Forget hydromorphone, give them fentanyl

Canada’s safer supply program is a good idea but the drug they hand out isn’t what users want. On the positive side, it does provide users with a safer alternative to the toxic, illegal drugs that they buy on the street.

image; Canadian Association for Safe Aupply

“Safer supply services can help prevent overdoses, save lives, and connect people who use drugs to other health and social services,” says the Government of Canada website.

There are nine safer supply sites in B.C., all of them on the lower mainland and Vancouver Island.

Safer supply is controversial because drugs are given to addicts who are not in a recovery program. Why feed addiction?

Well, the option to giving addicts safe drugs is often death. Canada is in the midst of an opioid crisis that has killed over 35,000 people since 2016. So why not give them safer drugs?

Despite being a good idea, the safer supply problem has created unintended consequences: the drug that’s given out, hydromorphone, doesn’t satisfy the users need to get high the way fentanyl does.

“Fentanyl is a stupendously powerful synthetic opioid that leaves users with a formidable drug tolerance,” says reporter Adam Zivo. “Those who use fentanyl generally don’t find that other, comparatively weaker, opioids give them a satisfying high (National Post, May 9, 1023).”

In Zivo’s investigative report, he found that a significant portion of the safer supply drugs end up being sold on the street.

Hydromorphone is being sold at rock-bottom prices. Proceeds of the sale are going to purchase often-deadly fentanyl.

The flood of hydromorphone on the street has reduced the price of a tablet to a fraction of what it once was.

According to a doctor in Vancouver, an 8-mg tablet of hydromorphone was $8 before safer supply. Then it dropped to $4 after Vancouver launched hydromorphone vending machines in 2020. The price dropped to between 25 and 33 cents per tablet after the safer supply program was expanded.

But why would drug users sell their hydromorphone to buy riskier street fentanyl?

“According to the addiction physicians I interviewed, although the typical 8-milligram tablet of hydromorphone given to addicts is four times the dose generally used in hospital settings, its effect relative to fentanyl is like holding a candle to the sun,” says Zivo.

The abundance of cheap hydromorphone has seen a rise of young people requesting help with dependence on hydromorphone. Because the tablets  are so cheap, users often pop a handful which can be deadly.

Youth generally understand the risks of using fentanyl and are therefore stay away from it. However, because hydromorphone is prescribed by a doctor and marketed as “safe,” young people underestimate its dangers and are more likely to try it.

Then, in an attempt to get a more intense high, some users are crushing hydromorphone tablets for intravenous injection, potentially leading to excruciating and disfiguring infections that have paralyzed some patients.

Dr. Sharon Koivu, an addiction physician with the London Health Sciences Centre, has noticed an increase in serious infections relating to intravenous drug use. Speaking with her patients, she learned that many of them were buying cheap hydromorphone, then crushing and injecting it.

The solution to the safer supply problem of hydromorphone is obvious: give addicts safe doses of fentanyl so they don’t die from the toxic stuff sold on the street.

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Sometimes it’s not easy being a pro-vaxxer

Despite the fact that vaccines have saved uncountable lives and virtually wiped out smallpox, polio, tetanus and rabies, vaccine risks exist. When those risks result in death, people lose trust in all vaccines.

image: Skeptical Raptor

Look at what happened in the Philippines. In 2015 they purchased three million doses of a new dengue vaccine.

Dengue is not as deadly as it might seem. Three-quarters of people infected by the mosquito-borne virus don’t notice anything. The remainder fall into three groups – symptoms similar to the common cold; or a fever accompanied by headache, pain behind the eyes, aching joints and bones that sometimes leads to internal bleeding; or the most deadly, dengue hemorrhagic fever and dengue shock syndrome where plasma seeps out of capillaries, liquid pools around organs, massive internal bleeding ensues. The brain, kidneys and liver begin to fail (Scientific American, April, 2018).

In the Philippines with a population of 105,000, dengue kills an average of 750 people a year. Any death is one too many but that number doesn’t even put dengue-deaths in the top ten list of killers. Of infectious diseases, many more die from pneumonia and tuberculosis.

The dengue vaccine wasn’t cheap. Made by the pharmaceutical company Sanofi Pasteur, Dengvaxia cost more than the entire national vaccination program for 2015, which covered pneumonia, tuberculosis, polio, diphtheria, tetanus, pertussis, measles, mumps and rubella. And it would reach less than one percent of the population.

Some wondered if the vaccine Dengvaxia had been oversold to the Philippine government in a panic mode.

Here’s where the nightmare for pro-vaxxers comes in.

