The recent slight drop in drug overdose deaths in the United States and parts of Canada could be a positive sign, but experts say the problem is far from subsiding on both sides of the border.
Recent data show a decrease in overdose deaths in the United States—from 70,000 in 2017 to 68,000 in 2018—driven mainly by a decline in deaths caused by heroin and prescription painkillers, although there was a continued rise in deaths caused by fentanyl and other drugs such as cocaine.
Experts are still evaluating what factors are linked to the decrease and how much of a role policies such as increased treatment programs, enforcement, and limiting prescription painkillers played.
In Canada, government figures show the issue has only worsened in recent years, with 4,600 deaths in 2018—or a death every two hours—compared to 4,100 in 2017, with around three-quarters of the deaths being caused by fentanyl. So far this year, British Columbia—which has the highest number of overdose deaths in the country—has had a decline in deaths compared to the same time last year, but it may be too early to draw any conclusions.
Neil Seeman, researcher and chief executive officer of RIWI Corp., a Toronto-based global trend-tracking and predictive analytics firm, says the public data from Canada and the United States shouldn’t be compared as they are collected from different types of sources and are from different time periods.
“Every study has different missing information, so we have to be careful about comparisons,” he said. “Our company’s data from late 2016 show that 15 percent of Canadians know a friend or family member who died of an opioid overdose, whereas in the United States, the figure is 19 percent.”
According to Seeman, the primary factors behind the drug epidemic are the rise in prescription and street use prior to the extent of the epidemic being recognized, and the increased availability of more deadly drugs and drug combinations on the street. He adds that the rate of drug-related deaths is underestimated not only in North America but around the world.
“Drug use often contributes to deaths officially recorded as stemming from other causes, such as a motor vehicle accident or suicide,” he said.
Dr. Aaron Orkin, an assistant professor at the University of Toronto’s Department of Family and Community Medicine, says it’s too early to tell if there’s been a significant enough drop in overdose deaths in the United States to point to either a policy or practice difference.
“There might be something there, but if you first see it, you don’t want to think ‘oh ok, there’s a world of difference here,’ because there might be something valuable, but there also might not,” Orkin said. “One of the things that experts do quite carefully, is we try not to get excited about those small differences each time we see them.”
He adds that the situation is quite different between Canada and the United States, and it may not be possible to compare the two.
“It’s a different epidemic in the two countries,” he said.
Dr. Sean Fogler, a Philadelphia-based physician who himself once had a substance abuse problem, says the issue of drug use and overdose deaths is quite complex and different factors could be at play in the recent experience in the United States, including education, improvements in treatment, and more availability of the overdose-fighting drug naloxone.
But, he notes, “there’s still a long way to go” to solve a crisis that has even lowered life expectancy rates in both Canada and the United States.
Fogler, who now works for the Pennsylvania Harm Reduction Coalition, points out that one of the main contributors to the opioid crisis in North America in recent years was the overprescription of opioids in the 1990s.
Adding fuel to the crisis are the realities of our modern world, he adds, such as “being in a faster-paced society, adverse childhood experiences, trauma, obesity, and chronic pain.”
His own experience with substance abuse started as a result of the trauma of having been at the scene of the 9/11 attacks. He considers himself fortunate as he has a supportive family who helped him recover, but he says many people don’t have the same advantage.
Looking at determinants such as overdose death reductions are part of the solution, but he says that won’t fundamentally solve the issue and help those suffering from substance abuse.
“In my experience, finding meaningful work and purpose was one of the most crucial things to move on,” Fogler said.
“It’s about recovery, living a meaningful and purposeful life, a connected life, and doing good things.”