Content Warning: Overdoses and Drug Use
Opioids are a class of painkillers that is naturally found from the poppy plant. Fentanyl, a type of opioid is manufactured synthetically and often mixed with other illicit drugs such as heroin, cocaine and methamphetamines. Known to be over a hundred times more toxic than morphine, fentanyl was originally prescribed for patients suffering from pain. In Canada, fentanyl was legalized for pain reduction in the 1970s and since the early 1980s, the volume of opioids sold to hospitals for prescriptions increased by over 3000%. With this becoming more popularized in health care the initial upswing of abuse of this drug hit the streets. In current day, it comes as no surprise that Canada has been undergoing an opioid crisis. Many Canadian cities and towns have seen an increase in overdoses in the recent years bringing with it more media attention to the issue.
So, with that, how did this become a national crisis? It is important to note that fentanyl itself is not illegal but it is when it is sold and made without the controlled administration from doctors and healthcare workers. Fentanyl became more noticeable in Canada after the increase of international trade and rapid change in technology which changed how we all interact with the world. This created new supply routes and the accessibility of the internet allowed you to order deadly amounts of fentanyl with only a few simple clicks on the dark web. First reported in British Columbia and Alberta in 2011, one of the issues that became a concern was that many of these synthetic drugs were being smuggled in by Chinese medical manufacturers. With the medical manufacturing business becoming more competitive in China, many of the smaller scale businesses looking to make money fast started making these synthetic drugs and setting up fake locations that they could dispose of very quickly. A reporter from the Globe and Mail discovered this firsthand when traveling to Wuhan to investigate. Once there, they discovered only empty buildings that have been abandoned. This is an easy tactic for a fake pharmaceutical company, as you can make an email address, have third-party sales agents and a supply address on Google maps displaying where your company operates out of. This business plan makes it nearly impossible for the Canadian government to crack down on companies that bring their product to the market.
For example, some packages weighing less than 30 grams, small containers, and silica gel packs were not always searched when the shipment arrived , usually offshore in British Columbia. For this reason, the production and selling of fentanyl came to Canada very quickly.
So, why are Canadians buying from China when we have other drugs?
Like most things in our capitalist society, the perp is financial gain. With buying synthetic fentanyl from China, you can turn a huge profit. In some cases, you can buy $1000 worth of fentanyl from China and the net sales can be up to $7.8 million. One pill can sell between $20-$40 and a “baggie” will be about $30. If you’re selling a pill at $20 apiece in many ways this has been called the “smugglers dream” as those who are selling the drugs and working with cheap companies turn a huge profit. The high profits for drug dealers are a major factor, the next is that the drug is way cheaper for customers in comparison to the “real deal”. The cheaper buy is also expanded by potency level being extremely strong – which gives users a more intense short burst high. This can be like playing Russian Roulette as many other drugs are laced with fentanyl and there is zero accountability on how much it contains from distributors. In some cases, 2 milligrams of Fentanyl could kill you. For example, if you are a cocaine user and you think you have been fine the past 10 times, your next dose could be your last. For many Canadians this has shown to have a real impact on those emotionally, with many of us losing loved ones.
1. China and Canada have worked together to investigate the production of synthetic drugs and unauthorized manufacturing processes of fentanyl.
2. Canada has moved towards decriminalizing drug use with the Good Samaritan Drug Overdose Act that was passed in May 2017. This Act allows more legal protection for those who witness or are experiencing overdoses.
3. There has been an increase in opioid-related harm reduction research and informative resources, Naloxone is widely more accessible saving thousands of lives. While educating more of the general public less stigma is attached to those who partake in drug use.
4. Bill C-37 was passed in 2017 which gave more power to border staff to inspect packages weighing less than 30 grams and banned pill presses that were imported from China.
Fentanyl and opioid-related deaths can affect any socio economic class, in particular it is more likely to affect those in targeted populations, such as homeless individuals, people with mental health issues and Indigenous populations. If you think the use of opioids is only common in these populations, think again. In my personal experience, many White middle-class people I’ve met started using opioid pain relievers such as OxyContin while in high school. These addictions can truly affect anyone. Since COVID-19 there have been more deaths in Canada which took place by increased overdoses and lack of resources for people who use fentanyl. Since COVID-19 the need for physical distancing has resulted in more people using drugs alone and the collective consciousness of stress has added to people with more thoughts of suicide and helplessness, leading to an increase in drug usage. Jürgen Rehm, from Centre for Addiction and Mental Health said “We have seen this lead to less supply, higher prices for illegal drugs, coupled with less possibilities to earn money and the closure of several consumption and treatment services sites.” With much concern, according to these numbers it has not this high since March 2019.
