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  • Cheap, Easy, and Lifesaving—Naloxone Treatment for Overdose

    Cheap, Easy, and Lifesaving—Naloxone Treatment for Overdose

    How much does it cost to save a life? That question got a clear and striking answer this week in the case of overdose from heroin in the United States. A study published in the Annals of Internal Medicine found that distribution of the overdose antidote naloxone—a safe, non-abusable, and inexpensive medicine—to one in five heroin users in the United States could prevent as many as 43,000 deaths. The cost of distribution would be equivalent to some of the cheapest, most effective, and most accepted medical interventions, like checking blood pressure at a doctor’s office.

    The study used mathematical modeling to assess whether giving out naloxone was “worth it”—that is, to determine how much naloxone distribution would cost per “quality-adjusted” year of life gained. This is the measure used by economists and policymakers to compare health interventions and decide which ones are affordable. The naloxone study also investigated assumptions that patient advocates would rather not acknowledge—like whether it would be cheaper to let illegal drug users die, or to put them in jail. Those are ugly questions, but ones that certainly run through the minds of opponents of health services for drug users worldwide. The answer was that naloxone saves lives with costs far below what health or prison systems pay. For example, screening for cancer with colonoscopy costs over $50,000 per quality adjusted life year gained in the United States, and screening for HIV costs around $40,000.

    Naloxone distribution saves lives for as little as $400.

    The other question, of course, is whose lives are deemed worth saving. Drug overdose now kills more adults a year in the United States than motor vehicle accidents, or deaths from choking or accidental falls. Most of us have seen safety messages related to driving, choking, or minding our step, but naloxone and other measures to prevent overdose remain unknown to many at risk. As noted in an editorial in the same journal, co-authored by officials from the National Institute on Drug Abuse and the FDA, making new and easy-to-use formulations of the medicine can help. However, action can be taken now to make the medicine available to heroin users—actions that will prevent thousands of needless deaths, and spare family and friends who may have to watch helplessly as their loved ones stop breathing.

    – Daniel Wolfe

    Daniel Wolfe is director of the International Harm Reduction Development Program at the Open Society Foundations. This blog post was originally published on the Open Society Foundations website.

  • Drug Policy Leaders Honoured with Diamond Jubilee Award

    Drug Policy Leaders Honoured with Diamond Jubilee Award

    At an event to be held at Simon Fraser University’s Harbour Centre Campus this evening, Senator Pierre Claude Nolin will award sixteen individuals from British Columbia’s drug policy reform community with the Queen’s 60th Anniversary Diamond Jubilee Medal.

    Among the recipients are the Canadian Drug Policy Coalition’s Executive Director, Donald MacPherson, and steering committee members Philippe Lucas and Gillian Maxwell.

    “All of these recipients have worked to improve public health in their community. They have dedicated many years of their lives to participate in the implementation, evaluation and construction of programs to help those struggling with addictions or health issues to connect with the services and medication they need,” said Senator Nolin. “They have worked with municipal, provincial and federal governments to advance critical public health programs, and such work is indispensable to our nation as a whole.”

    In lieu of the Senator’s absence due to medical appointments, the event will be presided over by Philip Owen, former Mayor of Vancouver, and Senator Yonah Martin, who will present the medals.

    The event will also feature a special tribute to Irene Goldstone, former Director, Professional Education and Care Evaluation at the BC Centre for Excellence in HIV/AIDS.

    Full list of recipients:

    Donald MacPherson, Bud Osborn, Liz Evans, Dean Wilson, Maxine Davis, Gillian Maxwell, Ann Livingston, Philippe Lucas, Rielle Capler, Kirk Tousaw, John Conroy, David Bratzer, Dr. Evan Wood, Dr. Thomas Kerr, Hilary Black, Mark Haden.

  • Attorney Generals Speak Out On Pot Prohibition

    Attorney Generals Speak Out On Pot Prohibition

    Last Friday, in a commentary piece for the Globe and Mail, four former B.C. Attorney Generals came out in very clear terms and said what needs to be said: Canada’s pot laws don’t work.

    “As four former attorneys-general of British Columbia, we were the province’s chief prosecutors and held responsibility for overseeing the criminal justice system. We know the burden imposed on B.C.’s policing and justice system by the enforcement of marijuana prohibition and the role that prohibition itself plays in driving organized crime and making criminals out of otherwise law-abiding citizens.”

    – Ujjal Dosanjh, Colin Gabelmann, Graeme Bowbrick & Geoff Plant

    This is the paradox of prohibition. Rather than reducing the flow of drugs, prohibition generates a profitable black market, especially in the case of a widely used substance such as cannabis. While banning drugs and applying the criminal law to those who produce, distribute and possess them is intended to stifle the market and curb use, in reality, it only makes the market more robust and profitable where are any consumer demand is present.

