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Category "Fentanyl"

14May

B.C. research study evaluates safety of take-home drug checking kits

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A fentanyl check in progress. One red line on top is a positive result for the presence of fentanyl or one of its analogs. Two red lines is a negative result.


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Vancouver Coastal Health and B.C. Centre for Disease Control are collaborating on a pilot project that will provide substance users with take-home drug checking kits to determine if people can safely use them on their own.

Clients will receive five free test strips, with instructions, to take home so they can determine whether their drugs contain fentanyl, a highly potent synthetic opioid being cut into the illicit drug supply.

“We know that most people dying from overdoses die while using alone,” said Dr. Mark Lysyshyn, medical health officer with Vancouver Coastal Health. .“We’re hoping that giving people the opportunity to check their drugs for fentanyl on their own could help them make safer choices and save lives.”

The VCH says fentanyl was responsible for approximately 87 per cent of illicit drug overdose deaths in B.C. last year.

A record 1,489 British Columbians died of suspected drug overdoses in 2018.

Currently substance users voluntarily check their drugs at overdose prevention sites, supervised consumption sites and other community health sites an average of 500 times each month. But since many fatal illicit drug overdoses occur in private residences, and when the user is alone, health authorities believe take-home drug checking kits could help more people.

B.C. Minister of Mental Health and Addictions Judy Darcy announces the opening of a new Overdose Emergency Response Centre at a news conference at Vancouver General Hospital on Dec. 1, 2017.


B.C. Minister of Mental Health and Addictions Judy Darcy.

DARRYL DYCK /

THE CANADIAN PRESS

“We know using drugs alone presents a significant risk amidst a toxic, unpredictable and illegal drug supply that is taking three to four lives every single day,” said Judy Darcy, B.C.’s minister of mental health and addictions. “Drug checking is an important tool in our toolbox and through this research project we can learn more about how to keep people safer and help them find a pathway to hope.”

The test strips were originally developed to check urine for the presence of fentanyl but in July 2016 in light of the overdose crisis, VCH pioneered the use of the strips to check the drugs themselves for fentanyl. A small amount of a drug is mixed with a few drops of water, the test strip is inserted into the solution, and a positive or negative for fentanyl is revealed within seconds.

The research study will evaluate the fentanyl positivity rates from the take-home checks compared with rates that trained technicians get at VCH sites during the same time frame. The study will help determine whether take-home drug checking kits can be effectively used outside of a healthcare facility without staff oversight.


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1May

Daphne Bramham: Alcohol, not opioids, is Canada’s biggest drug problem

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Alcohol is so much a part of our culture that 80 per cent of Canadians drink. But each year, nearly 15,000 people die from alcohol related harms.


Canadian governments are addicted to the revenue from alcohol


DALE DE LA REY / AFP/Getty Images

With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.

Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.

While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.

The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.

The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.

Over the past decades, the researchers found an erosion of effective policies and regulations.

“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”

British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.

Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.

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Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.

Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.

Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.

Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.

One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.

Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.

Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”

It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.

Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”

Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.

What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.

The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.

In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.

Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.

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Twitter: @bramham_daphne


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24Apr

Daphne Bramham: Decriminalization alone won’t end B.C.’s overdose crisis

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A man injects drugs in Vancouver’s Downtown Eastside, Wednesday, Feb. 6, 2019. Despite significant efforts to combat overdose deaths in British Columbia, the provincial coroner says illicit drug overdose deaths increased to 1,489, just over the 2017 death total.


JONATHAN HAYWARD / THE CANADIAN PRESS

The problem with the provincial health officer’s special report recommending decriminalization of all illicit drug users  is that Dr. Bonnie Henry chose to make that her only recommendation.

Three years after a public health emergency was declared because of an epidemic of deaths from illicit opioids, B.C. still has no comprehensive addictions strategy.

It has a stunning lack of treatment services, no universal access to services, no simple pathway to what few services there are, no provincial standards or regulation of privately operated treatment and recovery homes services.

Government ministries such as health, mental health and addictions services, social development and housing remain siloed and the root causes of addiction remain largely unaddressed.

While there has been substantial investment in harm-reduction measures including overdose prevention sites, free naloxone kits (to reverse an opioid overdose), low-barrier shelters and poverty reduction, the needs are greater.

