We Need a New Approach to the Opioid Crisis

The opioid crisis has continued to have a destructive effect on people and families across Canada. Opioid-related deaths and hospitalizations remain very high, with 7,328 people having died from apparent opioid toxicity deaths (overdoses) in 2022, an average of 20 per day. This rate is double the number of deaths per year than in 2019, pre-Covid-19, to provide a standard year comparison. British Columbia, Alberta, and Ontario accounted for the vast majority, 87 percent, of these deaths. It is estimated that 98 percent of all opioid-related deaths were accidental, and opioids are by far the leading cause of overdose deaths, with 78 percent of all accidental apparent stimulant toxicity deaths in 2022 involving opioids. Approximately 36,000 Canadians have died of an opioid-related overdose since 2016.

Many of us know someone, a friend, a family member, a neighbor, who has an opioid addiction. It’s a large-scale problem as fentanyl and fentanyl analogues continue to make their way through our communities, from large cities to small towns. It’s become so problematic that in BC, illicit drug toxicity is now the leading cause of death for people between the ages of 10 and 59. Northern Ontario’s five largest cities have three times the overdose mortality rates than the provincial average. While various efforts have been made at the federal level and of varying degrees across the provinces to help curb opioid-related death and addiction, those efforts have not been enough to slow those trend lines down.

Is there an example elsewhere in the world that we can model to guide a new approach to opioid addiction? Portugal seems to be one of the rare success stories when it comes to reducing opioid addiction and death rates, and it may have some answers for how we can develop a new approach to combatting our own addiction issues in Canada.

Portugal used to be the country with Europe’s highest addiction and drug-related death rates. Over 100,000 people, roughly one percent of its 10 million population, reported an addiction to hard drugs in 1999, particularly heroin. It was a devastating problem. Hundreds of people were dying every year of overdoses to drugs that weren’t nearly as powerful as the fentanyl and fentanyl analogues we are dealing with now. In a decade, those rates were cut in half.

What changed? In 2001, the nation took a new approach to how they tackle their addiction issues. They focused on rehabilitation over criminalization. They decriminalized possession of smaller amounts of drugs for personal use, although trafficking and public drug use remained against the law. They invested heavily in nationwide programs to provide addictions treatment, harm reduction, and recovery options, as well as public education campaigns. When a person is caught with an amount of drugs that would be considered small enough for personal use, they aren’t prosecuted. Instead, they are referred to a “drug dissuasion commission” to meet with a mental health and addictions specialists where they instead discuss their drug use habits and can be referred to addictions counselling.

Today, Portugal reports roughly 25,000 chronic heroin and other opioid users, a significant drop from where the country was two decades ago. New HIV infections have fallen by 90 percent, and drug use in Portugal among youth is now among the lowest in Europe.

It isn’t a perfect model, as no drug policy will fit every case and every scenario. In recent years, the program became decentralized, and some funding was cut, mostly for budgetary reasons. Users have increased, but the rate of addiction remains well below the peaks they were seeing two decades ago. The Covid-19 pandemic also played a role in the increase in drug use, as it has in most parts of the world. But it is a model we should be examining, and trying to take the correct lessons from. According to statistics from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), there were 6,166 overdose deaths involving illicit drugs across the European Union in 2021, less than Canada’s total estimated 8,013 deaths from opioids that same year.

It's time to take a new approach. Opioid addiction is a crisis across Canada, and the approaches we’ve been taking for decades have not worked. We have to start looking at jurisdictions that have had actual success in reducing opioid addiction, and build a made-in-Canada model that meets our own needs.