It's 2018, but with the Ontario government's recent regressive moves on the opioid epidemic, I sometimes feel like we've gone back to 1988. Back then, a different crisis was exploding: thousands had been diagnosed with AIDS, and protestors in Toronto took to the streets to decry the slow roll-out of treatment.
It's easy to look back now and see how homophobic stigma shaped the response to the so-called "gay plague." It's much harder to see how bigotry and moralizing of a similar nature is happening now, directed toward people dealing with drug addiction.
In the early 1980s, as mysterious forms of cancer and pneumonia devastated the gay communities of San Francisco, New York and Toronto, political leaders were pressed to respond to the growing crisis. Famously, United States President Ronald Reagan avoided the topic completely, refusing to publicly address the AIDS crisis until 1987, after more than 20,000 Americans had died.
This recording of U.S. press secretary Larry Speakes dismissing questions about AIDS with laughter and homophobic jokes is truly remarkable to listen to now, but it exemplifies the attitude of the era.
Even though HIV was shown in 1983 to be transmissible via heterosexual sex, it was widely thought of a gay man's disease, with those afflicted becoming pariahs in the eyes of many. Homophobic moralizing was quick to blame HIV positive men for their own deaths, leading Republican Pat Buchanan to call AIDS "nature's revenge on gay men."
In starker terms, the attitudes of the 1980s created a category of lives that simply mattered less than others. If you know that a deadly epidemic is spreading within a community and you don't do everything in your power to stop it, your underlying message to the public is that those deaths aren't important.
Premier Doug Ford subscribes to the ideology that supervised consumption is tacit approval of drug use
Here in 2018, the opioid epidemic continues to escalate. Last year 1,100 Ontarians died, a 63 per cent increase from the year before. In Toronto, 303 people died of overdose in 2017, with seven recent deaths happening in the span of just two weeks. Legal authorities suspect contamination of street drugs with fentanyl and carfentanil to be responsible for these and other episodes of mass deaths.
So, in the face of this crisis, one would expect it to be significant that 203 deaths were averted at a Toronto overdose prevention site using naloxone, a potent opioid antidote. And sensible leadership would surely recognize the life-saving potential of fentanyl test strips, which are available at some supervised consumption sites and have been shown to modify drug use behaviour if a sample tests positive for fentanyl.
But Premier Doug Ford subscribes to the ideology that supervised consumption is tacit approval of drug use, a stance wherein the value of moral disdain trumps the value of human lives. And while political language is far more nuanced and careful today — no more open laughter at the mention of people dying, or talk of "nature's revenge" — the message is clear: the lives of people who inject drugs are intrinsically worth less.
So, when Ford says he's "not going to have injection sites in neighbourhoods," what he's saying is that it's better for someone suffering from opioid addiction to inject drugs in an alley. And that can only seem right once you've thoroughly dehumanized the group of people you are denying shelter, cleanliness and compassion to. When Ford tells lies that these facilities are "feeding" drugs to people instead of acknowledging that naloxone saves lives, what he's saying is that he'd rather not give people with opioid addiction the tools to prevent their own deaths.
Likewise, when Health Minister Christine Elliott skips out on Health Canada's recent Opioid Symposium, what she's saying is that the opioid epidemic isn't an urgent priority. And when Elliott announces that planned overdose prevention sites are being put on hold to review the evidence, what she's saying is that the abundant research that already exists in support of these facilities is not enough to penetrate her ideological armour.
Devaluation of lives in a public health crisis is not just short-sighted, it's essentially cutting off the nose to spite the face. Moralizing attitudes about gay men allowed HIV to gain a global foothold. How many lives would have been spared if the public health significance of HIV had been appreciated early on by those in power?
Similarly, providing clean needles decreases the spread of HIV and hepatitis C, which is to the strong benefit of the entire population. Opponents like Ford fixate on the debunked falsehood that needle exchange programs encourage drug use, prioritizing their own moral feelings about addiction over a proven life-saving measure.
This attitude ultimately endangers the community as a whole, since communicable diseases are a serious threat to all of us. And the costs of treating these infections are far higher than simple prevention.
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What will be the legacy of Ford's moralizing attitudes toward drug addiction? Health care providers and addiction workers have stated in no uncertain terms that the cancellation of overdose prevention sites will lead to more deaths. And while Ford has promised investment in mental health and rehabilitation resources, he has said nothing about life-saving naloxone or the huge promise of fentanyl testing.
The promise of rehabilitation funding in the future does nothing to save lives today. Those halted overdose prevention sites could be actively preventing deaths right now.
How will history evaluate Ford's leadership on the opioid crisis? We take a dismal view of the politicians who turned their backs on the gay community during the AIDS crisis, but governments of the early 1980s could at least claim a legitimate dearth of science. Leaders in 2018 can't make that excuse; the relative wealth of information available now can give Ford no justification for privileging ideology over evidence.
The death toll from the opioid crisis continues to rise, and we'll never turn the tide if we fail to learn the lessons of epidemics past.
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