A syndemic occurs when multiple public health emergencies interact to make each other worse. This past year clearly fits the label: the global COVID-19 pandemic has indisputably intensified the existing drug overdose crisis in Canada.
For over a year now, there has been non-stop coverage of COVID-19, while a number of other issues continue to be neglected as “newsworthy.” For people who use drugs in particular, a public sense of the crisis has never quite taken hold, despite years of growing overdose deaths and harm across communities.
The pandemic has exacerbated risk and harm for people who use drugs. However, it would be inaccurate and short-sighted to suggest that the spike in drug-related deaths over the past year is solely, or even primarily, the result of the pandemic.
Rather, current realities should be understood as the result of decades-long, pre-pandemic political decisions and the consequent, entrenched policy failures. From the lack of welfare and treatment services to the criminalization of drug use and resulting stigmatization, it is long-standing political inaction and failed policy measures that have resulted in the thousands of lives lost to overdoses and now, drug toxicity.
The pandemic has simultaneously intensified the problem and laid bare the urgent and immediate need for radical change to Canada’s drug policies.
Drug-related deaths during the COVID-19 pandemic
Earlier this month, B.C. entered its fifth year of a public health emergency related to drug overdoses. And this past year has been the worst so far: across the country, overdose deaths reached a record high with 4,000 lives lost in 2020. The vast majority of these deaths are accidental.
However, these numbers do not include overdoses that are not fatal but still produce harm, pain and health consequences for users, loved ones and communities. Research has only begun to examine the ways drug use and associated harms have changed in the face of increased drug toxicity and increased social vulnerability.
There are a number of pandemic-related reasons for the reported spike in drug-related deaths. For one, drug supply chains have been disrupted by the closure of the Canada-United States border which has resulted in increased drug toxicity. Users and advocates are now signalling a shift from a drug “overdose” to a drug “toxicity” crisis. Last year, over one-third of all deaths of people under the age of 44 were caused by poisoned drugs in B.C. Many other provinces are seeing a similar trend.
What is more, public health measures aimed at curbing the spread of COVID-19 have had a number of unintended consequences that have gravely impacted the well-being and survival of people who use drugs.
Community-based organizations have noted the extent to which access to life-saving supports (like overdose prevention services, food and housing) have been restricted by physical distancing and other public health guidelines.
But as these organizations have struggled to pivot their services in response to ever-changing COVID-19 conditions, their ability to provide direct support and interact with people who use drugs has become more challenging.
This has meant that people are more likely to use drugs alone, which increases risk and limits access to care and support that contribute to safety and survival if an emergency should arise.
This particular gap in COVID-19 policy has starkly highlighted the pressing need for access to safe consumption supplies (including Naloxone) during the pandemic and beyond.
Crisis as an opportunity for radical policy change
It is important that we study and understand how the pandemic and the overdose crisis are connected. But it is even more important that we remember the decades of drug policy failures that have provided the perfect breeding ground for the devastation that has been unfolding this past year.
Crises, like COVID-19, can be pivotal moments in recognizing problems in need of a solution and clarifying our views about how society should work by allowing us to push for real systemic change. As researchers studying the nature of and criminal legal and public health responses to a so-called “meth crisis” in Manitoba, we believe it is essential to identify the relationship between current cascading and overlapping crisis points and understand them within wider political and social context.
We need to consider radical remedies to drug overdoses and deaths. First and foremost, decriminalizing the possession of illicit drugs for personal use . Decriminalization promises the opportunity to prevent accidental deaths and harm due to a toxic drug supply. It also contributes to reducing stigma and associated barriers to accessing supports.
Earlier this month, B.C. announced that the province will “seek an exemption from drug possession laws under Section 56 of the Controlled Drugs and Substances Act.” Users and advocates alike are wary of the announcement, however, stifling their excitement until words turn to action.
In the meantime, people who use drugs and activists will continue to advocate for decriminalization and access to safe, regulated supply. For the second year in a row, people have distributed clean heroin, cocaine and methamphetamine to people over 18 who already use illicit drugs in Vancouver’s Downtown Eastside.
If COVID-19 has not provided the push for our governments to take radical action, and if now is not the time to undo the harms of past drug policies, when will it be?