Pubdate: Tue, 07 Feb 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Page: A10


More than 900 British Columbians died of illicit drug overdoses last
year. That's 80 per cent more than 2015, and the highest total ever
recorded in our province. Nor is there an end in sight.

Drug deaths climbed throughout 2016, reaching 142 in the month of
December alone. If that trend continues, we could conceivably see
1,700 fatalities or more this year. Those are disastrous numbers.

The main effort to curtail fentanyl deaths has focused on the antidote
naloxone. Kits are being handed out to users, their families and
first-response teams across the province.

But this is literally a last-gasp solution. And it comes at a

Naloxone is associated with fierce withdrawal symptoms. Some addicts
overdose, take naloxone, then shoot up again to control the reaction.
There are instances of this cycle being repeated six times in a single

Public-health experts believe they have a solution. Would society
accept it? They are not sure.

By way of proof that they can halt the overdose crisis, they point to
the HIV/AIDS epidemic that swept our province two decades ago. At its
height, in the mid-1990s, 240 British Columbians were dying each year
of AIDS-related causes, a grim total.

Clever new drug combinations, pioneered by Dr. Julio Montaner and his
team at St. Paul's Hospital in Vancouver, played a role. Montaner's
treatment regimen was adopted worldwide.

But outreach into the gay community and among injection-drug users
turned the tide. Public-health nurses contacted every infected person
who could be found, and convinced them to get treatment.

Peer "navigators" were recruited among those with the disease, and
given the task of convincing friends to be tested. Outreach programs
were set up with community groups such as AIDS Vancouver Island.

It worked. AIDS-related deaths fell to just 44 by 2013. And in the
past 15 years, only two children in B.C. have been born with the virus
- - a record almost unmatched in any other jurisdiction with an AIDS

Now we have a fentanyl crisis on our hands, and the experts who dealt
with the AIDS onslaught believe the same techniques will work here.

Their key point is this: Drug addiction is not an infectious disease,
like AIDS. But it is contagious, in the same way that obesity or
smoking are contagious.

Youngsters who grow up in communities where poor diet or tobacco use
are everywhere in sight tend to follow along. Likewise, if drug use is
prevalent and visible - people shooting up on sidewalks or doorways -
it tends to spread and multiply.

The answer, at least in part, is to get addicts off the street and
into clinics. But how?

One option is to use the same peer-navigator strategy to identify and
contact potential fentanyl users.

Once users agree to come in for assistance, safer and less addictive
drugs such as methadone can be dispensed. Island Health is working
with municipalities to set up overdose-prevention sites.

There's a catch. It might also be necessary to provide stronger drugs
- - heroin included - to keep some people in the program. They might not
find methadone sufficient.

Will the public be comfortable with giving addicts heroin to keep them
off the street? Many might think this is merely perpetuating the very
ill we're trying to cure.

But if the alternative is a repeat of last year's disastrous death

This is one of those vexing issues where there are no good answers.
Every option has a downside.

Nevertheless, the provincial health officer, Dr. Perry Kendall, has
given his answer: Dispense heroin.

Are we willing, collectively, to go along?
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MAP posted-by: Matt