Claims to crisis: Rethinking opioid overdose in Canada

Overdose in Canada has been constituted as a ‘crisis’, with unprecedented mortality rates observed over the past decade. The origins of this situation have been located in opioid over-prescribing in the late 2000s, followed by increased diversion of opioids to the illicit market, then, beginning around 2015, a rapid market shift to highly potent synthetic opioids such as fentanyl. The present-day drug supply is characterised as ‘toxic’. Despite considerable investment, and occasional brief declines in overdose deaths in some regions, mortality remains high nationally. Following Janet Roitman’s work critically interrogating the stakes of crisis and what this concept enables, we ask what is being constituted as the overdose crisis in our field at this time and explore the effects of this claim. We examine how a focus on toxic drug supply shapes narratives regarding the boundaries and causes of the crisis – and also possible solutions. Drawing on epidemiological analyses of persistent growth in overdose deaths pre-dating the conventionally accepted beginning of the overdose crisis in Canada, we attend to how crisis is constituted through its evidence-making. By interrogating what is identified as being in crisis, and what crisis narratives afford in framing action and response, our analysis prompts critical reflection on how the claim to crisis operates as a theory for change. As a form of damage-centred narrative, crisis is no longer sufficient.