The numbers are heading just one way: sharply up. More than 11 Canadians are dying every day from opioids. This year is on track to be worse than last year, which was worse than the year before. Between the beginning of 2016 and the end of March 2018, more than 8,000 people in Canada died from causes related to overdoses. Drugs are now killing twice as many people as traffic accidents, and more than 70 per cent of those drug deaths involve the synthetic opioid known as fentanyl.
“I don’t even think we have the vocabulary any more to describe [how] it’s getting worse,” Benedikt Fischer, senior scientist at Toronto’s Centre for Addiction and Mental Health, told The Globe’s Carly Weeks.
Canada’s per-person fatality rate is not far behind the United States, which is on track for 52,000 deaths this year. Canada is heading towards 4,000. The U.S. death rate is ten times higher than it was during the heroin epidemic after the Vietnam war, according to journalist Andrew Sullivan, who has written an epic treatment of the fentanyl crisis.
Mr. Sullivan and drug experts agree that several factors are going to make this epidemic extremely hard to stop or even slow down. One is the potency of fentanyl. It is 50 times more powerful than heroin. Just a few grains can give you the highest high you’ve ever had, and a few more grains can kill you. The margin of safety is tiny. If you weigh it on a scale, then weigh another drug on the same scale, the cross-contamination can be fatal. Fentanyl has to be cut with all sorts of other materials to get the dosage right, and your average street dealer can’t do that reliably enough not to kill people some of the time.
Fentanyl is also unusually easy to distribute, points out Mark Kleiman, an illegal-drug analyst. It can be manufactured by any skilled chemist – many are in China – and shipped in small quantities anywhere in the world. Even if Chinese producers dry up, plenty of Indian producers could do the job. You don’t have to move it by the kilo. Just a pinch will do. Hundreds of millions of envelopes and parcels enter North America every year, too many to make inspection feasible. “And I don’t see a snowball’s chance in Hell of stopping the flow,” Mr. Kleiman writes.
Thanks to cell phones, text messaging and social media, the supply chain at the back end is simple too. No need to hang out in some bad part of town and hope your dealer shows up and you don’t get shot. These days he comes straight to you. “In the recent Global Survey on Drugs,” Mr. Kleiman writes, “cocaine users around the world reported that their most recent cocaine order was delivered in less time, on average, than their most recent pizza order.”
Tim Farquharson, deputy chief of the Peterborough police service, knows all about it. The police can’t keep up with the constant stream of new fentanyl-spiked products. (The latest thing is something called purple heroin.) As soon as you shut down one distribution path, he says up pops another. Even little Peterborough (pop. 81,000) has an opioid epidemic – 20 deaths last year, and rising.
So what’s the underlying cause of all this drug use? Canada’s chief public health officer, Theresa Tam, says the root causes are poverty and homelessness. But plenty of users are neither poor nor homeless. So I asked Deputy Chief Farquharson what he thinks.
“Pain and trauma,” he tells me in an interview. Like most modern police officers, he doesn’t believe in arresting drug users. His goal is to keep them alive so that they can eventually seek treatment. “Maybe we should have locked vending machines,” he muses, “so that people who need some drugs could get a free dose of Dilaudid."
The writer Andrew Sullivan talks about pain and trauma too. Most of our social institutions – the ones that used to offer solace, structure, friendship, and support – are under threat. The churches collapsed a generation ago. Families are in bad shape too, especially among middle – and lower-income earners, where marriage is on the wane and many kids grow up in households without both parents. Economic change hits some people hard. Communities disintegrate. We’re living in an age where faith, family and community – the pillars that we used to count on – are all eroding.
That’s the biggest reason why this war on opioids will be so hard to win. It’s not a war we need but a reconstruction of community. And we have no idea how to do that.