the city, said he was surprised Nuttall pushed the Portuguese blueprint.
“It’s a proven model that we need to emulate and adapt,” Turner told BarrieToday. “We need both: we can’t force people to accept treatment and (we need to) recognize folks are dying from a toxic drug supply."
Turner says supervised consumption sites reduce overdose mortality and "provide another entry to treatment that wouldn’t happen on its own."
After Nuttall visited safe injection sites in Vancouver (which he says “failed to address the source of the problem”) and Toronto, the Barrie-Springwater-Oro-Medonte MP says he’s convinced that approach doesn’t work. He says the sites exhaust emergency services on Naloxone calls and flood hospital emergency departments.
“Barrie is not unique, although it is above average,” he said. “What we’re seeing is this seeping into mid-sized and smaller municipalities and it’s affecting people across this country, spreading from west to east.”
Keenan Aylwin, who was recently elected as the city councillor for downtown Barrie, says the focus needs to be on reducing the number of overdose deaths in the city.
“This is unacceptable and that needs to be the focus of this conversation,” he said. “The reality is that someone who is dead cannot seek treatment. It is not a question of saving lives through harm reduction or more treatment services. We need both."
Recently elected Ward 6 councillor Natalie Harris, a retired paramedic and recovering addict herself, says she was surprised to hear Nuttall endorse the more left-leaning Portuguese model, while also being staunchly against injection sites.
“Saying that safe injection sites ‘don’t work’ is a vague statement to me,” she said.
Nuttall again points to Portugal, where the European nation focuses on prevention and education. Almost two decades ago, Portugal was facing an opioid problem similar to what Canada is experiencing today.
“It is Portugal that seems to have the answers, radical as they may be, to the questions Canadians are asking,” Nuttall said.
In 1998, Portugal’s government commissioned a panel of doctors, sociologists, psychologists, lawyer and social activists to find a solution. They responded by focusing on prevention and education, harm reduction and more treatment services, while also highlighting a person’s right to treatment “as an absolute priority.”
A person can be sent to a government-run treatment centre, which could be up to two weeks of detoxification and counselling, followed by their return to society. However, a lack of housing for people coming out of treatment has been an issue; there are government-owned apartments where people can stay for six months to a year.
To implement a similar system, Nuttall says funding should shift from what he refers to as “illegal-drug injection sites” and into a “treatment-focused approach.” He says this would address homelessness, mental health, pain management and addiction.
Nuttall believes that kind of system could work here, too. From a financial perspective, he says money could be redirected away from foreign aid to help address the opioid problem here at home.
“If you want to fund this crisis, there is more than enough dollars that are spent ineffectively and inefficiently around the world to be able to spend them right here at home, and change the lives of individuals who need it,” said the MP, who also wants his colleagues in the House of Commons to have a national discussion on opioid-related issues in their home ridings.
Aylwin said the federal government should "step up to the plate, declare a public health emergency and increase funding for evidence-based addictions treatment.
"I’m glad that MP Nuttall has raised this at the federal level,” Aylwin added. “All levels of government need to work together to tackle the addictions crisis and there is no easy fix.”
Nuttall says the federal government isn’t doing enough and has no co-ordinated approach.
“The only thing that I’ve seen so far from the government of Canada is an advertisement saying that there’s an opioid crisis,” he said. “That’s not good enough. We need to be on the ground in front of real people ... to prevent (them from) going down the wrong road in the beginning.”
Nuttall said he doesn’t expect the city to have to deal with the problem head-on. It should be a provincial matter, as a health-related issue, with help from the feds.
“If (the Liberals) want to lead this nation and lead this country, they need to do just that," he said. "Get everybody to the table, come up with a plan, come up with a funding formula and move forward. I don’t want this to become partisan and I’m not going to go after the Liberals, but certainly the government needs to do better."
Aylwin says it’s time to reset the conversation.
“We need to bring the temperature of the conversation down,” said the Ward 2 councillor. “This issue shouldn’t divide us, it should bring us together in a shared commitment to action. We must never lose sight of the fact that we are all fighting to save lives and address this crisis.
“These solutions aren’t partisan, they aren’t left or right,” Aylwin added. “They are either evidence-based or they are not. I believe we need evidence-based solutions to this crisis.”
Both Harris and Aylwin point to the health unit’s Simcoe Muskoka Opioid Strategy (SMOS) as an outline to deal with the local crisis, including prevention, treatment, harm reduction, enforcement and emergency management.
Aylwin says it’s everyone’s responsibility to look at the evidence, listen to experts, “and most importantly, centre the voices of people with lived experience in the conversation.
“Any claim that safe consumption services ‘don’t work’ is not rooted in fact,” Aylwin added. “Peer-reviewed studies have demonstrated that not only do they save lives, they reduce public drug use, they do not increase crime and they facilitate people seeking treatment.
“The facts are not up for debate. It is irresponsible for us to let misinformation go unchecked,” he said. “I am disappointed that this issue is being used to score political points and stoke fear when we should be working together to find concrete solutions.”
Harris said there's no easy answer, but it does require a layered approach.
“The complexity and magnitude of this topic demands a multi-faceted response,” she said, adding the plan needs to be supported "by a foundation of evidence, and lived experience, which I have, in their arsenal on the opioid crisis."
However, a safe injection/consumption site offering a range of medical services, including detox services and transitional housing support, is the first step, Harris said.
Harris also says overdose prevention sites have been proven to save lives by offering necessary health services to some of the most vulnerable and marginalized populations, adding such facilities do not normally assist with prevention, treatment, harm reduction and enforcement as much as supervised consumption sites do.
“Education is key,” she added. “I think it’s important for people to know that there are many different policy approaches to combating this crisis."
A comprehensive strategy that addresses root causes, provides treatment and saves lives is the only path forward, Aylwin says.
“We have a housing and homelessness crisis in Barrie that is intimately linked to the addictions crisis. Providing safe, stable and decent housing gives people a fighting chance to seek help for their addiction and live a life of dignity,” he said.
“We need short-term, life-saving measures to stop the rising number of deaths due to opioid overdose. If we aren’t taking immediate steps to stop our friends, neighbours and family from dying then what are we doing? The Ontario PC government has dedicated funding for harm-reduction measures, which will save lives, and that’s a good start."
