Overdoses on opioids: major gaps in prevention services

Surdoses aux opioïdes: des écarts importants dans les services de prévention

VANCOUVER — When one of his great friends died of an overdose of opioids, alone in his room, Brandon Bailey has begun to share her cell number on social networks.

The addict in remission has a message for consumers of opioids: if you are going to take it, call me. “I will come and see you, and I will make sure that you are safe,” wrote Mr. Bailey in a message on Facebook.

Brandon Bailey, who is also a member of a community organization in Windsor, Ontario, laments the shortage in her city of services, overdose prevention, as centres of consumption supervised. He would also like to see naloxone, a substance that can be used to stop the action of the opioids, is readily accessible in case of emergency, across the country. “We must do something”, lance-t-il.

The crisis of overdoses by opioids has devastated many communities in the country; it is believed that she was able to slow down the increase of the life expectancy in Canada, which had however increased by three years between 2000 and 2016. According to estimates from the public health Agency of Canada, opioids have killed about 9,000 people in 18 months – an average of 500 deaths per month – between January 2016 and June 2018. Approximately 94 percent of these deaths were considered accidental and nearly three-quarters are attributable to the potent opioid fentanyl.

But access to services, overdose prevention varies considerably depending on the regions, which leads some activists to assert that the chances of surviving an overdose depends greatly, at the bottom, the place where you live. According to Health Canada, there are nine consumer center supervised in British Columbia, nine in Ontario, six in Alberta, four in Quebec – but none elsewhere in Canada.

The places of consumption supervised enable people to use their drugs under medical supervision, with sterile equipment. In addition, many of these centres also offer to test the products in order to detect a possible contamination to be fentanyl, a powerful synthetic opioid that can be deadly when mixed with other drugs.

Sarah Blyth, co-founder of the Society for the prevention of overdoses in Vancouver, said that on the day of the interview, in December, three people who had overdosed in a centre supervised injection had survived because they were surrounded by a competent staff and well-equipped.

A revealing of the prejudices

Naloxone is now available in the pharmacies of all the provinces and all the territories, except Nunavut, according to the Canadian pharmacists Association. Access to the kits free of naloxone take-away is more variable: the province of Quebec offers the nasal spray at any person over the age of 14 in the pharmacies, New Brunswick provides the naloxone of health services and social services, while British Columbia offers free of charge to any person likely to overdose, and their friends and families.

Jordan Westfall, executive director of the canadian Association of drug users, finds that rural areas and remote regions are particularly underserved by these programs of prevention. It is estimated that the lack of education and of political will was the main obstacle to the prevention of death by overdose. Because, unlike most other policy decisions in the fields of health care, which are based on evidence, the sites of consumption supervised are generally subject to the public consultation, ” he recalls.

“It is a kind of metaphor for the way we treat the care of drug users, who are stigmatized by society,” says Mr. Westfall. The community worker even claimed that it could reduce risks even further by providing users with the supply without danger, since many of the deaths seem to be linked to drugs “cut” to the fentanyl. “Nobody is afraid to die, taking a sip of beer: we need to ensure the same security to all the citizens who consume drugs on the streets,” according to him.

The Downtown Eastside of Vancouver has been at the centre of the crisis of overdoses in British Columbia; it is also here that you will find some of the prevention services are more accessible. In order to prevent overdose, the mayor of Vancouver, Kennedy Stewart, was asked last month to create a place where drug addicts could obtain opioids without danger.

Targeted interventions

Rebecca Jesseman, a policy director at the canadian Centre on addictions and substance use, explained that although the services vary from one region to another, it is also because the problems vary geographically. The crisis of the opioids is more pronounced in British Columbia, Alberta, Ontario and Quebec, while Manitoba and Saskatchewan are more concerned with the fight against methamphetamine.

“We must therefore react in a manner specific to the local context”, she argues. The federal government is allocating the funds according to the severity of the crisis of opioid and the size of the population in each province or territory. In addition, Ms. Jesseman indicates that the mobile units have begun providing support to communities deprived of services of a permanent prevention.

But beyond the regional differences, she says, these services often do not meet the needs of the individual, in particular in relation to language, sex, age, and culture. “The system often sees people who need help such as people who are resistant to treatment, rather than examining what is wrong with the system and find out how we could meet their specific needs.”

“We wouldn’t accept such deviations in quality and availability of services for health problems such as cancer, diabetes and heart disease. So, why is this the norm in terms of addiction?”

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