Claims to crisis: Rethinking opioid overdose in Canada

Area of Science:

• Public Health
• Sociology
• Criminology

Background:

• Canada faces an unprecedented overdose mortality crisis, escalating over the past decade.
• The crisis evolved from opioid over-prescribing and illicit market diversion to a surge in potent synthetic opioids like fentanyl, creating a 'toxic' drug supply.
• Despite investments, national overdose mortality remains persistently high.

Purpose of the Study:

• To critically examine how the overdose crisis is currently defined and the implications of this framing.
• To analyze how the focus on toxic drug supply influences narratives about the crisis's causes and potential solutions.
• To explore how evidence-making processes constitute the 'crisis' and its framing for action.

Main Methods:

• Epidemiological analysis of overdose mortality trends, including pre-2015 data.
• Critical discourse analysis of 'crisis' narratives in the field.
• Theoretical interrogation of the concept of 'crisis' and its utility as a framework for change.

Main Results:

• Overdose deaths show persistent growth predating the commonly accepted start of the crisis, questioning the established timeline.
• The emphasis on 'toxic drug supply' shapes the understanding of the crisis but may limit the scope of interventions.
• Crisis narratives, while drawing attention, function as damage-centered narratives that may not be sufficient for driving transformative change.

Conclusions:

• The current framing of the overdose crisis, particularly the focus on toxic drug supply, requires critical re-evaluation.
• Relying solely on 'crisis' as a narrative framework may hinder the development of more comprehensive and effective public health strategies.
• Further research is needed to understand how crisis claims are constructed and their impact on policy and intervention.