Drug Abuse - Harm Reduction vs Treatment

[ronandannette]

I'm rather shocked and just don't understand public policy on this issue. Yesterday, the Provincial Health Authority in Alberta declared Fentanyl abuse to be a public health emergency. Almost overnight they have de-scheduled the drug naloxone (which reversed opioid overdose); meaning it no longer requires a prescription and can be purchased at any pharmacy and be administered by anyone. I'm not sure what the cost will be but presumably it will not be prohibitive even if price subsidies are necessary.

Our governments (provincial and municipal) are also investing millions of dollars in "safe-shooting" facilities at 6 locations in the various population centres. They are open 24/7 and medical supervision is provided for drug users; ostensibly to help with hygiene issues and intervene in over-doses.

And the most confounding thing is that access to public, in-patient treatment is practically non-existent. The few private programs in this province (I just did a quick google search) cost several thousand $$ per week. Because of our health-care system, very few people have private insurance that would cover this kind of thing; I checked mine out of curiosity and it would NOT.

I'm not sure if I'm asking a question, looking to stimulate discussion or just ranting - there's just so much about this that seems wrong.

 

[xjillianpaige]

i think that the two shouldn't be mutually exclusive! if we reduce harm, we save lives and build trust and can help people into treatment! but we need affordable, accessible treatment! i don't know a LOT about addiction and recovery/treatment as i didn't specialize in it, but i think the best way to approach it (like many other things) is with empathy. i wish i had taken some classes in it, but grad school is only 2 years and i needed to meet the class requirements for my speciality.

 

[lullwater]

The patent for naloxone has expired and the generic should be somewhat affordable.

Many countries don’t have treatment programs and use incarceration. In Japan the first step is to detain a drug abuser in jail without being charged with a crime for 20 days in the hope they sober up and stop using. They have some success with this as there is almost zero access to smuggled contraband. Japanese prison food contains a sedative to help keep the inmate population calm, but this helps with withdrawals as well. If this doesn’t work the offender is arrested, convicted and will be incarcerated for several years; no distinction between marijuana, heroin, cocaine or whatever when the judge passes sentence for drug use.

 

[low-key]

reading what any of our Country's are spending money on, they should provide us drugs when reading it

 

[MillauFr]

Not sure if a new approach will work but at least many people are starting to understand that throwing many of them in jail does not work.

 

[jevs]

Most Western countries have a harm reduction policy in place as opposed to a zero tolerance. With regards to the safe shooting policy we've had this in place for several years afaik (not 100% up with recent drug use policy) and more countries should do it as it has decreased the incidence of disease transmitted by blood i.e. HIV. as there's been a decline in needle sharing.

Harm reduction doesn't solely focus on the individual, but the general public as well. For example, I much prefer to see the syringe bins in public bathrooms as opposed to seeing syringes just thrown anywhere - and people do use the bins.

 

[momz]

I don't know what the answer is. But, our community has seen a spike in heroine use and overdose, as well as a dramatic increase in the incidence of HIV in relation to needle sharing.

About a year ago, a local pharmacy had a woman die in the bathroom form a heroine overdose. Apparently she went into the bathroom to shoot up and was found several hours later when the manager arrived and was checking the bathrooms. (Happened during the night). The staff did not notice her go in there and they were obviously not doing the required hourly checks of the bathrooms.

The city I live in has a drug treatment program where people go daily to get their dose of suboxone (or whatever), that is used to replace a persons use of heroine. They have to take it in the presence of the person dispensing it (so they are not diverting it), and they have to pass random drug screens to stay in the program. If they miss their appointment, they may be subject to incarceration. I have no idea if this program works to get people off drugs and back to being contributing members of society.

All I am certain of is that drugs destroy lives and families.

 

[Colleen27]

Affordable, accessible drug treatment is virtually unheard of here in the US too.

