The costs of Canada’s toxic drug crisis keep piling up.
In 2020, Canadians’ use and abuse of opioids resulted in an estimated $7.1 billion in health and productivity costs, or 14.4 per cent of the $49 billion in costs caused by alcohol, tobacco, opioid and cocaine use.
The same year, drugs resulted in the loss of over 200 lives per day, according to a report compiled by the Canadian Centre on Substance Use and Addiction and the University of Victoria’s Canadian Institute for Substance Use Research.
Canadian Substance Use Costs and Harms 2007–2020 notes that 2020’s opioid bill was the highest of any year examined, and that nearly 75 per cent of the $7.1 billion financial cost was related to lost productivity and “people dying at a young age from opioid use.”
The number of Canadians who died from that use in 2020 was double the number in 2007.
That is just one year and just one of the bills owing in Canada’s toxic drug account. According to Public Health Agency of Canada numbers, between January 2016 and September 2022, there were 34,455 opioid toxicity deaths in Canada. Eighty-seven per cent of those deaths were in B.C., Alberta and Ontario.
In April 2016, B.C. declared a public health emergency over a spike in illicit drug-related emergencies and deaths.
Between Jan. 1, 2016, and July 31, 2017, the province recorded 1,854 drug toxicity deaths. In 2017, B.C.’s chief coroner convened a panel to review the facts and circumstances surrounding those deaths.
Four years and another 6,007 drug toxicity deaths later, a second death review panel was convened.
Numbers from the second panel’s report show that the illicit drug death rate in 2016 was 20.4 per 100,000 population; by 2020-21 it had jumped to 38.4 per 100,000 population.
According to the BC Coroners Service (BCCS), another 1,095 British Columbians died in the first half of 2022 alone because of the toxic drug supply in the province. By year’s end, the death toll had risen to 2,272 – the second-highest total in a calendar year, behind the 2,306 lives lost in 2021.
That increased the number of B.C. lives claimed by the crisis to more than 11,170 since April 2016.
According to the Ministry of Public Safety and Solicitor General, 70 per cent of the deaths in 2022 were in the 30-to-59 age range and 79 per cent were male.
Those percentages have changed little in 2023. BCCS data shows that there were 177 unregulated drug deaths in February and another 197 in March. March 2023’s death toll was nine per cent higher than it was in March 2022; February’s was 11 per cent higher than the same month in 2022. Seventy-one per cent of those who died were aged 30 to 59, and 77 per cent were male.
In a press release accompanying the province’s toxic drug mortality tally in the first six months of 2022, Lisa Lapointe, B.C.’s chief coroner, noted that it had “surpassed the number of deaths experienced in the same period in 2021, putting our province, once again, on track for a record loss of life.”
She added that toxic drug victims came from every social and financial background.
“They lived in our neighbourhoods, worked in our workplaces and played on our sports teams. Some lived ordinary lives, while others faced enormous challenges. All of them fell prey to the lethal supply of illicit drugs that is omnipresent.”
Citing recommendations from experts on the death review panel, Lapointe emphasized the need for access to a safer supply of drugs across the province.
“It’s only when we drastically reduce people’s reliance on the profit-driven, illicit drug trade that we will save lives and turn the trajectory of this crisis around.”
The victims documented in the death review panel report paid the ultimate price for B.C.’s illicit drug habit.
On the hook for the rest of the bills being generated by the global trade in fentanyl, carfentanil, norfentanyl, oxycodone and other synthetic opioid medications are families, businesses and communities all over the province.
But B.C. is not alone here.
Consider that in the United States, which is the world’s biggest synthetic opioids market, the death toll by April 2021 for the preceding 12 months hit 100,000. Annual costs to the U.S. economy resulting from the country’s opioids epidemic are estimated at US$1 trillion.
North Americans do not have to look much beyond their bathroom mirrors to find out who will have to pay those bills eventually.
They and their governments will have to look further afield to figure out how to stop those bills from increasing exponentially, because there are more answers to questions about how those bills started arriving and why they continue to increase, than there are answers to the question of how to stop them.
