More focus needed on getting people off drugs

As the opioid crisis worsens, the more we learn about why people are dying. One thing is evident: the drug supply is becoming more toxic. The deadly drug fentanyl is being detected in more that 72 per cent of all overdose deaths in British Columbia. Two years ago, it was found in only 29 per cent; two years before that, just 15 per cent.

While untold fatal overdoses have been prevented by first responders, other health-care providers, and peer groups, the increasingly poisonous drug supply is clearly undermining the efforts to reduce overdose deaths.

One problem is much of the focus has been on reducing fatal overdoses among those using fentanyl, without an equal focus on the reasons people are overdosing in the first place.

For instance, major successful efforts have been made to expand access to the overdose reversal drug naloxone whereas efforts to get individuals off of fentanyl-laced drugs have been slower to implement.

Providing naloxone and other harm-reduction interventions when overdoses occur can save lives, but we cannot get out of the crisis solely through these means. We need a new approach involving strategies to improve the safety of the drug supply and strategies to get individuals off of fentanyl-laced drugs.

Substantial resources have been expended to reduce the street supply of synthetic opioids. Not only has this proven unsuccessful, any expectation that this will be successful fails to acknowledge that the fentanyl crisis is a consequence of similar prohibition efforts aimed at reducing the supply of traditional illicit opioids such as heroin. Indeed, street heroin is a product of the earlier supply reduction efforts aimed at suppressing the availability of opium.

The simple fact is that drug prohibition has the unintended consequence of creating a huge illegal market that contributes to increasingly sophisticated crime groups who ultimately make street drugs ever more potent and available.

While ending prohibition may not be on the agenda for the provincial and federal governments, old taboos must be broken. One successful approach was taken in Portugal, which transitioned its focus from drug law enforcement to addiction treatment and recovery, ultimately leading to a severe decline in overdose rates, among the lowest in the European Union. We must take a similar approach.

Last July, when the B.C. government announced the creation of its joint task force to respond to the overdose crisis, the announcement promised to establish a drug testing service to help people find out if their drugs include adulterants, including fentanyl. This urgently needed service must be made available as soon as possible.

We also must look to expand a range of addiction treatment and recovery services aimed at helping persons off of fentanyl-laced drugs. This includes substitution treatments as well as fully integrated recovery services to seamlessly help individuals transition out of all opioid use whenever possible.

As the original principal investigator of Insite, Canada’s first supervised injection site, I’ve seen the important role that these programs can have, but also the need to have a functioning addiction treatment system.

This has become particularly urgent in the era of fentanyl-laced drugs.

The next step is to implement all options for protecting people from the increasingly toxic drug supply. A focus on this strategy is the only way out of the current overdose crisis. Evan Wood is director of the British Columbia Centre on Substance Use and professor of medicine at the University of British Columbia.