I can see the sense in a harm-reduction approach, given the dismal success rate of rehab even when it is available. But I'd rather see rehab funded more fully and support systems made available to help with long-term recovery, and see opiate production and prescription reined in to reduce addiction rates to begin with. When crack was epidemic, we went after suppliers. Now opiates are epidemic, but because the suppliers are drug companies we approve their annual production increases and go after the users.

 

[Pea-n-Me]

http://www.forbes.com/sites/ritarub...ot-up-coming-to-a-city-near-you/#1af2a6963382

 

[pls5286]

As a former paramedic, I am vey familiar with the use of narcan, or naloxone (generic name). I have pushed it many times through the IV, as well as given through the nose when an IV could not be secured (which happens often with IV drug use). When someone pushes narcan, you should be prepared for a combative patient more often than not. It counteracts the drugs in the system and many times will go into sudden withdrawals. Also, narcan is only effective on opiod overdoses, not on the nonopiates such as cocaine, meth, ecstacy, LSD, and other similar drugs. Any time Narcan is used, the person should seek medical treatment immediately.

 

[cabanafrau]

The patent for naloxone has expired and the generic should be somewhat affordable.

Many countries don’t have treatment programs and use incarceration. In Japan the first step is to detain a drug abuser in jail without being charged with a crime for 20 days in the hope they sober up and stop using. They have some success with this as there is almost zero access to smuggled contraband. Japanese prison food contains a sedative to help keep the inmate population calm, but this helps with withdrawals as well. If this doesn’t work the offender is arrested, convicted and will be incarcerated for several years; no distinction between marijuana, heroin, cocaine or whatever when the judge passes sentence for drug use.

This is fascinating.

 

[cabanafrau]

IMO much could be avoided with better, more accessible and affordable mental health care, as addiction and mental health issues often go hand in hand. I suspect harm reduction is largely to deal with the crisis fentanyl is presenting at this time, as well as recognizing the huge price tag associated with repeated, long-term incarceration.

 

[Pea-n-Me]

This is fascinating.

Many moons ago I worked in a city ER. One Saturday morning a car pulled up to our ambulance doors. Several people pulled a newly-dead woman of the car, left her on the ground, and took off. It was the first time I saw narcan used. We somehow got her inside and placed an IV. I happened to be standing to her left when she came around. She sat bolt upright, suddenly, and grabbed my arm, screaming, "Bring me back! Bring me back!" It was one of the most dramatic things I'd ever seen at that point. She was completely freaked out. I just told her, "You're ok. You're here with us now", etc. She knew she was gone. Somehow. She left a welt on my arm.

I've thought about that a lot as I've followed stories and discussions about our current drug crisis. I never saw that woman again, and don't know even what her situation was. But she was somone's daughter, maybe sister or mother; someone's friend. She had a problem. She needed help.

Opioids take over receptors on the hemoglobin molecule, a blood component that delivers oxygen to cells, and that can lead to respiratory depression, and respiratory arrest in some cases, followed then by cessation of activity in all other organs, then death. Narcan reverses that process; it essentially knocks the opiod off the hemoglobin molecule. If used quickly enough, breathing can resume.

I was quite surprised when I first learned that narcan was being used outside hospital or ambulance-type settings. But I also knew that we had an increasingly severe problem and many people were dying. It really hit home when it happened to a friend's son, who I knew to be a bright, handsome, engaging young man, with a promising future. One day I ran into his Dad, and was shocked to learn he'd been desperately trying to save his son's life for some time, essentially following him around and on three occasions, finding him overdosed, slumped over in his car near his drug den. My friend had kept this a secret, and was completely burnt out from trying to keep his son alive and get him help. He was almost to the point of giving up, he couldn't take it anymore. But, his son is alive to this day, and, last I heard, doing well, so his efforts paid off.

And I think that that is the idea behind some of these efforts, ie to keep the person alive so they can get help.

People don't much like drug addicts, and that's probably a lot of what's behind some of the dislike of these programs. I get that. People say it's a choice, and it usually is, the first time. Then it becomes a physical and psychological addiction.