Overdose deaths have only hit a plateau – not dropped. Every day, four people British Columbians die.

Yet, Henry is adamant that decriminalization is the most important next step.

“It’s about a focus and an intent,” she said. “Instead of police focusing on requirement of the Criminal Code, it builds off-ramps to connect with services. And, that in itself, ensures those systems are built.”

The majority of those who have died of overdoses were young men using alone at home. Without fear of being arrested and with the stigma of addiction being reduced, the expectation is that addicts or recreational users would be more likely to go to a supervised injection site, use with a friend (with a naloxone kit at the ready) or call for help if they overdose.

Henry calls decriminalization “a necessary next step to stop the death toll from rising and to make harm-reduction services more readily available.”

But it’s a question whether those recreational users would do that, because many addicts say that they use alone for a variety of reasons — not least of which is that they don’t want to share their drugs or they don’t want anyone to know what they do when they’re high.

The report recommended two options for British Columbia to work around the Criminal Code provisions.

Solicitor General Mike Farnworth firmly and quickly said no to both. But he noted there are pilot projects in Vancouver, Abbotsford and Vernon where rather than charging for possession, police are linking users with services. An evaluation of those will be completed in the fall and, depending on the results, they may be expended to other communities.

Henry makes no secret of the fact that her ultimate goals for Canada are full legalization and regulation of all drugs to ensure that there is a safe supply. If that were to happen, Canada would be the first in the world to do that.

Portugal is mentioned frequently in the report and by Henry. Possession for personal use was decriminalized more than 20 years ago. But it was done only as part of a comprehensive, drug strategy.

Police still arrest anyone found with illicit drugs. They are taken to a police station where the drugs are weighed. If the amount is above the maximum limit set for personal use, they are charged and go through the criminal justice system.

If the amount is below the limit, tickets are issued and users told to appear at the Commission for the Dissuasion of Drug Use within 24 hours. There, they meet with a social worker or counsellor before going before a three-person tribunal, which recommends a plan for treatment.

People don’t have to comply. But if they are arrested again, the commission can impose community service, require that they seek treatment, impose fines and even confiscate people’s property to pay those fines.

That’s not the kind of decriminalization Henry is recommending. Instead, the onus here would be on police officers – not trained addictions specialists, psychologists or social workers — to connect users with services.

Part of the reason for the difference is that Portugal’s goal wasn’t legalization or keeping addicts alive until they chose to go treatment. Its focus was and is on getting addicts into treatment and recovery so they could resume their place in society.

Harm reduction is only a small part of the Portuguese plan. Its first supervised injection site has only recently opened. But there is free and easy access to methadone (which dampens heroin addicts’ craving for the drug) and free needles to stop the spread of infection.

These harm reduction measures are deemed to temporary bridges to abstinence for all but older, hardcore, long-term heroin users rather than long-term solutions. Of course, fentanyl and carfentanil have yet to be found in its illicit drug supply.

Its treatment services as extensive and include everything from outpatient treatment to three years’ residency in a therapeutic community during which time the users’ families are provided with income supplements.

Nothing in this decriminalization report moves British Columbia anywhere close to that kind of comprehensive system. And until we get there, it’s hard to imagine that this overdose crisis ending anytime soon.

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Twitter: @bramham_daphne


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24Apr

Overdose crisis: BC’s top doctor wants drug possession decriminalized

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B.C.’s top doctor has unveiled a bold proposal to slow the rate of overdose deaths — by decriminalizing possession of a small amount of drugs for personal use.

Provincial health officer Dr. Bonnie Henry’s report, released Wednesday, says it is known around the world that the “war on drugs” has been a failure, and says the criminalization of non-violent people for possessing a substance for personal use does considerable harm to the person and society.

Specifically, Henry says criminalization increases communicable disease transmission, stigma and drug-related mortality. Incarceration and criminal records exacerbate drug harms by preventing future employment and travel, she adds.

“As the Provincial Health Officer of B.C., I recommend that the Province of B.C. urgently move to decriminalize people who possess controlled substances for personal use,” Henry says.

“This is a fundamental underpinning and necessary next step for the continued provincial response to the overdose crisis in B.C.”

