Beyond Insite
Canada is ignoring easy, uncontroversial ways to prevent overdose deaths
Aparticularly potent batch of heroin recently resulted in 31 overdoses at Vancouver’s Insite safe injection clinic. The facility proved its value yet again, as staff applied immediate treatment and ensured none of the victims died. But what about those who can’t access Insite? In 2013, 308 people died in British Columbia due to illicit drug overdoses, the majority of which were opioid-related.
Canada-wide, we can only speculate about the total numbers because there is no national database tracking overdose deaths. But the numbers we do have, from a patchwork of provincial data and news reports, tell us that far too many Canadians are dying from an entirely preventable phenomenon. And not preventable in the sense of “well, if people didn’t use drugs, there wouldn’t be overdoses.” While that’s essentially true, we know people will use drugs. One hundred years of prohibition hasn’t stopped that.
No, these deaths are preventable thanks to easy-to-implement, non-controversial policy changes at our disposal.
The most pragmatic and immediately effective remedy would be to improve access to naloxone, a 40-year old medication that, when administered during an opioid overdose, reverses the effects of the drug. It has no narcotic effect and people cannot become dependent on it.
Currently, naloxone is used predominantly by ambulance and medical staff — like those at Insite — but we could save countless more lives if it were available to those most likely to be with someone experiencing an overdose. Eighty-five per cent overdoses occur in the presence of others, often in the home. For this reason, naloxone should be included in provincial drug plans and made available over the counter.
In addition, we should scale up existing “take-away naloxone programs” to increase the distribution of overdose response kits among people trained to prevent, recognize and respond to overdoses. Streetworks in Edmonton pioneered this programming in Canada, and similar initiatives have spread throughout the country. The most
When administered during an overdose, naloxone reverses the effects of the drug. It has no narcotic effect and is not addictive
robust program — Take-Home Naloxone (THN) — was established at the B.C. Centre for Disease Control in 2012. THN operates in 51 sites, from large urban hubs like Vancouver and Surrey, to smaller rural centres such as Cranbrook, Campbell River and Fort St. John. More than 2,200 people have been trained, including staff and volunteers at health and social service agencies, as well as friends and family members of people who use drugs. THN has dispensed more than 1,200 kits, and 125 overdoses have been reversed.
Clearly naloxone is a life-saver, but re- ducing barriers to its access and providing training are just part of a comprehensive overdose response. We also need to immediately implement appropriate guidelines for opioid prescriptions, improve national data collection on overdose events, and reduce barriers to calling 911 during a drug overdose. Again, most overdoses occur in the presence of other people. Though witnesses to heart attacks rarely hesitate to call 911, witnesses to an overdose often lose precious minutes wavering over whether to call for help — if they make the call at all. They may fear arrest, the loss of custody of children, or judgment from friends and family.
This would be resolved by the passage of Canadian 911 Good Samaritan legislation — so called because it provides protection from arrest and prosecution for drug possession if the evidence is obtained as a result of the person calling 911. In the last four years, 11 U.S. states have passed some form of this legislation, often with bipartisan and near-unanimous support.
Such legislation recognizes that accidental drug overdose is a health issue that doesn’t merit attention from the criminal justice system. Indeed, public health imperatives should drive all policy relating to overdose response.
While much of the responsibility for this issue rests at the local and provincial level, ultimately the federal government plays an important leadership role in setting the overall tone and guiding any national strategy. At the 2012 annual meetings of the United Nations Commission on Narcotic Drugs, delegates passed a resolution recommending that member states include effective elements for the prevention and treatment of overdose in national drug policies, including the use of naloxone. Although the Canadian delegation supported this resolution, and despite the simplicity of implementing such programs and policies, to date the government has not acted on this matter. It’s time for that to change.