Pubdate: Wed, 22 Oct 2014
Source: National Post (Canada)
Copyright: 2014 Canwest Publishing Inc.
Contact: http://drugsense.org/url/wEtbT4yU
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Donald MacPherson
Note: Donald MacPherson is executive director of the Canadian Drug 
Policy Coalition.

BEYOND INSITE

Canada Is Ignoring Easy, Uncontroversial Ways to Prevent Overdose Deaths

A particularly potent batch of heroin recently resulted in 31
overdoses at Vancouver's Insite safe injection clinic. The facility
proved its value yet again, as staff applied immediate treatment and
ensured none of the victims died. But what about those who can't
access Insite? In 2013, 308 people died in British Columbia due to
illicit drug overdoses, the majority of which were
opioid-related.

Canada-wide, we can only speculate about the total numbers because
there is no national database tracking overdose deaths. But the
numbers we do have, from a patchwork of provincial data and news
reports, tell us that far too many Canadians are dying from an
entirely preventable phenomenon. And not preventable in the sense of
"well, if people didn't use drugs, there wouldn't be overdoses." While
that's essentially true, we know people will use drugs. One hundred
years of prohibition hasn't stopped that.

No, these deaths are preventable thanks to easy-to-implement,
non-controversial policy changes at our disposal.

The most pragmatic and immediately effective remedy would be to
improve access to naloxone, a 40-year old medication that, when
administered during an opioid overdose, reverses the effects of the
drug. It has no narcotic effect and people cannot become dependent on
it.

Currently, naloxone is used predominantly by ambulance and medical
staff - like those at Insite - but we could save countless more lives
if it were available to those most likely to be with someone
experiencing an overdose. Eighty-five percent overdoses occur in the
presence of others, often in the home. For this reason, naloxone
should be included in provincial drug plans and made available over
the counter.

In addition, we should scale up existing "take-away naloxone programs"
to increase the distribution of overdose response kits among people
trained to prevent, recognize and respond to overdoses. Streetworks in
Edmonton pioneered this programming in Canada, and similar initiatives
have spread throughout the country. The most robust program -
Take-Home Naloxone (THN) - was established at the B.C. Centre for
Disease Control in 2012. THN operates in 51 sites, from large urban
hubs like Vancouver and Surrey, to smaller rural centres such as
Cranbrook, Campbell River and Fort St. John. More than 2,200 people
have been trained, including staff and volunteers at health and social
service agencies, as well as friends and family members of people who
use drugs. THN has dispensed more than 1,200 kits, and 125 overdoses
have been reversed.

Clearly naloxone is a life-saver, but reducing barriers to its access
and providing training are just part of a comprehensive overdose
response. We also need to immediately implement appropriate guidelines
for opioid prescriptions, improve national data collection on overdose
events, and reduce barriers to calling 911 during a drug overdose.
Again, most overdoses occur in the presence of other people. Though
witnesses to heart attacks rarely hesitate to call 911, witnesses to
an overdose often lose precious minutes wavering over whether to call
for help - if they make the call at all. They may fear arrest, the
loss of custody of children, or judgment from friends and family.

This would be resolved by the passage of Canadian 911 Good Samaritan
legislation - so called because it provides protection from arrest and
prosecution for drug possession if the evidence is obtained as a
result of the person calling 911. In the last four years, 11 U.S.
states have passed some form of this legislation, often with
bipartisan and near-unanimous support.

Such legislation recognizes that accidental drug overdose is a health
issue that doesn't merit attention from the criminal justice system.
Indeed, public health imperatives should drive all policy relating to
overdose response.

While much of the responsibility for this issue rests at the local and
provincial level, ultimately the federal government plays an important
leadership role in setting the overall tone and guiding any national
strategy. At the 2012 annual meetings of the United Nations Commission
on Narcotic Drugs, delegates passed a resolution recommending that
member states include effective elements for the prevention and
treatment of overdose in national drug policies, including the use of
naloxone. Although the Canadian delegation supported this resolution,
and despite the simplicity of implementing such programs and policies,
to date the government has not acted on this matter. It's time for
that to change.  
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MAP posted-by: Richard