How to reduce drug overdose deaths

There is no easy way to reduce drug overdose deaths but a simple first step is to provide users with safe opioids. The hard part will take time.

 North Vancouver couple die of fentanyl-linked overdose. Image:Vancouver Sun

The grim toll of deaths –of community leaders and ordinary citizens -marches on relentlessly. In just eight months of 2017, more British Columbians died of drug overdoses than the whole year before.

Lots of things don’t work. Still, politicians persist in the tried and unproven. B.C. Solicitor-General Mike Farnworth echoed concerns that rose in meetings with federal and provincial public safety ministers:

“We strongly believe that if you’re dealing fentanyl, you’re dealing death, and you should be facing much more severe penalties such as manslaughter charges,” Farnworth said (Globe and Mail, October 19, 2017.)

Tough talk has failed in the past. The divide between pushers and users is not as clear as Farnworth might think. Provincial Health Officer Perry Kendall says there is a risk that “the policy implementation will not be able to distinguish between importers or non-user, large-scale dealers and the easier-to-apprehend street-level user/dealer.”

“Our attempts to destigmatize,” adds Kendall, “through decriminalizing the user and treating him or her as a person with an illness rather than a criminal, could be jeopardized.”

Restrictions on importation will fail as well. LifeLabs in B.C. has been testing urine samples of patients screened for fentanyl and found that these patients also tested positive for the even more powerful carfentanil. Now another synthetic opioid, U-47700, has been detected. More synthetic opioids could be on the way. Garth Graham, director for LifeLabs says:

“Are we two steps ahead? No, we’re not. In my opinion, there’s more of this coming … I think it is difficult. We’re working with provincial stakeholders . . . They mentioned another fentanyl analogue, and we are now trying to work that up so we can look for that.”

It’s a cat-and-mouse game. As soon as one variety of fentanyl is identified, another is cooked up. Testing equipment for the new analogue has to be built and laws restricting it enacted.

Naloxone kits save lives but only if someone nearby is lucid enough to administer them. Bob Hughes, Executive Director of ASK Wellness, suggests an alternative:

“We’re not going to fix this with one approach, such as providing Naloxone. That they’ve got some other option like basically pharmaceutical-grade heroin for some of those folks who just can’t seem to shake it,” Hughes told Radio NL.

Providing heroin to drug addicts may seem like a bad idea because it enables an addiction. But if we’re concerned about saving lives rather than making moral judgements on users, then legal heroin or other opioids like hydromorphone is a good first step.

However, the hard part is not the supply of safe opioids. The hard part is the destigmatization of drug users. Deaths due to drug overdose are still seen as a moral failing rather than a disease or “a person with an illness” as Dr. Kendall put it.

Open discussions about mental illness have helped destigmatize what was once thought of as lunacy or possession by evil spirits. Now the conversation needs to start around addiction; not as a weakness of character; not an embarrassment to be hidden from public view by friends and family.

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