Many of us know people addicted, even if we don't know we know them. These are our family, friends, neighbors, classmates, coworkers, employees, etc.

It's not a pretty issue to deal with, by any means. But I do think that getting help is a requirement for getting clean. Just things to think about when discussing this. It's everyone's problem because it affects all of us. Our friends and family members aren't immune. Hopefully, in understanding why this has happened, and making changes, we can help turn the tide. But it's definitely not going to be an easy fix.

 

[cabanafrau]

Many moons ago I worked in a city ER. One Saturday morning a car pulled up to our ambulance doors. Several people pulled a newly-dead woman of the car, left her on the ground, and took off. It was the first time I saw narcan used. We somehow got her inside and placed an IV. I happened to be standing to her left when she came around. She sat bolt upright, suddenly, and grabbed my arm, screaming, "Bring me back! Bring me back!" It was one of the most dramatic things I'd ever seen at that point. She was completely freaked out. I just told her, "You're ok. You're here with us now", etc. She knew she was gone. Somehow. She left a welt on my arm.

I've thought about that a lot as I've followed stories and discussions about our current drug crisis. I never saw that woman again, and don't know even what her situation was. But she was somone's daughter, maybe sister or mother; someone's friend. She had a problem. She needed help.

Opioids take over receptors on the hemoglobin molecule, a blood component that delivers oxygen to cells, and that can lead to respiratory depression, and respiratory arrest in some cases, followed then by cessation of activity in all other organs, then death. Narcan reverses that process; it essentially knocks the opiod off the hemoglobin molecule. If used quickly enough, breathing can resume.

I was quite surprised when I first learned that narcan was being used outside hospital or ambulance-type settings. But I also knew that we had an increasingly severe problem and many people were dying. It really hit home when it happened to a friend's son, who I knew to be a bright, handsome, engaging young man, with a promising future. One day I ran into his Dad, and was shocked to learn he'd been desperately trying to save his son's life for some time, essentially following him around and on three occasions, finding him overdosed, slumped over in his car near his drug den. My friend had kept this a secret, and was completely burnt out from trying to keep his son alive and get him help. He was almost to the point of giving up, he couldn't take it anymore. But, his son is alive to this day, and, last I heard, doing well, so his efforts paid off.

And I think that that is the idea behind some of these efforts, ie to keep the person alive so they can get help.

People don't much like drug addicts, and that's probably a lot of what's behind some of the dislike of these programs. I get that. People say it's a choice, and it usually is, the first time. Then it becomes a physical and psychological addiction.

Many of us know people addicted, even if we don't know we know them. These are our family, friends, neighbors, classmates, coworkers, employees, etc.

It's not a pretty issue to deal with, by any means. But I do think that getting help is a requirement for getting clean. Just things to think about when discussing this. It's everyone's problem because it affects all of us. Our friends and family members aren't immune. Hopefully, in understanding why this has happened, and making changes, we can help turn the tide. But it's definitely not going to be an easy fix.

Cannot even imagine dealing with the emergent situation face to face. I see the situation in the aftermath of the immediate crisis when criminal justice is involved.

BTW, I think you quoted the wrong statement from me. I found the Japanese situation fascinating and have never heard about it at all. So far no one I've asked at work knows anything about it either.

 

[Pea-n-Me]

Cannot even imagine dealing with the emergent situation face to face. I see the situation in the aftermath of the immediate crisis when criminal justice is involved.

BTW, I think you quoted the wrong statement from me. I found the Japanese situation fascinating and have never heard about it at all. So far no one I've asked at work knows anything about it either.

Ah, you are correct. For some reason I thought you were responding to the post above you.

 

[The Mystery Machine]

I'm rather shocked and just don't understand public policy on this issue. Yesterday, the Provincial Health Authority in Alberta declared Fentanyl abuse to be a public health emergency. Almost overnight they have de-scheduled the drug naloxone (which reversed opioid overdose); meaning it no longer requires a prescription and can be purchased at any pharmacy and be administered by anyone. I'm not sure what the cost will be but presumably it will not be prohibitive even if price subsidies are necessary.

