Pubdate: Wed, 01 Mar 2017
Source: BC Medical Journal (CN BC)
Copyright: 2017 BC Medical Journal
Author: Mark Tyndal


Issue: BCMJ, Vol. 59, No. 2, March 2017, page(s) 89 BC Centre for 
Disease Control Mark W. Tyndall, MD, ScD, FRCPC

British Columbia is in the midst of a public health crisis, with 914
documented overdose deaths in 2016. While there has been a steady
increase in overdose deaths over the past 2 years, December 2016 had
the highest monthly total of deaths ever recorded (128 deaths).[1]
This is particularly alarming as it is happening despite a public
health emergency announcement in April 2016 and a massive scale-up of
the take-home naloxone program that has been used in over 3000
overdose reversals.

The common narrative that has emerged to explain the crisis centres on
the introduction of fentanyl into the illicit drug market. Fentanyl is
a potent synthetic opioid that has been detected in an increasing
number of postmortem toxicology reports as well as drug seizures by
law enforcement. Most of the deaths have occurred among people with
long-standing opiate use, and the explanation for the overdose is the
unexpected toxicity of a particular drug purchase. This makes the
recent increase in the number of deaths even more disturbing as the
correct dosage, even at the hands of unprofessional clandestine
distributors, should have been figured out by now.

Despite the fear of overdosing, the use of opioids and other drugs is
driven by a desire to self-medicate, and drug use will continue no
matter how high the risk. There are myriad reasons and events that
launch people into habitual drug use-trauma, personal tragedy,
injuries, sexual abuse, racism, and mental illness to name a few. But
one thing is consistent-no one started using drugs to become isolated,
stigmatized, destitute, and criminalized. These devastating
consequences of drug addiction are directly related to entrenched drug
policies that criminalize drug users and a societal indifference to
the pain, suffering, and even death of people who buy drugs from the
illicit market.

If we acknowledge that opioid addiction follows a chronic relapsing
course and that many people are not willing or ready to stop using,
then harm reduction interventions along with basic social supports are
necessary to reduce suffering and prevent deaths. Proven harm
reduction interventions must be scaled up, including supervised
injection sites, low-barrier supportive housing, better access to
primary-care based opiate agonist therapy (OAT), and an expansion of
prescription opioid programs. Physicians have an important role in
both speaking out in support of harm reduction initiatives and
ensuring that there is adequate access to quality OAT in their

There is evidence that physician prescribing practices have
contributed to the current opioid overdose crisis.[2,3] In response,
the College of Physicians and Surgeons of British Columbia released
Safe Prescribing of Drugs with Potential for Misuse/Diversion in June
2016, a document that provided standards and guidelines to address the
high rates of opioid prescriptions.[4] Although the standards are
directed primarily at reducing the risk of long-term opioid treatment,
there remain challenges in managing patients who already require high
daily doses of opioids. In the midst of an overdose crisis that is
driven largely by toxic street drugs, any changes in prescription that
may drive patients to seek opioids in the illegal market must be avoided.

A year ago it would have been unthinkable that over 900 people would
have died of unintentional drug overdoses in the province. Despite
intense media attention, community mobilization, and some new
interventions, the number of deaths continues to rise. While there are
no quick fixes to this crisis, we must challenge drug policies and
societal attitudes that criminalize, marginalize, and demonize drug
users. Our approach to reducing the death and devastating health
consequences of drug use must be based on engagement, social supports,
housing, harm reduction, and health care. Without these essential
components, treatment and recovery will remain elusive to many. -Mark
Tyndall, MD, ScD, FRCPC Provincial Medical Director, BCCDC

This article is the opinion of the BC Centre for Disease Control and
has not been peer reviewed by the BCMJ Editorial Board.
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MAP posted-by: Matt