To Tackle Opioid Crisis, Ask Why Our Society Produces Mass Despair

[Editor’s note: This is the last of a series of pieces drawn from All Together Healthy: A Canadian Wellness Revolution, written by Tyee legislative bureau chief Andrew MacLeod and just published by Douglas & McIntyre, that challenges assumptions about how best to improve health for Canadians.]

Midway through British Columbia’s provincial election campaign in April 2017, Derek Peach stood up at a town hall style meeting at a Victoria hotel hosted by NDP leader John Horgan, then running for premier. “We had 914 human beings die last year from drug overdose,” said Peach, an older man in a suit jacket who’d waited nearly an hour for his turn to speak. “My child was one of them.”

An NDP supporter whose daughter died two months earlier at the age of 50, Peach wanted to know what his party would do about the ongoing crisis. “Tell me you’ve got something better than just another phone number or website for people to phone. What have we got in our platform?”

Horgan expressed sympathy. “You and 900 other families are suffering because of a lack of action to address a health care crisis, an addictions crisis in British Columbia.” Horgan said he often thinks about the growing number of people dying from drug overdoses. “We need to work together on this,” he said. “On addictions, if you present wanting help, you have to have someone there to make sure the hand pulls people in for help. That means treatment beds. It’s in our platform.”

Horgan also said an NDP government would create a ministry of mental health and addictions so one person in cabinet could focus on the crisis and be accountable for the government’s response. “I’ll do my level best to make sure those numbers never ever get as high as they were last year,” he said. By the end of 2017 illicit drug deaths in B.C. topped 1,400 — up from 300 in 2012.

The numbers do show a small decline this year, but, as of June, more than 100 British Columbians were still dying every month.

Lawrie McFarlane is a retired civil servant who in the 1990s was B.C.’s deputy health minister. In a March 2017 opinion piece he noted that since 1990 the rate of deaths from suicide, alcoholism and illicit drugs among Canadians between the ages of 50 and 54 had jumped by 25 per cent. Sometimes described as “deaths from despair,” it’s a key question why they have been increasing.

“Stagnating incomes among working-class families might be part of the reason,” McFarlane wrote. “So, I suspect, is the age of the population segment we’re talking about. Younger people tend to be more resilient. And folks in their 60s have retirement to look forward to. But middle-aged men and women whose lives haven’t worked out can be trapped in a darker mentality.”

Broken marriages, difficulty providing for kids, guilt and self-blame are common, he said. Meanwhile, the supports people enjoyed in the past, such as religion, trade unions or service clubs, have weakened. “You might expect that young people fleeing dysfunctional homes, or kids willing to try whatever concoction comes along, would be the principal victims. But fentanyl is not, primarily, a plague that kills teenagers (or seniors), though there are deaths in both groups.”

Instead, the majority of drug-overdose deaths in B.C. were of people between the ages of 40 and 59.

The people who are dying are also predominantly men. McFarlane suggested the over-representation of men could be related to the decline in male-dominated parts of the economy, a drop in the availability of family-supporting jobs in resource extraction, mining and forestry. Gender roles have shifted in recent decades, but expectations that men will be providers largely have not.

“The hard truth is, we really don’t understand what is going on,” he wrote. “The symptoms of death from despair are well-known — opioid fatalities, homelessness, suicide — but we haven’t tied down the social malfunction behind them.” People point to mental illness, high housing costs, or childhood abuse, which are real but not the whole story, he wrote. “We need a public discussion of this crisis, before it gets worse.”

Besides overdoses, men are also more likely to die from workplace accidents, alcoholism and suicide. That’s significant, according to Dan Bilsker, an assistant clinical professor at the University of British Columbia and the co-author of A Roadmap to Men’s Health. “Both suicide and overdose may be acts of men who have lost hope that life will provide meaning through work, family or loving partnership, men who don’t care whether they live or die.”

In other words, the overdose crisis speaks to widespread loss of hope, particularly for men. The crisis is therefore existential in nature.

As Andre Piver, who worked in the mental-health system for 20 years, put it, “Rather than getting high, most people who get into trouble are just trying to get by and stop focusing on worry, hopelessness or just physical pain which, importantly, also may become a substitute focus for existential discomfort. We are in a ‘lost’ time at the end of this industrialized civilization.” Writing from Nelson in B.C.’s southeast, he called for rebuilding the mental health system in a way that allows caregivers to make human connections and build trust with the people they are supposed to be helping.