Henry’s report, called “Stopping the Harm: Decriminalization of People Who Use Drugs in B.C.,” says that despite expanded harm-reduction activities and interventions in the province, and increased access to evidence-based treatment, an average of four people continue to die in B.C. each day due to the toxic illegal drug supply.

“Decriminalization of people who use controlled drugs is an effective public health approach to drug policy in other jurisdictions and is the most appropriate option for B.C. at this time,” Henry says.

“While law enforcement in B.C. exercise their discretion when considering possession charges, such as the presence of harmful behaviour or identified need for treatment services, the application of the law is inconsistent across communities. As such, there is a need for a provincial-level commitment to support an official policy to decriminalize people who use drugs.”

Henry says decriminalization would allow law enforcement to work with health and social systems to help connect people with treatment and other social services.

In 2001, Portugal decriminalized all drugs for personal use in response to a surge in heroin use.

Henry said there are two means by which to decriminalize in B.C. One would use provincial legislation to allow the Ministry of Public Safety and Solicitor to set provincial priorities, such as declaring a public health and harm reduction approach as a priority for police to apply when toward simple possession. The other would develop a new regulation under the Police Act that would add a provision preventing police from expending resources on simple possession offences under Section 4(1) of the Controlled Drugs and Substances Act.


Provincial health officer Dr. Bonnie Henry answers questions during a press conference about the release of the latest provincial statistics by the BC Coroners Service at Legislature in Victoria, B.C., on Thursday, February 7, 2019.

CHAD HIPOLITO /

THE CANADIAN PRESS

The report explains decriminalization as follows: “Decriminalization involves removing an action or behaviour from the scope of the criminal justice system. In the context of controlled substances, it is typically focused on possession and consumption of drugs for personal use and does not set out a system or structure for production, distribution, or sale of controlled substances.

“Decriminalization does not exclude the application of fines or administrative penalties. For example, if possession of drugs for personal use was decriminalized (as is the case in Portugal), the drug itself is still illegal, but possessing it does not lead to criminal sanctions (unless the possession is at a trafficking level).”

More to come.

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22Apr

BC Interior warning on ‘trippy’ drug linked to ‘zombie’ outbreak in US

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KAMLOOPS — The B.C. Interior Health authority is warning street-drug users of a synthetic cannabinoid that has been linked to a so-called “zombie” outbreak in New York.

Chief medical health officer Dr. Trevor Corneil says tests at a Kamloops overdose-prevention site found the powerful drug mixed with heroin, fentanyl and caffeine.

The authority warns that users can look like they have overdosed on opioids, but they won’t respond to naloxone and they can experience “speedy” or “trippy” symptoms with possible hallucinations.

A 2017 article in the New England Journal of Medicine says the drug caused a mass intoxication of 33 people in New York City in July 2016 and was described in the media as a “zombie” outbreak because of the appearance of those who took the drug.

The journal article says the drug was developed by Pfizer in 2009 and it is a strong depressant, which accounts for the “zombie-like” behaviour reported in New York.

Corneil says they don’t like to use the zombie term because it can give people the wrong impression and what is important is they exercise caution when new substances come on the black market.


Dr. Trevor Corneil of B.C. Interior Health.

Corneil says they aren’t aware of any deaths where the cannabinoid is the only substance.

“Often overdose deaths are caused by a mix of different substance together and we’re not seeing any increase in overdose deaths related to this substance, relative to the impact of fentanyl, which is the major toxin we have in our drug supply right now.”

Corneil says the discovery of the drug is a good example of the level of sophistication that both harm-reduction workers and users have been able to access in the province.

“This is the problem with criminalization, in that it takes away any of the safeguards that the system puts in place to ensure that people get the product they think they’re buying and it hasn’t been mixed with something else.”

He says workers are seeing that users are becoming more aware that they need to have their illicit drugs tested and when they learn what’s in their drugs, they make better decisions.

The testing machines at safe consumption sites look at a large database of drugs, which Corneil says is used for both research and by police.

“Many of them are unusual and rare and we’re finding that manufacturers and suppliers are trying different new substances all the time … trying to make a buck off people who are quite marginalized by the criminalized setting around them.”

