The Opioid Crisis Is Surging. We’re Still Ignoring Experts

In late February, Andrea Sereda addressed the parliamentary health committee and spoke about her work as the lead physician directing a safer supply program in London, Ontario. Safer supply refers to providing individuals with opioid use disorder with a safer alternative to the toxic, illegal drug supply on the streets, where the likelihood of overdose and death is considerably higher. Referred to as harm reduction, it is one of several methods of combating an overdose crisis in Canada that has claimed over 44,000 lives since 2016.

Sereda was asked whether safer supply medications are ending up in the hands of users for whom the drugs have not been prescribed, such as children. She said there was no evidence of that happening. In a later conversation with the drug policy reform advocacy group Moms Stop the Harm, Sereda explained that it was possible for kids to access diverted safer supply—a simple reality of the proclivity of youth to experiment with drugs.

These are not contradictory statements. Something can be possible even if there is no hard evidence for it. Sereda was simply urging vigilance. People expect their doctors to think beyond the data. Despite this, Sereda found herself the target of Adam Zivo in the pages of the National Post’s opinion section. His June 20 column attempted to turn her statements into a scandal by insinuating she had lied in her testimony before the House committee.

While Zivo holds a master’s in public policy, he is not a health professional. He is a freelance writer who has carved out a niche covering Canada’s drug crisis from the vantage that safer supply is a scourge. Zivo has claimed that tablets of hydromorphone, an opioid used in harm reduction initiatives, are “potentially” leading to disfiguring and paralyzing infections. He has also claimed that British Columbia plans to give its youth “tax-payer funded recreational fentanyl.” In February, he launched the Centre for Responsible Drug Policy, a nonprofit that purports to provide policy analysis on addiction and crime. Among other positions, it opposes safer supply and favours involuntary rehabilitation. The CRDP states they “distill evidence-based research and data,” but a twenty-eight-page report on BC’s safer supply experiment that Zivo authored for the Macdonald–Laurier Institute listed just thirty-two references—eight of which were his own National Post opinion pieces.

According to the authors of a recent article in The International Journal of Drug PolicyZivo’s opinion pieces have been noted for their overreliance on anonymous sources—both as providers of anecdotal evidence to support Zivo’s often unsubstantiated claims but also in the form of unnamed addiction experts who fail to present evidence.

Within days of Zivo’s National Post column in June, in a statement that borrowed heavily from his allegations, the Conservative Party called for Sereda’s medical licence to be revoked. As reported by the Toronto Starshe even received death threats.

Throughout the COVID-19 pandemic, politicians encouraged Canadians to “trust the science” and get over whatever aversion they may have to vaccines. It took the members of some parties a little longer than others, but ultimately, more or less everyone got on board.

Trust in science remains just as polarizing. If Pierre Poilievre’s recent description of safe injection sites as “drug dens” belonging to the Liberal “wacko” policies is any indication, the success of mass immunization campaigns does not seem to have translated into any new-found respect for the medical profession when it comes to the drug crisis. Instead, doctors, nurses, public health officials, and other experts still find themselves having to justify their expertise and experience.

Poilievre isn’t the only politician looking to take advantage of the overdose crisis for political gain. It’s becoming a national, non-partisan phenomenon. Take, for instance, the recent reaction to proposed drug decriminalization efforts by the city of Toronto.

Outgoing Medical Officer of Health Eileen de Villa was clear in her appeal for drug decriminalization: “We cannot arrest our way out of this crisis.” Decriminalization recognizes that drug addiction is a public health issue for which law enforcement, courts, and incarceration are wholly inappropriate. The criminalization of drug possession and use not only penalizes the wrong group of people (users rather than dealers and organized crime), it is itself a leading cause of the steadily rising death rate. According to Human Rights Watch, criminalization prevents people from getting the treatment they need, makes it difficult for them to access safer supply and injection sites, and increases the likelihood of unsafe practices and, by extension, of overdose. This view is shared by the Registered Nurses’ Association of Ontario, among other organizations of health care professionals.

