The opioid ‘vending machine’ introduced in Vancouver seems like a liberal way to fight the opioid crisis. But like Canada’s approach to euthanasia, we may actually be giving up on deeper problems – while pharma companies profit.
Across Canada, the opioid crisis has had devastating consequences with nearly 14,000 people dying due to overdose and another 17,000 hospitalised since 2016. To tackle the problem, Vancouver has installed the world’s first biometric opioid vending machine, which dispenses prescription opioids to patients by recognising biometric information in their palms.
There is no doubt that projects like this solve a number of problems and can help save lives in the short-term. A more liberal approach to drugs, like that taken by Portugal in de-criminalising drug consumption, is a positive step. Medical treatment is certainly more humane and effective than incarceration. In a comment to the Lancet, supporters of the vending machine approach compared the opioid crisis to outbreaks of infectious disease, requiring “preventive vaccinations and emergency treatments.” Accordingly, public health initiatives should identify “as many as 1 million users at risk of toxic opioid products” and provide them with a safer supply.
An opioid vending machine © Twitter / MySafeProject
Yet therein lies the rub. It is well recognised that one of the key contributors to the opioid crisis was their over-prescription. Opportunistic pharmaceutical companies downplayed their addictiveness and exploited changing population demographics (e.g. ageing) as well as a lower tolerance to pain. Treating the issue as a medical problem with a medical solution—even easier access to drugs—may only exacerbate these issues.
More significantly, however, the opioid crisis affecting North America is not just a crisis of drug misuse and abuse but a crisis of despair. There are well-known connections between drug dependency and poverty, unemployment, substandard work, and a general lack of opportunities to better one’s life. Across North America there has been a long-term sense of decline—rising income inequality and the loss of jobs through deindustrialisation that were never replaced. The financial crisis of over a decade ago only saw the exacerbation of these issues and a rising sense of powerlessness among large swathes of the population.
In this way, sometimes what appear to be liberal steps are not so liberal on closer examination. Rather than infectious disease, perhaps a more apt comparison is Canada’s 2016 legislation allowing for voluntary euthanasia. While a seemingly liberal step, it was not long before reports began to surface claiming that patients felt pressured into accepting assisted dying rather than ‘assisted living’ when treatments and necessary supports were too difficult or expensive.
In this way, a more liberal approach to drugs, while no doubt helpful in many ways, may actually be spurred by different motives and thus have unintended consequences. Easier dispensation of drugs may play into the hands of pharmaceutical companies who will continue to benefit while shouldering much of the blame. More importantly, it may not be that we are becoming more liberal, but rather that we are giving up on solving the social crises that led to the ‘opioid crisis’ in the first place.