In America, the misuse of synthetic opioids and the resultant death toll began in the mid-1990s with the U.S. Food and Drug Administration’s 1995 approval of the sale of OxyContin, a prescription opioid painkiller marketed as being non-addictive.
It was a painkiller, but OxyContin was also extremely addictive.
The subsequent spike in OxyContin use led to widespread opioid dependence and addiction in the United States, and that opened a multibillion-dollar window of opportunity for triads, cartels and other international criminal organizations.
Fentanyl began flooding into North America about a decade ago. China was the principal source of the synthetic opioid medication until 2019, when the country’s president, Xi Jinping, delivered on a commitment made during the 2018 G20 summit to reclassify fentanyl as a “controlled substance.” The Chinese Communist Party instituted government controls and oversight of known fentanyl manufacturing areas in China. Stricter controls over advertising and shipping fentanyl followed. Fentanyl traffickers were targeted.
Problem solved? No. It just moved.
Fentanyl’s ingredients – precursor chemicals – are easy to conceal and hard to detect. Fentanyl is also up to 50 times more potent than heroin. So, a little goes a long way.
According to U.S. Commission on Combating Synthetic Opioid Trafficking (CCSOT) estimates, three to five tonnes of pure fentanyl could satisfy the country’s annual consumption of illegally supplied opioids, but it would require approximately 47 tonnes of heroin and 145 tonnes of cocaine to satisfy that same market demand.
Manufacturing fentanyl is cheaper than investing time, resources and money in growing poppies and processing them to make heroin. Fentanyl is also easily pressed into pill form, and users do not need to inject or snort it.
When China cracked down on its illicit fentanyl industry, producers shifted their operations to India and Mexico using opioid precursors shipped from China.
Mexican criminal gangs use those chemicals to make fentanyl, methamphetamines and other drugs, which are smuggled into the lucrative North American market.
Among the dangers here for consumers is that quality control is non-existent. The CCSOT notes in a February 2022 report that counterfeit tablets dressed up as prescription opioids often “contain dangerous and inconsistent doses of fentanyl. These fakes are potentially fatal, especially for unsuspecting buyers or others who might casually consume diverted prescription medications.”
Chemists can also substitute other ingredients in the toxic drug mix if supply chain congestion temporarily interrupts the flow of opioid precursors.
Vanda Felbab-Brown, director of the Initiative on Nonstate Armed Actors at the Brookings Institution, highlighted several other issues complicating the flow of opioids into North America.
She noted during a March 2022 panel discussion focused on China’s role in the smuggling of synthetic drugs and their precursors that controlling supply out of any country is difficult because it is easy to move opioid precursors from country to country.
“But the picture is all the more challenging because the co-operation [between China and the U.S.] is not there. And that gives the drug trafficking group a great sense of impunity. It complicates other dimensions of the relationship, and it also highlights how China views law enforcement co-operation with the United States [and] with the West … and how and when it acts against criminal groups.”
It acts when those groups hurt China’s interests, but the Chinese Communist Party does not necessarily act against them when organized crime damages the interests of other countries.
So, as Felbab-Brown pointed out, “from a trafficker’s perspective synthetic drugs, particularly synthetic opioids, are enormously advantageous.… They are enormously potent [so] one needs to smuggle much less of it to supply the market.”
But multinational pharmaceutical companies have also played a major role in establishing and expanding the market for synthetic opioids, as well as the crisis North America now faces from a booming and contaminated illicit drug trade.
Felbab-Brown, who is also the co-director of the Brookings series on America’s opioids crisis, pointed out that the opioid epidemic in the U.S. began with prescription opioids.
“It’s a very powerful demonstration of how heavily commercialized and abusive legal markets can create the most devastating drug epidemic in U.S. history,” she said. “U.S. pharmaceutical firms managed to create an addiction opioid-use disorder that an illegal market would never manage to do.”
Meanwhile, COVID-19 entered the market.
It disrupted more than supply chains, trade lanes and equity markets in every country and every major economy around the world. The global pandemic isolated people, increased depression and anxiety, and resulted in mass layoffs and economic distress. It also sparked a boom in the use and abuse of regulated and unregulated drugs.