    But the economic arguments against prohibition, while indisputable, neglect the real problem, which is moral in nature – prohibition puts our government, courts and police in a position where they are directly harming, rather than protecting, the Canadian public.

    The Canadian Drug Policy Coalition commends British Columbia’s former attorney generals for speaking out on the issue of cannabis regulation. The time has come for Canada to build a drug policy that does more good than harm – one that focuses on protecting the health and safety of Canadians.

    If you agree and would like to help, please consider becoming a member or signing up to our newsletter and we will keep you updated on upcoming events, actions and campaigns.

  • CDPC Heads to Panama to Create Alternative Scenarios for Drug Policy

    CDPC Heads to Panama to Create Alternative Scenarios for Drug Policy

    At the April 2012 Summit of the Americas in Cartagena, the members of the Organization of American States commissioned the OAS to analyze the hemisphere’s drug policies and to present and explore alternatives to address the issue of illegal drugs and drug use. On Saturday, January 20th, the OAS will formally commence this process in Panama City, Panama.

    The CDPC is proud to announce that CDPC Executive Director and SFU Adjunct Professor, Donald MacPherson, will be in attendance as part of the OAS’s scenario-building team and representative of Canada.

    “There is a real shift taking place in the global drug policy regime and the OAS review process is a good indicator of this. Governments from across the hemisphere are beginning to look for smarter alternatives to the war on drugs that are more effective at addressing both public health harms and public safety issues at the same time,” said MacPherson.

    “Who knows what will happen when we start imagining different futures in the area of drug policy. The important thing is to get people talking about alternatives – alternatives that have a hope of achieving success. The OAS process will begin to do that – it will bring people with diverse views together to look forward and see what kind of drug policies make more sense than prohibition. And in the end we all have the same goal – improved public health and safety when it comes to drugs and drug use.”

    The group will meet twice over the next two months and work together for four days each meeting. The meetings are being facilitated by Reos Partners and the Centro de Liderazgo y Gestion and will result in a report that will be used to inform the OAS’s position on drug policy.

  • The Insite Story: Transforming Health Care Services through Leadership, Risk Tolerance and Innovation

    The Insite Story: Transforming Health Care Services through Leadership, Risk Tolerance and Innovation

    It has been said that “an essential aspect of creativity is not being afraid to fail.” A PricewaterhouseCoopers’ survey conducted among the Times 1000 leading companies found that one of the common characteristics among the most innovative companies is that they take a balanced view of risk-taking behaviours. But a recent Conference Board of Canada survey conducted among Canadian health care executives confirmed that Canadian health care leaders have low tolerance for risk. Boards are perceived to be more risk-averse than executive teams by a fairly wide margin. As seen in the chart below, 57 per cent of respondents agreed or strongly agreed that their executive teams are risk-tolerant, compared to the 37 per cent who agreed or strongly agreed that their boards are risk tolerant, a difference of 20 points.

    blog-121812-2At a recent meeting of the Centre for the Advancement of Health Innovations in Vancouver, Insite, North America’s first legal supervised injection site for drug users, exemplified the importance of adopting a balanced approach towards risks. Insite’s leaders have taken bold actions, many of which carried significant risks, to implement innovative and transformative health care services.

    Insite was created to provide needed services to a population group that has suffered social stigma, abuse and social exclusion in Canada: drug-addicts. Before Insite, there were very few effective solutions to protect drug users from HIV and drug overdose but Insite has changed this reality.It offers clean injection supplies, withdrawal management support, detoxification areas and transitional recovery housing. A team of mental health workers, counsellors, nurses and physicians work with people with drug addiction to educate, intervene when necessary, plan a path to recovery and assist with re-integration in the wider community.

    And the results are outstanding: thirty-three per cent of Insite users are more likely to go to detox if they use the site once a week; 70 per cent are less likely to report syringe sharing, thus reducing HIV risk behaviour; and fatal overdoses within 500 metres of Insite decreased by 35 per cent after the facility opened compared to a decrease of 9 per cent in the rest of Vancouver. The benefits also extend to the heath care system and society: it has been estimated that supervised injection can save $14 million and 920 life years over 10 years due to a reduction in HIV, hepatitis and other medical interventions.

    Despite these proven benefits, Insite has had to fight legal battles to prove legitimacy. In 2006, the federal government deferred the decision to extend Insite’s special exemption from the Controlled Drugs and Substances Act, citing a lack of evidence to support the benefits of supervised injection. In a brave demonstration of leadership, Insite’s supporters took the matter to the Supreme Court of Canada, which in 2011, ruled unanimously to uphold Insite‘s exemption, allowing the facility to stay open indefinitely. Over the past nine years, more than one million injections have taken place at Insite under supervision and with clean equipment. It is the busiest supervised injection site in the world with over 1,200 visits every day.

