Pubdate: Fri, 04 Aug 2017
Source: Penticton Western (CN BC)
Copyright: 2017 Penticton Western
Author: Dustin Godfrey


In its fight to curb ever-climbing overdose death rates, middle-class
drug users have been a challenge to reach for health officials.

Part of fighting the overdose crisis means getting the right messaging
across to the right people, according to IH medical health officer Dr.
Silvina Mema. That includes letting people know help is available and
conveying tried and true safety precautions when using drugs, such as
not using alone and keeping naloxone on hand.

That can be an uphill battle, according to Mema, who said many people
still believe the overdose crisis mostly or exclusively affects
homeless or lower-class people.

"That is really a myth. It is true, in terms of many of those are
dying. Being homeless is a risk factor, for sure," Mema said. "But
they are not the only ones that are being affected by this crisis."

For those on the street level, Mema said there have been some
successes in getting some of the messages out to drug users.

"We've been giving hundreds of naloxone, so people are understanding
that they need to carry it, but at the same time there is more people
dying than before," Mema said. "The crisis is not stopping in a sense.
… This is a lot deeper problem than anybody imagined, really."

Related: IH chair: The drugs are here, we need intelligent approach

Mema said there are changes beyond messaging that need to be enacted
to try to halt the overdose crisis - particularly noting that the
illegality of drugs has led to a number of issues, including a
deregulation of drug purity and quality, as well as a demonization of
drugs, and by extension drug users.

"The war on drugs is what led us here. This is where we are, because
drugs are illegal, and because people who use drugs are stigmatized,
and they cannot talk about it, and because they have to use in a back
alley or in a bathroom by themselves," Mema said.

"Now, we are beginning to talk about it, and people are beginning to
be more comfortable."

Particularly, Mema said health officials have been talking with
homeless people about safe drug practices for so long that it has
become less stigmatized for that social group.

"They have their friends, and they also use, but then there is a lot
of people that are middle class that are marginalized in terms of they
can't speak with their friends in a pub about their drug use because
it's not what the other friends do," Mema said.

Related: Health officials battling damaging fentanyl myths

In places like Vancouver's Downtown Eastside, it's easier to provide
help because of the open nature of the drug issue there.

"We've been doing a lot of work toward these lower classes … and they
get it. They get it because we've been putting a lot of emphasis. They
are comfortable going into an agency and asking for naloxone, because
they are assumed to use drugs," Mema said.

"The other classes, where it's not normal to use drugs - and it
shouldn't be; I'm not trying to say that using drugs should be normal,
but having a problem and being able to reach out for help - that
should be normal.

"These other classes, the higher classes, they are more isolated in
their use. And that comes especially when they've gone through detox,
or they've done treatment, and then they relapse. That's the most isolated."

Part of that is because treatment will often encourage users to put up
a wall between themselves and their old friends who use in order to
keep away from drugs.

Related: IH board to discuss escalating overdose crisis

"Then if you relapse, then you're alone. Because you don't want
anybody to know that you've relapsed," Mema said, adding that those
who have relapsed are often most at risk, having lost some tolerance.

"Now, there is a big emphasis in trying to reach those who use alone …
the people who have not opened up to help, and how to bring those
people out from the shade and offer them help and what help they need
- - that's the most difficult group to reach."

A group of health officials is beginning to get together to try to
determine how to reach those particular drug users, according to Mema,
who is part of the group of officials.

"We'll be exploring these groups in more detail, doing research
projects there to understand how to reach them better."
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