How Depressing Overdose Stats Could Derail Opioid Crisis Progress
We’ve seen it happen with climate change. Here’s how experts keep going without feeling doomed.
It’s a hard fact to wrap your head around: British Columbia’s overdose crisis worsened in 2017. And not just by a little.
Despite a public health emergency declared nearly two years ago—greenlighting a bunch of innovative harm reduction programs—more than 1,400 people died last year, compared to 993 the year before. Fentanyl was detected in the vast majority of those cases.
To a casual reader, these numbers can seem like proof of failure—a sign that what experts are doing to stop overdoses isn’t working. The stats can also feed into a fatigue that is familiar for climate activists—a sense that our problems as a society are too big to fix, that no matter what we do, there’s no end in sight.
I recently chatted with author (and sometimes VICE contributor) Geoff Dembicki about the ways the current opioids conversation mirrors climate discourse of the last decade. When writing his book Are We Screwed? he came across this doomed sentiment often. “It’s just this pervasive sense that human beings and society, we’ve created problems that have gotten out of hand and that are effectively too big for us to solve.”
Like climate change, the opioid crisis is a massively complex issue. BC Centre on Substance Use scientist MJ Milloy says we’re working against decades of failed drug war policy, as well as intersecting housing and inequality issues, which can’t be undone with one silver bullet solution.
“We’re now having to come up with not only means to try and reduce levels of death and disease in communities, but also try to figure out new policies at the same time,” he told VICE.
In the world of climate activism, this complexity has worked in favour of people trying to derail progress, according to Dembicki. “The problem is so huge and scary that all the incentives point in the direction of people ignoring or denying the enormity of problem,” he said. “I found this a lot with climate deniers. When someone comes along who seems to have scientific credentials and gives an explanation about why the world isn’t totally doomed… we’re primed to want to believe it. It removes a psychological weight from our shoulders.”
Because these debates are so emotionally charged, they can also be super polarizing. In Vancouver, we live in a progressive bubble when it comes to drug policy, but if you travel far enough outside that, you’ll find heated opposition to supervised injection sites, a life-saving program supported by science. If we can take cues from the climate change conversation, a growing death toll could fuel that opposition.
To avoid shutting down the conversation, Dembicki says it helps to move away from moral framing. There has to be some incentive to fix the problem beyond “it’s the right thing to do.”
“I think with any big intractable issue like climate change, there’s really not one way to communicate that to everyone and have it be satisfying.” Instead we should tackle the problem from many different angles, in all kinds of disciplines. That a recently-launched experiment giving users clean hydromorphone is very low cost can counter some of the denial.
“The problem with anything related to drugs and harm reduction—even talking about economic benefits—is there’s a whole section of the population primed to see addiction as a moral failing on the part of the individual,” says Dembicki. “They’re suspicious of any government program that gives those people a helping hand.”
Even in the face of opposition and doomed thinking, Milloy says underneath the rising death toll there’s progress being made. Because the issue has become so mainstream, there’s a shift in tone and thinking among Canadians.
Milloy draws comparisons to the HIV crisis of the 80s and 90s, where we finally began seeing the discrimination inherent in our approach. “I think we’re living through a similar moment… We recognize that the old way of doing things was (reflecting) homophobia implicit in society.” According to Milloy, the way we treated drug users up until now simply wasn’t sustainable—and we’re only now starting to see the impacts of that paradigm shift.
The good news hidden within the BC Coroner’s latest release is there were significantly fewer deaths in the last four months of 2017. Is that sign of more good to come? “It’s difficult to really to say whether we have reached the apex or not,” Milloy told VICE. “But I think people are optimistic.
“When we hear the numbers from the coroner, I think it’s useful to keep in mind that without measures taken thus far, we would have seen a lot more deaths than we have now.”
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