What is the opioid crisis?

From our free online course, “The Opioid Crisis in America”: …

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The Opioid Epidemic: A National Emergency

Emory Medicine Grand Rounds – 9/5/2017 TOPIC: “The Opioid Epidemic: A National Emergency” LEARNING OBJECTIVES: –Describe the current opioid …

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The Opioid Crisis Is Much Worse Than You Think

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Our governments are addicted to alcohol

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Alcohol is one of the five most addictive substances according to many studies. Other drugs that are often on the inglorious list are heroin, cocaine, nicotine and barbiturates.

Of course, both heroin and cocaine are illegal in Canada. Barbiturates are a controlled substance. And products containing nicotine are highly regulated. Cigarette companies are prohibited from advertising their products or sponsoring cultural events.

However, alcohol is fully standardized. And despite mountains of evidence why drinking is a bad habit (heavy drinkers are more likely to die of heart disease, cancer, cirrhosis of the liver), government-controlled monopolies like the Liquor Control Board of Ontario (LCBO) and the Société des alcools. du Québec (SAQ) encourage us to consume more using various marketing tactics.

Alcohol abuse is a major problem in Canada. According to surveys conducted by Statistics Canada, 15.6% of the country’s population aged 12 and over self-declared “heavy drinkers” (males who reported consuming five or more drinks, or females who reported having drank four or more drinks, on one occasion). , at least once a month during the past year).

Also, according to a report recently released by the Canadian Center on Substance Use and Addiction (CCSA), in 2017, alcohol contributed to 18,000 deaths in Canada. That same year, the costs associated with alcohol use in Canada were $16.6 billion, with $5.4 billion of that amount going to health care.

A recent Statistics Canada study suggests the problem may have gotten worse recently, with nearly 25 percent of Canadians saying they thought their drinking had increased because of the pandemic.

As we all know, alcohol (except beer) is mostly sold by provincial Crown corporations like the LCBO and the SAQ. While it is debatable whether governments should have kept the distribution and sale of alcoholic beverages in their hands, one thing is clear: when it comes to alcohol, it is not only the consumption that creates addiction, but also the income generated by their sales.

In 2021, the LCBO paid a dividend of $2.55 billion to the Ontario government, equivalent to 1.4 per cent of the province’s annual budget. SAQ paid $1.22 billion to the Quebec government, which represents one percent of its annual revenue.

These great benefits make them hard to resist, but also complicated.

On the one hand, you have government-controlled monopolies, managed and governed primarily by entrepreneurs with retail and marketing experience. By nature, these professionals are constantly looking to increase the benefits that are paid in full to the councils that depend on them as part of their budgets.

But, unfortunately, alcohol consumption has its downside. Beyond the personal tragedies for individuals and their families, excessive alcohol consumption also imposes an enormous cost on the nation’s health care system. According to one estimate, alcoholism costs Canadians up to $15 billion a year. This means that the billions of dollars in dividends generated by the sale of alcohol are effectively used by governments to treat those injured by alcohol abuse. A bit absurd.

Much wine has been consumed since 1927, when Prohibition ended and the LCBO was established. According to an article published today on TVO, at the time, the stores “were designed to make the experience of buying alcohol as embarrassing as possible” and “LCBO officials believed that superior customer service was not reflected in the volume of sales but in the prevalence of good social conditions in the surrounding community and the absence of drunkenness”.

But today, the LCBO is a marketing partner of Air Canada, and you can earn extra Aeroplan points when you buy wine and spirits. And SAQ has its own loyalty program, Inspire, with 1.9 million members that can be directly targeted. According to SAQ spokeswoman Linda Bouchard, the annual cost of the program was $3.7 million in 2021.

Although small compared to other retailers, the LCBO and SAQ still have significant amounts of marketing and advertising efforts. For example, for the 2021-22 fiscal year, SAQ spent $7.13 million on “advertising and promotions.”

LCBO spent $2.36 million in the most recent year on advertising and promotional items. However, that figure represents “net expenses,” and an emailed statement from the LCBO press office confirmed that the advertising is “paid for largely by suppliers.” Therefore, the actual advertising budget is significantly higher.

