This Saturday, federal Health Minister Ginette Petitpas Taylor will be in Vancouver’s Downtown Eastside to visit ground zero of the worst public-health crisis in decades. In British Columbia, people are dying of drug overdose at a rate of almost four per day. Across Canada, more people are dying than at the height of the HIV-AIDS epidemic.
Despite the horror, however, this is a crisis that is being described as the “new normal” for our society. This means that an existential threat to anyone that uses drugs could quietly become a foregone conclusion. This is an absolute failure of policymakers to ensure the health and safety of a group of people. The public cannot go numb to this fact.
Hopefully, Canada’s health minister leaves Vancouver thinking that none of this has to be the “new normal”. The minister is visiting Crosstown Clinic, Vancouver’s supervised injectable-opioid assisted-treatment (siOAT) program. At Crosstown, she’ll likely hear from both staff and patients alike that nobody has died of an overdose within the clinic and how prescription heroin and hydromorphone are a lifesaver for the few that are able to access them.
The federal government has made steps toward increasing access to prescription heroin, including support for injectable opioid drugs through their Substance Use and Addiction Program (SUAP), but the responsibility lies with B.C.’s government to get this treatment out to people. In order for this service to be available for those at risk of overdose in B.C., the province’s government and regulatory bodies need to step up.
The British Columbia Centre for Disease Control is calling for rapid low-barrier expansion of hydromorphone (brand name Dilaudid) to protect people from fatal overdose by providing them immediate access to safer opioid drugs. This approach is genuinely a public-health one, applying the logic of past efforts to protect people from H1N1 influenza by circulating safe drugs to anyone at risk. The H1N1 epidemic is no longer a threat to public health because accessible drugs (vaccines) protected the people at risk.
At B.C.’s Ministry of Health, expansion of injectable treatments is moving far too slowly, a death march fronted by government bureaucrats far removed from the realities of the overdose epidemic. Guidelines for the expansion of iOAT sat unreleased and collected dust for months as the ministry reviewed them; meanwhile, the body count increased by hundreds.
These guidelines work as an instructional manual and set out the criteria for accessing the treatment. Finally, the siOAT guidelines have been released under the leadership of the new B.C. Ministry of Mental Health and Addictions, along with instructions from Minister Judy Darcy to provincial health authorities to rapidly scale up injectable treatments.
However, the situation is increasingly bleak and getting bleaker every day. The crisis continues. Vancouver Coastal Health (VCH) has made little progress in expanding injectable treatments and has, instead, put more focus on BOOST—a program based on seek-and-treat HIV-AIDS programs of the past that will attempt to put drug users on oral-opioid treatments like Methadose, which is the recently reformulated version of methadone.
A recent study, though, suggests that this reformulation led to an increase in heroin and illicit fentanyl use. VCH seems content to double down on treatments that have not shown much success in stemming the tide of death and that may have even made the overdose epidemic worse.
One of the major obstacles to ending this overdose epidemic is the startling lack of urgency among some provincial and local decision makers. The often stigmatizing images of the overdose epidemic that the public sees on TV and in the media—overdoses being reversed in alleyways, or ambulances speeding down Vancouver’s Hastings Street—are not the images that truly represent this epidemic. The images people need to see won’t grab their attention like these do. The images people need to see wouldn’t generate a lot of interest.
But it would sure paint a picture of bureaucratic negligence. It’s a picture worth a thousand deaths.More