The opium poppy was known to the Sumerians as the plant of joy. Based on fossilized evidence from Neanderthal times it has been controversially suggested in archeological circles that it was used by our forbearers 30,000 years ago. The opiate makes its way into Homers Odyssey when Helen used it to make Odysseus forget “Into the bowl in which their wine was mixed, she slipped a drug that had the power of robbing grief and anger of their sting and banishing all painful memories. No one who swallowed this dissolved in their wine could shed a single tear that day, even for the death of his mother or father, or if they put his brother or his own son to the sword and he were there to see it done… Later in Homers epic Circe slipped the opioid into strong wine “[…] she drugged it with wicked poisons to make them forget their homes, […]” The point of the brief history of the opioid is that it has been used for both good and for ill over millennia to ‘forget’ pain.

In British Columbia the latest form of ‘forgetfulness’ is fentanyl and it has had an increasingly lethal effect over the last 5 years as is evident from the graph to the right.[1] It is also amply evident fentanyl deathsthat fentanyl overdose deaths have impacted the families and communities in the province, with males representing 80% of victims and females representing 20% of the opioid epidemic in B.C.  The Men’s Centre is an organization that responds to the needs of men and their families and has a number of families and clients that are impacted directly by the fentanyl crisis. Clients have died. Counsellors, staff and volunteers of The Centre continue to witness the physical and mental withering of British Columbians under the cold dystopian psychopathy of fentanyl addiction and death. Some natural questions are – Why are so many dying and males in particular? Will knowing why help society prevent the deaths? Will knowing why help prevent addiction? What stigma(s) block the path of male health? All those questions and more have in varying degrees been explored by social scientists with varying results. No answer proffered here will satisfy all the minds spread out along the ideological spectrum. What can be affirmed about the above picture other than the asymmetry of mortality?

Take a look at the wider picture and follow the weave of the social fabric around male health in general. Do male lives matter? That may be partially answered by looking at the actions of the government because actions speak louder than words – compare for instance, the response by the B.C. Government when it dedicated $80 million dollars to combat H1N1, or swine flu, in 2009, when 57 people died – contrasted with virtually nothing when over 500 people die as a result of opiate addiction. Recently the provincial government talked the federal government into anteing up $10 million to help fight the epidemic. The province has indicated that some of that funding will help support the work of its Joint Task Force on Overdose Response which, according to the B.C. government, will “provide expert leadership and advice.”

We should not lose sight of the fact that women represent 20% of the fentanyl related deaths and that will be touched on momentarily. Recently, large splashes of cash have been announced for mental health initiatives which at first blush seem like progress, but it is coincidentally timed to coincide with an upcoming election. A closer examination of the initiatives contents reveals the recycled organ-grinder rhetoric of gendered imagery (semiotics); an interesting tangential topic to be examined later. The admitted element of distrustful sentiment expressed herein is a cynicism born from repeated dealings with governments who are deaf and dismissive. The continued political elitism negatively impacts families and communities across the province with the pernicious eroding of public trust by the rhetoric of pretend actions which are cold compassionless and empty and fail to address the asymmetry of poor male health. Affirmative action is required to address the annual $4.5 billion dollar costs of poor men’s health in the province.

In a simplified way, society tends to frame addiction on the one hand as the result of a disease, and on the other as a moral choice based on the character of the addicted. One perspective is heavily conceptualised around responsibility and blame (the guilty), and the other is considered as no fault, (the innocence). A chivalrous approach would be to look at the female deaths as innocent victims who were in need of help, and the male deaths as the culpable result of irresponsible and high-risk behaviour. But we don’t blame victims (or not all victims) and it would be a polarizing and divisive perspective to take. Although if the mortality graph above was reversed the chivalrous tack would be the reflexive/reactive approach the government would take. Those ideas are important tangents to be explored later.

Part of the wider problem is the diminished value placed on the traditional lives of males. Whether it is from an economic model, policy perspectives, or an evolutionary one, sons have less value in society than daughters; historically this was not the case. Again, that premise must wait for its defence in the interest of brevity and will be discussed in the near future.

Where economic arguments fail compassion is the only argument that can be used to effectively increase social services tailored to the unique needs of those males who’ve already fallen through the metaphorical cracks. Examining the education model in a changing social and economic environment may be one way to reduce the numbers of future B.C. sons from falling through the same metaphorical cracks, (again education models is a topic for another time).

