Canada - British Columbia health authority issues new plan to tackle opioid crisis

[S.J.B.]

British Columbia health authority issues new plan to tackle opioid crisis
Andrea Woo
The Globe and Mail
August 16th, 2017

The BC Centre for Disease Control issued a bold set of recommendations to address the province’s unparalleled overdose crisis that includes providing drug users with clean opioids to take home and inject or allowing them to grow their own opium.

The recommendations, if adopted, would push British Columbia closer to essentially legalizing and regulating the use of drugs beyond marijuana – something many of the province’s top drug policy and public-health experts have called for. It has taken on a new urgency, they say, with fentanyl’s domination of the illicit drug supply, which has led to a dramatic surge in overdose deaths.

The federal government has emphasized there are no plans to review other drugs beyond marijuana. However, B.C. does have some leeway in prescribing drugs off-label – especially during a public-health emergency.

Mark Tyndall, executive medical director for the BCCDC, described the current approach to addiction treatment as backwards.

“We strongly advise people to stop using street drugs, and if they can’t do that, then we offer them … Suboxone or methadone, and if that doesn’t work, we basically tell them to go and find their own drugs even though there is a very real possibility of dying,” he said.

Read the full story here.

Download the report here.

 

[S.J.B.]

Some of these proposals are very radical, so props to the B.C. Centre for Disease Control for being brave enough to publish them. B.C. has always been on the forefront of progressive drug policy - at least by North American standards - and this is definitely being stimulated by the current drug-poisoning epidemic. For some context: B.C. had an annual drug-related death rate of 200 per million population in 2016, well ahead of the U.S. and every country in Europe.

I really like the idea of opium growers' clubs.

I should also note that there is an inaccuracy in the article:

However, the new recommendations also propose dispensing oral hydromorphone that drug users could take home, grind up and inject without supervision.

The report actually states:

Expand physician capacity and confidence to prescribe opiates including oral hydromorphone, long acting slow release oral morphine and injectable opioids

They are certainly not suggesting that people who inject drugs should be given oral formulations to take home and inject.

 

[S.J.B.]

The crucial opioid interventions Canada needs now
Benedikt Fischer and Mark Tyndall
The Globe and Mail
August 18th, 2017

Canada is in the grip of an unprecedented opioid crisis. An estimated 2,458 Canadians died of opioid-related overdose deaths in 2016 – more than the national count of motor-vehicle accident and homicide deaths combined. British Columbia reported 967 (mainly opioid) drug-overdose fatalities in 2016, and is on track for 1,500 in 2017. Alberta and Ontario have also seen substantial increases. Numerous interventions have been discussed and initiated recently – yet, the number of deaths continue to rise.

Part of this deadly stalemate relates to the fact that, underlying the opioid crisis are two paradoxically linked challenges – neither of which are adequately understood or addressed by current responses. On the one hand, a substantial portion of the present crisis is due to years of systemic and non-evidence based overprescribing, which put too many people, for too long, on too high doses, of opioid drugs. To counter this, excessive opioid prescribing levels have to be substantially reduced in order to prevent even more Canadians being exposed to opioid misuse, dependence and undue death. These sensible reductions in harmful opioid prescribing at the individual and population level are the central objective of newly tabled Canadian prescription guidelines.


However, reductions in opioid prescribing are not occurring in a vacuum and are generating substantial collateral damage. While concrete numbers are lacking, it is estimated several hundred thousand Canadians are problematic opioid users (including those with dependence). While trauma, pain and mental illness often facilitate substance use, most people using opioids non-medically began or sustained their drug use with access to medically prescribed opioids. In addition to systemic overprescribing, the supply of pharmaceutical opioids is generated through double-doctoring, symptom feigning and diversion through or with the help of others. However, while engaging in “non-medical use,” the supply of opioids mostly originated from within the medical system, hence providing relatively predictable drug potency and purity.

Read the full story here.