But even though it temporarily shut down supply chains and created unprecedented port congestion, COVID-19 did not slow the flow of synthetic opioids into North America. Its higher potency and small packaging requirements made fentanyl a prime candidate for mail delivery. Along with trade in other goods, the opioid business moved online en masse.
And as the CCSOT report notes: “Regardless of distribution channel, smaller and more-compact shipments are easier to conceal, and novel chemicals can and often do escape existing detection tools and capacities. Law enforcement must rely on expensive, advanced technologies that require more personnel to screen or on conventional screenings that rely on agent observations and intuitions.”
Law enforcement also had to deal with the use of drones and other drug trafficker delivery innovations accelerated by the pandemic.
And the coronavirus onslaught did not galvanize co-operation between China and North America in a fight to slay the COVID-19 dragon.
Journalist Rupert Stone described the pandemic’s impact on that co-operation during the 2022 Brookings panel discussion.
“My general sense is that there was an expectation amongst those that were involved in the U.S.-China relationship [that] if there was this meteor-like moment, where, you know, there’s a meteor coming to Earth that’s crashing and threatening the survival of humanity, that the United States and China would be able to drop their swords and find ways to co-operate for the protection of their own people and the people of the world. COVID was an analog to a meteor moment.
“And instead of dropping their swords and coming together, what we found was that COVID sharpened the divisions that exist between the United States and China. It caused both countries to engage in a certain degree of blamesmanship, to compete for relative advantage of each other and really to fail the test of leadership when the world was looking to the world’s two most capable powers to protect their people.”
Stone added that, for China, the pandemic supported its view that the United States was decadent and undisciplined, “that it was incapable of controlling problems within its borders as COVID ravaged across the country. And it signalled a sign of a broader breakdown in social cohesion within the United States.”
“And this has a direct connection to what we’re talking about today, because I think it hardened the view of the opioid problem. It’s a supply-side problem; it’s a problem of the United States government being incapable of limiting the flow of fentanyl and other opioids inside the United States, and Americans being unable to suppress their insatiable desire for these drugs.”
Stemming the tide of that inflow into B.C. is similarly challenging.
As Abbotsford Police Department Chief Const. Mike Serr pointed out, “I think [it would] be naive for any police officer to ever tell you that we’re making a difference on the supply.… I’ve never in my career experienced a time where people said, ‘Oh, I had a hard time buying cocaine or fentanyl on the street. There is just so much of the product that can hit our streets.”
He added that B.C. has “always been an opioid province.”
“When I was walking the beat in the Downtown Eastside in the early 1990s, it was heroin. [Back] then, that was pretty unique to British Columbia. And heroin, as bad a drug as that is, it wasn’t killing people, for the most part. We might have had 200 overdoses roughly a year when we were dealing with heroin.”
So, where are we now, and how are British Columbians and their governments going to deal with present and future opioid costs and challenges?
For one, Big Pharma is being forced to pay at least a portion of the bills resulting from its opioid products and the marketing that masked their dangers.
In June 2022, Canada’s senior levels of government reached a $150 million settlement with Purdue Pharma (Canada) to recover some of the costs from the drug-induced devastation caused by its opioid medications.
B.C. initiated the class-action lawsuit launched in 2018 to recoup those costs. The settlement was reached early in the litigation process, and the allegations against Purdue Canada have not been proven in court.
Purdue was one of over 40 manufacturers and distributors named in the class action, which alleged that they and their consultants “engaged in deceptive marketing practices with a view to increase sales, resulting in increased rates of addiction and overdose.”
B.C.’s application to certify its class-action lawsuit in B.C. Supreme Court has been scheduled for fall 2023. If the application is successful, it could trigger further settlements to recover health-care costs.
That is only one settlement, and the dollars reaped from it are well below more ambitious claims against Big Pharma.
In October 2020, Purdue Pharma LP agreed to plead guilty to a three felony offenses: One count of conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute in connection with the opioid crisis in the United States.
The resultant penalty for the pharmaceutical company included US$5.5 billion in criminal fines and forfeiture. Purdue also agreed to pay US$2.8 billion to resolve its civil liabilities.
