Pubdate: Mon, 11 Jan 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Peter McKnight
Note: Peter McKnight is an adjunct professor, School of Criminology, 
Simon Fraser University.
Page: S2

NO EXCUSE FOR FENTANYL FOOT-DRAGGING

If we are ever to divorce drugs from death, we must not be afraid to 
implement bold solutions to medical emergencies

When gang violence erupted in British Columbia in 2009, the federal 
government acted at light speed to implement measures to contain the 
violence. That rapid response stands in stark contrast to the feds' 
lethargy in dealing with the very things the gangs were fighting over:drugs.

Drug overdoses are nothing new, of course, especially in Western 
Canada. But at the onset of the gang war, something new did appear: 
fentanyl, a synthetic opioid about 100 times more potent than morphine.

According to the Canadian Community Epidemiology Network on Drug Use, 
fentanyl was detected in more than 1,000 drug-poisoning deaths in 
Canada from 2009 to 2014. Furthermore, fentanyl-detected deaths 
increased by nearly 700 per cent from 2012 to 2014 in B.C., and by 
more than 2,000 per cent from 2011 to 2014 in Alberta. The trend 
continued unabated last year, with record numbers of 
fentanyl-detected deaths in both provinces.

Clearly, this is a crisis situation. And when you're faced with such 
a situation, you have to act fast, particularly when you have the 
means to avert the crisis.

We have the means. It's called naloxone, a drug that blocks opioids 
in the brain, thereby preventing or reversing an overdose. Naloxone 
has been used in Canadian emergency rooms for more than 40 years, and 
many provinces have recently started providing Take Home Naloxone 
kits to people who use drugs, along with training in recognizing and 
reversing overdoses.

Because of federal law, however, some people don't have the means. 
Since naloxone is provided to drug users by prescription, friends and 
family members - the people in the best position to administer the 
drug - are unable to obtain it. Even firefighters, often the first 
responders at the scene of an emergency, don't have access to naloxone.

In contrast, over-the-counter naloxone is available in many 
jurisdictions, including many in the United States, the country often 
vilified for its unenlightened approach to illicit drugs. Given this, 
and given the abundant evidence of the life-saving effectiveness of 
the drug - it's credited with saving tens of thousands of lives in 
the United States - you would think that the Canadian government 
would approve over-the-counter naloxone posthaste.

But you would be wrong. When fentanyl overdoses made headlines last 
summer, Health Canada announced that it was reviewing the status of 
the drug. Six months later, the review, and overdose deaths, continue.

During those six months, fentanyl probably claimed the lives of more 
people than B.C.'s entire gang war.

In a self-congratulatory e-mail, Health Canada states that it "is 
very concerned about the growing number of fentanyl overdoses and 
deaths" and notes that it took "the unprecedented step of initiating 
a review of the prescription status of naloxone." Yet, it is unable 
to indicate when the review will be completed, saying only that a 
decision is expected early this year.

That's not good enough. While the change of governments no doubt 
slowed the process, the failure to provide sufficient access to 
naloxone amounts to nothing less than withholding proven, lifesaving 
treatment. As I wrote five months ago, we need better access to 
naloxone, and we need it now.

Now, with that said, naloxone will not prevent all drug overdoses. 
While an essential element of any rational and humane drug strategy, 
it is, if you will, a quick fix for a bad fix. Many other measures, 
both short- and long-term, must accompany increased access to naloxone.

In the short term, enhanced surveillance would allow public health 
authorities to quickly identify and communicate to users the presence 
of contaminated drugs on the street. And drug users, their friends 
and families would benefit from improved training in preventing, 
recognizing and treating overdoses.

Many of the provinces have been working on these measures, and 
physician-epidemiologist Jane Buxton, harm reduction lead at the B.C. 
Centre for Disease Control, notes that B.C.'sDrug Overdose and Alert 
Partnership will be releasing a strategy to address these issues in 
the next week or so.

In the long term, the provinces ought to consider opening supervised 
injection facilities, like Vancouver's Insite, which provide a space 
for users to inject drugs under the supervision of healthcare 
professionals. Numerous studies have confirmed that Insite has helped 
to prevent overdose deaths while improving the physical, mental and 
social health of its clients. The facility also helps to introduce 
many disenfranchised drug users to the health-care system, some of 
whom proceed to rehab (Onsite) to cease using drugs.

Unfortunately, the previous federal government led by Stephen Harper, 
with its medieval attitude toward drugs, erected numerous barriers to 
the establishment of supervised injection sites through the Orwellian 
Respect for Communities Act. But Prime Minister Justin Trudeau, who 
has expressed support for injection sites, can easily dismantle those 
barriers by repealing the act.

Finally, increased access to opioid-substitution therapy would allow 
opioid users across Canada to obtain drugs from a doctor rather than 
a dealer, thereby avoiding potentially contaminated street drugs. 
Clinical trials around the world, including in Vancouver, have found 
that this treatment also improves patients' physical, mental and social health.

Such measures are, of course, not without controversy. But if we are 
ever to divorce drugs from death, we must not be afraid to implement 
them. And we must implement them now.
- ---
MAP posted-by: Jay Bergstrom