View Point: Sault is not ready for evidence-based treatment of opioid addiction

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opioids

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“Persons for whom, after every effort has been made for the cure of the addiction, the drug cannot be completely withdrawn, either because:-

  1. Complete withdrawal produces serious symptoms which cannot be satisfactorily treated under standard medical practice; or
  2. 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:

  1. Suboxone (buprenorphine/naloxone is the recommended first-line medication for most individuals in Canada.
  2. Methadone can be used as a second-line treatment if Suboxone is not appropriate, or ineffective.
  3. 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
  4. 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.

IN SUMMARY:

  1. LOW INTENSITY TREATMENT  –  WITHDRAWAL MANAGEMENT
    Tapered methadone or suboxone
    +/- psychosocial treatment
    +/- oral naltrexone
  2. MODERATE INTENSITY TREATMENT  –  OPIOID AGONIST MAINTENANCE THERAPIES
    Suboxone
    Methadone
    Slow-release oral morphine
  3. HIGH INTENSITY TREATMENT  –  SUPPLYING SAFE INJECTABLE OPIOIDS
    Diacetylmorphine
    Hydromorphone

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:

  1. Treating drug addiction as a disease, instead of a crime
  2. Harm reduction vs abstinence as the primary goal in treatment of opioid addiction
  3. Medication Assisted Treatment of drug addiction with Suboxone and Methadone and Naltrexone
  4. Safe Injection Sites
  5. Anonymous drug testing to screen for Fentanyl
  6. Injectable-opioid treatment for intractable Opioid Use Disorder
  7. Providing safe drugs to mitigate drug-overdose deaths
  8. 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.

14 COMMENTS

  1. ..& there it is, free government Heroin.

    The Hegelian Dialectic ‘Problem Reaction Solution..’ the government wants to be the ‘dealer’.

    Facilitate the problem, give some psychotic nitwit a tent, a bag-full of hygiene kits to help junkies ‘shoot-up’ this street-shit & then present pharmaceutical Heroin as the solution.

    Surely we can’t be ‘this’ stupid… but then again, maybe we are.
    .

    • And no one is demanding a clarification about who provide the tent and drug paraphernalia to that lady in the black Impala moving around and setting free access addicts party in Jamestown. And what’s worst yet, seems like “our representatives” are playing dead.
      Obviously, the couldn’t care less about the taxpayers money.

  2. I re-frame the “it’s a disease” to….. “it’s a CONDITION, that can be overcome!”
    How do I know it can be overcome? Because many many people are in recovery from it right now.

  3. SSM is always last to get on board with anything, especially things as important as this. It’s always been the town of ‘too little, too late’.

    • Massive eye roll.
      If one thing has been proven to be certain it’s that anything that typically works elsewhere does not work here, either due to poor execution or difference in culture.
      Alea Iacta Est.

  4. Another non qualified article of a person, or a group of people, that believe they can solve the results… but they continue ignoring the causes.
    Why we fail? Because we are using the wrong plan. Why are we unable to obtain a plan to deal with drugs, addictions and mental health? Well, because all three are a totally different issue. And we need people with qualifications, with recognized and valid credentials in each specialty.
    We, as a society, must demand services to curve and control the “causes” the “reasons” why people turn to drugs, that’s the solution, not providing free drugs.
    Providing free drugs is making people addicts for life, drugs or substances slaves.
    Just as an example here… why is not the Chief of Police telling the public what his plan is to combat and control the bikers in town? Or he doesn’t see the prostitutes on Albert Street and the downtown core or what’s even worst, he pretends that the bikers belong to a criminal organization? Instead, he beats the drum of opioid crisis.
    How about if you do your job first?

    • Honestly I wish the local bikers would step up and squash the meth coming into town from outsiders from Toronto. The bikers don’t supply this crap. One of the first things our new chief said was our local bikers are going to stand down bla bla. Right then I thought, oh lord no, we live in strange times and the only reason these thugs from Toronto are flooding the Soo with Meth and Fenty is because they can. With the crisis we have right now, business is too good for them to stop.
      Maybe an open letter to the local Outlaws is needed. Dear Mr. Motorcycle Club Enthusiast…Help us stop this! Please!! (P.S. RIP Duke)

      • Oh please, the Soo is also a supplier of drugs for down south. Smuggling rings bringing things across the river have been found and broken up here many times.
        Anyone bringing drugs here does it because it’s a lucrative market. If there wasn’t good money to be made here then they wouldn’t drive hundreds of km to bring drugs here. More often than not it’s a drug swap. Drop off one type to get another. There’s plenty of meth labs in town to supply the market.

  5. Yes it’s a disease buts it’s one that a conscious decision was made to start. Until things like insulin are covered for diseases that are forced upon people I will never support supplying addicts with drugs. Just because people with diabetes aren’t out robbing citizens they get no help. I’m tired of supporting bad life decisions!

    • Paul, there is a difference, with the exception of Type One diabetes, all other conditions can be reversed with diet alone. And we don’t know exactly why or how Type 1 develops.
      Processed foods are available everywhere for cheap and consumed massively by people with low resources. Add to it a genetic predisposition to sugars, highly processed fats and alcohol… and you have the results.

    • It’s not a disease. Maybe an illness, but not a disease.
      A disease is something you get via a virus or genetics. Illness is something acquired through your actions or in some cases where you work or what you are exposed to.
      The drug addict enablers have been saying it’s a disease for years to drum up sympathy and of course money to keep themselves employed and promoting their junk science.

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