Multifaceted Solutions Needed for Canada’s Addiction Crisis

Since the COVID-19 pandemic began in 2020, Canadian healthcare professionals have seen a significant increase in several types of addictions, including alcohol, opioids, stimulants, and gambling.

Although opioid- and stimulant-related numbers have improved slightly this year, overdose deaths and hospitalizations remain alarmingly high, according to the latest data from the Public Health Agency of Canada (PHAC). Opioid toxicity deaths are about 8% lower in 2024 so far, yet more than 1900 people died between January and March, equating to about 21 deaths per day on average.

During the same 3-month period, there were more than 1500 opioid-related hospitalizations, more than 6700 opioid-related emergency department visits, and more than 8700 responses from emergency medical services for suspected opioid-related overdoses.

“Addiction is a significant health concern that affects individual lives and the lives of family members,” Daniela Lobo, MD, assistant professor of psychiatry at the University of Toronto and addictions site coordinator at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, told Medscape Medical News. It is associated with several other mental and physical health concerns.

“Addiction affects people in all walks of life, including all ages and all genders,” she said. “We’ve seen that youth are at a particularly high risk, yet this is also the population that we hope to be fulfilling roles in society over the next decades, so this is a huge societal issue of also caring for our younger generation.”

Public Health Emergency

Although the addiction crisis spans Canada, 84% of this year’s accidental opioid toxicity deaths have occurred in British Columbia, Alberta, and Ontario. Nearly three fourths of deaths occurred among young men, particularly those aged between 30 and 39 years.

In each province, local leaders and health officials often work together to address the overlapping challenges associated with a toxic drug supply, homelessness, crime, mental health challenges, and appropriate treatment programs.

In British Columbia, for instance, the Union of BC Municipalities held a conference in mid-September to hear from municipal leaders, law enforcement officials, and health professionals about the complex, cyclical crisis. Correctional facilities already have addiction treatment centers in place, and new youth programs are being initiated to help young people, but those solutions only make up one part of the addiction-cycle response, leaders said.

“The toxic drug supply remains the cause of this emergency. It hasn’t been addressed,” Mark Lysyshyn, MD, deputy chief medical health officer at Vancouver Coastal Health and clinical assistant professor of public health, preventive medicine, and internal medicine at The University of British Columbia, Vancouver, British Columbia, Canada, told Medscape Medical News.

Of the opioid toxicity deaths across Canada between January and March, 81% involved fentanyl, and this proportion has increased by 42% since national surveillance began in 2016, PHAC data indicated. In addition, 61% of overdose deaths also involved a stimulant.

This year marks the eighth year of an overdose public health emergency in British Columbia, said Lysyshyn. Several initiatives have helped, such as using naloxone and opioid agonist therapies, as well as the establishment of supervised consumption and overdose prevention sites. Even so, the province needs additional prevention and treatment options.

“Harm reduction services keep people alive so they can get treatment,” he said.

In Winnipeg, Manitoba — as in most cities and provinces facing the addiction crisis — homelessness remains a key issue. First, communities often lack housing for residents with mental health and addiction issues. Beyond that, housing support services may not have enough beds to keep people safe as they seek help.

“We are now living through this…period as though the pandemic ended, and we are getting back to life as it was. There is no life as it was,” said Marion Willis, executive director of St. Boniface Street Links, which seeks to address homelessness through addiction treatment, job referrals, legal aid, counseling, and other social support services.

These “wraparound services” are key, she said, for helping people get back on their feet — and trying to prevent people from falling into the cycle of addiction in the first place. Although local officials seem to be moving in the right direction by setting aside funding for new programs, a successful response requires careful coordination among agencies and community organizations, she said, as well as more dollars at the provincial and national levels.

“We are dealing with a level of social distress unlike anything I have seen in my 40-year career, and we don’t have the resources to address these things,” Willis said. “It’s now at the point where we can’t seem to bring anything under control. It’s really desperate.”

Increasing Training, Reducing Stigmatization

Ultimately, new solutions need a systemic approach to implement effective change, said Lobo. In Alberta, for instance, officials removed numerous homeless camps in Calgary and Edmonton and created a Navigation Center to coordinate wraparound services, including access to a 24-hour shelter space.

Other provinces are looking at factors linked to homelessness and drug use, such as high rent prices, housing shortages, and landlord bias against leasing to at-risk people, particularly those with mental health challenges.

“I’ve been an addictions psychiatrist for 20 years, and I can tell you that concurrent disorders are the rule rather than the exception,” Lobo said. “Most people seeking treatment for addiction have underlying diagnoses or undiagnosed mental health concerns.”

Recent studies in Canada have supported programs such as specialized addiction medicine teams in hospitals, low-barrier addiction care, and access to harm reduction services and safe supply sites. But provincial policies and funding don’t always support these programs.

In Ontario, changes in provincial policy will lead to the closure of several supervised consumption sites and needle exchange programs this year but, in turn, the opening of 19 homelessness and addiction recovery treatment centers, which will offer support for housing, employment, and addiction.

“The idea of safe consumption is to prevent death and open the door for people to talk about treatment,” said Lobo. “On the other side, though, people have concerns about what happens around a safe consumption site, with discarded drug paraphernalia and increased violence, and the issue that that there’s usually not governmental funding for environment cleanup or wraparound services to help.”

Looking ahead, short-term solutions should include increased accessibility to addiction treatment and mental health services, she said. Long-term solutions, though, should include “capacity building” by training healthcare professionals across all specialties in addiction medicine and reducing stigmatization among the public.

“It’s important to realize that often the way people think about addiction is that it happens to somebody else and not them,” Lobo said. “But if we want the healthcare system in Canada to be sustainable and to be able to assess whether our governments are acting in the best interests of public health, we need to increase public awareness.”

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.