Pubdate: Fri, 14 Aug 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Peter McKnight (Adjunct professor at Simon Fraser University)
Page: 14
Referenced: Deaths Involving Fentanyl in Canada, 2009-2014 - August 
2015: http://mapinc.org/url/Fb3NlowW

WHY IS AN OPIATE ANTIDOTE HARDER TO OBTAIN THAN THE DRUG?

Recent overdose figures from the Canadian Community Epidemiology 
Network on Drug Use confirm one thing: Anyone who wants opiate drugs 
can get them.

The network's bulletin, released this week, focuses on fentanyl, a 
synthetic opiate about 100 times more potent than morphine. The 
report notes that fentanyl contributed to at least 655 Canadian 
deaths from 2009 to 2014 - an average of one death every three days. 
And in British Columbia, which has long experienced high rates of 
opiate use, fentanyl-detected deaths increased 700 per cent from 2012 to 2014.

Ironically, the spike in fentanyl deaths might be the direct result 
of a crackdown on prescription opiates, as street dealers substitute 
the ultra-potent substance for prescription drugs that are in short 
supply. So, 45 years after former U.S. president Richard Nixon first 
declared what has become a worldwide war on drugs, opiates remain as 
easy as ever to obtain.

But what if opiates aren't your drug of choice? What if you're 
looking instead for a drug that can reverse the deadly effects of 
opiates? Well - and here's more irony - that drug is a lot harder to 
get. It's called naloxone, a drug that blocks the effects of opioids 
in the brain, thereby reversing an overdose and preventing the loss 
of consciousness and cessation of breathing that often follow. A 
non-addictive, non-intoxicating, low-risk drug, naloxone has been 
used in Canadian emergency rooms for more than 40 years.

The trouble, of course, is that most people don't shoot up in 
hospitals. People commonly use drugs - and overdose - at home, in a 
washroom or in an alleyway. And if we are to reduce the risk of death 
or brain damage, naloxone must be available wherever an overdose occurs.

For this reason, many jurisdictions have started Take Home Naloxone 
programs, which provide education in administering naloxone along 
with a supply of the drug to opiate users or those who associate with 
them. These programs have met with conspicuous success: The U.S. has 
more than 180 such programs, and about 10,000 overdoses have been 
reversed. Edmonton started a program in 2005, followed by Toronto in 
2011 and B.C. in 2012. Ontario has now joined B.C. with a 
provincewide program, with further initiatives planned for Alberta 
and Quebec, and these programs have replicated the success of their 
U.S. counterparts.

Despite this, the recent spike in fentanyl-related deaths suggests 
that naloxone availability remains an issue. Indeed, current 
regulations unnecessarily restrict the availability of naloxone. 
Although details differ somewhat from province to province, Take Home 
kits are provided only by prescription and typically are available 
only to opiate users who are at risk of overdose. This effectively 
bars family members and friends of opiate users from receiving 
naloxone, yet those very individuals are often in the best position 
to administer the drug. Similarly, there will be no naloxone for the 
significant number of people who are unwilling to admit that they use 
illicit opiate drugs. These problems could easily be overcome by 
permitting over-the-counter distribution, something that has worked 
successfully in other jurisdictions. Health Canada has agreed to 
review the prescription-only status of naloxone, though the process 
could take up to 18 months. But it must not take 18 mont! hs. At 
current rates, 18 months means an additional 183 fentanyl-related 
deaths. We clearly have easy access to drugs that are killing us. 
Just as clearly, we need better access to a drug that can save us.
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MAP posted-by: Jay Bergstrom