Is North America’s opioid epidemic a crisis of masculinity?


Men accounted for 80% of the 935 fatal overdoses in British Columbia last year and a researcher says its time to pay more attention to the risks they face

The calls began just after midnight and continued relentlessly throughout the day. By the end of Wednesday 26 April, paramedics in the Canadian province of British Columbia had responded to a record 130 suspected overdose calls.

The day offered a window on the battle playing out in British Columbia as residents grapple with an opioid crisis that has claimed, on average, four lives a day in the province.

The struggle is playing out across North America, as authorities in Canada and the US grapple with an epidemic that has claimed thousands of lives on both sides of the 49th parallel.

Against this stark backdrop, a professor at the University of British Columbia has highlighted a different statistic from the crisis: in 2016, of the 935 fatal overdoses in the province, 80% were men.

Research that shows men are more likely to use illicit drugs, so it is perhaps logical that they are more likely to overdose. But the clinical psychologist Dan Bilsker argues that the figure suggests a relationship between the crisis and masculinity one that may offer clues as to why the death toll continues to rise, and where the solutions might lie.

I think we havent really thought deeply or well about who men are, about what the pressures on them are, what we need them to be, he said.

Bilsker has spent years studying mens psychological health, delving into why men live an average of four to six years less than women and are more likely to kill themselves. In some ways, the opioid crisis stems from the same tangled roots, he said. And as with many other health issues, its singular interaction with gender has been largely overlooked.

Across Canada, at least 2,458 people died last year of an opioid overdose, according to the federal government. The death toll is worse than any other infectious epidemic in Canada, including the peak of Aids deaths, since the Spanish flu that took the lives of 50,000 people a century ago, Jane Philpott, Canadas health minister, told a conference in Montreal earlier this year. (Her government has been criticised for not doing enough to address the crisis as she spoke, protesters unfurled a banner reading: They talk, we die.)

Jane Philpott: The death toll is worse than any other infectious epidemic in Canada. Photograph: Anadolu Agency/Getty Images

Bilsker believes the governments response would be different if those dying were 80% women. I suspect there would be more groups more people actively involved in raising public awareness who would speak up and engender a greater sense of this being an important issue, he said.

The gender divide in deaths reflects levels of drug abuse in the province, where 80% of users are men, said Patricia Daly, the chief medical health officer of Vancouver Coastal Health. People here often talk about mens health, she said. We dont have a focus on things that men are at greater risk for and this is certainly one dying of an overdose is primarily affecting men, and men in the prime of their life.

But others say that the federal governments reluctance to engage with the issue owes less to gender, and more to the stigma around drug use. I think if it was any other group of people dying like this, we would have handled it a long time ago, Jordan Westfall of the Canadian Association of People Who Use Drugs recently told the Guardian.

When it comes to explaining why so many men are dying, Bilsker pointed to a variety of factors. Data shows that men are more likely to suffer severe workplace injuries, which could in turn make them more likely to be prescribed opioids for pain. In our society, we slot men into the dangerous jobs, where they may be killed in small numbers, but they may well be injured, said Bilsker.

Across Canada, many of those dying are men between the ages of 19 and 50 years old. I think its easy to simply look at them as foolish risk takers, said Bilsker. But to do so would minimise the extent to which our culture socialises and rewards men who are willing to take risks, he argued.

Whether its logging or its the military, we need men to do it, he said. We need men to do inherently risky jobs.

That nudge toward risk is compounded by societal norms that discourage men from talking about emotional suffering or reaching out for help, he said. One of the main things drugs are used for is killing psychological pain. Theyre not just about taking something to become euphoric, theyre often escapes from ones experience of unbearable pain, he said.

A deeper understanding of these factors could offer tools to fight back against the crisis, said Bilsker, pointing to the informed and ultimately effective public campaigns waged against impaired driving in recent years as an example.

After months spent highlighting the gender disparity in the opioid crisis, Bilsker said hes beginning to see indications that the message is sticking.

Its just starting to be seen as something that actually needs to be talked about, he said.

  • In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

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