Meanwhile, Conservative Party of Canada (CPC) leader Pierre Poilievre has promised that a CPC government would seek $44 billion from pharmaceutical companies to address what he has said is their role the opioid crisis.
But covering financial costs is only one side of the toxic drug crisis equation.
Controlling the supply and demand is the other.
In the United States, where President Joe Biden declared the illicit drug trade a national emergency in December 2021, the CCSOT’s recommended actions for what it describes as a new response to new challenges on the illicit drug front include:
•developing a more unified central organization to co-ordinate planning, implementation and evaluation of all U.S. drug policies;
•disrupting drug supply through targeted oversight and enforcement;
•making public health demand-reduction approaches central in the fight against opioid trafficking; and
•collaborating with other countries involved in the production and distribution of synthetic opioids and precursors.
Back in B.C., key recommendations from the province’s death review panel include:
•ensuring a safer drug supply to those at risk of dying from the toxic drug supply;
•developing a 30/60/90-day illicit drug toxicity action plan with ongoing monitoring; and
•establishing an evidence-based continuum of care.
Serr, who was a member of the 2021 BCCS death review panel, noted that both the Canadian Association of Chiefs of Police and the BC Association of Chiefs of Police have endorsed decriminalization and “shifting from a criminal justice priority and moving it into a health priority.”
He said that means focusing on the demand side of the illicit drug market.
“And that’s not just people currently using drugs; that’s people who are also potentially emerging to be using drugs. So, how do we tell youth when you’re going through difficult times, or you experienced trauma in your life [that] you don’t resort to the illicit drug trade, that there are other tools in the toolkit.”
Drug decriminalization groups like the Canadian Drug Policy Coalition (CDPC) argue that the prohibition and demonization of drug use is the No. 1 cause of the toxic drug crisis.
“The first thing is that we don’t refer to it as an opioid crisis,” said Nicole Luongo, CDPC’s B.C. systems change coordinator. “That’s a misnomer because the astronomical rates of drug-related deaths and overdoses we’re seeing are not due to opioids. The direct cause is that the illegal drug supply is highly contaminated. So, people who are both heavy users of drugs and just very infrequent, or recreational users, are at immense risk, because there’s no predictability with the drug supply.”
She said the CDCP therefore advocates for a system that would replace the illegal drug supply with a legal community-run and regulated alternative.
Luongo added that the organization advocates “reframing the problem as not one of drug use but as one of drug prohibition.”
She said the criminalization of drug use is “really the origin story of a lot of the social problems we’re seeing today.”
Felbab-Brown also emphasized the need to rethink the war-on-drugs approach during the Brookings Institution panel discussion.
“We have very robust evidence that penalizing users and treating them harshly – not recognizing drug use as a public health illness – is deeply counterproductive.”
Serr, with 33 years of experience as a police officer, agreed.
He said addressing the toxic drug issue is complex, and will require a suite of solutions.
“This problem didn’t start overnight, and it won’t end overnight. It is going to take a while.… We’re not going to introduce one program that’s going to change things immediately.”
He said traffickers, producers and other key players in the supply side of the toxic drug trade should continue to be aggressively pursued by law enforcement and dealt with harshly by the courts.
“On the demand side, absolutely, we need more treatment; we need 24/7 access to detox, which does not exist today. We need the phone calls that can be picked up immediately to help give someone support who’s in need; more supervised consumption sites with options for people to get a safer supply who are in the middle of abusing drugs, and then a massive Part 2 will be education.”
Serr added that there will always be an illegal drug supply, because there is always someone willing to take the risk to produce and traffic in that supply.
“So, we have to find ways to try to deflect people away from the illegal market.... People will use drugs.… We’re naive to think that we will get people just to say no to drugs. But it’s how do we keep people alive; how do we support families?”
This article is part of an in-depth, provincewide journalistic effort by Glacier Media to examine the scope, costs and toll of the opioid and toxic drug crisis in British Columbia – a public health emergency that has taken at least 11,807 lives since 2016.If you or someone you know is in an emergency, call 911. If you need help with substance abuse, call the B.C. government's alcohol and drug information and referral service at 1-800-663-1441. It's available 24 hours a day.