Pubdate: Tue, 13 Mar 2018
Source: Peterborough Examiner, The (CN ON)
Copyright: 2018 Peterborough Examiner
Author: Rosana Salvaterra
Page: A4


In 2018 we find ourselves battling an opioid crisis that has been
years in the making. Opioids are drugs that act on the nervous system
to relieve pain and were originally derived from opium but now also
include synthetic preparations.

In the mid-1990s, their use by physicians was heavily promoted by the
pharmaceutical industry, leading to greater prescribing for both acute
and chronic pain. Patients using opioids can develop a dependency or

There are two sources of opioids: those that are produced by the
pharmaceutical industry and those that are illicitly produced.
Recently, the illicit supply has become so contaminated with fentanyl
(a very powerful opioid) or fentanyl-like substances that many people
are at risk of an unintended acute and potentially fatal poisoning.

Preventing the harms of opioid use can start upstream by preventing
the initiation of substance use in the first place. This work often
falls to governments and public health. Iceland has been able to
shrink rates of use by young people over the last 20 years from 42 per
cent of 15 to 16 year olds reporting inebriation to only five percent.
Rates of smoking tobacco have dropped to three percent among youth.
It's taken a broad initiative by communities and parents but the
impact has been breathtaking.

Physicians and other prescribers can help reduce harms by very
judicious use of opioids for the management of pain: new
evidence-informed guidelines and standards now outline practical ways
to use these drugs in ways that protect patients from becoming
dependent. And better pain management resources, like pain clinics,
will help provide safer and sometimes better options to opioids.

We need to accept that a percentage of patients prescribed opioids
will develop an opioid use disorder, and we need to offer earlier and
better help. Many stand to benefit from improved identification and
treatment of their dependencies.

This can be accomplished by integrating the treatment of opioid
disorders into primary care, and by enhancing access to both community
withdrawal to assist people to transition into treatment services. Our
LHIN has recently invested in these services, with a new Rapid Access
to Addiction Medicine, or RAAM Clinic funded for Peterborough.

As an example of what needs to be done, the recent expansion of
Naloxone kit provision through the emergency department at our local
hospital included anti-stigma training for all implicated personnel.
This type of approach bears repeating.

Which is one reason why harm reduction must be accessible,
non-judgemental, and comprehensive. We know that some harm reduction
strategies, like needle exchange, are extremely cost-effective. We
have seen how supervised consumption sites (SCS) save lives in large
urban centres both in Canada and internationally. We now have
widespread access to Naloxone, a rescue medicine to reverse an
overdose and buy time until first responders arrive.

Added to these, Peterborough may also soon be hosting an overdose
prevention site(OPS), funded by the province as an interim measure
while longer term permission is sought from the federal government for
an SCS.

SCS are places where people can bring their drugs to use safely, in
the presence of health care workers who can respond if there is an
overdose. OPS are usually temporary versions, with very few barrier to
encourage those who are fearful or feeling very stigmatized to access

So far, we are seeing signs of success in Ontario. In London, overdose
deaths have been averted because of the services available at their
temporary overdose prevention site.

A Toronto Drug Strategy review of safe consumption sites has found
that they save lives, help get people into treatment, reduce public
drug use and do not cause any increase in crime. For all these reasons
and more, it's a strategy worth trying and one that we should all support.

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For more information about Dr. Rosana Salvaterra, Peterborough Public
Health's medical officer of health, visit
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