On May 29th, after a spike in Fentanyl overdoses and deaths, the Liberal government announced new measures to combat the arrival of this latest drug in the province.
A partnership between the City of St. John’s, the province, Eastern Health, and community groups – as well as the introduction of potentially life-saving Naloxone kits used in the case of overdose – were the initiatives highlighted in a press release.
In this confabulation between government, health services, and community resources to address an already deadly spate of drug overdoses, there are echoes of the OxyContin crisis of the past decade.
In 2004, eight deaths prompted an inquiry and report into recommendations to stem the tide of preventable overdose in the province. Tree Walsh, current Coordinator for SWAP – The Safe Works Access Program – returned from Toronto in 2004 just as the government release its report on OxyContin.
“The issues around OxyContin have never gone away,” says Walsh. “And Fentanyl is just the next chapter in the same crisis. Fentanyl, like OxyContin, is the flavour of the week. That’s the current issue. Next year it may be something different. But it is an opioid crisis.”
The establishment of SWAP was one of the items implemented based on recommendations from the 2004 OxyContin report. With its emphasis on a philosophy of “harm reduction,” SWAP offers drug users a safe way to acquire and dispose of needles and represents a shift away from what Walsh calls the “punitive model of care.”
“The report, in essence, says implement harm reduction as an approach to addictions,” says Walsh. “Not in those words, but it calls for a needle exchange to start … it calls for street outreach programs … it calls for a methadone clinic. And it took Eastern Health about six years to get that off the ground. And it called for a medical detox.”
Walsh says it was approximately 10 years before Eastern Health implemented the medical detox recommendation. However, in exchange, the regular detox program was eliminated.
“Access to detox in St. John’s is a problem because it’s medical now,” says Walsh. “The folks who don’t need medical detox are forced to go through that process.
“Access to detox in St. John’s is a problem because it’s medical now,” says Walsh. “The folks who don’t need medical detox are forced to go through that process. So they have to go to the Waterford to get into the detox on the weekend. It’s become so convoluted. But that’s where Eastern Health is.”
13 years after the release of the report on the OxyContin crisis, Walsh has seen some gains in the awareness of harm reduction in the health care system. However, certain aspects of the punitive model remain. For example, if you are a drug user, paradoxically, using drugs will get you ejected from the methadone program.
Aside from the loss of the regular detox program, Walsh says other major gaps remain from the OxyContin findings.
“To this day SWAP is the only needle exchange in the province. We do have an office in Corner Brook. But the rest of the province is in dire need in terms of harm reduction services.”
SWAP will mail out needles to the rest of the province, but the service lacks the ability to talk to someone face to face. Funding for SWAP, originally $50,000 for the entirety of its operations, did see some increase in its first years.
“Somewhere along the way, the increases stopped,” says Walsh. “But the costs keep rising, so the situation being now we have an underfunded safe works access program not meeting the needs of people. But doing the best we can with what we’ve got.”
With Fentanyl showing up in cocaine and pills, it is not only intravenous drug users who are at risk of overdoses. And more overdoses are coming says Walsh. “Next it’s the George street partiers. Because Fentanyl is being cut into everything. While deaths make the news, the overdoses don’t.”
With Fentanyl showing up in cocaine and pills, it is not only intravenous drug users who are at risk of overdoses.
Pop-up Naloxone tents will be at community events this summer like The Regatta and The Folk Festival giving away kits. 1200 kits arrived in the province in May, with 600 given to the health care authorities and 400 to SWAP.
“400 have been given out and SWAP has given out about 370 of them,” says Walsh. “So the uptake within the health care authorities seems to be glacially slow.”
For Walsh, changing perceptions of Naloxone is part of this current public outreach.
“This is like first aid. If you know anyone who uses any drug – the George Street crowd, ecstasy, anything that they’re doing – get a kit.”
Read the 2004 OxyContin Task Force Final Report here: http://www.health.gov.nl.ca/health/publications/oxycontin_final_report.pdf
Whenever the Gummint™ or the Establishment™ brings up the opioid crisis, they either (1) ignore the connection between opioid use and chronic pain or (2) claim that opioids are not very effective in the treatment of chronic pain or (3) say that we need programs for helping those with chronic pain. Then, in regard to (3), those programs either never seem to materialize or have incredible wait lists. Laughably, Eastern Health’s Centre for Pain and Disability Management referral form states that “Clients referred should … be able to attend the program 4 days per week from 9 AM – 3 PM for a five week period…”. Excuse me? Six hours per day, four days per week, for five weeks? I’ve spoken with a number of people with chronic pain who all say that, if they could make that kind of commitment, then they wouldn’t need a pain management program. It’s only through a combination of opioids and NSAIDs that I can (sometimes) get out for a couple or three hours in a day to pick up a few groceries or get to medical appointments. And, yes, we’ve tried it all _ physio, acupuncture, lots of mindfulness meditation, which helps a bit, supplements and all of the fashionable meds like anticonvulsants and low dose antidepressants, muscle relaxants, etc., etc. Yeah, even marijuana. Only the opioids and NSAIDs give credible, if temporary and not complete, relief. Oh, shut up about carbs and chronic pain; yes we’ve been the anti-inflammatory diet route.