Could a medically supervised distribution program be the answer to the opioid crisis?
Canada should develop a regulated program to distribute opioids and prevent deaths if it wants to address the opioid overdose crisis, argues a new commentary in the Canadian Medical Association Journal (CMAJ).
According to Dr. Mark Tyndall from the B.C. Health Centre for Disease Control in Vancouver, the public health response to any poisoning epidemic should be to provide safer alternatives for people at risk.
In this case, he says, this would be to provide a regulated supply of pharmaceutical-grade opioids to people who have the highest risk of overdose.
There were an estimated 2,816 deaths due to opioid overdoses in 2016, according to the Government of Canada. In the first eight months of 2017 there were over 1,000 deaths in B.C. alone – Canada’s “ground zero” for the crisis, Tyndall says.
While official 2017 statistics have yet to come in, the government’s special advisory committee announced back in December that the recorded death toll could reach beyond 4,000.
A major source of the crisis, Tyndall says, is a drug supply contaminated with the synthetic opioids fentanyal and carfentanil that’s been circulating on the streets.
“I think most of us who have been at this now for a couple of years at least, as far as the current crisis goes, we’ve come to the conclusion that it’s really the toxic drug supply driving a lot of the deaths,” Tyndall says. “A lot of the harm reduction tools at hand aren’t going to be enough to make a major dent in the number of people dying. So we need to think of ways that start to address the root of the problem, which is a change in the drug supply.”
Tyndall isn’t saying that the current tools at hand addressing the problem aren’t working – what he does believe is that they are not accessing the people who they need to access the most.
And even though widespread opioid prescribing from physicians have been recognized as playing a role in the crises, any efforts that have been carried out by physicians to reduce unnecessary prescribing has led people to turn to other illegal and potentially deadly means to get the drug.
“For instance, in British Columbia about 70 per cent of the deaths happened to people who are found alone and are isolated,” he says. “They’re unlikely to be coming forward to supervised injection sites, and are unlikely to be engaged in substitution therapy with suboxone and methadone. We really need ways to draw them out of isolation and also to give them options to get drugs that aren’t full of fentanyl and carfentanil.”
The government’s special advisory committee acknowledged that while the opioid crisis has affected all regions within Canada, new data from the December report shows that some regions continue to be harder to hit than others.
For example, western provinces and territories continue to report higher rates of opioid-related deaths. However, B.C. continues to lead the way in overall deaths.
Tyndall suggests that provinces roll out medically supervised dispensing of opioids, dispensing of slow-release oral morphine or large-scale dispensing of hydromorphone pills, which he says are inexpensive and available. These, he believes, will be able to reduce the number of deaths and help in the fight against opioids.
– With files from Monique Scotti
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