HOW TO STEM OVERDOSE CASES
Quality checks of illicit drugs is one way, writes Kenneth Tupper.
When consumers of street drugs are able to have their drugs analyzed for purity and quantity, they’re empowered to boycott those dealers who sell poor-quality or heavily adulterated products. Kenneth Tupper, official at B.C. Centre on Substance Use
In recent years across B.C., a public-health tragedy has resulted in thousands of preventable deaths from street drugs containing powerful opioids such as fentanyl or its analogs.
Toxicity from adulteration has occurred not just in the heroin supply, but also in stimulants, club drugs and counterfeit pills. Border agents and police have tried to reduce or disrupt the supply, but they have had little success in stemming the tide of illicit drug importation and consequent deaths.
A public health emergency relating to the drug overdose situation was declared by Provincial Health Officer Dr. Perry Kendall in April 2016, and more than a year later the deaths continue on a daily basis.
In response, a range of harm-reduction interventions have been scaled up — including public education, takehome naloxone kits (an antidote to opioids that can revive someone who has overdosed) and supervised consumption services. These measures have undoubtedly saved lives, yet the toxicity of the drug supply hasn’t diminished.
However, there is one approach that might help to reduce the risk of overdoses, but hasn’t been rigorously tried yet in Canada: drugchecking.
Drug-checking refers to a service where individuals are able to anonymously submit samples of street drugs to have them analyzed to determine their chemical constituents. As with many harm-reduction interventions, drug-checking is not new: it exists in a range of settings in a number of European countries.
It has been tried in a very limited way at Insite, Vancouver’s flagship supervised injection service, and at the Shambhala Music Festival in the Kootenays, but not yet with the scale and rigour that might help significantly reduce the risk of death.
There are a variety of different kinds of technologies that can be used for drugchecking, but the basic concept is to provide information to consumers of street drugs about what is in them. This information may then in turn allow them to make different choices about where, how much, with whom or even whether to use them.
Drug-checking also gives health and other serviceproviders a means to collect and assess information about what is circulating in illegal drug markets, the monitoring and surveillance of which are otherwise notoriously difficult.
Drug-checking is grounded firmly in the overlapping terrains of public health and consumer safety. In the history of modern public health, after clean drinking water and vaccinations, perhaps the most important contributor to improved population health outcomes was the passage of pure food and drugs legislation in the late-19th and early-20th centuries. Before this, as a consumer you took your life into your hands if you bought a sandwich at a restaurant, a drink at a bar or a patent medicine at the pharmacy. Illness or death from contaminated foods and drugs was common, and conventional wisdom at the time was to blame the victim: “Too bad — you ought to be more careful about where you get your meals or medications.”
However, public health officials and legislators came to realize that to protect consumers, quality-control standards could be imposed on the producers and distributors of products that can potentially be harmful.
This consumer safety principle is now applied to a wide assortment of goods and services: not just foods, beverages, and pharmaceuticals, but also automobiles, children’s toys and hang-gliding equipment. We understand people have a right to be assured that products — sometimes inherently risky products — sold by retailers are manufactured to certain quality standards and that they’re what they’re purported to be — with one glaring exception: psychoactive drugs used for non-medical purposes.
Due to the erroneous belief that prohibition and law enforcement could eradicate their use, psychoactive drugs such as cocaine, heroin and MDMA were excluded from consumer safety regulations, so these commodities were relegated to uncontrolled black markets.
As the likelihood of regulation and control over currently illegal drugs is politically remote at present, a viable harm-reduction approach to consumer safety is to offer drug-checking services. Drug-checking provides valuable — potentially life-saving — feedback to people who use drugs, allowing them to make better informed decisions, which contributes to improved selfdetermination. A street drugtesting service that provides timely feedback to clients creates a level of accountability between the consumers of street drugs and those who supply them.
When consumers of street drugs are able to have their drugs analyzed for purity and quantity, they’re empowered to boycott those dealers who sell poor-quality or heavily adulterated products. In the midst of an unprecedented public health crisis of overdose deaths from adulterated street drugs, an innovative, public health-based service such as drug-checking — along with rigorous scientific evaluation of its impacts — is urgently needed.