Ending the overdose crisis will not happen through prohibition

Written and submitted by Mark Tyndall.

Epidemiologist, physician and public health expert Mark Tyndall has dedicated his career to studying HIV, poverty, and drug use in multiple places around the world, starting with Nairobi, and now in Vancouver. Mark spoke on the TEDMED Stage in 2017, and you can watch his talk here.


We are now well into year three of an opioid overdose epidemic in North America. Drug overdoses are now the leading cause of unintentional deaths for adults between 20 and 50 years old, far out-stripping automobile crashes, suicides and homicides. In many cities, first responders now spend the majority of their time racing to the next overdose and filling emergency departments with overdose victims. While the loss of life is tragic beyond words, the impacts of this crisis go far beyond the individual and will leave families forever broken, communities torn apart and children with no parents.

Yet despite the ongoing crisis, we find ourselves stuck debating the most mundane issues and doubling down on the very policies that have created all this misery in the first place. Despite overwhelming evidence to the contrary, we cling to the belief that any programs designed to reduce the risk of overdose and make drug use less hazardous will somehow encourage people to keep using drugs, dissuade people from entering addiction treatment, make our neighbourhoods more dangerous, and entice our youth to launch into a career of drug use. Common-sense, evidence-based harm reduction interventions like needle distribution programs, supervised injection sites, naloxone distribution, methadone and buprenorphine substitution therapy, low-barrier supportive housing, and accessible residential addiction care are shot down as unacceptable, disruptive, risky and too expensive.

Apparently devoid of any new ideas, we fall back to our worst tendencies – demonizing drugs and the people who use them. The moral panic that is perpetuated in the media gives us cover to continue to stigmatize people who are using drugs and commit them to ever harsher criminal sanctions that all but ensure they can never recover. This is all based on some sort of magical thinking. Do we really believe that if only we punished and isolated people more that they would stop using drugs? Do we really think that taking society’s most vulnerable people and cycling them through the prison system is part of a recovery program? Do we really think that busting drug dealers reduces drug use?

It is clear that the upstream drivers of addiction – the poverty, the hopelessness, the trauma, the isolation, the violence, the physical pain and the mental illness – must be addressed. More people are in pain, more people are being left behind, and more people are using drugs to self-medicate. In such an environment, it is in everyone’s best interest to make drug use as safe as possible while we invest in the myriad of societal challenges that are driving demand. We need a whole different approach to drug use and addiction that recognizes that people will continue to use drugs as long as they feel that drugs are their best option. Pushing people with drug addiction to the margins of society by continuing to enforce drug policies based on crime and punishment just doesn’t make sense.

September 19, 2016, Vancouver, B.C. —Urban artist Smokey Devil’s work is prominent in the alleys of Gastown and the Downtown Eastside, most of them pleading with locals to take care of themselves in the wake of Fentanyl overdoses. Gordon McIntyre / PNG [PNG Merlin Archive]
There is no indication that the overdose epidemic will go away anytime soon. While many thousands of people have already died, it is clear that there are many more at risk. In many communities the street supply of opioids, which was traditionally dominated by diverted prescription opioids and imported heroin has been largely replaced by potent synthetic opioids – mainly fentanyl. In fact, in many places the chance of dying of an overdose today has increased from a year ago due to the worsening toxicity of the supply.

We urgently need a comprehensive approach to the overdose crisis that is built on reducing the upstream drivers of drug addiction while promoting proven harm reduction initiatives that reduce the adverse health effects of drug use, provide a crucial point of connection, and keep people alive. This will require a dramatic shift in the way we treat people who use drugs and removal of the perverse criminal sanctions that continue to ruin lives and perpetuate the overdose crisis.