Opioid crisis worsening, ARCHES exploring new harm-reduction methods for addicts

By Lara Fominoff @LaraFominoff on Twitter
June 11, 2018 - 5:23am

LETHBRIDGE -  "The unfortunate part is we waited so long to identify this as a public health crisis and by the time the province, the country, the feds realized that this was of epidemic proportions, it was too late to get ahead of it."

ARCHES Executive Director Stacey Bourque says despite the best efforts of everyone –  from those working at the safe consumption site, to EMS, to police to every-day citizens – the opioid crisis is getting worse.

And it's not just because of the prevalence of cheap, easy-to-get drugs in the community. It's also because there is such a huge gap in a broad spectrum of treatment and services in Lethbridge; because even if addicts that use the safe consumption site want help, it's almost impossible to get it in a timely manner. The wait time can be more than a year in many cases.

“(The) definition of insanity is doing the same things over and over again and expecting a different result... or we step out of our comfort zone and try to attack this from a different perspective.”

 

– Stacey Bourque

"It's so hard to even fill the pockets of certain gaps, (so) we can make them up in other areas. We don't have accessibility and availability of necessary health care services to support a very vulnerable population of people that are addicted to opioids.

"When you lack so many other services, when you lack permanent supportive housing, you lack transitional housing, you lack intox and medical detox and all of these other things, it puts all this pressure on the other systems which have to pick up the pieces."

That is reflected in new information released by Alberta Health May 29, 2018, that shows the opioid crisis is still increasing by leaps and bounds.

  • Between Jan. 1 and March 31, 2018, eight people died in Lethbridge alone, due to an accidental fentanyl-related overdose. There were a total of 18 during in 2017 and nine in 2016.
  • In the South Health Zone, there were seven deaths due to accidental carfentanil poisoning between Jan. 1 and March 31, 2018.
  • In Feb. 2018 alone, there were about 400 calls for emergency services for opioid-related events, including overdoses, or just over 14 calls on average, per day. From Jan.10, 2018 to the end of that month, there were about 150 calls. Figures prior to that are not available.
  • The South Health Zone continues to have the highest rates of Emergency Room visits and hospitalizations per 100,000 person-years in the entire province.

Bourque says there have been 157 overdoses within the walls of the safe consumption site since it opened its doors just three months ago; they are now seeing about 500 people per day, and there have been about 15,000 visits to the site since it opened in late February.

They're running the safe consumption site 24 hours a day, seven days a week. And it's not enough, by far.

So, ARCHES is considering how to approach the opioid crisis in a different way. That includes exploring and trying out methods that are bound to divide the community and to cause controversy.

One of those options includes something that select sites in Vancouver and Ottawa are currently employing that give addicts pharmaceutical grade heroin.

"I think the things we need to introduce as this crisis is different, it's something we've never seen before...it's very difficult for society to understand some of the programs that are necessary to curb this, or to assist with this epidemic. They're not very palatable quite frankly and that makes it really, really hard to implement. Because they're extremely controversial."

It's not clear when it might occur, but the organization is actively working towards potentially offering supervised injectable opioid agonist therapy (iOAT).

http://www.bccsu.ca/wp-content/uploads/2017/10/BC-iOAT-Guidelines-10.201...

https://www.publichealthontario.ca/en/eRepository/Effectiveness_SiOAT_EB...

What is that? According to Public Health Ontario, where it's being used, (along with B.C.), the therapy involves giving chronic opioid users controlled and measured amounts of injectable heroin like hydromorphone (HDM) and diacetylmorphine (DAM).

The method is currently used in Switzerland, the Netherlands, Germany and Denmark as another treatment approach to those who have not responded well to other therapies.

According to the study listed above from Public Health Ontario,

"As opioid-related harms increase in the population, many have called for additional treatment options for opioid use disorder. The current evidence supports siOAT as a second-line treatment. Recent policy changes in Canada allow physicians to apply for permission to prescribe DAM and permit jurisdictions to request the import of medical DAM for urgent public health reasons. These changes may facilitate the availability of this treatment option. Further evaluation of the emerging practice with siOAT in Canada can assist with understanding implementation issues and informing program decisions."

Bourque says it's the next step in supporting and treating the drug crisis.

"One, providing people with pharmaceutical grade, non-contaminated substances is an important step forward in preventing deaths because they're measurable. You know what's in them, there are no surprises. People know what they're getting, and it's not contaminated with toxic substances. The other side of that is, it cuts the head off the illicit market. If we don't have a need for street-level fentanyl and carfentanil because people are being provided with pharmaceutical grade substances, there's no need for them to go out and secure them. So, we see crime rates decrease in our community."

She says it also means that people are more likely to come to the supervised consumption site every single time they use, if they know they're getting something that won't kill them. It also theoretically could mean a further reduction in needle debris and public drug consumption in the community.

And for those who will say they are enabling the opioid addictions even more, Bourque explains that whether they get the heroin at the SCS or somewhere else, they'll continue to use, regardless. What ARCHES would do essentially, is provide a medical service.

"It's no different than taking suboxone and methadone. It's just a different method of taking a replacement therapy. There are programs across the world that offer this... for chronic substance users who have tried every other thing without success."

Bourque acknowledges that if and when the safe consumption site begins offering the new injectable heroin as a replacement for street drugs, that it will be extremely controversial. But that's nothing new.

"We're not re-creating the wheel. It's not unique, it's not new. It's something they have been using in Europe and other areas around the world for many, many years because it's effective. We know that it's something that is needed and necessary."

And with many members of the community crying out for solutions, for something to be done to stem the tidal wave of drugs that flood Lethbridge every day, Bourque asks people to step outside the box to consider new options, because it's a conversation that's going on not just in southern Alberta, but across the province.

"Clearly what we have been doing for the last few decades isn't working. So, definition of insanity is doing the same things over and over again and expecting a different result... or we step out of our comfort zone and try to attack this from a different perspective." 

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