As COVID-19 continues to dominate North American media coverage, a drug-overdose crisis rages under the radar.
Deaths from drug overdose in Canada are up by an average of 54% during the pandemic.1 Some experts are calling on the government to make access to drugs easier as supply dwindles and demand is at a fever pitch.[2]
In the province of British Columbia, there was an increase of more than 50% in the number of “paramedic attended overdose events” during the first months of the COVID-19 pandemic compared to the same period of the year before. Twice as many overdose deaths occurred in 2020 as in 2019, and a third more than 2018.[3] There is no sign of the downward trend that traditionally follows the seasonal peaks for deaths and events.
Alberta reported an increase in opioid-related deaths in Q2 of 2020 of more than 62.5%, with a significant drop in addiction treatment program adherence and an increase in opioid-related hospital visits.[4] Ontario experienced a 25% increase in opioid-related deaths March through May 2020, compared to the same period in 2019.
The United States has seen an increase in overdose deaths of 18% during the pandemic, with 46 of the 50 states recording increases. Nevada, Idaho, New Hampshire, and Alaska reported modest decreases.[6]
A source from a public health agency in British Columbia has suggested a major factor was the shutdown of the Canada-US border to non-essential travel, thus limiting the trafficking potential of the cross-border drug trade. A decline in supply translates to a drop in quality as drugs are being cut (the process of decreasing purity by adding cheaper fillers) with dangerous substances and spurring users to take larger doses to offset a less effective product. Other causational speculation includes self-medicating of isolation-related mental health concerns, abuse of less traditional drugs, and restricted access to treatment programs due to pandemic closures and fears.[7][8]
Financial Implications
Regardless of personal position on the pandemic, drug use, or on politics, this trend concerns everyone, even if just for its implications on tax dollars.
In 2017, substance abuse management cost the Canadian economy $46 billion ($1,259 per citizen).[9] While Canada has a federal public health system, each province has its own public health system, responsible for taking on part of the substance-abuse cost burden. The Alberta government estimates that opioid/illicit drug use cost the local economy $5.5 billion in 2014 alone ($1,332 per capita), representing just over one-quarter of the total tax cost of management.[10] In 2017, the average Canadian family earned $85,883; it paid $37,058 in taxes.[12] The substance-abuse cost represents about 3.4% of the total tax burden.
Another negative effect of pandemic drug abuse and overdose rates is the future implications of narcotic use. Illicit drugs, as in the case of any tradable goods, are subject to the rules of supply and demand. There has never been a better time to be a drug trafficker or dealer – if you can get your hands on product, that is. Reports indicate that cost “at source” of cocaine and opioids is very low, to the point of discouraging growth because borders are being locked down all over the world. Consequently, the demand for effective smugglers has never been higher. If a dealer can manage to import the goods under limited supply, the cost on the street has increased.[13] There is speculation that increasing stockpiles of drugs in producing countries will create an oversupply of product, and cheap, high-quality narcotics will flood the market once COVID-19 restrictions ease.[14] There is concern that this will lead to another wave of overdoses. Reports from Los Angeles have the street price of methamphetamine doubling compared to the same time last year.[15] In New York, marijuana prices have jumped by 55%, cocaine by 12%, and heroin by 7%. Similar rates are being reported across the globe.[16]
Drug Enforcement
Like most cause-and-effect propositions, the increase in overdoses is based on theories. BIG Media addresses mental health and self-medication during the COVID-19 pandemic in an earlier article. However, a foundational hypothesis for the most recent overdose crisis is that, due to restrictions, illegal narcotic supplies are not crossing the border with as much frequency or volume.
Drug seizure rates reported by the Canada Border Services Agency (CBSA) on travellers coming into Canada are down 82% April through June 2020, compared with the same period in 2019. Further, the CBSA reports a significant shift from individual narcotics seizures to commercial vehicle seizures.[17]
Meanwhile, the United States Customs Border Protection (USCBP) agency’s total southbound narcotics seizures along the northern border (by weight) are up 1,000%, with the largest spikes represented by fentanyl, methamphetamine, and marijuana.
Another side effect reported by the United States Drug Enforcement Agency (DEA) is that its agents are making cash seizures extending into the millions of dollars when raiding cartel establishments, whereas they used to seize an average of around $100,000. This is being attributed to the shuttering of non-essential businesses that might otherwise launder money on their behalf.[19]
Harm reduction and broader access
In 2017, 38% of adults in the U.S. battled a drug-use disorder. Since the “war on drugs” was proclaimed by Richard Nixon in 1971, it has cost American taxpayers $1 trillion, the prisons are full, and adolescents are still using at an alarming rate.[22] Some experts have suggested that making drugs more accessible and making drug-use locations more abundant would help combat the current crisis.[23]
The concept of sanctioned safe-injection sites was born in the mid 1990s in Vancouver, B.C.; the first sanctioned site was officially launched in 2003.[24] At safe-injection sites, users can get free, clean paraphernalia, and can use their drug of choice under the observation of a trained medical professional. Data shows many seemingly positive results, including limiting infectious disease transmission, a 35% decrease in fatal overdoses in the surrounding area, and a 9.3% decrease in the rest of the city.[25] It appears to be cost effective with models projecting $14 million in savings and 920 life-years gained over a 10-year period. Reports indicate savings to Canadian taxpayers of $17.6 million in lifetime HIV medical care costs while billing $3 million per year to operate. But the question remains, is providing drug alternatives to addicts during times of supply shortage cost effective and reducing harm?
