PETITION FOR A ROYAL COMMISSION INTO CANADA’S OPIOID OVERDOSE EPIDEMIC
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This petition calls on the Right Honourable Prime Minister Trudeau and Health Minister Ginette Petitpas Taylor to Establish a Royal Commission examining the circumstances, including government actions and inactions, leading up to and accounting for Canada’s Opioid Overdose Epidemic. This petition is a follow-up to a letter written by Dr. R. Dan Small to Prime Minister Trudeau on 15 May 2018 formally requesting the establishment of a Royal Commission (attached link to the original letter below).
North America’s first supervised injection facility, established in 2003, has proven successful in reaching a challenging target population, reducing fatal overdoses and HIV while bringing people with addictions into the doorway of a successful life along with detox and treatment. The independent, scientific, peer-reviewed evaluation resulted in dozens of publications indicating its success.
In his capacity as co-director of the community agency that established and co-managed Insite, Dr. R. Dan Small wrote to the Vancouver Coastal health authority after the successful commencement, operation and evaluation of the program to request a scale-up of supervised injection services to meet the increasing population-based need. The request was repeatedly rejected. The request to scale up supervised injection services wasn’t visionary, it was epidemiological common-sense.
On the dawn of the Supreme Court decision in favour of Insite in 2011, Canada was poised for a paradigm shift in the realm of drug policy. Despite the decision in favour of Insite and its establishment as a key part of the standard of care, supervised injection services remained isolated to a single program in Vancouver operating for only 18 hours per day. For well over a decade, the project didn’t move forward in terms of capacity and didn’t operate consistently for 24 hours per day.
Structural Violence Towards Drug Users
At the federal level in Canada, the Conservative Government sought a legislative strategy to quash the symbolic victory of Insite case. In practical terms, the government put in place legislative obstacles, arguably a form of structural violence, that all but outlawed supervised injection in the form of Bill C-31. Rather than being able to move ahead, supervised injection was stalled on the national front and the development of a range of harm reduction services that could have largely prevented the overdose epidemic were hampered.
Until the advent of temporary pop up services in 2016, Insite remained as the only supervised injection facility open to the general public in Canada. Its standard operational hours encompassed 18 hours each day and left a 6-hour daily period during which supervised injection was unavailable. The period during which Insite was closed each year represented 2190 hours per annum. Translated into days, that figure is 91.25 days per year. Extrapolated over the period since Insite opened, the period of non-service represents over 3 years of time during which life-saving supervised injection services were absent in Vancouver. For the rest of Canada, that number remained at zero. This tragic medical ethical conundrum is exemplified by the fact that this life-saving service while legally enshrined in the nation’s highest law, was only made available for 75% of each calendar day in only one city in the entire country.
Structural Violence: Definitions
In order to understand how this could have happened, we need to investigate the institutional approach to (e.g. health, enforcement, governmental) to illicit drug use (and drug users) in Canada. This requires an examination of structural violence:
“Structural violence is not, however, primarily about individual choice—it is built into the functioning of impersonal (bureaucratic, technocratic, and automatic) systems and applied to whole classes of people without regard to the characteristics of any individual case; hence the limitations of the moral vocabulary derived from individual agency for analyzing the larger systems of oppression and exclusion. We need to understand how the system builds and rebuilds itself, neutralizing and absorbing opposition and reform”(Kirmayer 2004) (p. 321)
In the case of the opioid epidemic, sociocultural forces have arguably perpetuated structural violence towards the drug users:
“Structural violence is exerted systematically—that is, indirectly—by everyone who belongs to a certain social order: hence the discomfort these ideas provoke in a moral economy still geared to pinning praise or blame on individual actors. In short, the concept of structural violence is intended to inform the study of the social machinery of oppression. Oppression is a result of many conditions, not the least of which reside in consciousness” (Farmer 2004) (p. 307).
A Royal Commission into the opioid epidemic will allow us to examine taken-for-granted social arrangements that have allowed structural violence that has contributed to the overdose epidemic:
“Structural violence is a powerful metaphor that leads us to look for the brutality in taken-for-granted arrangements. The notion that it involves ‘sinful’ social structures assigns blame and urges a moral response, but how are we to characterize this sin (as avarice, self-interest, gluttony, pride, racism, ignorance, aggression?) when there are so many sins on display? The moral language should encourage us to think about where, when, and why we sin.” (Kirmayer 2004) (p. 321)
Royal Commission of Inquiry: Logic
The most recent epidemic of fatal overdoses in Canada highlights not only the poignancy of preventable deaths but also the equally preventable social construction of drug use in relation to crime, individual choice, blame, and society. The Supreme Court decision regarding Insite marked the sociohistorical establishment of supervised injection as a standard of care in science, population health and law. Yet, supervised injection services were not adequately scaled up.
The fact that the failure to put in place supervised injection services across Canada would have saved hundreds, if not thousands, of lives is as subtle as an open grave. The barriers that have prevented harm reduction service innovations were and are not scientific, medical or epidemiological. The barriers are implicit and explicit values, the bedrock of our culture and institutions, regarding addiction and drug use. It took the tragedy of an astonishing overdose epidemic in order to bring about significant government or institutional action to substantively address the dangers of illicit drug use.
This petition calls for the establishment of a Royal Commission to examine the variables that have accounted for the dramatic overdose tragedy. The Commission would look to the past as well as the future and could take place alongside continued efforts to address the opioid overdose epidemic. Beyond seeking the truth and uncovering errors, a Royal Commission into the opioid crisis has the potential to contribute to positive social change through recommendations, action items, and public education. Such processes also serve a restorative function in commissions and inquiries can make a contribution towards the healing of individuals, families, systems and a society that has lost so many lives to preventable deaths.
If you support this call for a Royal Commission, then please add your full name and contact information to this petition. By adding your name, you are indicating your support for a Royal Commission into the opioid overdose epidemic and providing permission for the publication of your name and contact information as part of an overall list of supporters. This list will be shared publicly and forwarded to government officials and policy makers. Should you wish to remain abreast of ongoing activities related to this petition, you can indicate your willingness to be contacted again by email. Otherwise, the addition of your name will solely indicate your support for the petition and its call for a Royal Commission.
2004 An Anthropology of Structural Violence. Current Anthropology 45(3):305-325.
2004 Comments: An Anthropology of Structural Violence. Current Anthropology 45(3):321.
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