DDN Sept 2021 September 2021 DDN Magazine - Page 21

POLICY

British Columbia is leading the way by expanding access to safe supplies of opioids , says Bill Nelles

SAFETY FIRST

More than 7,000 people have died here since 2016 when our overdose crisis was uniquely declared a public emergency – last year 1,716 people died of opioid overdoses in British Columbia , compared to 901 who died from COVID . More conventional interventions – access to naloxone and opioid agonist therapy ( OAT ) – have not reduced the increase in overdose deaths . Even worse , in the first three months of 2021 more than 500 people died from our toxic drug supply .

The rising death rate has closely followed changes in the street supply . In 2011 , fentanyl was first detected mixed in with morphine base to give a ‘ bigger buzz ’. The proportion of fentanyl to street heroin steadily increased , then took over . The next spike followed the presence of fentanyl analogues such as carfentanil , previously used for knocking out large wild animals . And our most recent rise reflects the increasing presence of designer benzo-like sedatives in the supply , seriously complicating resuscitation .
The pressure to take effective action has been intense . In mid- July , our provincial government endorsed a radical plan to provide access to clean pharmaceutical opioids and stimulants to drug users risking death from utterly
poisonous product . This strategy hasn ’ t just happened . For more than two years , a team of doctors have quietly recruited drug users and provided them with access to safe clean drugs . In March of last year , 677 people were being prescribed oral hydromorphone ( Canada ’ s diamorphine ) and by December , there were 3,348 – an increase of 395 per cent . Dexedrine and Ritalin will also be provided to those using the equally tainted stimulant supply , and fentanyl is also likely to be offered as many people now prefer the drug .
Clean injectable drugs are to remain supervised . Both hydromorphone and diamorphine are available , but the staffing costs still confine this to the largest cities . Pharmacists can supervise injectables but few wish to do so . Outcomes have been judged successful enough for the Ministry of Mental Health and Addictions ( created in 2017 as an early response to the overdoses ) to publicly endorse the plan . BC also plans to request a federal exemption from Health Canada to decriminalise personal possession of drugs within the province .
This may be more of a challenge . Provinces provide health care services , but the federal government regulates controlled drugs , and they continue to insist that controlled substances can
‘ Last year 1,716 people died of opioid overdoses in British Columbia , compared to 901 who died from COVID ...’
only be provided when prescribed by a doctor or nurse practitioner . There has also been disagreement amongst doctors in BC . Highly charged arguments have taken place between those doctors who support conventional OAT but feel providing drug of choice is going too far , and those doctors who see safe supply as a reasonable solution to keep users alive . It took the intervention of Dr Bonnie Henry , our provincial health officer , to provide the official backing to those doctors providing safe supply by advising them to endorse their prescriptions ‘ safe supply as per CMO ’ s advice ’.
The other problem is the time frame to cover the entire province . This policy will roll out through a phased approach , beginning with existing health-authority funded programs that currently prescribe
alternatives to illicit drugs .
However , a rural area like mine has no specialist clinic . Our OAT clinic is done from a local practice one day a week by an exceptional doctor who holds four clinics for more than three hundred patients , and she does a small amount of safe supply when she believes it is appropriate . But I won ’ t end on a depressing note . The last paragraph belongs to our redoubtable minister of mental health and addictions , Sheila Malcolmson . When have any of you heard a UK health minister even approach such evidence-informed compassion ?
‘ For people who use drugs or who care about someone who does , the risk of death is omnipresent because of the increasingly toxic illicit drug supply ,’ she said . ‘ At the start of the pandemic , BC provided access to some prescribed safer supply medications to save lives from overdose and protect people from COVID-19 . Building on what we ’ ve learned , we ’ re expanding access to prescribed safer supply to reach more people and save more lives . We will also continue to build up a treatment system so everyone can get the care they need . There is more to do , and we won ’ t stop until we turn this crisis around .
Bill Nelles is an advocate and activist , now in Canada . He founded The ( Methadone ) Alliance in the UK
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