Pubdate: Mon, 14 Apr 2014
Source: Toronto Star (CN ON)
Page: GT2
Copyright: 2014 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Joe Fiorito

WE NEED TO TALK ABOUT SAFE DRUG USE

Here are one or two things you might not know about the safe use of
dangerous drugs; and yes, safe is a relative term.

I had not seen my pal Frank in a while, and so I was pleased when we
bumped into each other. As soon as we had said hello, he invited me to
an event - he said he was going to speak at a public health workshop
designed to educate those who work with drug users.

Frank is a drug user. He uses crack. He is thoughtful and insightful,
he has had his share of troubles. He is also the first guy I ever met
who has a maintenance crack habit. I had not known that such a thing
was possible before I met him.

Prior to that, my experience with crack was anecdotal, and based on
what I had seen in my neighbourhood - you start using it one day and
three months later your teeth are gone and you are covered in sores
and crawling on your hands and knees on the sidewalk. Frank is proof
that this is not always or inevitably the case.

I showed up early to the event, well before Frank was due to speak. I
found a seat and began to listen as a tall and slender fellow
explained the safe use of crack; and yes, if people are going to use
drugs then they ought to use them as safely as possible and so, to
that end, there were safe crack use kits on the table.

They are a tool of public health.

Among other things, each kit contains a glass pipe, a sort of Pyrex
rod open at both ends, used for smoking.

Someone in attendance looked at the pipe and frowned thoughtfully and
asked why the crack didn't fall out when you were smoking it. The
fellow explained that, when you put a flame to it, the crack sort of
melts in place. I did not know.

I take him at his word.

The talk then turned briefly to opioid drugs - heroin and morphine;
also painkillers such as OxyContin, fentanyl and so on - and the
fellow began talking about overdoses.

It seems some drug users will try to extract and inject the active
ingredient contained in a fentanyl patch, and it is very easy to get
it wrong and overdose; and no, I cannot imagine.

But the fellow talked of naloxone, an injectable drug which is new to
me; it is used to counteract an opioid overdose; it is a lifesaver and
a magic, if short-term, bullet.

What does naloxone do? "It gets in the way of the opioid receptors. It
works for 45 minutes or so; that's how long you have. You do the shot,
you call 911." And if you are in luck, the ambulance comes and
finishes saving your life. Naloxone is intended for opioid overdoses
only.

Back to crack cocaine: someone asked about how to prepare it for
injection. I am fearful of explaining how that is done because I might
get it wrong. But as the fellow was explaining, he did something very
smart.

He demonstrated how to use an alcohol swab to sterilize yourself
before injection. He rolled up his sleeve and held a swab and said,
"You swipe with one side of the swab, in one direction."

He said doctors nurses in hospitals do not always get this right; they
tend to swipe forward and then back again over the same spot, or they
use the swab to go around in circles on the skin, which sort of
nullifies the purpose - you want to wipe the skin clean.

This fellow should know. He has been injecting himself with drugs
since 1980, which is a lot longer than most nurses have been nursing.

Back again to overdoses: someone asked what to do in the absence of
naloxone. The fellow said it was important to keep people breathing,
to do chest compressions, and to keep people talking.

We need to keep talking.

And what did Frank have to say when it was his turn? More anon. 
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MAP posted-by: Jo-D