Even for those working in small communities, the roots of the crisis are not always immediately apparent. Esther Tailfeathers was a family physician and emergency room doctor at the Cardston Hospital who came from the Kainai, or Blood Tribe, Reserve in southern Alberta, which was in the midst of its own fentanyl overdose crisis. “Initially, we had thought the main reason for this epidemic in our community was we were seeing the intergenerational trauma from residential schools being resurrected,” she has said, adding that turned out not to be the main factor leading young people into addiction.

“We’re finding out that the number one social determinant for what we’re seeing with addictions in this community is poverty,” she said. “In order to address our poverty issue, we need to address our self-sustenance... We need to be sustaining our own population with work on-reserve and with agriculture and industry on-reserve that is environmentally friendly [since] we consider the stewardship of the land as important.”

Cracks the size of Grand Canyon

After Horgan made Judy Darcy responsible for a new ministry of mental health and addictions, she laid out her thoughts on the issue. A prominent union leader before entering politics, she said her perspective on the issue was broad. Noting that about half the people who came to her constituency office seeking help were dealing with mental health issues and addictions, she said it had been impossible to know what to suggest.

Later, Darcy wrote that the system is fragmented and people wait too long for treatment.

“If you break your leg, you know where to go to get the help you need quickly. However, we don’t have that same system if you are suffering from mental-health issues or addictions — even though hundreds of thousands of British Columbians are suffering from such illnesses. We need a more effective system that focuses on prevention, early intervention, treatment and recovery — a system where you ask for help once and get help fast.“

She continued, “We need to look at underlying issues like stigma, poverty, homelessness and housing, and work with First Nations leaders on the unique issues faced by Indigenous people who are so disproportionately affected by the overdose crisis.”

That failue to deal with the underlying causes is long standing. Diane McIntosh, who teaches in the psychiatry department at the University of British Columbia, has written, “I believe this crisis is due, to a great extent, to the wilful blindness of all levels of government through the inadequate resourcing of mental health care.” The cracks that people fall through are the size of the Grand Canyon, she said. Without care, many people with mental illness suffer silently, she wrote. “Untreated mental illness drives addiction and addiction drives mental illness, creating a vicious cycle that too often is broken by death, not recovery.”

The overdose crisis, like homelessness and tent cities, is a symptom of a sick society and it speaks to a broader malaise. We live in an economy that depends on consumption and that requires people to need more stuff, to feel unsatisfied with what we already have. Or as a shaman from B.C. who is known as both Ronin Niwe and Dave has explained, “We don’t love ourselves... That’s the root of it. Our society is sick, our society is depressed and mass parts of the population have huge traumas.”

Invisible cages

The conclusion is similar to those a retired Simon Fraser University psychology professor, Bruce Alexander, has made. Alexander started by studying rats, then extended his observations to people, including the experiences of Indigenous people after European colonizers in western North America in the 18th and 19th centuries. The presence of an addictive substance matters less than the social conditions that made people, or rats, want it, he wrote.

Alexander concluded that addiction — including addiction to drugs or alcohol, which he described as a relatively minor part of the phenomenon — is more of a social problem than an individual problem, and that when a society fragments, addiction increases dramatically. In a piece available on his website, Alexander wrote:

“When I talk to addicted people, whether they are addicted to alcohol, drugs, gambling, Internet use, sex, or anything else, I encounter human beings who really do not have a viable social or cultural life. They use their addictions as a way of coping with their dislocation: as an escape, a pain killer, or a kind of substitute for a full life. More and more psychologists and psychiatrists are reporting similar observations. Maybe our fragmented, mobile, ever-changing modern society has produced social and cultural isolation in very large numbers of people, even though their cages are invisible!“

The flood of addiction that we see is because “our hyperindividualistic, hypercompetitive, frantic, crisis-ridden society makes most people feel social and culturally isolated,” he wrote. In this view, addiction to drugs and other pursuits are a temporary relief from widespread, chronic isolation. The problem is not fentanyl, opioids, heroin or alcohol. The problem is modern life. It’s a perspective that shifts blame from the person who is addicted to the broader circumstances within which they live.

This concludes a series of four pieces drawn from Tyee reporter Andrew MacLeod’s book All Together Now: A Canadian Wellness Revolution, published by Douglas & McIntyre. Find the entire series here.