Opinion: How to effectively address the overdose epidemic

published on July 30, 2017 by Evan Wood in Vancouver Sun

We’re now more than a year into the public health emergency declared by British Columbia’s provincial health officer as a result of the province’s rising rate of drug overdose deaths.

Tragically, the death toll continues to mount. The latest report from the province’s coroner shows we’re on pace to see more than 1,500 people die of overdoses in 2017 — more than the last two years combined.

As the opioid crisis worsens, the more we learn about why people are dying. One thing that has become startling evident: the drug supply is becoming more toxic by the day. The deadly drug fentanyl is being detected in more that 72 per cent of all overdose deaths. Two years ago, it was found in only 29 per cent; two years before that, just 15 per cent.

While untold fatal overdoses have been prevented by the broad range of courageous first responders, other health care providers, and peer groups who have worked tirelessly to respond to overdoses as they occur, the increasingly poisonous drug supply is clearly undermining the efforts to reduce overdose deaths.

One problem is that much of the energy expended to date has focused on efforts aimed at reducing fatal overdoses among those using fentanyl without an equal focus upstream on the fundamental reasons people are overdosing in the first place. For instance, major successful efforts have been made to expand access to the overdose reversal drug naloxone whereas efforts to get individuals off of fentanyl-laced drugs have been slower to implement.

Providing naloxone and other harm reduction interventions for when overdoses occur can absolutely save lives, but it has become painfully obvious that we cannot get out of the crisis solely through these means. Instead, we need a new approach involving a laser-like focus on strategies to improve the safety of the drug supply and strategies to get individuals off of fentanyl-laced drugs.

Here, it is worth noting that substantial resources provincially and federally have been expended in an effort to reduce the street supply of synthetic opioids like fentanyl through drug interdiction efforts. Not only has this proven unsuccessful in the fentanyl era, any expectation that this will be successful fails to acknowledge that the fentanyl crisis itself is a natural consequence of similar prohibition efforts aimed at reducing the supply of traditional illicit opioids like heroin. Indeed, street heroin is likewise a product of the earlier supply reduction efforts aimed at suppressing the availability of opium.

For those who question the economists and other experts who have long argued that drug prohibition, just like the prohibition of alcohol, simply creates more potent and more toxic drugs, we can simply look to past experience to see the historical failure of supply reduction efforts.

For instance, between 1990 and 2007 the U.S. Office of National Drug Control Policy saw a budget increase of more than 600 per cent (inflation adjusted) aimed at reducing illicit drug supply through the nation’s war on drugs. The result: the average inflation-adjusted and purity-adjusted price of heroin decreased by over 80 per cent while average purity increased by 60 per cent. The simple fact is that drug prohibition has the unintended consequence of creating a huge illegal market that contributes to increasingly sophisticated crime groups who ultimately make street drugs ever more potent and available to consumers.

While ending prohibition may not be on the agenda for the provincial and federal governments, old taboos must be broken. Elected officials must look at successes elsewhere and be willing to act in a manner consistent with the scale of the crisis. One successful approach was taken in Portugal, which transitioned its focus from drug law enforcement to addiction treatment and recovery, ultimately leading to a severe decline in overdose rates — among the lowest in the European Union. We must take a similar approach.

Last July, when the provincial government announced the creation of its joint task force to respond to the overdose crisis, the announcement promised to establish a drug testing service to help people find out if their drugs include adulterants, including fentanyl. This urgently needed service must be made available as soon as possible.

We must also look to expand a range of addiction treatment and recovery services aimed at helping persons off of fentanyl-laced drugs. This includes substitution treatments — from Suboxone to injectable treatments including prescription heroin — as well as fully integrated recovery services to seamlessly help individuals fully transition out of all opioid use whenever possible.

As the original principal investigator of Insite, Canada’s first supervised injection site, I’ve seen firsthand the important role that these programs can have in reducing overdoses, but also the absolutely clear need to have public health programs supported by a functioning addiction treatment system. This has become particularly urgent in the era of fentanyl-laced drugs.

If we accept the reality that fentanyl is a product of drug prohibition — while also acknowledging the benefits but also limitations of solely focusing on reversing overdoses after they have occurred — the next step is to implement all options for protecting people from the increasingly toxic drug supply. A focus on this strategy is the only way out of the current overdose crisis.

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