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19Mar

Coroners: Carfentanil detected in 13 of 90 overdose deaths in January

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A Vancouver RCMP officer opens a printer ink bottle containing the opioid carfentanil imported from China. Drug dealers have been cutting carfentanil and its weaker cousin, fentanyl, into heroin and other illicit drugs to boost profit margins.


Submitted / RCMP

B.C.’s coroners say there were 90 suspected illicit-drug overdose deaths in the province in January, including more than a dozen in which they detected carfentanil.

The synthetic opioid carfentanil, which began showing up in B.C.’s street-drug supply in late 2016, turned up in 13 illicit-drug overdose deaths in January, according to a B.C. Coroners Service update released Tuesday. Carfentanil was detected in 35 deaths in all of 2018 and 71 deaths in the last seven months of 2017. Carfentanil is many orders of magnitude more potent, and dangerous, than fentanyl.

Fentanyl and analogs were detected in about 87 per cent of overdose deaths last year, up from 82 per cent in 2017, the service said.

Coroners also updated the total number of illicit-drug overdose deaths in 2018 to 1,510, up from the 1,489 deaths it reported last month (the numbers change as toxicology reports are completed and investigations are concluded). Overdoses killed 1,486 in 2017 and 991 in 2016.

The coroners said 90 people died of an illicit-drug overdose in B.C. in January, down from 130 deaths in January 2018, and below the 116 deaths in December 2018.

The coroners service says no one died at a supervised consumption or drug-overdose prevention site.

Most of the deaths in January were in the Vancouver Coastal Health (29) and Fraser Health (27) regions, and 88 per cent occurred indoors, including 62 per cent in private residences and 26 per cent in other residences such as social housing or hotels.

People aged 30 to 59 accounted for 76 per cent of those who died, and 83 per cent were male.

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13Mar

Grand Chief Stewart Phillip: ‘I want my son’s death to be meaningful’

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“There’s no way to describe the enormous shock a parent experiences when you get a phone call informing you … You lose your ability to stand, and you sink into the closest chair. Your heart stops and you just can’t believe it. This terrible wave of shock goes through your entire body.”

Grand Chief Stewart Phillip took that terrible call last August from his wife, Joan. She was nearly hysterical.

“The minute I heard her, I thought, ‘Oh, no. Oh, no.’ She kept saying over and over, ‘He’s gone. He’s gone.’”

It was Aug. 7, 2018, the day after Kenny Phillip’s 42nd birthday. Their oldest son had died alone in a hotel room of a carfentanil overdose in Grand Prairie, Alta.

“I don’t think he knew that he had taken carfentanil,” his father told me. “But nobody was more well-versed in addictions and the variety of drugs available than he was.

“Having gone through so many treatment programs, he had high level of expertise. He knew everything about his addictions, the pattern and so forth. Yet he still was vulnerable to the powerful call of the addiction.”

Kenny struggled with addiction to drugs and alcohol since he was a teenager, and had been to at least half a dozen treatment programs. Still, his father said, “You’re never ready for that phone call.”

His son followed the usual cycle. Bouts of drug and alcohol use punctuated by detox, treatment and periods of recovery. His longest recovery period lasted nearly three years. But this time, his parents were optimistic that it was different.

He had graduated from the Round Lake Treatment Centre. He was working as an apprentice mechanic. He loved it. He had been obsessed with cars since he was a kid. One of the people who worked with him in Penticton described Kenny to me as “a helluva guy.”

After he died, a former co-worker designed a logo with two crossed wrenches, Kenny’s initials with the years 1976 and 2018, and had decals made up so that his friends could honour him by sticking them on their toolboxes.

Phillip says something happened when Kenny went up to northwestern Alberta, triggering his addiction. And given Grande Prairie’s reputation as a crossroads for drugs, he wouldn’t have had to go far to find them.

Northwest of Edmonton, Grande Prairie has had several recent large drug busts. In January, RCMP seized four kilos of crystal methamphetamine, 2.2 kilos of cocaine, 200 grams of heroin, about 5,500 oxycodone tablets and about 950 fentanyl tablets.

A few months earlier, guns, ammunition as well as meth, cocaine, heroin and magic mushrooms were seized in a follow-up to a July raid.

“I have first-hand knowledge,” Phillip said. “I started drinking when I was 15, and was 40-something when I sobered up. It was the hardest thing that I ever did, and I was an alcoholic not strung out on crystal meth and some of the street drugs.

