The COVID-19 pandemic has vastly consumed our news channels, daily conversations, government policies, and hygiene practices for the past two years. With the pandemic taking up most of our airwaves, little notice has gone to the large epidemic that has affected many: the overdose epidemic. Between January 2020 and July 2021, the overdose epidemic took the lives of 3,000 people in British Columbia, vastly outpacing the 1,800 individuals who died from COVID-19 in the same period (1). Opioids have contributed significantly to this overdose crisis causing the deaths of nearly 23,000 Canadians between January 2016 and March 2021(2). The lives lost to the opioid epidemic have created a leading public health concern and should be addressed with the utmost urgency.
Opioids are pain-relieving substances with compounds extracted from opium poppy seeds that can be taken as prescription medicine or recreationally in non-pharmaceutical forms. Opioids come in various forms, including codeine, oxycodone (Oxycontin), hydrocodone (Vicodin), fentanyl, morphine, heroin, and tramadol. Alongside its pain-relieving properties, opioids produce a euphoric feeling, a relaxing high that has been described as a “secure and safe hug”. The combination of opioids' pain relief and the euphoric high makes opioids a highly addictive substance.
There has been a considerable increase in the use of prescription opioids for pain relief since the 1980s and, subsequently, the harmful use of opioids, including taking more than prescribed, tampering with the product, or using it to get high or to improve mood. Harmful use of prescription opioids has been linked to increased risk for non-prescriptive opioid use and potential opioid dependence. While the pharmaceutical push for opioid prescription has caused significant dependencies and encouraged harmful use, it should be acknowledged that prescribing of opioids in Canada has declined in recent years. With the rate of prescribing opioids dropping, there has been a noticeable increase in deaths caused by non-pharmaceuticals, with 83% of opioid-related deaths caused by non-pharmaceutical opioid use in 2021 (2).
Many opioid deaths have been linked to the presence of additive fentanyl in drug supplies, commonly referred to as “lacing”. Fentanyl was the most common drug detected in the analysis of drug samples by Health Canada’s Drug Analysis Service in 2020 (3). Fentanyl is a common choice for drug lacing because of its extreme potency (up to 50 times stronger than heroin and 100 times more potent than morphine), making drugs cheaper, more potent, and more addictive. Additionally, powdered fentanyl looks like many other drugs and cannot be detected when mixed with heroin, cocaine, or meth. The lacing of drugs with fentanyl has provoked a wave within the opioid epidemic, now commonly referred to as the “Toxicity Epidemic,” due to its overwhelming presence in the illicit drug market, causing epidemic proportions of drug overdoses and dependencies.
It is essential to acknowledge that while opioids are highly addictive, each individual has a different experience with opioids that are influenced by many factors. Some groups of individuals may be more likely to experience more adverse outcomes due to opioid use than others. For instance, opioid-related deaths seem to impact individuals between the ages of 30 and 39 years more than any other age group (2). Additionally, males are more likely to experience opioid-related deaths in Canada than females (2). Although, sex and gender differences are not the same among all demographics in all regions. For instance, among First Nations people in Alberta, males and females were almost equally impacted by opioid-related deaths from 2016 to 2018 (4). Indigenous communities have been disproportionately harmed by opioids, mainly attributable to many systematic factors. This is evident in hospitalizations due to opioid toxicity, where Indigenous-identifying people and Métis and Inuit-identifying individuals were 5.6 and 3.2 times more likely to be hospitalized than non-Indigenous people (5).
It is essential to acknowledge that while many systemic factors contribute to this epidemic, there are ways in which each individual can contribute to the decline in opioid-related deaths. Through harm reduction strategies such as obtaining and carrying a naloxone kit, we can temporarily reverse opioid overdoses. Naloxone can be administered by anyone who encounters an individual suspected of overdosing. Take-home naloxone kits and training are available throughout Canada for free within pharmacies and require no prescription. Additionally, the stigmatization of addiction and opioid dependence is the most significant barrier to individuals seeking and receiving proper treatment and care. By acknowledging the impact of our language and actions on others, we can actively change the real-life consequences we have on others. Changing the words we use to describe and converse about addiction is one simple way of reducing stigma.
Image by HitaJast from PixaBay
Blog by Tanisse Epp
References
1. BCCSU. Opioid deaths in B.C. far outpaced those from COVID-19 [Internet]. Opioid deaths in B.C. far outpaced those from COVID-19. 2021 [cited 2022 Nov 4]. Available from: https://www.bccsu.ca/blog/news/opioid-deaths-in-b-c-far-outpaced-those-from-covid-19/
2. Government of Canada. Opioid- and Stimulant-related Harms in Canada [Internet]. 2022 [cited 2022 Nov 7]. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
3. Government of Canada. Drug analysis Service: Summary report of samples analyzed in 2020 [Internet]. 2021 [cited 2022 Nov 7]. Available from: https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/drug-analysis-service/2020-drug-analysis-service-summary-report-samples-analysed.html
4. Government of Alberta. Alberta opioid response surveillance report : First Nations People in Alberta [2019] - Open Government [Internet]. 2019 [cited 2022 Nov 7]. Available from: https://open.alberta.ca/publications/alberta-opioid-response-surveillance-report-first-nations-people-2019
5. Carrière G. Social and economic characteristics of those experiencing hospitalizations due to opioid poisonings. Health Reports. 2018;29(82):9.