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Vancouver’s Fentanyl Crisis

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Last April, British Columbia’s chief health officer took the unusual step of declaring a public health emergency after 200 people died from (suspected) fentanyl overdose during the first three months of 2016. By August the number of deaths had risen to 488. This is a record high, a 61.6 per cent increase on the same period in 2015 (302).

Fentanyl is a synthetic opioid, fifty to a hundred times more potent than morphine. Paul Janssen first synthesised it in 1960. It is used as an anaesthetic in hospital and given to people with advanced cancer in severe pain. Most fatal overdoses are caused by illicitly manufactured fentanyl. The street drug supply is widely contaminated. A recent pilot study at Insite, Vancouver’s safe injection site, found 86 per cent of drugs tested contained fentanyl.

Public health emergencies are typically declared in response to outbreaks of contagious diseases. British Columbia is ‘the first province to take this kind of action in response to the current public health crisis from drug overdoses’, the health officer said. We were told that the declaration would permit ‘robust, real-time information on overdoses in order to identify immediately where risks are arising and take proactive action to warn and protect people who use drugs’. It did not say how much, if any, extra funding would be made available.

Opioid overdose can be reversed by naloxone (sold as Narcan) if it’s administered swiftly enough, though you need to call an ambulance too (naloxone wears off after an hour or so, which means an overdose can return). Narcan is injected intramuscularly and a portable kit about the size of a spectacle case has been created containing single-use needles, three doses of Narcan (one dose is not always effective in habitual drug users), alcohol wipes and a protective mouth guard for CPR.

Much of the outreach, training and distribution of Narcan kits in the Downtown Eastside area, which houses the highest number of known injection drug users in the city (around 4000), has been carried out by underfunded activist organisations, who were struggling before the crisis hit. The Vancouver Coastal Heath Authority (VCH) recently announced funding cuts to these organisations, whose efforts have saved hundreds if not thousands of lives. VCH proposes opening a brand new integrated facility, which is great because many more treatment beds are needed, but you cannot immediately replicate the trust that organisations like VANDU (Vancouver Area Network of Drug Users) and DURC (Drug Users Resource Centre) have earned over years of working with drug users.
 
Naloxone has been available without a prescription since late March, and training is provided at some community pharmacies, though there’s no easy way to find out which ones. Nobody I asked seemed to know how much the kit costs. (It’s given free, along with training, to opiate users, but you have to identify yourself.) A number of friends who live in the Downtown Eastside area were confused about where and how they, as non opiate users, could obtain a kit. Finally, thanks to a mistakenly shared Facebook post, three of us went last month to a Narcan training session organised by VANDU. This is a public health emergency, after all, and as members of the public we wanted to be able to help.
 
Justin Trudeau’s Liberal government says it supports harm reduction, but shows no immediate signs of repealing Stephen Harper’s 2015 Respect for Communities Act, an odious amendment to the 1996 Controlled Drugs and Substances Act that makes it difficult to open safe injection sites. Several new sites have been approved in Vancouver even so, but they aren’t scheduled to open till 2017.  
 
The three days following ‘welfare Wednesday’, when monthly social assistance payments are made, have the highest rates of overdose. Last month, fed up with the inadequate official response, Sarah Blyth, Ann Livingston and Chris Ewart, who run the Downtown Eastside Street Market, made a pop-up safe injection site. They put a tent at the back of the market, facing out onto an alley where a lot of users shoot up. I visited the site last Monday. Someone overdosed outside on the street, a man ran into the market shouting ‘Narcan, Narcan,’ a kit was quickly produced from inside the tent and passed over to him. He confirmed that an ambulance was on the way. ‘This is a perfect example of what happens here all day long, this is what we deal with,’ Blyth said.


 
At my son’s high school, the response has amounted to a traditional assembly telling them not to do drugs, and that fentanyl is out there and dangerous. Last year a letter was sent to parents urging us to discuss fentanyl with our children. They have had no instruction on how to recognise opioid overdose or any practical naloxone training. They’re taught CPR once, but it’s never followed up. One activist told me there’s very little outreach to young people on the streets. The Vancouver police chief has said that ‘thankfully only a small number of our teens are at risk for overdose.’ His other tips for parents include:

Friendships are a very important part of our kids’ lives. Encourage them to look out for their friends, to share information about the dangers of fentanyl, and to support their friends making good decisions.

Has he ever met any teenagers? I feel like writing to him to say it would be much more use if we all came down from Button Moon and supplied them with the kits and training to save each other’s lives.

Comments on “Vancouver’s Fentanyl Crisis”

  1. Bob Beck says:

    You might well write to the chief constable, though writing to the premier and the ministers of health and finance could be more to the point. Not necessarily more effectual, of course. If the current BC government believes in anything beyond tax cuts, LNG projects, and getting re-elected next May — whatever the short-term costs of that project — I see little evidence of it.

    Nor have I seen much real improvement on the part of the feds in the year since Trudeau’s Liberals took over. They could have repealed most of Harper’s tendentiously-named bills (“Respect for Communities,” forsooth) with a few pen-strokes. In fact they could almost have done so by simply scribbling “not” at random on every page of those dreadful omnibus bills, and ramming them through Parliament. I’m not sure whether cynicism or incompetence better explains their foot-dragging. Likely some of both.

    As for the fentanyl crisis: if opiates and opioids are now as cheap as rumoured, it’s hard to see how even a carefully-designed program of decriminalization and clinical prescription of quality-controlled drugs could reach all the users it would need to. (Not that such a program has been mooted by any politician I’ve heard of). I imagine some would rather keep using street drugs than identify themselves to health authorities. All the more reason for said authorities to continue working with, and properly funding, front-like experts like VANDU and others.

  2. Ifor Evans says:

    I spent four days in East Hastings a couple of years ago. It was and is like no other place I had or have ever been.

    Before going to Vancouver, I had never encountered heroin or crack. Doing so, even at a (relative) distance, made me realise how inadequate my understanding of addiction was and how impotent any reaction of mine to it – whether social, political, ethical, personal or whatever – could ever be.

    I’m totally at sea with how to react to an article like this, or to the issues it describes. Even an expression of concern seems to spill into some sickly form of pity which I suspect is almost certainly an objectifying way to approach the experiences of many (if not most or even all) drug users.

    If anyone has any recommendations of people/organisations to read/speak to to get a slightly more informed handle on current thinking about addiction, I’d be very interested to hear them.

    Thanks.

    • Bob Beck says:

      You might start with a book called “In the Realm of Hungry Ghosts,” by Dr. Gabor Mate (pron. Mat-AY). He’s a neurologist and psychiatrist whose patients are mostly drug users on the Downtown East Side. He’s worked there nearly thirty years, I think.

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