The coronavirus disease (COVID-19) has everyone extremely worried, and understandably so. But there is another public health emergency that still hasn’t been resolved – the overdose crisis. And COVID-19 is threatening to create two epidemics among people who use drugs, unless we take immediate action.
Conflicting public health messages
Public health messaging for people who use drugs has long emphasized: use new supplies, carry naloxone, “start low and go slow”, and do not use alone. Now, in the midst of COVID-19, public health messaging for the general public has been: stay at home, avoid non-essential outings, do not gather in groups, limit contact with people at higher risk and practise physical distancing.
So how can people who use drugs not use alone and limit our contact with others? With overdose prevention sites (OPS) and safe consumption sites (SCS) either closed or open with extremely reduced hours, people are being forced to use alone, which could present an even more dangerous result: fatal overdose.
To help people avoid using alone, harm reduction workers have been providing “witnessing programs” similar to the Grenfell Ministries Overdose Prevention Line in Hamilton, Ontario, but with video chat and conferencing apps like Facetime or Zoom. The service allows a person to use drugs under the remote supervision of a “witness” who can provide or call for support, if needed.
Addressing the roots of the crisis
This is an amazing way to provide emergency medical services to people who have overdosed, but it’s still just another band-aid solution to the problem of a toxic drug supply. And as the precursors to fentanyl are becoming harder to enter our borders in the midst of a worldwide lockdown, we need to be providing a safer alternative to the toxic fentanyl found on the street, or the cuts being used to stretch a batch out until things are back to “normal” again.
Meanwhile, our country has branded people who use drugs as “addicts” and “criminals”, ignoring that they are forced into the illegal drug market because doctors won’t prescribe them a safer supply of pharmaceutical alternatives to fentanyl and methamphetamine.
Recently, however, some exciting news came out of British Columbia, where doctors can now legally prescribe take-home doses of opioids, stimulants, benzodiazepines and safer alternatives to alcohol and nicotine. This new guidance is an amazing step forward in the push for legalization, but it isn’t enough! We need a safe supply program across the country. We need all Canadian prescribers to get on board and save lives.
What does safe supply look like?
Safe supply refers to the medical provision of a legal and regulated supply of mind- and body-altering drugs that have traditionally only been accessible through the illicit drug market. It is an acknowledgement that people who depend on drugs may need to be prescribed these drugs as part of proper healthcare.
In my opinion, drug users don’t get treated with enough respect and dignity; we don’t receive healthcare without discrimination and we definitely don’t get adequate pain and symptom management. Physicians must know the harms they create by denying their patients a safe supply of drugs. This denial forces their patients into unsafe situations to pay for an illicit drug, which could cause more harm or even death.
It’s time to reframe safe supply as an essential life-saving service, not a third- or fourth-line treatment. Especially during a pandemic, doctors who do not prescribe take-home drugs are putting more people at risk. Drug users without a safe supply are not going to stay home. They are going out to score, pandemic or no pandemic!
Safe supply gets results
The time for safe supply was a long time ago. It’s an initiative that should have been incorporated into the first supervised injection site in North America. After all, some people still have to engage in activities like sex work, selling drugs and petty crimes to be able to buy drugs: providing supervised injection doesn’t address the health and safety issues associated with acquiring the drugs. Some European countries that have started programs like heroin-assisted treatment have seen reductions in illicit heroin use and crime, and improvements in the quality of life of people who use drugs. More Canadian clinics need to provide medical-grade heroin, like the Crosstown Clinic in Vancouver.
There are some amazing doctors in Vancouver who are leading the way with safe supply, such as Dr. Mark Tyndall’s MySafe Project, which offers a vending machine that dispenses hydromorphone to people who are registered opioid users. This machine reduces the risk of coronavirus infection because there is no in-person contact. But more importantly, it can save a life by reducing the risk of overdose from the extremely toxic drug supply on the streets everywhere.
Another healthcare hero is Dr. Andrea Sereda in London, Ontario, who has been prescribing a safe supply of drugs to her patients for more than four years. Dr. Sereda treats a lot of sex workers and people who consume fentanyl. Recently she participated in a webinar for the British Columbia Centre on Substance Use that provides an overview of her program and how her patients have benefitted.
We need more doctors in all provinces to start prescribing safe supply as a first line of treatment, not wait until they lose multiple patients from illicit fentanyl use before they change their minds.
The medical model of safe supply can’t be the only solution. We need to have various approaches to really meet the demand currently being served by the illicit black market. We need to look at growing our own poppies domestically to produce heroin in Canada so that the drug can be provided by prescription. Advocates in British Columbia and other parts of the country have been calling for heroin to be produced in Canada for quite some time.
With more than 14,000 overdose deaths in Canada since 2016, why is the government dragging its heels in allowing drug users a safer alternative to the illicit toxic drug supply? Do they really want us all to die?
Matthew Bonn is the program coordinator with the Canadian Association of People Who Use Drugs, a member of the Halifax Area Network of Drug Using People, the lead substance use culture expert with Peers Assisting & Lending Support and national board member of Canadian Students for Sensible Drug Policy. He is also the co-founder of the HaliFIX Overdose Prevention Society, which implemented Atlantic Canada’s first overdose prevention site.