Overdose: Heartbreak and Hope in Canada’s Opioid Crisis by Benjamin Perrin
Book about drug policy, centered around the recent opioid epidemic in North America but especially in Vancouver. The problem recently intensified with the introduction of fentanyl, which became popular around 2012. Fentanyl is especially bad because it’s easy to overdose when using it, and many users are not expecting fentanyl when doing other drugs such as cocaine and heroin. Contrary to stereotypes, most overdoses are not homeless people; casual users are more likely to overdose since they have not built up a tolerance for the drug.
Efforts to stop fentanyl have been unsuccessful because it is so potent that very small quantities are enough to get high. It is easy to manufacture and nearly impossible to detect when sent through the mail. Prosecuting offenders is difficult: it takes lots of effort to gather enough evidence to convict a leader in the operation, and while catching low-level dealers is easy, they are often poor drug users themselves and easily replaced.
Instead of treating it as a crime, recent policies focused on harm reduction. Naloxone is effective at preventing overdose deaths, and safe injection sites are easy to administer, preventing deaths without encouraging new drug use. Giving people free drugs prevents them from committing crimes to buy drugs, although it is controversial. Detox centers are not very effective because when they inevitably relapse, they are more likely to overdose after losing tolerance.
What should we do about the problem? Prohibition has been the default approach for many years but clearly, it has not been working. The book advocates for decriminalization of all drugs to reduce the harm to users and to society. It’s not clear whether these approaches work better in the long run, since the opioid problem keeps on rising. The outlook is bleak but all the simplistic solutions have been tried and failed, and similar to management of any other chronic illness, progress will be slow and gradual.