A man looks at cardboard gravestones with the names of victims of opioid abuse outside the courthouse where the Purdue Pharma bankruptcy is taking place in White Plains, N.Y., on Aug. 9.Seth Wenig/The Associated Press
Canada’s drug overdose epidemic is bad – the number of deaths has never been higher. In the United States, things are even worse. And that should have Canadians worried.
In the 12 months through the end of March, 2021, the Centers for Disease Control reports that overdoses killed 96,779 Americans. The pace of deaths has risen by almost a third since the start of the coronavirus pandemic. This latest surge pushes the number of U.S. overdose fatalities this century to nearly one million. It’s the equivalent of wiping out America’s 12th largest city.
The overdose crisis – North America’s other epidemic – started in the U.S. with the misuse of prescription opioids such as OxyContin. In West Virginia, where the per-capita death toll is highest, deaths from abuse of OxyContin peaked in the early 2010s. By the mid-2010s synthetic opioids, led by fentanyl, had shot higher. Across all 50 states, the death rate from overdoses over the past year was 29 per 100,000 people. In chart-topping West Virginia, it’s 87. In Ohio, it’s 47; in Pennsylvania, 43.
In Canada, things aren’t as bad – at least not yet. In the 12 months to March, 2021, opioid overdoses killed 6,946 Canadians. (The Canadian figure tallies opioid deaths; the U.S. number counts all overdoses. The statistics are roughly comparable because most overdose deaths involve opioids.)
Canada’s death rate over the past year is 18 per 100,000, or more than a third lower than the U.S. However, Canada’s annual number of overdose deaths has almost doubled since 2019.
In Ontario, the annualized rate of opioids overdose deaths in the first three months of 2021 was 19 per 100,000. In Alberta, the rate of all drug deaths, through the end of July, was 34 per 100,000. British Columbia’s rate of all drug deaths has reached 40 per 100,000. That puts Alberta and B.C. near the same league as the hardest-hit states.
As in other areas of public health, the U.S. is a benchmark for Canada – a benchmark of failure, and a reminder of how worse is always possible. Canada’s current overdose death rate is below where the U.S. is today – but it matches the U.S. fatality rate of just two years ago.
Their numbers are rising and so are ours, marching a few steps behind. There’s a risk that our overdose epidemic is not so much better than theirs as later.
The litany of death statistics can begin to blur. But their message should be simple: All these thousands of people did not need to die, and something can be done about it.
What’s different between the two countries is Canada is trying somewhat harder to do something. In the U.S., the long tail of the war on drugs, and a misplaced sense that addiction is a failure of personal responsibility stymies action. Legislators in West Virginia this year actually restricted access to harm reduction services. Pennsylvania and Ohio have done more but it’s the basics, such as clean needles and Naloxone, the overdose reversal medication. California is trying to become the first state where supervised drug injection sites – a proven life-saving service – would be allowed, but the state Senate barely passed a bill in April, with Republicans there opposing “taxpayer-staffed and funded drug dens.”
That leaves the U.S. where Canada was a decade ago. Canada today looks relatively better – how can it not? Supervised consumption sites are well-established and work progresses on decriminalization and a safer supply of regulated drugs, to combat toxic street drugs. But more needs to be done: the rising death toll is an obvious sign of that.
Ottawa this year commissioned two expert reports. They called for an overhaul of Canada’s drugs strategy. They unanimously backed decriminalization of small amounts of drugs and deemed a safer supply “an urgent priority.” They want a full strategy, from harm reduction to treatment and recovery. Just before the election, the Liberal government said the reports would “inform our next steps in drug policy.”
The slow realization that addiction is not a criminal issue, but one of health care, has taken a wider hold. The policy work needs to include everything from harm reduction to innovations in treatment and long-term recovery. The crisis of preventable overdose deaths is not something that will be solved soon. The first goal must be to stop it from worsening. The U.S. is a bleak how-not-to example. And it’s a blaring warning sign that, absent action, things can get a lot more dire.
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