Pubdate: Tue, 10 Oct 2017
Source: Globe and Mail (Canada)
Copyright: 2017 The Globe and Mail Company
Author: Jessica Leeder
Page: A7


Grassroots harm-reduction initiative launched as those on the front
lines lament provincial government's boardroom approach

Health officials in New Brunswick are taking too long to address the
serious and growing opioid problem in the province's two largest
cities, say local harm-reduction activists who have launched a
grassroots initiative in the face of what they describe as government

It has been more than six months since the province's top doctor
formed an advisory group to come up with solutions to address the
issue, but the government's response so far has been lean compared
with that of other Atlantic provinces and the rest of the country.

Jennifer Russell, New Brunswick's acting chief medical officer of
health, said her task force is still privately conducting research on
the numbers. While some recommendations have been submitted to the
province - including the committee's suggestions on whether and how
opioid antidote kits ought to be distributed - Dr. Russell said her
team is still largely parsing the data. They are also watching closely
as other provinces pilot possible solutions. Nova Scotia and
Newfoundland have both started to distribute free opioid-antidote kits
to those who need them. In New Brunswick, the kits cost about $35 at

"Are we being too cautious? Are we taking too long? We are where we
are," Dr. Russell said in an interview. "There's a process we follow
to put these types of things in place and we're following [it]."

Recently released national statistics show that, per capita, New
Brunswick recorded the most hospitalizations for opioid poisoning in
all of Atlantic Canada for 2016-17. The cities of Moncton and Saint
John both had higher rates of opioid poisoning per 100,000 people than
Vancouver, a city at the centre of Canada's opioid epidemic.

Those dealing with the opioid problems on the front lines say they are
fed up with the province's boardroom approach, which they say is not
nearly proactive enough for the growing problem at hand.

"Please stop studying it. Please, just do something," said Debby
Warren, executive director of AIDS Moncton, a non-profit
harm-reduction agency that is, out of necessity, shifting its focus to
opioid-substance misuse. "You can study forever and look into things.
But sometimes, it's just about getting it done," Ms. Warren said.

In the absence of an official plan to deal with the opioid problem at
street level, her group has begun to take the initiative. Earlier this
month, AIDS Moncton held an opioid-training session for front-line
workers that included information on various drugs but also on how to
deal with a person who has overdosed. Ms. Warren was surprised at the
interest, which drew community workers that would not normally be
associated with drug-related solutions, including social workers and
even librarians, and generated a waiting list. Another free training
session is scheduled for next month. In the meantime, Ms. Warren and
her team have begun distributing 500 opioid-antidote kits donated by
the New Brunswick-based medical-marijuana company Organigram Inc.

Ms. Warren said AIDS Moncton will turn the kit distribution into a
pilot program that will generate data. She knows the number of kits is
small, but said it is one more drop in the bucket as advocates wait
for word of a plan from the province.

"For our little population, there's a serious situation," Ms. Warren
said, adding that she does not think most people in New Brunswick
understand its proportions. "We need a champion for addictions here -
we need leadership."

The province has dramatically sped up its ability to gather data on
opioid-related deaths. Instead of a year to collate numbers, it is now
done monthly and released quarterly. Between January and the end of
June, 68 per cent of drug-related deaths in New Brunswick were related
to opioids. Of 17 total opioid-related deaths, five were related to
illicit fentanyl. The deadly opioid has not hit New Brunswick in the
same proportions that it has been ravaging the West Coast, although
officials here say they are bracing for it.

"It doesn't matter whether we're higher or lower than the next person.
It's too high," said Ed Schollenberg, registrar of the New Brunswick
College of Physicians and Surgeons. New Brunswick's opioid problem
centres largely on prescription pills, Dr. Schollenberg said, meaning
doctors have to do their part. "If we're dealing with prescription
drugs, they all start out of the pen of the doctor. You have to figure
out how to influence that exact point."

A prescription-drug monitoring program that doctors are currently
training to use may help somewhat, he said. It is designed to flag
potential misuse or overprescribing of opioids. But the province has
not made a formal decision on what, if anything, will be done when
those flags go up, he said, adding that other jurisdictions have had
mixed results with similar monitoring programs.

For now, doctors across the province are making individual decisions
on how to regulate their own prescribing of opioids, which creates
inconsistency and volatility, said Tom Evans, a pain specialist based
in Moncton. "There is a lot of concern about the prescribing practices
in New Brunswick, in terms of safety, knowledge and lack of
awareness," he said.

Dr. Evans has had discussions with at least one doctor who boasted he
hasn't written a prescription for an opioid in six months. But cutting
patients off, even with good intentions, Dr. Evans said, creates new

"Will it potentially drive people to the street? I think so," he said.
"These folks are motivated. They're going to get what they need, no
matter what."

Most chronic users of opioids are not using the drugs to get high,
said Tim Christie, a professor of health-care ethics at the University
of New Brunswick and an adjunct professor of bioethics at Dalhousie
University in Halifax who has studied harm-reduction solutions for
more than 25 years.

Instead, they're suffering from substance-use disorder and are
typically using simply - and relatively safely - to avoid going into
withdrawal. "That disorder doesn't go away simply because you dry up
the drug supply," Prof. Christie said, adding that stemming the flow
of prescription opioids risks creating a desperate situation for those
suffering from misuse.

If front-line groups are calling for an expedited opioid action plan,
provincial officials would do well to listen, Prof. Christie said.
"Community groups are the canary in the coal mine," he said.
"Complacency is going to be deadly in this situation."
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MAP posted-by: Matt