A dose of care
THE upcoming International Overdose Day on August 31 acts as a reminder to consider the lives lost to avoidable overdose across the globe, and how we can reduce these deaths in our community.
The use of psychoactive drugs, which impact the brain to temporarily change perception, mood, consciousness and behaviour, has been occurring since ancient times, in all cultures, men and women, young and old, rich and poor. Attitudes towards the use of these chemical substances have created stigmas that perpetuate myths about these people.
Heroin in particular has been the focus of countless media portrayals, from television to newspapers, and it is rarely painted accurately. The most common depiction of someone who uses this drug, or one of its many cousins, is one of crime, violence and abject poverty. While this can be true, the reality is often markedly different.
Recently, attention has turned to prescription opioids. These medicines have been prescribed for decades and play an important role in vital pain relief for many people. Yet, they are now a major contributor to overdose deaths, killing four Australians a day — far more than the number of lives lost on our roads. Marketing campaigns from government-funded agencies should be applauded for their efforts in reducing the road toll and the destruction it leaves in its wake, but we must now turn equal, if not greater, attention to this other widespread tragedy of opioid dependence.
I started my healthcare career in the late 1990s, with a particular focus on those who used drugs. I can still recall those early times of walking around my city late at night, talking with the homeless, the disenfranchised and lonely, huddled up against the cold. Housing was near impossible to get and access to medical care was limited, even before you consider the stigma associated with drug use that kept most people from entering services in the first place. What I found was a rich and diverse melting pot of humanity on the streets. Fine art jewellers, business operators, fathers, mothers, and former shop owners were all among those the system did not accommodate.
I still have a photograph of these individuals, sitting in my desk drawer. It shows me, in my early 20s, having dinner with them at a dining table in a hostel, before they returned to the streets, to the squats and doorways. Most of the people in the photo are now dead. Nearly all of them died a lonely and miserable, and most importantly, preventable death from opioid overdose.
In 1961, a medicine to treat opioid overdose was patented, called Naloxone Hydrochloride, or Narcan. It was approved some 10 years later in the USA and has become an extremely cheap, generic medication. The World Health Organisation lists it as an essential medicine and it is available without a prescription, simply purchased over the counter of a local pharmacy.
It is estimated that roughly 70 per cent of all fatal overdoses are witnessed by another person, who can be a potential lifesaver with the right training and the medicine to help. Unfortunately, it took more than another decade for Naloxone to eventually find its way into the hands of those who need it most — people who use substances, take opioid pain relief, or their families, friends and carers.
Australia began Naloxone programs most earnestly in 2011, which was followed by a Victorian Government-funded pilot program in 2013 to train the Alcohol and Other Drugs workforce in providing this intervention. Barwon Health began its Naloxone program in 2014 and since then we have trained more than 900 people to help prevent overdose deaths. Most importantly, we have recorded more than 190 occasions where Narcan saved a life, and expect there have been many more we don’t know about.
However, we still have a long way to go. Despite halving the heroin-involved fatalities in the region between 2016 and 2017, we have seen a rise over the past year.
The focus of our work for the future will be broadening the range of programs to include homeless individuals, those who do not access mainstream services such as people from Aboriginal and Torres Strait Island backgrounds, and those who may not know they are at risk, such as prescription opioid patients.
We need to persist with our efforts if we want to stop these preventable deaths, which now far exceed the loss of life from road trauma in Victoria.
For information on opioid overdose, including learning the vital skills in prevention and response, including the use of Narcan/Naloxone, we encourage you to call our Harm Reduction Team on 1800 196 850. Craig Harvey is Barwon Health’s Mental Health, Drugs and Alcohol Services harm reduction co-ordinator