“But I know that at the end of the day, it’s up to the person. The individual.”

Seven years into marriage with, at the time, three children — two daughters and Kenny — Phillip’s wife told him she was finished with the fighting, picking him up when he was drunk, and buying liquor for him. But if he wanted to carry on, he was free to go.

“I thought, ‘Free at last,’” Phillip recalled. “I lasted a month. I was downtown drinking with all my so-called buddies talking about my newfound freedom. One evening in a Chinese restaurant — nobody else was there — I put in an order and was staring at the tabletop. I just broke down. I started crying and then howling.

“The howling was coming from the soul. I was scared stiff.”

At that moment, he realized his stark choice.

“If kept going, I was going to die at my own hand. But to contemplate stopping … which at the time was like contemplating to stop breathing or stop eating because it was such an integral part of who I was.”

What had kept Phillip from suicide, he told the Georgia Strait in May 2018, was the thought of his son. “I thought he would have to grow up with that stigma.”

With the help of Joan and Emery Gabriel, a drug and alcohol counsellor and the only sober friend Phillip had, he got into treatment at the Nechako Centre and has never relapsed.

Every day, Phillip thanks the Creator for sobriety because abstinence has enabled him to take on the work he has done and continues to do as president of the Union of B.C. Indian Chiefs, grand chief of the Okanagan Nation, and as a board member for Round Lake Treatment Centre.

Phillip grieves for the “incredible, amazing young man who touched so many different lives” and for the choice Kenny made last August, knowing full well the risk he was taking in the midst of the opioid overdose crisis.

He speaks openly, and urges others to as well, because those who have died need champions to bring about change.

“I want my son’s death to be meaningful,” Phillip said. “The path forward has to be an abundance of resources to help those who are struggling with addictions. … More treatment centres, more programs, and a greater commitment from governments and society to pick up the responsibility for it.”

So far, governmental response has been “minimalist,” said Phillip.

“This notion of harm reduction is just kicking the issue down the road. It’s not dealing with getting people from an addictive state to where they are clean and sober. That’s what we need to do.”

As for cannabis legalization, Phillip said, “I just shake my head when I think of where we are at and the direction we are going.”

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Twitter: @bramham_daphne


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28Feb

Daphne Bramham: First Nations’ solution to a modern, medical crisis

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Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.

First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.

Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.

They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.

It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.

“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.

What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”


Dr. Evan Adams is the Chief Medical Officer for the First Nations Health Authority.

Jason Payne /

PNG

“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”

Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.

“They need healers who can do ceremony. Maybe they need love. They need justice.

“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.

The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.

“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”

It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.

Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.


The Crosstown Clinic in downtown Vancouver.

JONATHAN HAYWARD /

THE CANADIAN PRESS

“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”

To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.

“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”

What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.

Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.

That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.

This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.

With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.

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Twitter: @bramham_daphne


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21Feb

Daphne Bramham: B.C. group’s call for legally regulated heroin sales is unfounded

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Desperate times call for desperate and often unfounded measures. And, that’s exactly what a new report from the B.C. Centre on Substance Use is proposing in response to the unabating opioid overdose crisis.

It wants government to immediately clear the way for “heroin compassion clubs.” These would be free-standing co-op stores staffed by health care providers selling untainted heroin — diacetylmorphine — to members at the same price or less than street heroin. It would be free to members who can’t afford it, even though the report acknowledges that the risk of street resale of prescription opioids is greatest when the drugs are free.

And that would all be possible, the report says, because of things like volume discounts and “other economies of scale.”

“It would be precisely measured and dispensed in known quantities and at relatively safe doses,” says the report that was released Thursday. The emphasis has been added.

The heroin would be in powdered form, rather than an injectable liquid, just like it is on the street except this would be untainted heroin, not heroin cut with caffeine to prevent overdoses or any other additives to bulk up the product.

Members would be able to buy a couple of days’ supply and take it home with them.

Membership would be low-barrier, a term that’s not defined in the report.

Applicants would be screened by staff members who are “health care providers,” although not necessarily addictions physicians.

The co-op’s board members would be people with “lived experience” — a.k.a. users and former addicts.

