Overdose escalation and the pandemic: An urgent reminder to innovate Canada’s response to the opioid epidemic

Abstract

A ‘dual crisis’ situation in Canada has gained more attention in the past two months, as deaths by overdose have reached record highs within the context of the COVID-19 pandemic overtaking the opioid epidemic. Given the already dire state of the prevailing overdose crisis (with no sustainable gains in improving mortality rates despite being declared a national emergency in 2016, expanded harm reduction and access to treatment), this acute spike is an urgent reminder of the unsustainability of the current system, in this case demonstrated by its inability to withstand stress. Under this premise, this article reviews recent literature on possible factors contributing to the present surge in overdoses, with the aim of identifying pre-existing systemic issues exacerbated in the past months of pandemic response. Sociopolitical issues were found to be most contributory; specifically, legal restrictions to innovative, evidence-based approaches to harm reduction (i.e. “safe supply” programs and decriminalization of drug use) based in stigmatizing attitudes. An overview of potential ways these issues may be addressed by innovative initiatives (both current and proposed) is included. Advocacy leading to prompt expansion of such interventions may help address the alarming rise in opioid-related mortality during the COVID-19 pandemic and promote a more progressive and sustainable approach to the overdose crisis.