Canadian Harm Reduction Network Newsletter – September 2014

Canadian Harm Reduction LogoHarm reduction can be parsed as discrete elements – Needle Exchanges, Safe Injection Services Controlled Drug-Use Programs, Harm Reduction Psychotherapy, Outreach at dance venues, etc. The list is long, and the temptation, often, is to look at the separate elements and not see harm reduction as the integrated driving force for all our drug-related work, from policy through programs, through evaluation and research. It is important to keep in mind that all of the elements of harm reduction are interwoven and form a whole cloth, even when we choose to focus on one particular strand of it.

While keeping an eye on the whole, the Canadian Harm Reduction Network has decided to concentrate this year on accidental drug overdose, something that affects just about everyone who uses one or more substances. Fatal accidental drug overdoses are out of hand. Throughout most of Canada, as well as in, at least, the USA, they surpass in number accidental motor vehicle deaths. No, this is not hearsay. Check it out in your own jurisdiction, though you may find it difficult in some places to get numbers.

This focus on accidental overdose is, however, not about mere numbers. It is about people. People who die unnecessarily (most drug overdose deaths are preventable), their families, their friends and their communities, all of whom often experience traumatic consequences of these deaths. But, that said, it is MOSTLY ABOUT THE PEOPLE WHO DIE.

There are many things that could be done immediately to slake the deadly consequences of drug overdose. For one, Naloxone (Narcan) could be widely available. Naloxone is in most cases the perfect response to opiate overdose, since it reverses almost immediately opiates’ life-threatening effects. It is a reversal that lasts a relatively short time, but it is sufficient to get the person the help they need to recover completely. What is more, it does nothing more to the body. It is far safer than most-over-the counter medications.

In some parts of the US, Naloxone can be purchased without prescription. This is not the case anywhere in Canada. Though harmless, it is tightly controlled.

Further, all first responders are being provided with Naloxone in some US jurisdictions. Here in Canada, many but not all paramedics carry it, but as yet no police or fire fighters are equipped with it or trained to use it.

In the US as well, most of the naloxone-based overdose programs for peopoe who use illicit drugs are delivered by peers. That is not generally the case in Canada.

Our Naloxone programs are based largely on the US experience. Our first program was in Edmonton, and that was initiated almost ten years ago. Other Canadian programs have sprung up only in the past year or so.

Another essential piece of overdose prevention is passing of Good Samaritan legislation. Again the US has shown leadership – though not without lots of work by articulate and passionate advocates. Approximately 20 states and the District of Columbia have enacted legislation to prevent people from being arrested if they place a distress call about an overdose and are still present when the police arrive. We don’t have Good Samaritan Laws in Canada. Anywhere. We should.

Then there are the issues of cocaine and stimulant overdose and overdose from drugs used at parties, especially by youth. This summer, across Canada, we have seen several drug-related deaths at large parties organised for young people. These are preventable too – though not with a “magic bullet” like Naloxone. There are no magic bullets for stimulants. Naloxone works only for opiates. To address party and stimulant overdoses, more resources are needed, and more information – about the drugs themselves, what overdose on a variety of drugs look like and what it does to the body, how to prevent it and how to address it when it happens.

If these concerns seem to be focussed only on outliers – homeless people, “addicts” (Oh, how I dislike that label!), “reckless” youth, etc., look further. We are also seeing deaths from prescribed opiates which have been overused unintentionally – chalk this up to poor directions given by prescribers, carelessness or confusion on the part of their patients – in the latter instance particularly the confusion caused by aging – and the curiosity of young people who get into their parents’ medicine cabinets. There are these deaths, too, to consider.

Earlier this year, the Canadian Harm Reduction Network presented a forum in Toronto called “Apathy and Overdose”. It was well attended and got a huge amount of national coverage, particularly on CBC. At this forum, we released “Opioid overdose prevention and response in Canada” a paper produced by the Canadian Drug Policy Coalition. We played a role in the development of this paper, as part of a national committee. It is not a long report, but it is well written, current and in accessible language. We encourage you to read it, to talk about it with friends and colleagues and to consider what actions you might take to address this in your organisation or community

We also participated in two community-based research projects on cocaine (including crack cocaine) and cocaine overdose. This is truly preliminary research, done with almost no funding. We will release the results of these research projects as soon as they are completed.

As we have in the past, we will be partnering with six to eight students in a 4th-year toxicology class at the U of T, through the University’s Centre for Community Partnerships. Several of thes students will focus their work on overdose awareness and prevention.

Finally, we expect to work with a 4th-year class at U of T’s Rotman School (their business faculty) on a project to determine how best to market overdose prevention to key power holders – people who can make a difference on a broader level. These latter projects are just now forming, and we are holding back on writing more about them until things are clearer – both to us and our university partners,

We will also present a series of workshops on Overdose Awareness, Prevention and Emergency responses to community members and agencies in Toronto.

We will write up whatever we can to distribute to people on this list, and post it as well as on our Facebook and Webpage.

Our hope is that this concentration on overdose might culminate, in communities across Canada, in the public recognition of International Drug Overdose Day.

International Drug Overdose Day deserves some explanation. It was initiated in the year 2000 by the Salvation Army in Australia, in the state of Victoria, in the city of St. Kilda. It commemorates people who have died of drug overdose, or are living with a permanent injury after suffering from drug overdose. It is a day to grieve, and also a day dedicated to raising awareness about drug overdose and to lowering the stigma attached to drug use.

At that first Overdose Awareness Day, the Sally Ann planned to hold a local memorial event and give ribbons out for anyone who wished to commemorate a friend, partner or family member who had passed away. Any member of the community, even if not directly affected, could wear a ribbon to offer their condolences and support to those who had suffered overdose. On that first year 6,000 ribbons were distributed not only locally but throughout the state of Victoria and beyond.

Now internationally recognised, Overdose Awareness Day is marked throughout Europe, in some localities in the Scandinavian Countries, in Russia, and in some cities in the United States and Canada. As well, it is recognised by the UN.

Can you imagine what its impact would be if, on August 31, 2015, commemorations were held across Canada … if cities and towns would designate this day, if mayors and premiers would deliver proclamations … and even our new prime minister? It is a dream. It is up to all of us to make it happen.