Meet people where they are: harm reduction and the opioid crisis in British Columbia

British Columbia is in the midst of a public health emergency, declared in April 2016 in response to the increasing overdoses and overdose deaths in the province.

Last year there were 922 deaths from illicit drug overdose, up from 513 in 2015, according to the BC Coroner’s report. There were no deaths at supervised consumption or drug overdose prevention sites, part of the arsenal of harm reduction services used to combat the current crisis.

We sat down with BCCDC harm reduction lead and SPPH Professor Jane Buxton (JB) and Associate Professor Eugenia Oviedo-Joekes (EOJ) to talk about their work in this field of public health, what harm reduction involves, and what measures they would like to see to address the crisis.

What is harm reduction? Why don’t people just stop taking drugs?

EOJ: Harm reduction refers to policies, programs and practices that aim to reduce the harms associated with the use of substances in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, and the focus on the wellbeing of people who continue to use drugs. The evidence for harm reduction services is overwhelming – they tend to see reduced use of illicit drugs, and improved mental and physical health.

Addiction is a chronic relapsing disease. Everybody accepts we cannot cure diabetes, but we can stabilize a patient for years – why not accept this about substance use issues?
Associate Professor Eugenia Oviedo-Joekes

BCCDC harm reduction lead and SPPH Professor Jane Buxton

JB: Harm reduction is a non-judgmental approach which meets people where they are and treats individuals with respect and compassion. The reality of people’s lives is they are taking drugs for different reasons, including past trauma. Poverty and homelessness can make recovery harder. Stigma and shame around drug use may increase social isolation and prevent people from seeking help.

Dr. Buxton, why do you say people with lived experience of substance use issues are the ‘real experts’ in the opioid crisis? Does Take Home Naloxone work – and why?

JB: People who have taken drugs, or work with people with substance use disorders, have direct experience of the crisis – they are part of the community who respond to the overdoses, who help and look out for each other. They know the realities of the situation and what strategies could work and barriers to accessing programs.

The Take Home Naloxone program has seen more than 5,400 overdose reversals – it is certainly saving lives. Opioid overdoses can cause a person to stop breathing. Naloxone temporarily reverses the overdose, allowing a person to breathe again.

Being trained to respond to an overdose can be empowering for a person who uses drugs.
Professor Jane Buxton

Dr. Oviedo-Joekes, what would you say to the argument that giving medically-prescribed heroin to people with substance use issues is making an illness worse?  

EOJ: There is an important minority of people – possibly about 10-15% of people with chronic substance use issues in Canada – not reached or engaged by standard treatments. Many will not even consider engaging in other first line effective treatments such as methadone, and continue injecting illicit opioids, with the tremendous associated risks. This is the reality we are facing.

Participants in our trials received pharmaceutical grade opioid on site, thus drastically decreasing the use of street opioids. While on treatment, there was little to no risk of overdose, they were in daily contact with the health care system, and saw improvements in many areas, including a decline in illegal activities performed, because they didn’t have to find money to buy drugs.

Not only do these programs mean less overdoses and crime, they allow us to reach people in the most need – we are able to engage them with other services, such as housing, mental health, and more.

What are some measures you would like to see taken to address the overdose crisis?

JB: There is no easy simple solution; we need a collaborative and multipronged approach to prevent overdoses happening and provide a rapid response when an overdose occurs. This includes improving access to opioid agonist therapy such as methadone and suboxone and other alternative treatments and ensuring people can use drugs in an environment where people can respond quickly if an overdose occurs (such as supervised consumption sites, overdose prevention sites, friends and loved ones having naloxone).

Associate Professor Eugenia Oviedo-Joekes

We have to change attitudes, and make people feel supported so they come forward for help and not hide their drug use, which increases the risk of harmful consequences.
Professor Jane Buxton

EOJ: I would like to see a comprehensive approach that does not leave behind any of the evidence-based options available. Treatment with pharmaceutical-grade injectable opioids plays a small part in this response, however, it aims to reach the most vulnerable long-term street opioid injecting users. As such, expansion of clinics such as Crosstown across Canada, can help provide safe alternative treatments for those in dire need.

I hope the policy makers transform the evidence from our research into programs – at some point, we will have to be brave, and push for treatments that are evidence-based and compassionate.

Dr. Buxton presented ‘More than just numbers: hearing from the real experts in the opioid crisis’ on March 3rd in Michael Smith Laboratories Room 102. Click here to view the recorded talk.