Pubdate: Mon, 31 Jul 2017
Source: Vancouver Sun (CN BC)
Copyright: 2017 Postmedia Network Inc.
Author: Evan Wood
Page: A9


New approach is needed to tackle the overdose epidemic, writes Evan

We're now more than a year into the public health emergency declared
by British Columbia's provincial health officer as a result of the
province's rising rate of drug overdose deaths.

Tragically, the death toll continues to mount. The latest report from
the province's coroner shows we're on pace to see more than 1,500
people die of overdoses in 2017 - more than the last two years combined.

As the opioid crisis worsens, the more we learn about why people are
dying. One thing that has become evident: the drug supply is becoming
more toxic by the day. The deadly drug fentanyl is being detected in
more that 72 per cent of all overdose deaths. Two years ago, it was
found in only 29 per cent; two years before that, just 15 per cent.

While untold fatal overdoses have been prevented by the broad range of
courageous first responders, other health care providers and peer
groups who have worked tirelessly to respond to overdoses, the
increasingly poisonous drug supply is clearly undermining the efforts
to reduce overdose deaths.

One problem is that much of the energy expended to date has focused on
efforts aimed at reducing fatal overdoses among those using fentanyl
without an equal focus upstream on the fundamental reasons people are
overdosing in the first place. For instance, major successful efforts
have been made to expand access to the overdose reversal drug naloxone
whereas efforts to get individuals off of fentanyl-laced drugs have
been slower to implement.

Providing naloxone and other harm reduction interventions for when
overdoses occur can absolutely save lives, but it has become painfully
obvious that we cannot get out of the crisis solely through these
means. We need a new approach involving a laser-like focus on
strategies to improve the safety of the drug supply and strategies to
get individuals off of fentanyl-laced drugs.

Here, it is worth noting that substantial resources provincially and
federally have been expended in an effort to reduce the street supply
of synthetic opioids like fentanyl through drug interdiction efforts.
Not only has this proven unsuccessful in the fentanyl era, any
expectation that this will be successful fails to acknowledge that the
fentanyl crisis itself is a natural consequence of similar prohibition
efforts aimed at reducing the supply of traditional illicit opioids
like heroin. Indeed, street heroin is likewise a product of the
earlier supply reduction efforts aimed at suppressing the availability
of opium.

For those who question the economists and other experts who have long
argued that drug prohibition, just like the prohibition of alcohol,
simply creates more potent and more toxic drugs, we can simply look to
past experience to see the historical failure of supply reduction efforts.

For instance, between 1990 and 2007 the U.S. Office of National Drug
Control Policy saw a budget increase of more than 600 per cent
(inflation adjusted) aimed at reducing illicit drug supply through the
nation's war on drugs. The result: the average inflation-adjusted and
purity-adjusted price of heroin decreased by over 80 per cent while
average purity increased by 60 per cent. The simple fact is that drug
prohibition has the unintended consequence of creating a huge illegal
market that contributes to increasingly sophisticated crime groups who
ultimately make street drugs ever more potent and available to consumers.

Old taboos must be broken. Elected officials must look at successes
elsewhere, such as the approach taken in Portugal, which transitioned
its focus from drug law enforcement to addiction treatment and
recovery, ultimately leading to a severe decline in overdose rates.

Last July, when the provincial government announced the creation of
its joint task force to respond to the overdose crisis, the
announcement promised to establish a drug testing service to help
people find out if their drugs include adulterants, including
fentanyl. This urgently-needed service must be made available as soon
as possible.

We must also look to expand a range of addiction treatment and
recovery services aimed at helping persons off of fentanyl-laced
drugs. This includes substitution treatments - from Suboxone to
injectable treatments including prescription heroin - as well as fully
integrated recovery services to seamlessly help individuals fully
transition out of all opioid use whenever possible.

As the original principal investigator of Insite, Canada's first
supervised injection site, I've seen firsthand the important role
these programs can have in reducing overdoses, but also the clear need
to have public health programs supported by a functioning addiction
treatment system. This has become particularly urgent in the era of
fentanyl-laced drugs.

If we accept the reality that fentanyl is a product of drug
prohibition, the next step is to implement all options for protecting
people from the increasingly toxic drug supply. A focus on this
strategy is the only way out of the current overdose crisis.

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Evan Wood is the Director of the B.C. Centre on Substance Use, a Canada 
Research Chair and UBC professor of medicine.
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