For its part, the Canadian Drug Policy Coalition—which represents fifty organizations and 7,000 individuals working toward drug policy reform in Canada—argues harm reduction, safe consumption, and decriminalization can all work together to help get people suffering from substance abuse disorder the health care they need, calling it a win-win solution for communities as much as for those suffering from drug abuse disorders.

The proposal was not created in a vacuum—de Villa had developed it in collaboration with organizations that serve people with substance abuse disorder, based on the lived experiences of people suffering from addiction, and further with the support of none other than Toronto Police Service. De Villa’s decriminalization approach has been championed by harm reduction experts and advocates for people living with mental illness, substance abuse disorder, and the unhoused. It was never proposed as a panacea but rather as one evidence-based tool to employ in addressing the interrelated drug, mental health, and homelessness crises.

Yet despite all this considerable expert opinion, the initiative was shot down. Federal Minister of Mental Health and Addictions and Associate Minister of Health Ya’ara Saks decided to reject Toronto’s decriminalization request on May 17. According to the statement issued on her behalf by Health Canada, Saks reportedly argued that decriminalization “does not adequately protect public health and maintain public safety.”

Saks is neither a physician nor a public health professional. She also appears to have no medical or scientific training of any kind. And yet her “deep concerns” were enough to override the consensus of experts working in the field, including de Villa—Toronto’s chief medical officer, a person who has built her entire career on public health. And who did Health Canada defer to in coming to its determination? The opinion of Ontario’s health minister, Sylvia Jones.

Jones stated her opposition to drug decriminalization in a tersely written letter to de Villa a week before the federal government’s decision. She argued decriminalization would “only add to crime and public drug use while doing nothing to support people struggling with addiction.” It wasn’t clear what evidence, if any, she had to support her position.

Jones is not a physician and has no experience in the areas of public health, mental health, or addiction counselling. She has no training or experience in health care, nor has she any scientific training. She has a diploma in radio broadcasting and worked as a personal assistant to former mayor John Tory before becoming a politician herself.

If drug policy is being shaped by non-experts, that’s maybe because political considerations are often taking precedence over science.

Take David Eby, the premier of BC, of the New Democratic Party. BC is the epicentre of Canada’s overdose epidemic, with over 2,500 deaths reported last year alone. Since declaring the drug crisis a public health emergency in 2016, the death toll has surpassed 14,000. Eby’s political opponents have blamed harm reduction strategies the province has implemented, such as safer supply and, starting in 2023, a three-year decriminalization pilot project, in which adults were not being arrested or charged for possessing small amounts of certain illegal drugs associated with overdoses. Debate around these policies has intensified as BC approaches an election this fall.

To counter the criticism, Eby attempted to recriminalize drug use in certain public places, such as parks, restaurants, and beaches. After his proposed law was struck down by the province’s Supreme Court, which determined that it would irreparably hurt drug users, Eby came back this year and suspended the decriminalization pilot well short of the halfway mark.

Eby’s new hard-line position has forced him to side against the province’s top doctor, Bonnie Henry. Henry was one of several experts invited to testify on May 30 before a parliamentary standing committee examining the ongoing drug crisis. She reiterated her commitment to drug legalization and regulation. Eby publicly disagreed with her position, while BC Conservatives demanded she be fired.

Eby is also trying to assuage nervous voters. While there is substantial empirical evidence supporting decriminalization and safer supply as two effective strategies to address the drug epidemic, polling indicates only a slim majority of Canadians favour the approach. According to a 2023 survey conducted by the federal government, 62 percent of respondents thought decriminalization would improve access to health and social services, but 51 percent feared it could lead to increased harms, such as overdoses. It’s unclear how well versed respondents were in the science behind decriminalization and safer supply, but when the public is so split on an issue, it can be hard to stay the course on controversial initiatives.

In other words, while following expert advice would result in better policy, it’s politically dangerous. The aversion to experts’ suggestions for dealing with the drug epidemic has led to a situation where fear triumphs over evidence and reason, harming the most vulnerable and marginalized people in our society.