There is an unhealthy asymmetry in multiple directions with males falling victim in disproportionate levels, whether it is in physical health, mental health, cancer victimhood, or educational attainment to name a few. Both the provincial and federal governments know the financial costs associated with poor male physical and mental health but yet there is a gaping absence and a lack of political courage when it comes to addressing the elephant in the room[2]. There obviously needs to be better representation of men where they have traditionally been under-represented, such as in accessing health care. If males were effectively encouraged to access it then there would be billions less in preventable healthcare costs. Yet the costs are huge as is the toll it takes on society and that is an inherency problem. Inherency is a challenge for male mental health. Inherency relates to the barriers which keep harm from being solved because it is buried in the shadows of the status quo. A succinct explanation would be the cultural tendency to psychically[3] bury the challenge, thereby reinforcing the status quo. It is rooted in taboo and stigma and affirmative action presents itself as a solution to a problem that society does not have, when in fact the numbers show a tremendous need. That produces an official and collective dismissive dissonance. The official policy is to be dismissive of suggestions that males require affirmative action initiative to solve the cost problem. Some researchers have noted that “there is an understandable tendency to measure the extent of a problem by the community resources that are mobilised to deal with it, as well as the number of clients, patients, and program participants that are served by these resources. If there are no programs and no program participants, then it is assumed that there is no problem.”[4] The asymmetry of fentanyl deaths in B.C. represents one facet of the wider social problem, part of that is the lack of courage to express compassion which is professionally buried in the bureaucratic halls of influence.

It is not just a small group of individuals and a smattering of service providers who see the writing on the wall. According to Sun-Life Financial, “The Canadian Health Index provides evidence that [poor health cost pressures of all Canadians] will only mount unless significant changes are made. “ A fundamental shift of mindsets and policy – toward prevention and away from current treatment-centric models – is critical.”

If the lack of compassion exists on the mental illness spectrum then the B.C. government as a whole is affected by a psychiatric disorder which contributes to their collective self-doubt and low self-esteem. Courage is needed to emerge from those shadows of self-doubt and poor-esteem, and someone needs to take responsibility for poor male health and denounce the aphorism where no one is guilty because everyone is – this is not about guilt, this is beyond blame. To say that men need to be responsible is a dismissive and surreptitious attempt to blame the victim – we don’t do that here – do we?…There is no room for fainthearted and skeptical politicians; this is about the cowardly lion having the self-respect to act in the face of fear to confront the stigma contributing to the poor health costs of males which run at $4.5 billion annually in the province[5]. Actions speak louder than words, lead by initiative.

Sources:

Carter, David. “CDC Advisory Warns of Possible Nationwide Increase in Fentanyl Deaths.” AJN The American Journal of Nursing 116.2 (2016): 15.

Cole, Alexander, et al. “Pharmacokinetics and pharmacodynamics of carfentanil and naltrexone in female common eland (Taurotragus oryx).” Journal of Zoo and Wildlife Medicine 37.3 (2006): 318-326.

Hankir, Ahmed, and Rashid Zaman. “Jung’s archetype,‘The Wounded Healer’, mental illness in the medical profession and the role of the health humanities in psychiatry.

Hjelm, Erika. “How loneliness affects sexual risk-taking behavior; A cross-sectional study using data from a survey on young people in Skåne, Sweden.” (2014).

Ronay, Richard, and William von Hippel. “The presence of an attractive woman elevates testosterone and physical risk taking in young men.” Social Psychological and Personality Science 1.1 (2010): 57-64.

Stanton, Steven J., Scott H. Liening, and Oliver C. Schultheiss. “Testosterone is positively associated with risk taking in the Iowa Gambling Task.” Hormones and behavior 59.2 (2011): 252-256.

Zhang T, Hoddenbagh J, McDonald S, et al. “An Estimation of the Economic Impact of Spousal Violence in Canada, 2009

http://classics.mit.edu/Homer/odyssey.mb.txt

http://www.opiates.net/

http://news.nationalpost.com/health/organ-transplants-surge-in-b-c-because-of-fentanyl-overdose-deaths?__lsa=cfcb-c6ac

http://www.cbc.ca/news/canada/british-columbia/carfentanil-confirmed-metro-vancouver-1.3962548

http://www.cbc.ca/news/canada/british-columbia/fentanyl-emergency-spending-1.3866620

http://www.cbc.ca/radio/the180/why-men-are-dying-of-drug-overdoses-condos-are-tiny-houses-and-conflict-of-interest-1.3942875/why-the-opioid-crisis-hits-men-the-hardest-1.3944914

http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health101a-eng.htm

http://www.theglobeandmail.com/news/british-columbia/more-than-900-fatal-overdoses-in-bc-in-2016-deadliest-year-record/article33659321/

https://www.vice.com/en_ca/article/why-do-men-account-for-80-percent-of-bc-overdose-deaths

http://www.sunlife.ca/static/canada/Sponsor/Bright%20papers/CHI%20BrightPaper%20E.pdf

[1] The data for the proportion of illicit drug overdose deaths for which fentanyl was detected will be updated in March, 2017 by the B.C. coroner’s service to allow time for toxicology tests to be completed for the 2016 year.

[2]Thirty seven billion annually https://menshealthfoundation.ca/wpcontent/uploads/2016/10/economic-impact-1.pdf

[3] Of, relating to, affecting, or influenced by the human mind or psyche

[4] Kosberg, Jordan I. “Meeting the needs of older men: Challenges for those in helping professions.” J. Soc. & Soc. Welfare 32 (2005): 9.

[5] https://menshealthfoundation.ca/wp-content/uploads/2016/10/economic-impact-1.pdf