North America is now into year five of an unprecedented increase in overdose deaths. While the genesis and drivers of the overdose epidemic have regional variations, structural violence, drug prohibition and stigma play a central and consistent role. The criminalization of drug users has led directly to marginalization and isolation, violence and incarceration, entrenched poverty, and a vicious cycle of trauma. This has created an environment where any initiatives to prevent and reverse overdoses have been severely limited. The overdose crisis is not unlike the HIV and HCV epidemics that have had such a devastating and disproportionate impact among people who inject drugs. The same structural and social environments continue to disrupt access to testing, treatment and care. What makes the overdose crisis different is the profound impact of drug prohibition that has pushed the illegal market into more concentrated and dangerous compounds and increased the population of vulnerable people who now rely on this unregulated market. Harm reduction programs that have proven effective for HIV and HCV prevention have not had the same impact on overdose prevention. While the research and medical communities have long recognized the major role of social determinants in disease transmission, especially as it relates to infectious diseases, the call to address these determinants has largely fallen to the communities most impacted. The massive loss of life directly related to overdose along with the limitations of harm reduction and other evidence-based interventions calls for a reassessment of our advocacy efforts.

Disclosure No significant relationships.