Election 2021: The Opioid Crisis | The Agenda

while all eyes have focused on the covet 19 pandemic over the past year and a half there is another terrible health emergency unfolding the opioids crisis it was bad before it's much worse now with fatal overdoses up 60 percent in ontario joining us now for a closer look we welcome dr mckenzie ceo at the health policy nonprofit the wellesley institute and a professor of psychiatry at the university of toronto and dr hassan sheikh emergency and addictions physician in toronto and assistant professor in family and community medicine at the u of t and it's good to see you too again happy to have you on our program uh let me just start with a bit of a fact file to set the scene for our discussion to come according to the public health agency of canada between january of 2016 and december 2020 more than 21 000 people died from opioids in the year 2020 17 canadians died every day from opioid poisoning or overdose the federal government has not released the numbers for 2021 yet but justin ling the journalist at mclean's magazine has looked at the provincial numbers for this year and here is what he found british columbia reporting that a thousand and eleven people died between january and june of this year that's up 33 over last year saskatchewan reported 221 deaths between january and august that's already two-thirds of last year's total deaths ontario counted 638 deaths between january and march that's 57 percent higher than in the same period last year all right how would you characterize what we are facing in canada at the moment with opioids well we're in a very difficult position we've had a war on drugs but it doesn't seem to have worked with regards to opioids and we i know we've been going through the pandemic and we've been uh worried about uh covid obviously for good reason but in some places uh such as bc more people have died in the last year from opioid addictions and then covet 19. so when we start thinking about it in those terms you can see that we're in a really bad place with regards to opioid deaths hassan sheikh to what extent do you think the pandemic covert 19 pandemic that is has made the opioid situation even worse than it might otherwise have been yeah it has certainly made the already dire situation much worse and you put out some numbers there you know when i talk to my patients it's been a desperate situation for them you know the pandemic has made us all scared more anxious and that's when people who use drugs are at their most vulnerable and in addition we've asked people to actually socially isolate at this time so they've lost whatever you know minimal social supports they had and they're using a loan and that's an extremely dangerous time for people there was a question uh last week in the english language leaders debate that related to the object situation are you come to you first are you satisfied with the amount of attention the opioid crisis has received during the election campaign well as a mental health advocate i'd always like there to be more attention to mental health but i don't want it just to be during the campaign i want to some focus on mental health now and focus on mental health for whoever gets into power afterwards so i i i am always want there to be more talked about but i don't want it just to be in the context of an election i want it to lead to real change i appreciate your position hassan how about for you obviously myriad issues out there that the candidates the leaders have to consider opioids did come up in the debate were you satisfied with that i really have not been satisfied you know the last 18 months have shown us how we need a central plan when it comes to a public health emergency and the opioid crisis is a public health emergency and we don't see the same proper well thought out plan for that all four of the major parties running in the province of ontario do have things to say about the opioid crisis and what they are promising to do and i want to take just a moment now to briefly outline some of what the parties have on offer so sheldon if you would let's bring this graphic up here starting with the liberals the liberals would propose to invest 25 million dollars for public education to reduce the stigma associated with problematic substance use they've got 500 million dollars in their plan for a full range of evidence-based treatment and they'd like to reform the criminal code to repeal relevant mandatory minimum penalties the conservatives the second place party in the last parliament would invest 325 million dollars over the next three years to create a thousand residential drug treatment beds law enforcement should focus on dealers and traffickers say the conservatives and all policies have the reduction of harm and promotion of recovery as their objectives the ndp would immediately declare the overdose crisis a national public health emergency they would purport to create a safe supply of medically regulated alternatives to toxic street drugs and end the criminalization and stigma of drug addiction and the greens declare that the drug poisoning crisis is a national public health emergency they would create a national safe supply of drugs of choice and decriminalize the possession of illicit drugs for personal use let's uh you know what i think maybe the best thing to do here is just with all of that having been said let me get uh kwam to you first year expertise on what you what stands out for you there is being particularly useful or relevant given the challenges afoot i'll just give you a bit of context in how i'm thinking so one of the things that has happened during the pandemic is that we've had a significant change in who is actually dying from opioids and we've got more people who are not in contact with services or who would probably never have been in contact with services and more accidental deaths because of a toxic supply of fentanyl so we've seen the supply of opioids change to make them more dangerous the reason i say that is because if we're thinking about