Pubdate: Fri, 23 Dec 2016
Source: Medicine Hat News (CN AB)
Copyright: 2016 Alberta Newspaper Group, Inc.
Contact:  http://www.medicinehatnews.com/
Details: http://www.mapinc.org/media/1833
Author: Gillian Slade
Page: A11

LET'S CONSIDER ALTERNATIVES TO DEALING WITH FENTANYL CRISIS

Perhaps it is time to re-evaluate the best way to tackle the illicit
drug crisis.

Vancouver is facing epidemic proportions of people overdosing on
illegal drugs and many deaths. Safe injections sites are not making a
significant difference. They're calling for more detox and addictions
treatment programs but even that is not the answer.

The majority of males in emergency departments because of an overdose
are young people without a history of prescription opioid use, Dr.
Nick Mitchell, senior medical director, addictions and mental health,
Alberta Health Services (AHS), recently told the News.

Detoxifying is one aspect of treatment but depending on the person,
abstinence can lead to a dire situation, said Mitchell. After
abstaining for a while, the user loses their tolerance and a relapse
can be deadly. Medically-assisted addictions treatment moves people
off substances acquired on the street, hopefully, to
pharmaceutically-controlled substances such as methadone and
buprenorphine (commonly known as suboxone) given in secure
environments. There is the potential over time for the person to reach
the point where they are slowly weaned off those medications but not
everyone reaches that point.

In Vancouver this week someone in emergency after an overdose was
being told about addictions programs. They said they were already on
methadone.

In general, more people are seeking help for addictions, particularly
around opioids, but it is not clear whether this is associated with
the increased risk with illicit fentanyl, Mitchell told the News recently.

"I have seen a number of individuals clinically who have presented
with fentanyl overdoses, who have friends and family who have died
from fentanyl and still they struggle to stop," said Mitchell. "These
are intelligent people. Some of them are high functioning individuals
who are still maintaining jobs and family."

A program to get physicians to stop prescribing opioids is not keeping
people away from illicit fentanyl and we now know most have no history
of opioid prescription use.

Illicit fentanyl and carfentanyl is unpredictable and can be deadly.
This raises the question of whether we should consider making
fentanyl, the kind that can be obtained with a prescription, available
without a prescription from a pharmacy. At least the fentanyl from a
pharmacy would have been manufactured in a controlled laboratory
environment. We could still offer the range of programs to treat
addiction but the fentanyl would not be laced with a deadly substance.

Naloxone treatment for someone who has overdosed is no longer working
in the quantity it once was. A radio program from Vancouver this week
had audio of an emergency room where a physician said it is now
necessary to give higher and higher doses. For some it takes an
infusion of naloxone coursing through the addict's system for an hour
or so to stabilize them.

If we allowed people to access fentanyl from a pharmacy it could be
taxed to cover the cost of additional treatment programs to help
addicts. There is a chance it would put the drug traffickers out of
business too.

Society is not going to win the war on the illicit fentanyl overdoses
if we carry on doing what we have been doing all along. It is time to
consider alternatives.

In the long run we need to look at the reasons for an increasing
number of people becoming addicts and start addressing that in early
childhood.
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MAP posted-by: Matt