Marijuana legalization vs ‘Opioid crisis’

The Canadian Parliament approved in the Senate in June the bill, known as “Cannabis Act,” to lift the 95-year-old ban on cannabis and allow Canadian adults to openly smoke, ingest or grow the drug.

Prime Minister Justin Trudeau decided to delay the legalization until October to give the provinces more time to prepare for a smooth transition when the new law comes into force. This makes Canada the first developed country to legalize cannabis completely – not only medical marijuana but also recreational marijuana – nationwide.  In some U.S. states, recreational marijuana is legal, but the federal government bans marijuana for recreational consumption. In the world, Canada is second to Uruguay, where cannabis is legal nationwide.

As Trudeau said the government is treating cannabis the same as alcohol and tobacco, the federal legislation allows individuals to grow cannabis at home in small amounts. But Justice Minister Jody Wilson-Raybould said provinces can pass their own laws regarding home cultivation, apparently in consideration of opposition from Quebec and Manitoba, which wants to ban homegrown plants.

Canadian adults older than 18 years will be able to possess up to 30 grams of marijuana for recreational purposes but will get severely punished when they give the drug to minors.

The Parliament approval of the bill will reportedly lead to a legal multibillion-dollar industry being set to appear in Canada. Licensed producers will be allowed to start shipping dried cannabis to approved retailers across the country and to set up mail delivery. (Globe and Mail, June 19, June 20)

But, the historic move to lift the prohibition on cannabis since 1923 gives some people a sense of déjà vu since the Liberal Party had pledged as one of its campaign promises to legalize recreational marijuana in the 2015 elections, and also because medical marijuana has been already legal since 2001 – which has brought about the situation where, in addition to 50,000 approved marijuana users for medical purposes, some 500,000 Canadians are consuming marijuana for non-medical purposes even when the ban is still on recreational marijuana, according to Health Canada.

Opioid abuses

On the other side of the cannabis legalization, however, a serious situation of the spreading drug abuse is escalating in Canada.

The same week the marijuana legalization was approved by the Parliament, the federal government released figures showing that almost 4,000 people in Cana dies in opioid-related deaths in 2017. That’s 11 people every day – or one person is dying every over two hours. “Canada’s opioid overdose rate is a national health crisis. And it’s getting worse.” (Globe and Mail, June 20)

The number of deaths in 2017 – exactly 3,987 – was 34% higher, or 1,126 more than 2016. This exceeded the deaths from AIDS when the dreadful disease raged. The Canadian government is increasingly having a sense of crisis, as media play this up as “Canada’s national health crisis” or “Opioid crisis.”

Of these opioid overdose deaths, 72% involved prescription and illicit fentanyl – up from 55% in 2016. The majority of deaths involved men and nearly 30% of all opioid-related deaths occurred in people aged 30 to 39 – most of them obtaining illicit fentanyl on the street. (The Globe and Mail, June 19) Fentanyl is a powerful synthetic opioid, as powerful as 30 to 50 times as effective as heroine and 50 to 100 times as effective as morphine in alleviating pain.

Nearly 90% of all opioid-related deaths come from the three hardest-hit provinces of British Columbia, Alberta, and Ontario. Of these, 1,399 died in opioid-related deaths in B.C., 1,127 in Ontario, and 714 in Alberta – accounting for 3,240 of the overall 4,000.

The fact that Canada is the world’s second highest per capita consumer of opioids, such as oxycodone, hydromorphone and fentanyl, illustrates how serious Canada’s “Opioid Crisis” is.

In the U.S., President Donald Trump, alarmed by the “worst ever situation,” declared last October the opioid crisis a public health emergency, although falling short of declaring “a national emergency.” In 2015, 33,000 Americans died from opioid-related drug abuses, and the number of opioid-related deaths further jumped to the “worst level” in 2016, according to a UN Office in Drugs and Crime. In the U.S. 100 people are dying from drug overdoses. Another FDA report shows that more than 59,000 people died from drug overdoses, including opioid drugs, in 2016. (Financial Times, Dec. 12, 2017) Michael Jackson was known to have been taking two kinds of opioids – OxyContin and Demerol – every day. It was reported he had had a Demerol shot shortly before his death.

It is not that the Canadian government has done nothing. Health Canada has stepped up regulatory measures to tighten the legal use of opioids and plans new restrictions on drug companies’ marketing and advertising activities to promote prescriptions of opioids.

So far, some dozen opioid makers, including Perdue Pharma, have responded to Health Minister Ginette Petitpas Taylor’s call on pharmaceutical companies to stop promoting opioids, by suspending activities such as sales representatives’ visits to doctors, which could lead to the overprescribing of opioids, and ads in medical journals.

Canada’s opioid epidemic traces its roots to the introduction of OxyContin in 1996, when Health Canada approved OxyContin as prescription painkiller, which Perdue had promoted in North America as safer and less addictive than other opioids, encouraging doctors to prescribe opioids more widely for everything from back pain to fibromyalgia. Until then, opioids had been used primarily for terminal cancer patients. (Globe and Mail, June 27, July 10)

The government has also stepped up measures to slow the smuggling of illicit fentanyl from China and elsewhere – a major culprit of the recent sharp spike in opioid overdose deaths, replacing OxyContin. Police and prosecutors across the country have also intensifying crackdown on the gangs and dealers that sell illegal opioids.

Despite these government efforts, a solution to this “opioid crisis” is not found easily while the huge oversupply opioids in all forms, and the same huge demand for the drug do not show any signs of decreasing.

 

By Yoshikazu Ishizuka, senior consultant, TOCS

 

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