There are many prescriptions a medical professional can choose from, but methadone and buprenorphine are two of the most commonly used medical substitute interventions for those trying to manage drug addiction. In terms of being part of a greater treatment protocol, both have shown to be effective in the reduction of fatal overdose rates. These studies are focused on the purpose of treatment, and it is assumed that the patient is invested in the end result and that adherence is voluntary and intentional. Users report the high elicited by methadone to be a poor substitute for traditional opioids. There are other substitute options, but their effects on overdose rates have not been subject to much study.[29] Will those not on a treatment program opt for a free alternative in an open, albeit deficient market?
Just before the COVID-19 pandemic struck, many parts of Canada and the U.S. were beginning to show improvement on the overdose crisis which, in the years prior, was running away from them.[30][31] March hit, borders closed, supply dwindled, and demand rose. The street cost of drugs and the cost to attend to overdose-related traumas jumped. Once borders reopen and businesses are allowed to run at full capacity, will we go back to normal? Do we even want to go back to normal? Or, to peddle a line that has been the reticent rallying cry of the downtrodden masses, is this new phase of the overdose epidemic simply the “new normal”? In countries with social health care, large sums of money are being spent on substance-abuse management. Do personal convictions override the bottom line? Is prevention more important than enforcement? Now that that you know what it costs and what is at stake, how do you think your tax dollars should be spent in in addressing the overdose crisis?
[1] Opioid- and Stimulant-related Harms in Canada – Public Health Infobase | Public Health Agency of Canada
[2] https://www.cmaj.ca/content/192/34/E967
[3] http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Overdose/Overdose%20Response%20Indicator%20Report.pdf
[4] https://open.alberta.ca/dataset/f4b74c38-88cb-41ed-aa6f-32db93c7c391/resource/e8c44bab-900a-4af4-905a-8b3ef84ebe5f/download/health-alberta-covid-19-opioid-response-surveillance-report-2020-q2.pdf
[5] https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en
[6] HAN Archive – 00438 | Health Alert Network (HAN) (cdc.gov)
[7] https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00700/full
[8]https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/data-surveillance-research/modelling-opioid-overdose-deaths-covid-19.html#considerations
[9]https://www.ccsa.ca/sites/default/files/2020-06/CSUCH-Canadian-Substance-Use-Costs-Harms-Infographic-2020-en_0.pdf
[10] https://www.albertahealthservices.ca/assets/info/amh/if-amh-economic-costs-of-substance-use-in-ab.pdf
[11] Taxes versus the Necessities of Life: The Canadian Consumer Tax Index 2018 edition (fraserinstitute.org)
[12] https://www.fraserinstitute.org/studies/taxes-versus-necessities-of-life-canadian-consumer-tax-index-2020-edition?utm_source=Media-Releases&utm_campaign=Canadian-Consumer-Tax-Index-2020&utm_medium=Media&utm_content=Learn_More&utm_term=531
[13] https://www.unodc.org/documents/data-and-analysis/covid/Covid-19-and-drug-supply-chain-Mai2020.pdf
[14] https://www.unodc.org/documents/data-and-analysis/covid/Covid-19-and-drug-supply-chain-Mai2020.pdf
[15]https://www.courier-journal.com/story/news/crime/2020/06/08/coronavirus-pandemic-mexican-cartels-stockpile-drugs-money/5193971002/
[16] https://www.nbcnews.com/news/crime-courts/covid-19-costing-drug-cartels-millions-dollars-n1213181
[17]https://www.richmond-news.com/local-news/drug-seizures-at-bc-border-plummet-during-pandemic-3126856
[18] https://www.cbp.gov/newsroom/stats/cbp-enforcement-statistics-fy2020
[19]https://www.latimes.com/california/story/2020-04-29/coronavirus-slows-money-laundering-to-a-crawl
[20] https://americanaddictioncenters.org/rehab-guide/addiction-statistics
[21] https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/
[22] https://www.prisonpolicy.org/reports/pie2015.html
[23]https://www.cmaj.ca/content/192/34/E967
[24] https://www.cmaj.ca/content/192/34/E967
[25] https://www.sciencedirect.com/science/article/abs/pii/S0140673610623537
[26] https://www.cmaj.ca/content/179/11/1143.full
[27] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.02977.x
[28] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227298
[29]https://americanaddictioncenters.org/methadone-addiction/high
[30] https://health-infobase.canada.ca/substance-related-harms/opioids/graphs?index=169
[31] https://www.cdc.gov/drugoverdose/data/statedeaths.html
Footnotes