Internist Antonio Dans and paediatrician Leonila Dans at the University of the Philippines Manila College of Medicine discovered some startling results: young children who were vaccinated were more like likely to suffer from dengue that those who weren’t vaccinated.

They found this out by studying publications by the makers of the vaccine, Sanofi Pasteur. While it worked for older children, for younger ones, the vaccine made things worse.

The two Dans warned the Philippine secretary of health in 2016 of their findings but in the meantime, the World Health Organization said that there was no problem.

“It was either believe us or believe the WHO,” said Antonio Dans. “If I were them, I’d believe the WHO. I mean, who were we? We were just teachers in a small medical school.”

The Philippine secretary of health responded with her own warning: doctors who engaged in “misinformation” on the vaccine would be responsible for every death from dengue that could have been prevented.

Then Eva Harris, a dengue expert at the University of California, Berkeley, found strong evidence in 2017 to support the Dans:

Harris’s evidence made the world take notice. Now Sanofi Pasteur and the WHO don’t recommend Dengvaxia for young children who have not been previously infected.

The reasons why Dengvaxia makes matters worse for children who have not been infected and better for those who have is puzzling. There are a few theories but it’s debatable.

The confusion has led to lack of confidence in vaccinations. In 2015, 93 per cent of Filipinos strongly agreed that vaccines are important.  In 2018, less than a third thought so.

Now, Filipinos suspicious of vaccines aren’t getting kids vaccinated and several outbreaks of measles have occurred.

Vaccines save lives but in a rush to save lives at any cost, the rollout of Dengvaxia was too soon and the cost was a loss of confidence of all vaccines.

Advice to TRU: educate, don’t prohibit cannabis

Thompson Rivers University plans to prohibit the recreational use of cannabis on campus. This, despite the failure of prohibition to deter use for the last 95 years in Canada.

image: SchoolFinder

Cannabis is not harmless. Inhaling smoke, be it from wildfires, tobacco, or cannabis carries risks. But banning cannabis is not the way to control those risks.

Education is. Education has reduced the consumption of tobacco. Reductions have been especially greater for those with a higher education according to a report from Statistics Canada.

TRU has nine designated locations where tobacco and medical marijuana can be smoked. Once cannabis is legalized on October 17, those locations would be a logical place for recreational cannabis smokers as well.

TRU’s Joint Occupational Health and Safety Committee voted on March 5, 2018, to ban all smoking of recreational marijuana on campus for health and safety reasons. Chris Montoya, committee member and Senior Lecturer in Psychology, says not all of the 20-member committee agreed:

“Pro-marijuana smokers on the TRU committee argued that marijuana smoke is no different than cigarette smoke and that smoking areas designated for cigarette smoke should also be used for marijuana.”

But they were apparently swayed by arguments  presented by Montoya: cannabis is more potent than ever before, bystanders can get stoned from second-hand smoke, and marijuana has been linked with psychoses.

Montoya is a member of the National Advisory Council (2016-18) and the Partnership for a Drug Free Canada. He repeated some of his claims to Kamloops This Week:

“A student cannot get drunk walking next to another student drinking a beer. However, students, staff and faculty can get stoned breathing in second-hand smoke.”

Ian Mitchell, Kamloops Emergency Physician, disagrees:

“There have been a series of studies in which non-smokers are shut into a small room with cannabis smokers and tested for both impairment and positive urine tests. While these things can happen, it is only under the most extreme circumstances,” he told me by message.

A doctoral student in clinical psychology at UBC Okanagan also disagrees with Montoya:

“Researchers at John Hopkins University have been conducting studies on the effects of cannabis smoke exposure to non-users and have found that, under regular indoor conditions, non-smokers did not experience changes in cognitive ability –i.e. ’get high,’” says Michelle Thiessen in a letter to KTW.

There are places on campus for students and staff to drink alcohol as well as smoke cigarettes. TRU spokesperson, Darshan Lindsay, told CFJC Today: “There are a lot of regulations, systems in place to promote responsible use of alcohol. We just don’t have that in place for cannabis. For the university, recognizing that we are a place of education and that we want to promote an environment that’s safe and healthy for everyone, our position is that recreational cannabis should not be present on campus.”

Failing to have a “place for cannabis” perpetuates the notion that prohibition will reduce cannabis use. Banning cannabis has a predictable effect -it simply drives consumption into the shadows and prevents dealing with the risks.

TRU should become a model in harm reduction, as “a place of education.”

Prohibition is futile: TRU might as well prohibit wildfires -it would be as effective.