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As the fourth wave of the COVID-19 pandemic rages across Canada, a slower, more deadly crisis has continued to evolve.

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Across Canada, deaths from opioid drug toxicity increased by more than 60% between 2019 and 2020, and deaths are expected to increase even more this year. Deaths are due to an increasingly toxic drug supply that many experts say eludes traditional harm reduction strategies.

In Ontario, deaths from opioid toxicity are on the rise, and this year is expected to see the highest number yet. In 2016, 867 deaths related to opioid toxicity were reported in Ontario, in 2020 that number reached a record 2,403 and in 2021, between January and June alone, 1,414 deaths were reported.

“We call it a phantom pandemic,” Ashley O’Brien, the head of the integrated care center, explained in an interview with The Whig-Standard.

Although drug poisoning deaths are generally on the rise, the Kingston area is one of only two health units in the province to have seen a decrease in drug poisoning deaths between 2019 and 2020.

“What we’re seeing in Kingston is actually an anomaly compared to the rest of the province. The Office of the Chief Coroner released a report about a month ago which stated that with the exception of Chatham Kent, (Kingston, Frontenac and Lennox and Addington), public health is one of only two regions in the province to have seen a decrease in the consumption of drug poisoning deaths, ”said Gilles Charette, executive director of regional HIV / AIDS services, in an interview with The Whig-Standard.

Despite the decline in mortality, the Kingston area has not escaped the supply of toxic drugs. Over the past year and a half, the ICH has responded to over 500 overdoses and has seen an increase in brain damage from overdoses.

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“(This) we’re seeing is a significant increase in anoxic brain damage when people overdose,” O’Brien explained. Anoxic brain damage occurs when the brain is deprived of oxygen.

The increase in overdoses in general, according to O’Brien, is linked to an increasingly complex and unpredictable mix of drugs.

“What we’re seeing with drug toxicity is because opiates – especially fentanyl – are mixed with a lot of other toxic substances, other types of opiates, other types of benzos, so you Sometimes you can have more than one substance in a substance that you ‘re-using that would lead to (one) overdose, ”O’Brien explained.

O’Brien illustrated the toxicity of the drug supply by explaining how past harm reduction practices aimed at making drug use safer are no longer as effective.

“We would say to people, take a test dose, just a small amount. Make sure everything is fine, take it slow, then use a little more, “but now the reality is that a test dose can kill you,” she said.

Harm reduction strategies, such as testing doses and group use, have been undermined by the COVID-19 pandemic, which has limited access to services for many people.

“We have two health crises happening simultaneously. We have a drug poisoning crisis and we have COVID-19. The impacts of COVID-19 have exacerbated the impacts of the other, the drug poisoning crisis, and this is largely related to access to services and the increase in mental health issues that have been reinforced by COVID -19, ”Charette explained. . “When you think about the impact of COVID on things like, you know, the health care system and who has access to physician care, emergency care, you know, the reallocation of resources towards the response. COVID likely inadvertently had a negative impact on the poisoning crisis drug.

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The increased isolation has also been a challenge as it directly undermined the notion of “always using together” and limited the ability of friends, family and frontline workers to respond to and reverse drug overdoses.

“When you need to isolate yourself to protect others from the transmission of COVID 19, people who use substances alone risk drug poisoning,” O’Brien explained. “In a global health pandemic it is safer to be apart, but in a global or drug poisoning crisis it is safer to be together.”

O’Brien and Charette both believe that decriminalizing drug use and possession and providing a safe and legal drug supply would be an effective strategy for preventing people from dying of drug toxicity and for combat the aggravating social and economic consequences of criminalization, including homelessness and poverty. .

“The situation we have right now is not based on evidence. In fact, criminalizing substance use only further stigmatizes and traumatizes people and, you know, also contributes to serious mental and sometimes physical damage. And so, at the end of the day, it comes down to the stigma surrounding substance use. Not just the stigma around substance use, but the stigma around everything around people and their understanding of substance use, poverty, mental health issues, that sort of thing, ”Charette explained. .

They are not the only ones to advocate for decriminalization. In December 2020, the Ontario Association of Chiefs of Police released a statement calling for the decriminalization of illicit drug possession, the City of Toronto and the City of Vancouver asked the federal government for an exemption from Health Canada that would decriminalize drug possession. In Kingston, the Kingston, Frontenac and Lennox and Addington Public Health Community Drug Strategy Advisory Committee issued a statement in April 2021 expressing support for the decriminalization of drugs.

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However, for Charette and O’Brien, decriminalization must go beyond the simple decriminalization of possession.

“We have come a long way in Canada in decriminalizing cannabis use and broadening the recognition for many people (around) of the benefits of cannabis use, but also, in terms of cannabis use. recreational cannabis, (demonstrating) negligible harm – and certainly compared to alcohol consumption, which we as a society don’t think twice about. And yet, you know, there are people who are forced to choose between their accommodation or their food, or access to other supports that they might need because they need to be able to finance the substances that they are. need to feel good, ”Charette explained.

What Charette would like to see is a deeper understanding of substance use as a physical and mental health problem in health care interventions, and an expansion of safe supply programs that would enable people to access the substances they need and connect them with resources to support their mental and physical health.

“A safe supply means that the individual will know what they are taking and could be confident that their dosage is accurate,” he explained. “There are all kinds of programs that are medically supervised. We’re thinking (for example) of opioid substitution therapy, which is helpful for some people, and it’s really an example of a safe supply. So we just need to expand this so that people are connected to good care and we can mitigate the impacts of the drug poisoning crisis. “

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Despite a mountain of evidence showing that decriminalization and safe supply is an effective public health policy that saves lives, there is still political resistance to the program. For O’Brien, this resistance is linked to the stigma surrounding drug use.

“Research shows that it is more cost effective in all health, social service and criminal justice systems. This research has been done in other countries (which) have implemented decriminalization and safe supply, and it has been found to be more effective. I think the only thing that stands in our way is the stigma, but with these three intersecting crises (COVID-19, drug poisoning, and the province-wide housing crisis) I mean it’s more that’s stigma now, isn’t it. I think it is now a disability and human rights issue and our government continues to reject effective, evidence-based strategies, ”said O’Brien.

O’Brien points out that those affected by drug criminalization are largely racialized, impoverished and marginalized individuals. Treating drug toxicity as a health problem rather than a criminal justice problem would lessen the aggravating consequences of criminalization and allow increased access to support and services.

“The reality is that a substance use disorder means that people who use substances continue to use them despite negative health outcomes and want to quit, but they don’t have the ability to do so. do, ”she said. “A secure supply program would provide stability for many people on their recovery journey so that they have the opportunity to focus on housing, life skills, employment and the many unique aspects of repairing their healing journey. And it’s important to note that the three key factors in recovering mental health are relationships, meaning, and participation, and criminalization provides shame, isolation, and punishment.

As the COVID-19 pandemic redirected resources from the drug toxicity epidemic, it highlighted to O’Brien and Charette the government’s ability to implement coordinated responses to health threats.

“We have seen a very coordinated and rapid response to COVID-19, and we are not seeing it with the drug poisoning crisis. The reason we don’t see this is because we’re always stuck with the idea that people are doing this to themselves, and they’re not, ”O’Brien said.

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