Asked how the SAQ’s marketing efforts can be justified given the known harms of alcohol, spokesman Bouchard said the Crown corporation is “very sensitive” to the issue and promotes in its advertisements “a responsible consumption… where good practices are proposed (glasses not too full, limited number of bottles on the table, etc.).

The LCBO press office wrote that “as part of our commitment to safe and informed consumption, we advocate for responsible retail practices and foster a culture of moderation to help Ontarians make responsible choices for their health and well-being”.

As for the LCBO-Aeroplan partnership, the press office declined to disclose any financial details, writing that “customers are not necessarily buying more products, but are encouraged to try new products.”

However, a quick browse of the LCBO website shows that customers who purchase a full case (12 bottles) of new vintage arrivals currently receive 1,000 bonus Aeroplan points.

Wine and spirits are a legal product and consuming them in moderation could be fun. Just like cigarettes and cannabis, we all know where to find them. However, encouraging consumers to consume more alcohol is wrong practice. This is especially true given Canada’s new low-risk drinking guidelines that the CCSA will officially launch in January 2023. The new guidelines recommend avoiding alcohol altogether or consuming no more than two drinks per week.

Alcohol is not much different than tobacco and should have similar regulations and standards regarding its marketing and advertising practices. Alcohol revenue paying for healthcare costs makes no sense.

Amir Barnea is an associate professor of finance at HEC Montréal and a freelance columnist for the Star. Follow him on Twitter: @abarnea1TO SHARE:

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Black opioid overdose deaths are rising faster than whites, according to the study: shots

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New research shows racial inequalities in the rate of opioid overdose, with a mortality rate among blacks growing faster than in other groups. Researchers are calling for expanded access to drug treatment and education on how to prevent overdoses with the antidote drug, naloxone. Spencer Platt / Getty Images hides the title

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New research shows racial inequalities in the rate of opioid overdose, with a mortality rate among blacks growing faster than in other groups. Researchers are calling for expanded access to drug treatment and education on how to prevent overdoses with the antidote drug, naloxone.

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A study published on Thursday reveals a growing racial disparity in opioid overdose mortality rates. Deaths among African Americans are growing faster than among whites across the country. The study’s authors call for an “anti-racist public health approach” to addressing the crisis of black communities.

The study, conducted in collaboration with the National Drug Abuse Institute of the National Institutes of Health, analyzed overdose data and death certificates from four states: Kentucky, Ohio, Massachusetts, and New York. He found that the rate of opioid deaths among blacks increased by 38% from 2018 to 2019, while the rates of other racial and ethnic groups did not increase.

The study used data collected before the coronavirus pandemic began; Preliminary data show that the global drug overdose increased in 2020.

According to another study published last year in the journal Addiction, African Americans had lower overdose death rates in the first waves of the opioid crisis than whites, and black rates remained the same from 1999 to 2012. No however, in 2013 white rates began to decline while black rates began to rise.

The new NIDA study confirms the trend.

“We’re seeing change in demographics,” says Dr. Nora Volkow, director of NIDA.

Dr. Edwin Chapman, an internal medicine and addiction medicine specialist who serves the African-American community in Washington, DC, says the study is useful because it shows the serious impact of opioid addiction on black Americans.

“It points to the fact that we need to do something different, a more intensive intervention in the African American community,” he says.

What is behind the disparity?

The change raises a number of pressing questions about what is driving the growing gap in addiction treatment and prevention and how it can be closed.

The opioid crisis began with the strong prescription of opioid analgesics, mainly in the white communities of the 1990s. Volkow says the crisis initially affected white Americans more because they are much more likely to be prescribed opioids than black Americans.

“This, in part, reflects on the stigma against blacks that even if they have pain, doctors won’t be as receptive to prescribing them as opioids,” Volkow says.

Structural differences in health care are also to blame for racial disparities in the treatment of addiction, Volkow says. These include access to effective evidence-based treatments.

“If you’re a black American and you have an opioid use disorder, you’re much less likely to be prescribed medications for opioid use disorder,” says Volkow, who notes that medications like buprenorphine have been very effective in protecting patients from overdose. “That’s discrimination,” Volkow says.

