Bring drug overdose plan to B.C. interior

To reduce drug overdose deaths, Vancouver Coastal Health authority plans to track patients to make sure they are taking their prescribed opioids.

image: IFL Science

I may seem odd that lives can be saved by making sure that patients take one opioid (Methadone) so that they don’t die from another (fentanyl). But that’s what statistics show. If patients stay on Methadone they’re more likely to be alive a year later.

It’s the first program of its kind in Canada and the latest effort to turn the tide on the opioid crisis that is projected to kill 1,500 British Columbians (Globe and Mail, Sept. 15, 2017). That’s up from 914 in 2016.

The problem is that patients have hectic lifestyles that make daily prescriptions difficult to take. As a result, only one-third are still on Methadone after a year. Laura Shaver, board member of the B.C. Association for People on Methadone, supports the plan:

“I would think it would be a great idea for many people that are, you know, a little bit unstable, for them to have a bit of a push behind them. With a bit of support, things could be a lot different.”

Rolando Barrios, assistant director at the Vancouver Coastal Health, sets his goal at 95 per cent Methadone compliance:

“We may not achieve that, but think about doubling the 30 per cent to 60 per cent . . . and the impact that would have.”

Tracking Methadone patients is labour intensive. The unregimented lifestyles of drug addicts make it difficult for them to make daily appointments. Starting this month, 20 teams, each comprising of three health professionals, will check on 3,000 patients to make sure they are taking their drugs.

Pharmacists will alert the teams if patients have not taken their daily dose. The team will then phone or visit the patient to check up. Participation in the program is voluntary: the teams are not policing patients.

The plan is modeled on the highly successful program to stop HIV/AIDS launched in 2010. It actively sought untreated HIV-positive people and followed up with an antiretroviral therapy. As a result, the transmission of AIDS was reduced by 96 per cent.

“With HIV,” says Dr. Barrios, “we used to wait until people had low immune systems before they started treatment . . . and then science came in and said we need to treat them earlier and faster. We learned that we needed to be aggressive.”

If the plan is so good for Vancouver, why isn’t it being applied throughout the province? Vancouver’s drug deaths may make news but the problem is worse in B.C.’s interior on a per capita basis.

Kamloops is bad -40 people died of drug overdoses in 2016- but Kelowna is worse. Kelowna led all Canada in per capita opioid poisoning hospitalizations. Vancouver was 16th. Kamloops didn’t make the top twenty but the program is needed here.

The Interior Health Authority needs to match the efforts of Vancouver Coastal Health. Users of prescription opioids need to be monitored. Only by reaching out will the death rate be brought down.

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Help fentanyl labs make a safer drug

Illegal fentanyl lab operators don’t intend to kill users. They would prefer to have return customers. The problem, I suspect, is that the fentanyl used is so concentrated that it’s hard to dissolve to a uniform consistency. The resulting doses are uneven –from low to deadly. It’s a good idea to provide testing facilities for fentanyl cooks to let them know the potency of their product. Dr. Tyndall of the BC Centre for Disease Control says:

  fentanyl lab. image: Global news

“I’m still firmly of the belief that nobody’s actually trying to kill people. These manufacturers don’t know what they’re doing and they’re putting out ridiculous concentrations of these drugs.”

The BCCDC recommends an expansion of drug-checking services where anyone, including producers of illegal fentanyl, can have their drugs tested for toxicity. B.C.’s Minister of Health, Judy Darcy, endorses the expansion.

As it stands, drug policy is perverse because we tell users not to use street drugs but provide no other option when legal supplies fail.

“We strongly advise people to stop using street drugs,” says Dr. Tyndall, “and if they can’t do that, then we offer them … Suboxone or methadone, and if that doesn’t work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying.”

The BCCDC suggests ten “areas of action.” If they were adopted, opioids would be essentially legalized much in the way that marijuana will be next year. Grower’s clubs and individuals would be allowed to make medical grade opiates. To clarify, opiates are derived from poppies whereas opioids include all synthetic and natural products.

Legal opioids are not likely to happen any time soon. I started lobbying for legalization of cannabis 40 years ago and look how long that took. Optimistically, with the model of legalized marijuana to be established soon, it won’t take another 40 years for the legalization of opioids.

Even without legalization, off-label uses of opioids are allowed. The BCCDC suggest dispensing take-home opioids such as oral hydromorphone which users could take home, grind up, and inject without supervision.

If the above recommendations only seem radical, it’s only because of a false sense of what criminalization can achieve. Criminal law can’t accomplish societal goals. If we want to stop people from using harmful drugs, criminalization has been a dismal failure. Instead, make drugs legal and educate people of the unhealthy consequences of use. It works with tobacco. If the goal is harm reduction, the recommendations don’t seem so radical.

Imagine that we are talking about baby strollers instead of drugs, and that some early models collapsed resulting in injury or death. An irrational solution would be to make strollers illegal. The sensible solution would be to regulate manufacture of the strollers to make them safe.

Prohibition of opioids isn’t working. It didn’t work for coffee, cigarettes or alcohol.

If the current trend continues, the death rate will continue to climb. More than 1,500 will die in British Columbia this year -ordinary people like friends, family and neighbours. Forget the stereotype of street people overdosing in alleys: 90 per cent of deaths are indoors. Isn’t it time to abandon prohibition and give harm-reduction a chance?