saving lives just increasing treatment will not do the trick because a lot of the people who are dying are not people who would be in contact with services or who believe they need services and a lot of people are dying because of accidents because now the supply of a particular opioid fentanyl is so toxic that very small amounts will kill people so if we want to deal with that we have to do something about toxic supply and safe supply as well as doing something about treatment which means that we need to really really change up what we're doing so when i see and i think the the platform seemed to bifurcate on the one hand we've got the ndp and the greens saying we need to fundamentally change things and then on the other side we have the conservatives and the liberals that seem to be saying in their platforms we need more of the same and my view from the research and from all of the policy work that i've seen is more of the same more treatment and all of the other things that's good but it won't actually solve the problem you need something much more fundamental if you want to really save people's lives okay hassan again i'm not asking you to endorse anybody's platform in particular but what stands out as being particularly useful here yeah i think what really stands out to me is what seems like an artificial distinction between treatment and harm reduction when i think about almost everything i do in medicine it's all harm reduction when i treat someone's diabetes i'm not curing their diabetes i'm reducing the harms of high blood sugar but when it comes to people who use drugs we seem to have made these artificial distinctions where you're either for you know safe supply and decriminalization or you're for kind of recovery and abstinence space treatment and i think that's really dangerous and i'll give you an example of why you know for some of my patients they live in sober housing where you know they can't use substances or they lose their housing we have a housing crisis where if they do relapse they have nowhere to go and so they have to choose between keeping their housing or using in the bathroom of a fast food restaurant alone when they're at highest risk and we make people make these impossible choices as opposed to providing a large spectrum of options reducing the barriers between them and letting people you know get the treatment they need when they need it and where they need it and that's not the fundamental shift that i'm seeing in these platforms okay couple of follow-ups here for you hassan number one we're not ignoring the people's party here but from what we saw in their platform they did not speak to this issue that's why they were not on the list uh of what we just enumerated second thing is you know there was a time hassan in this country when when the conservative party was very much more focused on uh punishment and a sort of a criminal approach to this and they seem in this campaign to have focused much more on uh harm reduction harm reduction and sickness treatment and at least they've been getting a lot of positive notices for that have you noticed that in what they have on offer so i think it's a step in the right direction and i would say it's a tiny step in the right direction in the sense that they are kind of saying globally that they embrace harm reduction but if you look at their actual platform there's a lot of wording around you know living a drug-free life and increasing treatment and when we force that paradigm on people we actually create real harms and so i think what we really need to see is a shift towards an idea of a comprehensive set of treatments and reducing the barriers between them and quen my follow-up for you on this is and i and i ask you this question given that you were the co-chair of health canada's expert task force on substance use where you folks said in your report it is time for a paradigm shift in policy do you see a paradigm shift in any of those four platforms well i'm working on the assumption that some of the people who wrote the platforms had read the expert task force and substance misuses um two reports and if anybody hasn't read them they're sort of a wonderful group of experts who came together i was lucky to be one of a number of people co-chairing and there's some really deep thinking on what needs to be done to improve uh the lives of people who use substances but actually substance use policy in general in canada and that's uh up on the uh health canada website and we really said that um just more treatment and expanding treatment services as uh lots of people have said is a good thing really good thing we just don't think it will solve the problem the problem isn't just more treatment the problem is decreasing the number of people who need treatment and the way you do that is by having better policy and so lots of people have talked about the war on drugs ending up being like a war on the people who use drugs and so you need to decrease the number of people who are ending up in prison for simple possession of drugs and then some people have said well you know people are using toxic drugs because they can't get a safe supply of drugs so we need to increase the safe supply of drugs and some people uh including think people like the uh global task forces that have been out there have said you've got to go even further and you've got to think about regulating drugs regulating opioids like you like we regulate cannabis or alcohol and working out how people can get a supply of of that in a safe way so that's where people are going and it's that paradigm shift of saying well you know we haven't actually managed to deal with the opioid crisis by the war on drugs we need to do something different and we need to think about whether the road we've been going down is actually going to work and and if i look at the platforms as i said it looks like the ndp and the greens are talking about that the liberals have left the door open to that saying that they are um want a strategy to deal a big strategy to deal with the opioid