Our governments (provincial and municipal) are also investing millions of dollars in "safe-shooting" facilities at 6 locations in the various population centres. They are open 24/7 and medical supervision is provided for drug users; ostensibly to help with hygiene issues and intervene in over-doses.

And the most confounding thing is that access to public, in-patient treatment is practically non-existent. The few private programs in this province (I just did a quick google search) cost several thousand $$ per week. Because of our health-care system, very few people have private insurance that would cover this kind of thing; I checked mine out of curiosity and it would NOT.

I'm not sure if I'm asking a question, looking to stimulate discussion or just ranting - there's just so much about this that seems wrong.

I am having a hard time understanding what your first point is. I think deregulating naloxone is probably a smart thing to do. More access to narcan more lives can be saved.

As far as point #2, I would say it is an experiment worth watching to see if it helps. Doing nothing is not good either.

Do you have out patient programs for drug addicts? I know the typical way to handle it is that the an addict or a mentally ill person, is arrested on another charge to get them help. Then they are put into a lock up ward and given some help (if possible). That is one way of playing the system here in the US.

 

[Bilberry]

For over coming addiction I enjoyed reading about the work of Dr. Meg Patterson. She is best known for helping famous rock stars over come their addictions. She worked with Eric Clapton, Pete Townshend of the Who, Keith Richards of the Rolling Stones, etc. Her treatment method was to use an electrical stimulation device that would raise the bodies natural endorphins/ opiate levels. These a somewhat common devices as they are sometimes used for treating depression.

What Dr. Patterson found is the body is able to handle high levels of natural endorphins without experiencing withdrawals. The natural endorphins are able to override synthetic created addictive drugs which allowed for minimal withdrawals for drug addicts. Some further information on Dr. Patterson can be read here:

MEET THE ROCK 'N' ROLL MISSIONARY
77-year-old Scot helped Clapton, Moon, Richards, other music stars

Read more at http://www.wnd.com/1999/08/3778/#C5Rsr0BEW7pdsbzL.99


Sadly, while many in the music world tried to help promote Dr. Patterson's drug addiction program, her ideas never took hold in the medical establishment. Dr. Patterson was a trained surgeon. Since she was a surgeon, those that worked with addicts never took work seriously.

Interestingly low dose naltrexone (LDN) also raises a persons natural endorphin levels. That is turn has been found to help many people with autoimmune conditions, such as Crohns, MS, etc. The problem with naltrexone, whether highdose or low dose, is that it can cause sudden withdrawals in opiate addicts.

 

[NFLDERS]

I'm rather shocked and just don't understand public policy on this issue. Yesterday, the Provincial Health Authority in Alberta declared Fentanyl abuse to be a public health emergency. Almost overnight they have de-scheduled the drug naloxone (which reversed opioid overdose); meaning it no longer requires a prescription and can be purchased at any pharmacy and be administered by anyone. I'm not sure what the cost will be but presumably it will not be prohibitive even if price subsidies are necessary.

Our governments (provincial and municipal) are also investing millions of dollars in "safe-shooting" facilities at 6 locations in the various population centres. They are open 24/7 and medical supervision is provided for drug users; ostensibly to help with hygiene issues and intervene in over-doses.

And the most confounding thing is that access to public, in-patient treatment is practically non-existent. The few private programs in this province (I just did a quick google search) cost several thousand $$ per week. Because of our health-care system, very few people have private insurance that would cover this kind of thing; I checked mine out of curiosity and it would NOT.

I'm not sure if I'm asking a question, looking to stimulate discussion or just ranting - there's just so much about this that seems wrong.

I hear, and feel your frustration. The thing that compounds this for ME is that Physicians sounded alarm bells on this very thing a decade ago, that fell on deaf ears!! According to an interview broadcast here a few weeks ago.