B.C. doctors look to fight opioids with lessons learned from AIDS crisis

The opioid epidemic has proven to be one of the most trying public health problems since the HIV/AIDS crisis.

Some believe the lessons learned during the multi-decade AIDS crisis can be used to help combat the opioid overdose epidemic.

As Vancouver has been at the forefront of the deadly opioid epidemic, programs like BOOST Collaborative work with partners across the health-care spectrum to improve the lives of people living with addiction.

It’s a daunting task, one that is about more than just fentanyl.

“We have the medicine that can actually replace the heroin or fentanyl, but it’s often not enough,” Cole Stanley of BOOST said.

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Some of the strategies in fighting fentanyl stretch back decades.

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In the early 1990s, AIDS had become one of the biggest killers in North America. In Vancouver, the death toll was staggering.

“Every day, we met early in the morning to just review who from our clients have died,” Rolando Barrios, assistant director of the BC Centre for Excellence in HIV/AIDS, said. “It was incredibly hard on the staff.”

Barrios said AIDS advocates had to fight not HIV/AIDS, but the social stigma that surrounded it.

“What traditionally has happened in other epidemics is blaming some sectors of the population that further stigmatized them and marginalized them.”

The tide turned against HIV/AIDS, Barrios said, when the stigma began to melt away. When it was diagnosed as a virus, proper treatment, like effective drugs and social supports, became normal.

Doctors say opioids are a more complex problem, but like the HIV/AIDS crisis, removing stigma is still key.

Frontline health-care workers say oral opioid replacements work well but only if they can find the patients who need them.

“Often, they don’t have a phone, they may have an email, or a friend with a phone, or an outreach team can find them in their apartment,” Stanley said. “There are all sorts of creative solutions to following up with people.”

“Retention rates in opioid therapies are as low as 30 per cent in Vancouver,” Barrios said. “So no wonder… people are still using and people are still dying from overdose.”

Stanley notes that doctors dealing with the opioid crisis face some of the same obstacles faced by colleagues during the AIDS crisis.

“It’s the same things getting in the way,” he said. “It’s often mental health… it’s often inadequate housing. People have gone through trauma, not getting trauma-informed care, and then not coming back because they’ve had bad experiences in our system.”

Stanley said increased outreach and more time engaging clients in the clinic made a difference combating HIV/AIDS, and they are starting to take a similar approach with opioid users.

Last month, four people a day in British Columbia died from an overdose, twice as many as at the height of the AIDS epidemic.