While the opioid-overdose epidemic is a major focus of concern, it is worth recalling that it is not the most important cause of addiction-related deaths in Canada or even in B.C., the epicentre of the opioid epidemic.
There were almost 4,000 opioid-related deaths in Canada in 2017, but tobacco, which is also addictive, kills 11 times as many Canadians every year as opioids — yes, 11 times as many.
The latest data from Statstics Canada show that in 2017, more than 16 per cent of Canadians 12 and over — 5 million people — smoked. Smoking is more common in low-income populations; more than one in five low-income Canadians smoked, compared with less than one in 10 high-income people. Clearly, we are still a long way from eliminating this scourge.
Shockingly, the most recent information release on tobacco-related deaths available from Health Canada is from 2011, and is based on data from 16 years ago. In 2002, about 17 per cent of the 230,000 deaths that year were due to smoking — more than 39,000 deaths. In the absence of any apparent federal interest in the issue, it was left to the Conference Board of Canada to bring us up to date. In a 2017 report based on 2012 data, it estimated that smoking caused more than 45,000 deaths, more than 18 per cent of all deaths.
In B.C., the Vital Statistics Agency reported that in 2015 there were 6,582 deaths attributable to smoking. This compares with more than 1,400 unintentional illicit-overdose deaths in B.C. in 2017 and 742 in the first six months of 2018, according to the Coroners Service and the B.C. Centre for Disease Control.
So while I recognize that there are good reasons for the widespread concern with opioid addiction and deaths in Canada, we are largely ignoring what is still the largest cause of addiction-related deaths in Canada and B.C. — tobacco use. You can almost hear the sighs of relief in the executive offices of the tobacco industry as attention shifts away from their products, enabling them to go on making money while killing and sickening people.
In fact, there was a concerted attempt by Stephen Harper’s government to undermine the tobacco-control movement. In an opinion piece in the Montreal Gazette in May of this year, two of Canada’s most respected and distinguished tobacco-control experts, Gar Mahood and Neil Collishaw, laid out the ravages of the Harper government and the inadequate response of Justin Trudeau’s government.
They note that: “When the initial Federal Tobacco Control Strategy was launched in the early 2000s, it was promised funding of $100 million a year. Yet over time, governments cut this fund — to about $35 million in health spending last year.” In particular, they note that the grants and contributions program, which was an important source of funding for major tobacco-control organizations, was cut from $22 million in 2006 to a paltry $2 million today, leading to “the major loss of valuable capacity and experience in the tobacco-control movement.”
Regrettably, there is not much evidence that the Trudeau government is reversing that neglect. It is indicative of the way that pressure has been taken off this issue that Health Canada is still using data from 16 years ago, and Mahood and Collishaw commented that the “inadequate funding” and “timid language” in the government’s plans seem “to presage another pie-in-the-sky tobacco-reduction program.”
Meanwhile, the tobacco industry continues to prey on people in Canada and around the world, still peddling a product that, as they well know, if used as intended will kill and sicken millions of people and cost nations billions of dollars in health costs. The World Health Organization reports: “Tobacco kills more than seven million people each year,” with 80 per cent of the victims living in low- and middle-income countries, where tobacco controls are weaker.
The tobacco industry is the world’s most successful drug pusher, and governments need to deal with it vigorously and harshly. We need a tobacco-control effort commensurate with the scale of the harms this addictive substance causes — at least 10 times the amount committed to prevention and control in the $231.4 million over five years that the Canadian government has committed to address the opioid epidemic.
Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.