Apocalyptic scenes could await us if opioid pandemic hits amid housing crisis

It’s a Mad Max meets Trainspotting scene. The market district of Ottawa, the beautiful capital of the world’s second-largest country, home to the most polite people this side of Tokyo, offers a 21st-century vision of apocalypse. Interspersed among slow-fashion boutiques, sushi restaurants and designer gin bars, the poor souls roam, contorted by their addiction to a potent drug. An opioid epidemic has ravaged a small, although very public, section of Canada’s drug-using population.

This time last year, I witnessed a similar urban nightmare in Vancouver’s East Hastings district, where substantial sections of the downtown area are lost to opioid addicts. Ottawa suffers, as do parts of picturesque Quebec City and commercial Toronto. This is caring Canada, not the vengeful United States.

Canada, the liberal country of Margaret Atwood, with one of the world’s most enviable welfare and health systems, is blessed with enormous mineral wealth, making it a destination for thousands of young Irish migrants. Side by side with prosperity, parts of Canada’s cities are poisoned by synthetic opioids – fentanyl and oxycodone – that are decimating large parts of North America. Hundreds of destitute men (and some women) sleepwalk around the streets, devastated by addiction.

The economics of opioids are fairly straightforward – they kill you, but not immediately. An addict can last a long while and that is the market for a dealer. Drug cartels are flooding North America with this junk.

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Apocalyptic scenes could await us if opioid pandemic hits amid housing crisis

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In today’s Ireland, the rich live in houses that were built for the poor

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To get a sense of how we got here, the history of opioid addiction is worth exploring, because in contrast with heroin, synthetic opioids are relatively new. Until recently, opioid treatment for pain was shunned in the US due to the emergence of morphine addiction in the 1930s. However, by the mid-1990s medical and, to some degree, public opinion shifted towards a focus on pain management. Conventional wisdom contended that “therapeutic use of opiate analgesics rarely results in addiction”, based on two small and shoddy studies from the 1980s.

Armed with this spurious “evidence”, several prescription opioids were developed and marketed heavily by pharmaceutical companies, infamously relying upon exaggerated claims about the “non-addictive nature” of these medications. Between 1990 and 1995, there was an increase of two to three million opioid prescriptions each year. It is often claimed that much of this was concentrated in the Appalachian region encompassing rural Kentucky and West Virginia, where doctors sought to treat the chronic pain of workers who had sustained workplace injuries in the local labour-intensive coal-mining and agricultural industries. (If you are interested in this regional problem, Barbara Kingsolver’s novel Demon Copperhead is a wonderful, if terrifying, read.)

[ Barbara Kingsolver: ‘The first time I set foot in Ireland I felt so at home. Something about the language, the culture’ ]

By 2016, synthetic opioids surpassed both heroin and prescription painkillers as the leading cause of opioid-related overdoses [in the US]. From 2015 to 2020, the rate of opioid-involved overdose deaths (driven by fentanyl) again doubled

In 1995, Purdue Pharma obtained FDA approval for OxyContin and from 1997 to 2002 OxyContin prescriptions increased in the US from 670,000 to 6.2 million a year. Since then, an estimated 645,000 people have died from opioid overdoses. The sad figures in Ottawa are only the latest in a line of destruction that is now typically broken down into three waves.

The first surge hit around 2000, when the rate of opioid-involved overdose deaths doubled from 2.9 to 6.8 deaths per 100,000 people. The second wave, beginning in 2010, saw a sharp increase in overdose deaths involving heroin (which became a cheaper alternative to the over-the-counter prescription drugs) and, from 2010-2016, heroin-implicated deaths increased from one to 4.9 per 100,000.

The third wave kicked off around 2013 with a significant increase in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. By 2016, synthetic opioids surpassed both heroin and prescription painkillers as the leading cause of opioid-related overdoses. From 2015 to 2020, the rate of opioid-involved overdose deaths (driven by fentanyl) again doubled, from 10.4 to 21.4 per 100,000. This is what we are witnessing on the streets of urban North America.

Put succinctly, building ‘posh’ houses for rich people eases the housing problem because it takes these rich people out of the market for homes that used to be reserved for poorer citizens

The reason that some urban areas are wastelands is due to the interaction of the opioid pandemic and the housing crisis that afflicts many English-speaking countries. The addicts are increasingly homeless as a sort of “shunting on” process that afflicts the housing market. Because we are not building enough homes, of any sort, rich people who used to buy upscale homes are buying the homes that used to be reserved for middle-class people.

As last week’s column argued, these middle-class and upper-middle-class people are now buying the homes that were once built for poorer people. The poorer people who used to live in these homes are being shunted into the rental market, where they compete for scarce accommodation. The people who used to live in the lower end of the rental market are being elbowed out and, as prices rise, finding themselves homeless. These are some of the unfortunate people we see on the streets, hopelessly addicted to opioids.

Commentators and politicians seldom focus on the “shunting on” dynamic, preferring to zero in on building “affordable” or subsidised homes. This is understandable but it fails to take into account the dynamic nature of the housing market. Put succinctly, building “posh” houses for rich people eases the housing problem because it takes these rich people out of the market for homes that used to be reserved for poorer citizens. Building all sorts of homes helps, “posh” ones and affordable ones. It doesn’t offer a great political soundbite, but it is a fact.

At the other end of the scale, opioid users sleep on the streets of North American cities. West coast cities such as San Francisco, Los Angeles and Vancouver, with their warmer climates, attract more homeless, but other cities are also afflicted. Ottawa is one of the coldest capital cities in the world, reducing further the survival rates of people with opioid addiction.

In Canada, official government sources suggest that since 2016 the country has seen 42,494 opioid-related deaths and 169,723 opioid-related poisoning emergency department visits. In 2022, an average of 21 lives were lost each day because of opioid-related overdose.

Ireland’s cities have a similar problem with heroin. If these opioids – 50 to 70 times stronger than morphine – flood into Ireland in the same volumes as North America, God help us.