by Peter Chow
53 people have died of drug overdoses in this city in 2020, up from 17 in 2019.
So far, in 2021, we are on track for well over 60 opioid overdose deaths.
But Sault Ste Marie, not surprisingly, is not yet ready to accept many major best medical practices, evidence-based actions in relation to treatment of opioid addiction.
An average of 5.2 people are now dying every day in B.C. from drug overdoses, the vast majority due to opioid drugs laced with fentanyl.
As a result, Dr. Bonnie Henry, B.C.’s chief medical officer, has issued an order to mandate health professionals to help people at risk for overdose access safer alternatives to the toxic street drug supply.
British Columbia will require all health authorities to develop programs that provide pharmaceutical-grade opioids, stimulants and other addictive substances to street-drug users, under a policy directive on safe supply aimed at curbing overdose deaths.
The B.C. government recognizes that providing drug users with regulated versions of street drugs such as morphine, cocaine, and methamphetamine can reduce deaths and other drug-related harms.
Prescribed safe supply drugs such as long-acting morphine tablets and injectable hydromorphone will be covered under PharmaCare, the province’s drug plan.
Stimulants, cocaine and crystal meth, are expected to be added at a later date.
Surprisingly, the directive does not provide for the use of diacetylmorphine (heroin), a drug that has been prescribed for decades in England and certain countries in Europe.
The British System. originated with the publication of the Report of the Committee on Morphine and Heroin Addiction in 1926 and basically, British drug policy remained unchanged until the 1960’s.
British drug policy defined drug addiction as an illness, not a crime, and therefore the responsibility of doctors.
Doctors could prescribe opioids for:
“Persons for whom, after every effort has been made for the cure of the addiction, the drug cannot be completely withdrawn, either because:-
- Complete withdrawal produces serious symptoms which cannot be satisfactorily treated under standard medical practice; or
- The patient, while capable of leading a useful and fairly normal life so long as he takes a certain non-progressive quantity, usually small, of the drug of addiction, ceases to be able to do so when the regular allowance is withdrawn”
There were approximately 700 addicts in 1936, the first full year of recording.
The number of known addicts declined yearly to a low of 290 in 1953.
During this time, the number of addicts in the country was so small that the Home Office was able to keep itself informed about the personal life and history of each addict.
In the 1940s, between one-quarter and one-fifth of all addicts fell into the category of “professional addicts” – a Home Office term referring to doctors, dentists, and pharmacists who had direct access to and were addicted to morphine.
In the 1970s and 1980s, several highly respected physicians, after retirement, revealed that they had been injecting morphine for virtually their entire adult and professional lives, unknown to their patients, their colleagues and even their own families.
Under pressure from the US, Britain abandoned the “British System” and opted instead for an American-style penal policy, joining the disastrous “War On Drugs” in 1971.
In a document published by the Canadian Centre on Substance Use and Addiction in 2018, its National Guidelines for the Clinical Management of Opioid Use Disorder recommends:
- Suboxone (buprenorphine/naloxone is the recommended first-line medication for most individuals in Canada.
- Methadone can be used as a second-line treatment if Suboxone is not appropriate, or ineffective.
- Treatment with slow-release oral morphine prescribed by an experienced, trained addiction physician should be used if first- and second-line treatments are not successful
- For individuals who do not respond well to other pharmacological treatments, diacetylmorphine assisted treatment resulted in greater treatment retention and reductions in illicit drug use compared to methadone or suboxone treatment
This treatment should only be considered for individuals for whom other treatment options have not been successful, and with careful medical supervision.
- LOW INTENSITY TREATMENT – WITHDRAWAL MANAGEMENT
Tapered methadone or suboxone
+/- psychosocial treatment
+/- oral naltrexone
- MODERATE INTENSITY TREATMENT – OPIOID AGONIST MAINTENANCE THERAPIES
Slow-release oral morphine
- HIGH INTENSITY TREATMENT – SUPPLYING SAFE INJECTABLE OPIOIDS
Injectable opioid treatment should be understood as one part of a continuum of care for individuals with an opioid use disorder.
By stabilizing patients and providing a point of regular contact with healthcare services, injectable opioid treatment clinics facilitate the establishment of necessary therapeutic relationships and routines.
Injectable opioid treatment is indicated for those individuals who have not benefited from oral opioid agonist treatment (i.e., methadone, suboxone, and/or slow-release oral morphine).
For patients who are not able to stop or reduce use of non-medical opioids with methadone or suboxone, injectable opioid agonist treatment offers an evidence-based alternative.
Regrettably, Sault Ste Marie and Northern Ontario are far from being receptive to such a proposal.
The Overton window is the range of policies politically acceptable to the mainstream population at a given time; it is also known as the window of discourse.
Consider the following evidence-based medical actions:
- Treating drug addiction as a disease, instead of a crime
- Harm reduction vs abstinence as the primary goal in treatment of opioid addiction
- Medication Assisted Treatment of drug addiction with Suboxone and Methadone and Naltrexone
- Safe Injection Sites
- Anonymous drug testing to screen for Fentanyl
- Injectable-opioid treatment for intractable Opioid Use Disorder
- Providing safe drugs to mitigate drug-overdose deaths
- Decriminalising all drugs
#1 is pretty well accepted by most people in the Sault.
#2 and #3 are being grudgingly more accepted.
According to local opinion polls, #4 is generally not well-accepted, although the police chief has endorsed it.
The Overton Window is pretty narrow in Sault Ste Marie – the Sault is definitely not ready yet for the remaining actions on the list.
Thankfully, progress, like time, tends to move only in one direction, forward.