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The changing nature of Canada's overdose crisis calls for a more aggressive response, experts say

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An evolving mix of opioid cocktails and changing drinking habits mean governments must now respond more aggressively to the overdose crisis, experts say.

More than 32,000 Canadians have died from toxic drug overdoses since 2016, according to data released by Health Canada last month.

More than 3,500 people died from overdoses in the first half of 2022 (data only available through June). That’s nearly 20 people a day and more than half the number of people who died of drug overdoses in the first year of the pandemic.

The federal government has spent hundreds of millions of dollars to fight the crisis by funding community projects such as safe consumption sites and safe supply programs and improving access to naloxone, a drug that can reverse the effects of an opioid overdose.

People hold banners during a march to remember those who died during the overdose crisis and to call for a safe supply of illicit drugs on International Overdose Awareness Day in Vancouver on August 31, 2021. (Darryl Dyck/The Canadian Press)

Fentanyl remains a determining factor in overdose deaths; According to Health Canada, 76% of all overdose deaths involve this opioid. But a growing number of overdose deaths involve more than one substance.

Health Canada said just under half of the 3,556 overdose deaths that occurred in the first half of last year involved a stimulant like cocaine or methamphetamine. At the same time, health services increasingly warn against illicit opioids contaminated with depressants such as benzodiazepines or “benzo”.

Tara Gomes of the Ontario Drug Policy Research Network said the two trends are likely linked.

“What we’re seeing more and more are benzodiazepines in the opioid supply. So they’re actually mixed with fentanyl,” she said.

That means people who use these drugs aren’t necessarily aware they’re taking the benzo with the opioid, she said.

But Gomes said some are intentionally using stimulants to counteract the sedative effects of a cocktail of opioids and benzos.

“A lot of times what they’re looking to do is counteract those effects, try to moderate the effects of the opioid so they’re not too sedated,” she said.

Benzodiazepines are dangerous when combined with an opioid like fentanyl because the added sedation increases the risk of overdose, according to Health Canada.

And the life-saving drug naloxone doesn’t work on benzos.

Cases for naloxone injection kits and supplies needed for naloxone injections. (Flora Pan/CBC)

“It makes the job harder for already overstretched overdose prevention services,” Cheyenne Johnson, executive director of the British Columbia Center on Substance Use, told CBC News.

Johnson also said that a mix of opioids and benzos can also complicate drug treatment by intensifying withdrawal symptoms. These symptoms can include extreme anxiety, sweating, and dangerous seizures.

“It makes it very complicated to manage their cravings and withdrawal when there are multiple types of potentially unknown substances like benzodiazepines,” she said.

Fentanyl and benzodiazepines alone can be used in clinical settings, but Johnson said substances never intended for human consumption are showing up in the illicit drug supply.

Xylazines, an animal sedative, and nitazenes — a synthetic opioid believed to be several times more potent than fentanyl — are two such drugs, Johnson said.

“The sky’s the limit for what’s to come,” she said.

Karen McDonald, head of Toronto’s Drug Checking Service, echoed Johnson’s point, saying the illicit drug supply “is becoming more contaminated, more toxic and less predictable.”

“[It’s a] recipe for disaster,” she said.

The McDonald’s organization tests samples from the illicit drug supply to warn people who use drugs of what is mixed in. But while the technology used by her organization is quite sophisticated, she said the illicit supply is changing so rapidly that it feels like they’re “constantly playing catch-up.”

An infrared spectrometer tests street heroin for fentanyl. (Darryl Dyck/The Canadian Press)

“By the time we may have improved our method to better identify or provide better information to a service user, this drug may in fact have come and gone from the supply and something else that is potentially more harmful has happened,” McDonald said.

Many harm reduction services do not have access to the same technology used by the McDonald’s organization. Johnson said most only use inexpensive mechanisms meant to detect fentanyl alone.