Evan Wood, the head of the B.C. Centre on Substance Abuse, says the proposal is unprecedented so there is no evidence that it would reduce overdose deaths or disrupt organized crime’s role in fentanyl, money laundering or housing affordability, which is what’s advertised on the report’s cover.

“To be fair, we are in an unprecedented situation with fentanyl and the prescription opioids overdose crisis,” Wood said. “We are in uncharted waters.”

The two main goals are keeping users alive and disrupting the evils of organized crime.

These are ambitious albeit inappropriate goals for an organization whose mandate is to “develop, help implement, and evaluate evidence-based approaches to substance use and addiction.”

Using heroin to treat users isn’t new. But every other trial or program has a treatment component whether they’re at Vancouver’s Crosstown Clinic, the PHS Community Services or in European countries.

In Europe, heroin is prescribed with the goal of stabilizing users to a point where they can get jobs, form relationships or switch to other (cheaper) opioid replacement therapies such as methadone or Suboxone. (The annual cost per patient in European prescription-heroin programs ranges from $19,000 in Switzerland to $30,000 in the Netherlands.)

But there’s nothing like this in Canada.

“I’m not aware of the existence of ‘heroin clubs’ anywhere else,” Jann Schumacher from the Swiss-based Ticino, an organization of addictions specialists, said in an email. “In Switzerland the heroin assisted therapy is strongly regulated and always under medical control.

“Our Swiss model (heroin assisted treatment) has strong evidence as a harm reduction method, in getting people into treatment and stabilizing their lives, and in reducing the illegal market.”

To qualify, Swiss patients must have at least two years of opioid dependence and at least two failed tries using other addictions treatment methods. They are only allowed to the drug in pill form and take it with them after being in the program for six months and only if it’s necessary to hold down a job.

Drug-related crime in Switzerland has decreased 90 per cent. But compassion clubs would have no effect on drug-related crimes because members would still have to find some way to buy the heroin.

As for disrupting organized crime, the report suggests that compassion clubs would be competing for sales, influencing both the demand and market for heroin.

“The establishment of a regulated and controlled supply of fentanyl-unadulterated heroin may increase demand for street heroin among persons who use street opioids and force organized crime groups to return to the provision of heroin as part of the illicit drug market,” the report says.

And since violence is criminals’ usual response to unwelcome competition, it seems likely that they will attempt to terrorize compassion clubs out of business.

What makes this proposal all the more absurd is that it is aimed only at British Columbia. Surely, low-barrier access to pure heroin would be a magnet to every opioid user across the continent, let alone Canada.

British Columbia is already the epicentre of the overdose crisis just as it was ground zero for the cannabis legalization movement that began with compassion clubs dispensing so-called “medical marijuana,” which led to an explosion in unlicensed and unregulated pot shops.

It’s also where Canada’s harm-reduction model was birthed with free needles, supervised injection sites and readily available naloxone. But it was supposed to be part of a four-pronged strategy just as Switzerland’s is — a strategy that includes access to treatment and recovery as well as education aimed at dissuading drug use.

But since 2017, the $608 million spent by the B.C. government has gone almost exclusively to harm reduction. Yet, the number of overdose deaths is still rising.

It’s clearly not working and Canadians can’t help noticing now that 9,000 are dead including more than 4,000 in British Columbia. According to an Angus Reid poll released last week, 85 per cent of Canadians want mandatory treatment for opioid addiction. Forget legalization or free drugs, decriminalization was favoured by only 48 per cent.

Although the B.C. Centre on Substance Abuse is proposing a radical and untried solution, Wood dismissed mandatory treatment as an option because it’s unsupported by evidence.

As for decriminalization, Wood said, “The problem with it is that you still leave control of the market to organized crime. The user is not criminalized, but they still have to go to the black market.”

Yet, 20 years’ worth of evidence from Portugal show that paired with assertively promoting treatment and recovery, providing universal access to those programs and enforcing drug trafficking laws, decriminalization works.

There, it not only effectively brought an end to Portugal’s heroin overdose crisis, addiction and usage rates for all drugs including cigarettes and alcohol are now among the lowest in Europe.

[email protected]

Twitter: @bramham_daphne

 


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20Feb

Report coming Thursday to outline proposal for regulated heroin sales

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