You need multifaceted solutions to Canada’s addiction crisis

Since the start of the COVID-19 pandemic in 2020, Canadian health care professionals have seen a significant increase in several types of addictions, including alcohol, opioids, stimulants and gambling.

While the numbers related to opioids and stimulants have improved slightly this year, overdose deaths and hospitalizations remain alarmingly high, according to the latest data from the Public Health Agency of Canada (PHAC). Deaths from opioid toxicity are about 8% lower in 2024 so far, but more than 1,900 people died between January and March, equivalent to about 21 deaths a day on average.

During the same 3-month period, there were more than 1,500 opioid-related hospitalizations, more than 6,700 opioid-related emergency department visits, and more than 8,700 EMS responses for suspected opioid-related overdose.

“Addiction is a major health problem that affects individual lives and the lives of family members,” Daniela Lobo, MD, assistant professor of psychiatry at the University of Toronto and coordinator of the addictions site at the Center for Addictions and Mental Health, Toronto, Ontario, Canada, said Medscape Medical News. It is associated with other mental and physical health problems.

“Addiction affects people in all walks of life, including all ages and all genders,” he said. “We’ve seen that young people are at particularly high risk, but this is also the population we expect to be serving roles in society for decades to come, so it’s a big social issue to look after our older generation as well young”.

Public Health Emergency

Although the addiction crisis spans Canada, 84% of accidental deaths from opioid toxicity this year occurred in British Columbia, Alberta and Ontario. Almost three-quarters of the deaths occurred among young men, especially those aged 30 to 39.

In each province, local leaders and health officials often work together to address the overlapping challenges associated with the supply of toxic drugs, homelessness, crime, mental health issues and adequate treatment programs.

In British Columbia, for example, the Union of British Columbia Municipalities held a conference in mid-September to hear from municipal leaders, law enforcement officials and health professionals about the complex cyclical crisis. Correctional facilities already have addiction treatment centers and new youth programs are being started to help young people, but these solutions are only part of the answer to the cycle of addiction, leaders said.

“The supply of toxic medications remains the cause of this emergency. It has not been addressed,” Mark Lysyshyn, MD, assistant chief medical officer at Vancouver Coastal Health and clinical assistant professor of public health, preventive medicine and internal medicine at The University of British Columbia, Vancouver, British Columbia, Canada said Medscape Medical News.

Of opioid toxicity deaths across Canada between January and March, 81 per cent involved fentanyl, and that proportion has increased by 42 per cent since national surveillance began in 2016, PHAC data showed. Additionally, 61% of overdose deaths also involved a stimulant.

This year marks the eighth year of an overdose public health emergency in British Columbia, Lysyshyn said. Several initiatives have helped, including the use of naloxone and opioid agonist therapies, as well as the establishment of supervised consumption and overdose prevention sites. Still, the province needs additional prevention and treatment options.

“Harm reduction services keep people alive so they can get treatment,” she said.

In Winnipeg, Manitoba, as in most cities and provinces facing the addiction crisis, homelessness remains a key issue. First, communities often lack housing for residents with mental health and addiction issues. Beyond that, supportive housing services may not have enough beds to keep people safe while they seek help.

“Now we’re going through this … period as if the pandemic is over, and we’re going back to life as it was. There is no life as it was,” said Marion Willis, executive director of St. Boniface Street Links, which seeks to address homelessness through addiction treatment, job referrals, legal aid, counseling and other social support services.

These “comprehensive services” are key, he said, to helping people recover and trying to prevent people from falling into the cycle of addiction in the first place. While local officials appear to be moving in the right direction by setting aside funding for new programs, a successful response requires careful coordination between agencies and community organizations, he said, as well as more money at the provincial and national levels.

“We’re facing a level of social distress unlike anything I’ve seen in my 40-year career, and we don’t have the resources to address these things,” Willis said. “Now it’s at the point where it feels like we can’t control anything. It’s really desperate.”

Increasing training, reducing stigma

Ultimately, new solutions need a systemic approach to implement effective change, Lobo said. In Alberta, for example, officials eliminated numerous homeless encampments in Calgary and Edmonton and created a navigation center to coordinate comprehensive services, including access to a 24-hour shelter space.

Other provinces are looking at factors related to homelessness and drug use, such as high rental prices, housing shortages and landlord bias against renting to at-risk people, especially those with mental health issues .

“I’ve been an addiction psychiatrist for 20 years and I can tell you that co-occurring disorders are the rule rather than the exception,” Lobo said. “Most people seeking addiction treatment have underlying diagnoses or undiagnosed mental health issues.”

Recent studies in Canada have supported programs such as specialty addiction medicine teams in hospitals, low-barrier addiction care, and access to harm reduction services and safe supply sites. But provincial policies and funding do not always support these programs.

In Ontario, changes in provincial policy will lead to the closure of several supervised consumption sites and needle exchange programs this year, but in turn the opening of 19 homeless recovery treatment centers and addictions, which will offer housing, employment and addiction support. .

“The idea behind safe drinking is to prevent death and open the door for people to talk about treatment,” Lobo said. “On the other hand, though, people have concerns about what happens around a safe drinking place, with discarded drug paraphernalia and increased violence, and the problem that there’s usually no government funding for the cleaning of the environment or aid services”.

Looking ahead, short-term solutions should include greater accessibility to addiction treatment and mental health services, he said. Long-term solutions, however, should include “building capacity” through training health professionals of all specialties in addiction medicine and reducing stigma among the public.

“It’s important to realize that often the way people think about addiction is that it happens to someone else and not to them,” Lobo said. “But if we want Canada’s health care system to be sustainable and able to assess whether our governments are acting in the best interest of public health, we need to raise public awareness.”

Carolyn Crist is a medical and health journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.