Just the other day, the news reported that 71 per cent of all crash victims on island test positive for drugs or alcohol in their system. Recent statistics have us outpacing most countries with road traffic deaths equivalent annually to 19 per 100,000 of population. To be real, one is too many. But, what if behind some of those crash scenes is the reality that getting access to a lot of drugs — or alcohol — is too easy? What if getting too high or too drunk is a result of a system that has too many regulatory and resource gaps? Here is an effort to expand the discussion about access to some of our legal drugs and to hopefully start generating more solutions.

Growing up as a man of colour, reaching my forties sometimes felt like it would be an insurmountable task. I started to celebrate the wins of each year of life as I filtered my view of reality through the lens of statistics, social media and cultural nuances. I realised that life was fragile, and the evolving cracks in my life cup were much more prone to breaks with the heat that I was constantly facing. Thank God that He was merciful, and I made it. I made it to a place that a significant number of my peers never got to experience either in breath or in freedom.

Now when I see people die unnecessarily before their age — especially young people — whether through life stresses, violence, or road crashes, the inner child in me loses another piece of his innocence. Each death makes the already challenging life of those around us that much more difficult. As we deal with concerns about cost of living, uncertain global peace, random acts of violence, trade wars and technological advancements, the question I often ask myself is, what is there left for us to control in respect to our fates.

It seems like every day something else is taking over our innate ability to choose and choose wisely. But with each deep sigh — with too many of us in prison, too many of us on no-fly lists, too many of us being homeless or in financial distress, too many of us living with chronic conditions and stresses, too many of us facing hidden mental health challenges, too many of us struggling with self-identities that teeter between being at the bottom rung of the social ladder and the top of the social safety net — there is still the promise that “yea though I walk through the valley of the shadow of death” we are not alone in our unique fights.

Almost 20 years ago, I was fighting through my grad school classes at Johns Hopkins University. As I opened my textbooks, I often questioned why the walls of such a prestigious institution seem to insulate its greatness rather than extend it to the Baltimore residents who needed it most — those struggling with preventable disease and those struggling with the scourge of yet another wave of drug epidemic. Walking the streets of Baltimore, I would readily see the effects of drug abuse in the community. I would see Brother Joe’s hands stretched out backwards as in prayer towards the ground, a gentle sway in his torso, and a rapid tapping of his foot against the cold concrete. I could see the blank stare of his empty eyes against the crease of his eyelids, while the trees lining the driveways of public housing blew their golden leaves on to the backdrop of this gritty scene.

I knew Brother Joe was high. But beyond the observable plight of those drowning in their illicit addictions and the systems that enabled it was the potential that behind so many wooden doors along the blocks of row houses surrounding the Hopkins medical campus held uncounted learned professionals at the precipice of similar challenge. Whether legal or illegal, the outcomes to this complex brain disorder and mental health epidemic of addiction were still the same, and the accountability for the results were borne on more than Brother Joe.

Around that same time, an article came out that highlighted statistics on deaths from prescription drug overdoses. It described the epidemic of prescription drug abuse, and the tripling of deaths related to the massive increase in the abuse and misuse of prescription opioids and sleep-inducing medications. A quote from the article stated that:

“Prescription drugs now surpass motor vehicle accidents as the No 1 cause of accidental death in almost half the states in this country. Last year, nearly 30,000 Americans died from an overdose, with at least half of these deaths related to legally controlled substances that were misused, abused, prescribed incorrectly, or simply just in the wrong person’s hands. More people in the US die from an overdose of medications such as oxycontin than they do of heroin. Over one third of some 35,000-40,000 poisoning deaths each year in the US involve prescription opioids. These medications are sourced from individuals’ own doctors, friends, drug dealers and, increasingly, online.”

“Legal” addiction can often stem from gaps in systems of care that are abused. These deals are much different than the transactions depicted by characters such as Avon Barksdale, “Stringer” Bell, Mario Stansfield and the drug collectives portrayed in The Wire. In many countries, “doctor shopping”, the practice of visiting multiple physicians to obtain multiple prescriptions, is known among people with substance-use disorders, suppliers of addictive substances, hypochondriacs or patients of factitious disorder, including factitious disorder imposed on another.

Here towards the end of 2024, several e-mails and phone calls have come across my desk at the Bermuda Health Council, noting the concern about this kind of doctor shopping and access to drugs. Understanding that it is Christmastime and gift-giving is top of mind, maybe the gift of access to addictive products is not something we need to gift-wrap. This is not the fault of any provider or health business or even individual. This is just the reality that without stronger protocols in place within our system, things will slip between the cracks. Patients are getting prescriptions filled for multiple years’ worth of pills in one go or going to five different office visits within a single week and getting the same prescription written without communication channels automatically opening between facilities.

Living with substance-use disorders is hard enough. The health system lacking the proper safeguards, technological platforms and legal frameworks to dissuade easy and excessive access to drugs that are known to take lives is a challenge worth solving. A challenge that many within the medical community, seem ready to take on.

Globally, countries are implementing solutions to doctor shopping such as:

• Implementing stricter regulations on controlled substances

• Adopting interoperable health records or universal patient identifiers

• Educating healthcare providers on recognising and addressing doctor shopping

• Expanding access to addiction treatment services

• Launching public awareness campaigns on medication misuse

• Empowering pharmacists as gatekeepers for prescriptions

With so many layers of seemingly uncontrollable chaos and problems happening at the same time, it is imperative that we pull together as a community and work together on solutions to these concerns. Not divided into two halves, not siloed spiritual congregations, not stratified by income categories, but united through a common love and respect for all our people. Hopefully that message of collaboration and community togetherness will ring like jingle bells throughout this festive time.

As a reminder, though, during the days of partying, the holidays can trigger a rollercoaster of emotions. Loneliness, grief and nostalgia for past celebrations can lead to emotional turmoil. Some individuals turn to substances as a means of coping with these overwhelming feelings. Let’s be there for each other during this holiday season and beyond. Let’s be reminded to give each other the gift of the chance to celebrate the wins of life, and support each other’s opportunity to experience more breath, more life and more freedom.

Merry Christmas, happy Hanukkah, joyous Kwanzaa and happy holidays to everyone celebrating. One love.

• Ricky Brathwaite, PhD is the chief executive of the Bermuda Health Council