problems but they haven't detailed that and as you said in the previous question uh the conservatives have moved over uh a bit to towards the center uh talking uh less about uh criminalization and punishment and penalization and more about health and um and harm reduction uh which is a welcome step uh in the right direction having said that hassan the and this is a question the liberals get all the time of course and i'll put it to you here they have been in power for six years and when you see the liberal platform say something like introduce a comprehensive strategy to address problematic substance use to end the opioids crisis uh how do you react to that yeah i think it's uh you know we've been in an opiod crisis for five years and i think uh you know until we see action they're just words on a paper and people continue to die and so uh i think you know i find it a little frustrating when it's been this long and we're still talking about creating a plan as opposed to actually implementing it what would your view hassan be on the issue of decriminalizing all drugs as a means to ending this crisis would that be a step in the right direction it would certainly be a step in the right direction because we need to start looking at this as a health issue as opposed to a criminal justice issue and criminalizing possession of uh you know small amounts of drugs for personal use is not really getting us anywhere it's just continuing this cycle of you know marginalization and pushing people out to the the fringes of society so it's certainly a step in the right direction but you know we have a legalized source of substances when it comes to alcohol and we still see tremendous harms from that so it's not going to be the silver bullet that fixes everything now quam when the current prime minister's father was the prime minister of canada and we're going back almost 50 years now to 1972 he struck something called the ladain commission a member of the supreme court heading up this committee that was looking at the decriminalization at the time of marijuana it advocated that and trudeau the father decided not to go there in 2019 jane philpot who of course was the health minister and then resigned from cabinet and was kicked out of the liberal caucus said decriminalization of all drugs is not popular when you pull it question is the decriminalization of all drugs advisable in your view so you could have my view or you could have the view of the global commission on drug policy so there have been national and international commissions that have looked at this and what they found is that when you go down the line of prohibition that the market and the market for a particular drug acts a certain way so you make it illegal and so trafficking becomes difficult which means they make smaller more potent drugs and that's how you end up with hooch and stuff like that in prohibition you ended up with smaller more potent alcohol if you criminalize or other substances the market produces things that easier to smuggle which is smaller and more potent and that's what we're finding with things like fentanyl and that's what we found with just about every drug and as they become smaller and more potent the number of people who end up with serious consequences such as the opioid crisis and the deaths increase okay so that's what we've got to think about and then of course if you go full legalization then people worry that you get an expansion of use of the drugs which leads to more problems as well so you've got to find the sweet spot and some people say the sweet spot is regulation where you limit their access and supply but you don't criminalize and you make sure that people who need those drugs who are addicted to those drugs and get them and so that's how people like the global commission have been thinking and they're saying if you're going to do that dip your toe in the water to start off with by using by doing it in a drug with uh smaller amounts of harm and so you start with something like cannabis and then you work up to working to making sure that you've got the legislative muscle and you've actually got the bureaucratic know-how to actually get to regulating something like opioids and so some people might see what the liberals have done over a period of time as a sensible joined up strategy towards um towards regulation other people would say it's not it's just one policy at a time so you we need to see where this goes uh but certainly if you polled now compared to when you're polling just a few years ago i think you'd find slightly different results on the number of people who would support further uh legalization regulation so i think it may be different now and i think uh you know jane philpots uh had a particular view at a particular time but the context has changed true okay uh last 30 seconds to you then hassan whoever becomes prime minister after the 20th what's the first thing they ought to do on this file i mean i think the first thing they need to do is uh embrace this kind of large radical paradigm shift that qualm and i have been talking about here today um i think if you're asking me for a specific policy i think probably decriminalization and looking at a safe supplier the two most important first steps because that's going to prevent people from you know experiencing the most immediate harms but we have a lot of work to do hassan shaikh and kwan mckenzie it's good to have both of you on tvo tonight thanks so much for your wisdom and expertise on this thank you very much the agenda with steve pakin is made possible through generous philanthropic contributions from viewers like you thank you for supporting tvo's journalism

Channel: The Agenda with Steve Paikin

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Keywords: The Agenda with Steve Paikin, current affairs, analysis, debate, politics, policy, Opioid crisis, Fentanyl, Election 2021, Justin Trudeau, Jagmeet Singh, Naloxone, Decriminilization, Toxic supply

Id: -E1pOplaP3g

Length: 20min 53sec (1253 seconds)

Published: Mon Sep 13 2021