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Drug use is a medical issue not a moral one

Lorraine Graves   Aug-31-2018

Kenn Wilson via

Overdose Awareness Day is August 31. Overdoses are nothing new but with the rise of highly potent additions to street drugs, mainly heroin, drug overdose deaths continue to climb in British Columbia.

To counteract this problem, many prongs of government and health care are coming together to save lives.



Caitlin Etherington is the regional director for prevention for Coastal Health. She says we should treat those who use illegally-obtained drugs, like heroin, from a medical point of view, using good scientific evidence and compassion to guide us.

“Opioid Use Disorder is a health issue and it’s something we need to respond to in a really compassionate, evidence-based way--with a health lens.”

Etherington also suggests we stop calling people drug addicts, “I’m just so aware of how stigma works. I’m aware of language.”

Pointing out that many people at risk for overdose grew up in supportive, loving homes in ordinary neighbourhoods, Etherington suggests we shift our thinking: “It would be just remaining mindful that (overdose) is something that can happen to folks in any walk of life.”

On Overdose Prevention Day, Etherington points out the two prongs to her message, “We have the the Opioid Use Disorder component and then the toxic drug component.”

Judy Darcy, BC Minister of Mental Health and Addictions, points out the scope of the tragedy. “Last year, we lost 1,450 people here in B.C., and by the end of this day three or four more British Columbians will die from a drug overdose as a result of a poisoned and unpredictable illegal drug supply.”

Experts say that as much as 80 per cent of the heroin sold illegally is contaminated with vastly stronger drugs, often fentanyl, drugs that can kill by stopping breathing, stopping hearts, damaging brains and introducing infections. In a hospital, a person given a known dose of medical-grade Fentanyl is watched closed because they can suddenly stop breathing. Outside a hospital, with an unknown amount of fentanyl or similar drug, an overdose is far too likely.

Etherington says there are other drugs like fentanyl, illegally produced, that can be added to street drugs so she says professionals prefer to call the adulterations, “different analogues.” When asked, she says, “Most of the time there are other drugs (added). A minute shift in the minute amount of analogue can cause somebody to overdose even if they are a regular user.” Sometimes the addition of one grain of an adulterated drug, the size of a crystal of sugar or salt, can make the illegal drug lethal. And, like salt and sugar, these don’t look any different.

Etherington says, “The solutions lie both within the health care system for the Opioid Use Disorder, but we can’t only rely on the health care system. In the context of a toxic drug supply we have to be a bit bolder.”

Many different approaches are being tried because most people living with Opioid Use Disorder, as well as the professionals and families who care for them, recognize one size doesn’t fit all. Different approaches will work better for different people.

Cabinet minister Darcy says, “We are seeing some success, because we know more options are available with more opportunities for people to create their own unique pathway to hope and healing. Every person we can move onto a treatment program removes them from the unpredictability and toxic illegal drug supply currently available on our streets.”

Richmond’s Anne Vogel Clinic is one prong of the multi-faceted approach to helping those with Opioid Use Disorder. A team of outreach and social workers connect people, who have recently experienced opioid overdose, or who are at high risk for opioid overdose, to addictions care and support. At the clinic, clients can receive overdose prevention education and get help in accessing Opioid Agonist Therapy such as methadone or suboxone.

People can phonethe clinic without a doctor’s referral to make their own, same day appointment. If the clinic is open, people can also just show up. The compassionate staff work to offer practical care that can keep people alive.

Etherington speaks of welcoming and including families in the supportive mix.

As another example, she points out the role of the Overdose Outreach Teamwhich offers families, patients and other health care professionals advice and connections to programs for the person at risk of overdose. It’s as simple as a phone call. Currently available 8 a.m. to 8 p.m. weekdays, the workers encourage callers to leave a message to have someone call you back as quickly as possible. No doctor’s referral is required. The services are covered by the provincial health plan.

“This team is really focused on people who are at risk of overdose,” says Etherington.

“One really important thing about our outreach team,” she says, “They are all very warm-- the right type of people to make people feel comfortable and to be totally non-judgemental.”

Aimed at preventing death, this group works to connect people who need help with the solutions that will work best for each individual.

“The whole approach is non-judgmental and working with exactly where people are,” says Etherington.

Today’s hopeful news, according to Etherington is that, “In Richmond, we are getting an outreach worker to be connected to the team at Anne Vogel and to the Overdose Outreach Team in Vancouver.”

Darcy says, “We are losing more people from accidental overdoses than from suicides, car accidents and homicides combined. These are our brothers, sisters, mothers, fathers, co-workers and friends, and the families and communities they leave behind are filled with tremendous grief and heartbreak.”

Etherington adds, “As a community, we really need to embrace and support people.

It is truly like a chronic relapsing condition like diabetes. (Opioid Use Disorder) needs a response that is not based in morality. It needs a response that is based in good practice.”

Today, Overdose Awareness Day, Dr. Evan Adams of the First Nations Health Authority says it best, “Drug use is a health and social issue, not a moral issue.”

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