“We don’t have these kinds of low-cost solutions for things like nitazene and trying to keep up with that designer drug opiate market and contamination is next to impossible,” Johnson said.

A “rapid response” fentanyl test kit, complete with test strip.
Fentanyl test strips are used to detect the presence of the substance in illicit drugs. (Jane Robertson/CBC)

More people die after smoking

In 2021, up to three-quarters of people killed by British Columbia’s toxic drug supply in parts of the province had smoked – not injected – their lethal dose, according to figures from the coroner’s service.

Gomes and some of his colleagues released a report last November that found a similar trend in Ontario. Between January 2018 and June 2021, half of opioid poisoning deaths in the province were related to smoking or inhalation.

The trend makes it difficult for safe drinking programs, which are more focused on needle users, Gomes said.

“It’s very difficult in those settings because if you’re smoking a drug, it’s a lot harder to contain that substance,” she said.

A user prepares to smoke fentanyl. (Elizabeth Withey/CBC)

Johnson said many safe drinking programs are struggling to keep up with the trend because adapting to inhalant drinking could put them at odds with zoning restrictions and other laws or regulations.

“It’s a bit more complicated process, but it’s by no means insurmountable,” Johnson said.

The Whitehorse Safe Consumption site, for example, opened for inhalation consumption in May.

Liberal MP Brendan Hanley, who previously served as Yukon’s chief medical officer of health, said smoking was generally the preferred method of consumption in the territory and therefore change was needed.

“That’s where you see people go. We have very few people going to the injection table, but we have a lot queuing up for the inhalation room,” he said. .

Experts call for safe supply expansion

While improving access to safe consumption sites would help, McDonald’s said a more permanent and less ad hoc strategy is needed to tackle the root cause of the crisis.

“These services, they’re still seen as temporary, which just doesn’t work when you’re in the middle of a crisis and you’re losing so many people,” she said, adding that governments need to consider formal arrangements. for harm reduction services.

Johnson said she thinks Canada needs to move more quickly away from a policy of prohibition toward a health-focused model for illicit drug use.

The federal government’s Bill C-5, which became law in November, gives police the ability to divert people found in possession of illegal drugs to health services instead of laying charges. The federal government is also granting British Columbia a Criminal Code exemption to decriminalize the personal possession of illegal drugs in the province.

But a federal task force of substance use experts unanimously recommended in May that the decriminalization of personal possession be applied nationwide.

“Criminalization of simple possession harms Canadians and must end,” the task force report says, citing issues such as the stigmatization of people who use drugs and the burden on the health care and criminal justice systems. .

While BC’s exemption will begin in late January, Toronto is still awaiting a response to a similar decriminalization request.

A briefing note prepared for Mental Health and Addictions Minister Carolyn Bennett suggests another 55 municipalities have expressed interest in decriminalization.

But Johnson, who was a member of the federal expert task force, said while nationwide decriminalization would be a “good first step”, it would not go far enough.

“Decriminalization has no impact on the toxicity of the supply,” she said.

Yukon Liberal MP Brendan Hanley in the House of Commons in December 2021. Hanley says Canada needs to expand secure procurement programs. (Adrian Wyld/The Canadian Press)

Hanley agreed and said Canada needed to provide a regulated and stable alternative to the illicit drug supply.

“We need to have secure supply as one of the options and we don’t see that enough,” he said, adding that it would complement treatment programs.

The expansion of secure supply programs was included in the list of recommendations from the federal task force.

CBC asked Bennett’s office and Health Canada whether the government intends to follow the task force’s recommendations. A government official told CBC that the government “agrees with the spirit” of the recommendations and is using them to inform its current approach to the crisis, but did not specify which recommendations, if any, would be fully implemented. implemented.

NDP MP Gord Johns says the government is not acting fast enough and has asked the auditor general to probe the government’s response to the overdose crisis.

“Canadians have every right to start losing faith in what this government is doing and what the minister is doing in response to this crisis,” he said. “It’s a lot of talk and very little action.”

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