In Peterborough specifically, visits to the emergency department for opioid poisoning increased 214% between 2014 and 2018. As well as, between July 2017 and June 2018 Peterborough Public Health (PPH) ranked Peterborough as the 3rd highest in the province for average opioid-related deaths per 100,000 population. The provincial average is 8.4% and Peterborough is nearly doubled at 15.4%. This has caused many community members, social service workers, City workers and healthcare workers to meet together to pose something that will help the city achieve safer drug use and prevent overdoses. The former Greyhound bus station located at 220 Simcoe St. will become home to the Opioid Response Hub. Announced in October, the hub will include two services: the Harm Reduction Works Program by Peterborough Aids Resource Network (PARN), and the launched Mobile Strategic Overdose Response Team (MSORT). The MSORT team aims to reach people within 24 hours of their overdose and will supply them with mental health and addiction resources, as well as assess their physical and social situations, if they are not choosing to go to the hospital. Because of the negative stigma on people who use drugs, for many people, this option provides less paper trails and attention on the individual as well as more one on one care. The team hopes that the third service will operate out of the building, this being a Safe Consumption Site. A Supervised/Safe Consumption Site (SCS) a health service that provides people with a safe space for people to consume pre-obtained drugs under health professionals. Staff will be present for emergencies and individuals will have the access to sterile supplies. These services also include access to social services, housing programs, drug treatment and mental health resources. Check out their Virtual Tour of the Proposed Safe Injection Site for more information and a visual representation of what this will look like.
On the opposing side, many community members and local politicians have been opposed to this method because it requires a large sum of money to be put forward and concerns of more drug use. Research on injection sites and crime in Vancouver reported that there was no increase in crime and a decrease in vehicle break-ins and theft. In Australia, studies show to find a decrease in drug-related crime involving public drug use and loitering. More reports out of Portugal report a dramatic drop in drug use, HIV infections, overdose deaths, and incarceration rates. These examples show the positives in decriminalizing drugs and supplying the public with SCSs. The Peterborough Drug Strategy, reports that there will be reduced needle sharing, less changes of HIV and Hepatitis C, less overdose deaths, less drug litter, less public drug use, increase in drug treatment services, cost-effectiveness. Additionally, these services will link people to resources for housing, food banks and connections for referrals to other health services.
I got in contact with the Prevention and Education Coordinator from PARN, Dylan DeMarsh, to discuss some of the details about the Consumption Site and issues that drug users face in Peterborough.
Aras Mommertz: With many stats formulated in 2017 and with obvious poverty and addictions in Peterborough, why hasn’t the city done something about this sooner? What were some barriers (building codes, funding, people disagreeing with us needing a safe injection site, etc.)?
Dylan DeMarsh: A group of agencies and citizens began meeting in December 2017 to bring supervised consumption services to Peterborough, shortly after the Government of Ontario announced their plan to support and fund these sites.
The challenge since that time has been finding a suitable location for a site. The application process for a Consumption Treatment Services site contains specific requirements for a Site, and we were unable to identify a property owner who could meet these requirements until August of this year.
We are pleased to say that there has been tremendous support in Peterborough for the efforts to establish a Consumption Treatment Services site in the community. A survey conducted by the Peterborough Drug Strategy in November 2019 garnered 1,621 responses and found that 74 percent of participants agree that a CTS site will benefit the community. A separate survey of 122 people in Peterborough who use injection drugs found that 91% would access a Consumption and Treatment Services site in downtown Peterborough.
A: There was an original concern from citizens of a site being right downtown, “in plain sight” so to speak, what changed and why did you decide on that location?
D: We understand that some people have expressed concerns, and we will be hosting a series of community consultation meetings over the coming weeks to address these concerns. Our intention has always been to locate the site in the downtown area, as it is more accessible and increases opportunities for people to access other health and social services.
We have always disagreed with the notion that this service should be hidden from our community and were very intentional in our community consultation survey in November 2019 to ask people their thoughts on locating a site downtown: 74% of respondents supported locating a site in downtown Peterborough.
Stigma surrounding drug use pushes people into the margins of our community, makes it harder to access support, and increases risk of death from drug poisoning. We are working with our community to help increase the awareness and understanding of addictions. People who use drugs deserve access to health services like everyone else in our community.
A: Do you believe the new safe injection site will be beneficial for Peterborough?
D: This site will primarily benefit Peterborough by reversing overdoses and potentially saving the lives of friends, family and neighbours who are at risk for opioid poisoning. In addition, Canadian and International research shows that supervised injections services provide many benefits both for individuals using the services and for the community, including:
A: Does this play into the long-term projection for Peterborough?
D: This question should be directed to a representative of the City of Peterborough.
A: There have been over 30 overdose deaths this year, for a small city this is an extremely high statistic. Do you think COVID-19 and the lack to access mental health care played a huge part in this unfortunate occurrence?
D: There is evidence that safety measures surrounding COVID-19 are contributing to drug poisoning deaths: increased isolation and the changing nature of the drug supply due to border closures are likely playing a factor. However, we have averaged around 30 drug poisoning deaths in Peterborough for the past three years and recognize COVID-19 is simply exacerbating factors that have already been contributing to these deaths: isolation and poisoned drugs were already killing people before COVID.
A: Why and or how does drug usage play a big role in this City? Do you think the “common” person understands the benefits of a safe injection site running?
D: Peterborough is a compassionate community and the consultation survey from last November demonstrated that there is overwhelming support for a Site in downtown Peterborough. There is a wide range of understanding in our community about the nature of addictions, but it feels like there is a core understanding that this is a crucial health service for people at risk of death. Our upcoming Community Consultation sessions are designed to help further increase the understanding of how a site operates and the benefits it provides to the community.
Note: I reached out to MP Maryam Monsef as well as Mayor Diane Therrien, both of whom did not respond with comments.
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