The increase in fentanyl, a potent synthetic opioid often found in heroin, has also affected overdose rates among blacks, she says. The main engine of overdose deaths has shifted “from prescription opioids then to heroin and now to fentanyl.”

Overdose deaths in black communities are largely caused by fentanyl.

Other factors are also at play in these mortality rates, Volkow says. It recognizes that the federal government and health care systems, such as hospitals, community clinics, and family physicians, need to put in place mechanisms to collect better data. Currently, many doctors do not detect opioid use disorder, Volkow says.

These data, she said, could “provide us with a better perspective of the nature of the problem and help or guide physicians in interventions.”

In the study, the authors noted that there are also disparities in access to the antidote drug, naloxone, and in training on how to use it to save a life.

Need for a true “public health response”

“It’s downtown communities that have been hardest hit by addiction, where the problem was put aside for four decades,” says Dr. Andrew Kolodny, medical director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. “It wasn’t until we saw a drug crisis affecting white communities that we began to see the resources of Congress.”

He says it’s important that addiction resources go to the communities that need them most.

“One of the problems here is that we have terrible surveillance of the opioid crisis,” Kolodny says. He notes that nationwide, tracking data on drug addiction has been a mosaic, with some federal agencies focusing exclusively on overdose deaths, others on treatment, and others on research. “Surveillance fell through the cracks,” he says.

For COVID-19, the U.S. tracks cases, deaths, and hospitalizations at the county level, and generally on a daily basis, Kolodny says. “But for the opioid crisis, we don’t have a good estimate of how many Americans are opioid addicts or the communities that have the most impacts or incidence rates. We don’t know how many people become opioid addicts.” says Kolodny. “We’re still in the dark era.”

“Opioid addiction is a disease that can be prevented and treated and you need a public health response that is similar even to an outbreak of a communicable disease like COVID.”

He says that in addition to overdose data by race, the U.S. should track demographics such as gender and age and whether those affected live in rural or urban areas. “We need data on which we can act. And that’s not here,” says Kolodny, referring to the new NIDA study, which calls it “far too little, too late.”

Improve access to treatment

Addiction specialist Edwin Chapman has worked his life to fight the drug epidemic in the black community. He says drug addiction in these communities has always been treated differently. “Whether it’s racism or cultural incompetence, we need to correct that,” he says.

NPR outlined Dr. Chapman’s work in 2018 when the opioid crisis began to escalate in urban black communities across the country.

Chapman knows all too well the problems facing the African American population when it comes to drug addiction and treatment, “starting with the fact that our epidemic was largely ignored, followed by insurance barriers and access to treatment, ”he says.

“Our population has always been treated as a moral and criminal problem, which means that the patients we treat in the African American community have this added burden,” he says.

From his experience at his clinic, he says he has found it more complex to treat black patients, as additional resources are needed, such as helping to navigate the health care system, advising and helping to find housing or a job.

Chapman says black communities also have a “provider access problem.” He notes that relatively few addiction treatment specialists focus their practice on treating black patients. “In addition, there is stigma within the provider community about the treatment of these patients because they are always perceived to have a criminal inclination or are not desirable as patients,” he says.

On the contrary, Chapman adds, “there is the shame and stigma that patients carry, so patients do not seek treatment.”

Chapman says the number of patients he is currently treating has decreased during the pandemic, “some died of COVID, others from overdose,” he says by early 2020, his clinic was seeing 270 patients, now the number of patients is 230.

The COVID-19 crisis increased overdose deaths in Washington, DC, according to the chief medical examiner’s office. In 2019, which was previously the highest peak, there were 281 overdose deaths, but in 2020 there were around 408, and there have been a total of 157 overdoses this year.

Finding solutions to these problems will not be easy, Chapman says. “What we need is what I call a Marshall Plan that is basically a cut and funded by taxpayers in this subset of high-risk, high-cost patients,” he says.

Ignoring the African American population will ultimately be more costly for the country, he says. It gives him renewed optimism to see a new focus on these disparities and he will continue to treat people and talk about how to solve the problem, he says.

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