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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Opioid use rises despite crisis

Am I the only one not surprised that the opioid crisis has worsened? Despite the widespread distribution of naloxone kits to save lives from fentanyl overdose. Despite increased prescriptions of methadone to treat addiction.

       opium den

It’s all so predictable. The fuse to the opioid bomb was lit long ago.

I just finished reading Dan Malleck’s thoroughly researched book When Good Drugs Go Bad: Opium, Medicine, and the Origins of Canada’s Drug Laws. He traces the opioid crisis that gripped young Canada at the turn of the twentieth century and led to the Opium Act of 1908.

As now, the problem wasn’t the “recreational” use of opium, but rather the prescribed and drug store concoctions of opium. Laudanum, a tincture of opium, was commonly found in medicine chests to treat toothaches and diarrhea, and as a cough suppressant.

Opium was, and still is, a powerful drug in a doctor’s medicine bag. It was especially useful to treat the illnesses of urbanization before the advent of antibiotics; diseases such as dysentery, cholera, and tuberculosis. Even today, nothing surpasses it as a pain killer.

As now, the crisis then was triggered by drugs other than opium. Cocaine had been introduced as a pain killer. The effect on users was startling different than that of opium and its sister morphine. The concept of “drug fiends” didn’t exist until cocaine came on the scene. Now the term easily applies to crystal meth addicts. Charles Heebner, Dean of the Ontario College of Pharmacy commented in 1906 that the public alarm over drug users was non-existent until “the Cocaine Monster came upon the arena . . . Cocaine proved to be a far more enslaving drug than opium or morphine (p.199 of Malleck’s book).”

The politics of the opium scare were quite different than the reality of the problem. Whereas the medical problem was opium addiction and the crazed effect of cocaine, the politics dwelt on the anti-Asian sentiment, especially in B.C.

Nineteen hundred and eight was a federal election year and Prime Minister Laurier was looking for his fourth majority in a row. In response to “race riots” in Vancouver, Laurier sent his minister of labour, William Lyon Mackenzie King, to Vancouver to investigate.

King found that Chinese workers had been brought to British Columbia to build the railway and there now 16,000 Chinese immigrants and their decedents which amounted to eight per cent of the population of B.C. White Canadians claimed they were taking jobs away. Chinese Canadians were demonized for leading good, white, Canadian women astray in “opium dens.” The Chinese were perfect scapegoats: too many, too shady. Laurier played the race card and was returned to power in 1908.

One hundred and eight years later, nothing much has changed. The opioid problem is characterized by sensational news coverage of ordinary Canadians, many of them in the prime of their lives, being killed in alarming numbers by overdosing on fentanyl.

However, the root of the problem is not the recreational use of opioids but the prescription of opioids by doctors. “Prescriptions for hydromorphone have soared 57 per cent over the past five years (Globe and Mail, March 27, 2017).”

And predictably, the more opioids that are prescribed, the more Canadians get hooked. The problem is compounded as users get habituated and require increased dosages for them to work. So they turn to multiple doctors to get them. Failing that, they turn to the streets and the deadly fentanyl.

The problem is not recent -it’s been going on for generations according to the Globe and Mail. “The problem is particularly challenging for new doctors who have inherited patients on high-dose opioids from a colleague who has retired.”

It feels like 1908 all over again.