Free fentanyl antidote not enough: crisis workers
Antidote plan not enough: workers
As the fentanyl crisis slinks into Montreal, harm-reduction workers say giving drug users the antidote for free is compelling but not enough to counter the devastating effects of addiction.
Their message came as Canada’s chief public health officer warned Thursday of a growing epidemic — 2,816 deaths from drug overdoses in 2016 — with the number of dying “sadly adjusted upwards” and expected to surpass 3,000 this year.
Deaths involving fentanyl more than doubled in the first three months of 2017 compared with the year-earlier period, Theresa Tam said in a media briefing from Ottawa. While the western provinces have been hit the hardest, no one province is safe, Tam said, because the rates in the eastern provinces are rising.
“It’s a national crisis,” Tam said of illicit drugs laced with fentanyl fuelling the overdose epidemic.
In response to the recent spike to Quebec overdoses, provincial health officials announced Wednesday that Quebecers would be able to obtain naloxone free of charge in pharmacies. The move follows the examples of other provinces in offering the life-saving drug without a prescription, including Ontario, British Columbia, Alberta and Nova Scotia.
Quebec public health minister Lucie Charlebois made the announcement hours before Montreal police led another raid in connection with two recent drug overdoses. At least 12 people died in August in Montreal after overdosing on drugs laced with fentanyl, an opioid described as being 50 to 100 times more potent than morphine. Late Wednesday, a security guard called police around 11:30 p.m. to report two men passed out near the Lucien L’Allier métro with needles sticking from their legs.
Naloxone is one answer, but prevention is key, said Quebec Health Minister Gaétan Barrette, who promised to have a comprehensive strategy on the table by the end of the year.
In Montreal, the directive for wide distribution of naloxone should also extend to safe injection sites, say crisis workers with Cactus and Dopamine, because of the spike of users taking street heroin cut with fentanyl.
While first responders including police will be able to carry the kits and administer the antidote, free access at every pharmacy doesn’t go far enough, said Cactus Montreal representative Sandhia Vadlamudy, whose centre gets 6,500 visits every year.
“We are missing the tools to intervene in case of an overdose,” Vadlamudy said. Naloxone is free to users, but it’s not available universally, she explained.
“(But) many of the people we work with, who come to us for equipment, are reluctant to go to clinics and pharmacies,” she said. “What we want on the ground is to offer naloxone directly at centres, because the people who inject trust the centre as a safe and secure place, they come to us every day. We don’t want naloxone to be limited to users only.”
Prevention should include, for example, extended hours for safe injections sites, which open late in the day at 4 p.m., she said.
“People start to use during the day. They don’t wait until 4 p.m. to inject,” Vadlamudy said. “There’s a lineup for over an hour before we open and some go into an alley or another public space.”
Also, the methadone program, which has a two-month wait list for patients addicted to heroin and other opioids before they can get medication-based therapy, should be extended to include other substitution drugs, she said.
Vadlamudy also called for the services of a physician on-site in harm-reductions centres to prescribe opioids, “so people would know exactly what they inject.”
To really counter fentanyl on the streets in big cities like Montreal, the politics need to change, said Martin Page, director of Dopamine, an outreach group that also provides training on how to use the kit, including to drug users. “Legalized drugs — stop criminalizing drug use,” he said.
As for naloxone, the antidote should be as widely available as possible in the community, he said.
“It saves lives. We’ve seen it directly at our facility,” he said.