U.S. Attorney-General Eric Holder said it best when he called the soaring rates of opioid-related deaths an “urgent and growing public-health crisis.”
High-profile deaths such as that of actor Philip Seymour Hoffman attract all the attention, but the reality is that more than 100 Americans a day die of accidental drug overdoses. That’s more people than are murdered or than die in car crashes – and many of the 38,000 ODs a year are preventable. At least 16,000 of those deaths are related to misuse of opioids, everything from heroin to OxyContin.
Though data collection in Canada is poor, it’s widely known we have rates of opioid use comparable with the United States. By extrapolation we can assume that approximately 3,800 overdose deaths occur here, with about 1,600 due to opioids.
The people using and abusing opioids (and dying as a result) are not all stereotypical “junkies” shooting up in alleys. They are also grandmothers who take too many painkillers, labourers who get addicted after treatment for a back injury, teenagers who raid their parents’ medicine cabinet, kids who mistake pills for candy and recreational users who can be anyone from Bay Street brokers to squeegee kids.
Let’s not forget that prescription drugs are, for many, the recreational drugs of choice. OxyContin, for example, is known as “hillbilly heroin,” and the powerful painkiller fentanyl, once used only for cancer patients with severe pain, is now sold on the streets. As the authorities crack down on misuse of prescription drugs, there has been a resurgence in the use of heroin. It’s now more affordable than it has ever been.
The reasons for misuse of drugs can be complex and there is no magical solution – especially not the simplistic “tough on crime” approach.
As R. Gil Kerlikowske, former head of the U.S. Office of National Drug Control Policy, has said: “We cannot arrest our way out of the drug problem.” What is required is a series of measures, such as better education about the real benefits and risks of drugs like painkillers (for patients and medical practitioners alike), sounder prescribing practices, investment in non-pharmaceutical pain-control methods, better access to addiction treatment and harm-reduction measures.
What is also needed are pragmatic approaches to dealing with one of the frightening symptoms of the public-health crisis that is opioid abuse: overdoses.
Ideally, you would like no one to ever become addicted to opioids and for everyone who is, to be admitted to rehab, treated and live happily ever-after, drug-free. But that’s simply not realistic. One of the practical things we can do is give people who use opioids in large quantities – therapeutically or recreationally – protection against overdose.
Naloxone is a drug that has been used for decades in emergency rooms to reverse opioids overdoses. It blocks opiate receptors and essentially reverses the effects of drugs such as heroin. Paramedics carry naloxone (also known as Narcan) and so do firefighters and police in many cities. In fact, there are ongoing squabbles about who should be allowed to administer the drug.
When turf wars are set aside, the simple answer to that question is whoever arrives first. That’s because, when stopping an overdose, a few minutes can mean the difference between life and death.
Administering naloxone is simple. It works much like an epinephrine auto-injector (best known by the brand name EpiPen). You have a vial loaded with the drug (or sometimes a syringe and liquid that need to be combined) and stick the needle into a muscle (thigh, shoulder or buttocks); if that doesn’t work, you inject a second dose. When responding to an overdose you should also perform CPR and make sure the person gets to hospital, because the drug can trigger withdrawal. It should be noted, however, that the drug works only for opioid overdoses; it won’t reverse an OD from cocaine or crack, drugs that bind to other receptors.
Naloxone is so easy to use and effective that forward-thinking public-health officials have taken to handing out take-home naloxone kits to regular drug users, those who tend to use needle-exchange programs.
About 85 per cent of intravenous drug users who overdose do so in the presence of others, according to a study in the Annals of Internal Medicine. But, because their activities are often illegal, there is a reluctance to call 9-1-1 for help.
In New York City alone, more than 20,000 kits are distributed a year, and some 500 overdoses are reversed. (And that doesn’t count all the other ODs reversed by paramedics and firefighters.) Toronto, Edmonton and Vancouver also have take-home naloxone kits, and others are considering them.
But there are still a lot of bureaucratic hurdles. Naloxone needs to be prescribed by a doctor and, in some provinces, it is not on the formulary, meaning it is not covered by public drug plans.
Given the extent of opioid use, there is a good argument to be made for routinely prescribing naloxone along with pain medications like OxyContin (and its tamper-proof sibling OxyNEO) and fentanyl. It’s a prevention method similar to prescribing an EpiPen to someone with a severe allergy, or prescribing glucagon to insulin-dependent diabetics in case they have severely low glucose and can’t give themselves insulin.
Naloxone should be in first-aid kits in any home where opioid-based pain medications are used. This is harm-reduction at its best: Acknowledging a problem exists, and giving people – without judging them – practical tools to combat it.