    Insite’s leaders did not run away or gave up on their vision when the many obstacles appeared; they relentlessly focused on implementing change and appropriately and effectively managing the risks associated with a program of this nature. And these efforts have paid off: by partnering with the local health authority, Insite has been able to effectively bringing innovative health care services to marginalized populations who were previously unreachable.

    The program continues to work with low-income people to bring more opportunities for this hard-to-reach population to control their addictions and access effective, culturally appropriate chronic disease management and disease prevention programs. Insite’s daring leaders were not paralyzed by fear of failure. They are transforming health care services by demonstrating that the “best health care solution lies in treating all people humanely”.

    – Jeannette Lye

    Jeannette is a graduate of the School of Public Administration at Dalhousie University and in addition holds a Master of Science in Cultural Psychology from Brunel University and an undergraduate degree in psychology from Acadia University. This blog post was originally published on ConferenceBoard.ca

  • The Missing Link in Overdose Prevention

    The Missing Link in Overdose Prevention

    Long-established medical practice supports prescribing pre-loaded syringes of epinephrine to people having severe, life-threatening allergic reactions to allergens such as bee stings, nuts and shellfish. Patients, including children, are taught how to use them and carry them with them at all times in order to administer the drug without delay when they have a reaction. It “buys time” to allow the person to get to emergency medical care for monitoring and further treatment if needed. Epinephrine is considered an emergency drug and in most circumstances is administered by trained medical personnel in health care settings. However, the risk of death from a severe allergic reaction, when seconds count, outweighs the risks associated with dispensing the drug for unsupervised use by lay people in the community.

    For about thirty years, the harm reduction approach has been advocated by some in Canada as a means of promoting health and preventing needless injury and death among people who use drugs. It accepts that, whatever one’s beliefs about drug use and the people who use drugs, at any given time some people will use drugs unsafely. It holds that preventing unnecessary morbidity and mortality is best accomplished by a continuum of strategies which include educating drug users about the drugs they use, the risks involved, ways to mediate those risks, and the availability of supports to reduce or cease risky use.

    For example, research from Australia has shown that needle exchange programs prevented 32,000 HIV infections and almost 100,000 Hepatitis C infections in the first decade of the 21st century, saving over AU$1 billion – which represents a five-fold return on investment.  Despite decades of robust evidence supporting the efficacy of harm reduction, in general health care providers have been “slow adopters” of harm reduction strategies.

    In September 2010, the College of Physicians and Surgeons of Ontario (CPSO) described widespread addiction to strong painkillers, known as opiates, as a “public health crisis” in Ontario. Earlier this year, a potent long acting opiate known as OxyContin was removed from the Canadian market and replaced with a new formulation called OxyNeo, which is made with a time release coating which is more difficult to bypass, making it less accessible to people using it without a prescription. This has resulted in fewer people using the drug, but not fewer people addicted to opiates.

    Research from the United States shows that many former Oxycontin users turned to more readily accessible opiates such as fentanyl and heroin after Oxycontin was taken off the market there.Reports from police and addiction workers suggest the same is now happening here in Canada. One of the problems with this is that people have had to change from opiates with a precisely known strength to others with variable potency. The risk of overdose has increased as a result. Recognizing this, Ontario Health Minister Deb Matthews announced in April 2012 that her government was increasing resources to address opiate addiction, including distribution of “emergency overdose kits across the province.”

    Similar to the way in which we provide emergency epinephrine to people with life-threatening allergic reactions, distributing a drug called naloxone, which reverses opiate overdoses, has been saving the lives of people who have overdosed on opiates since 1995 in the UK and Germany. There are 150 such programs in 19 American states but so far only Toronto and Ottawa have naloxone distribution programs up and running in Ontario, eight months after the health minister’s announced support of the strategy.

    Naloxone distribution involves providing opiate users with education on overdose prevention, first aid, CPR, as well as naloxone administration in an overdose situation, which “buys time” to get someone to emergency care. The OHRDP received Ministry of Health funding to create a detailed guidance document, which they have compiled building on the work of the Toronto and Ottawa pioneers. It is replete with supporting documentation, current statistics, training manuals, sample protocols and medical directives (required legally to prescribe and dispense this medication to lay people). The naloxone has been purchased and is ready to be used by trained lay people.

    Few health care providers would argue that the opiate addiction crisis has gone away. Small communities are dealing with issues like heroin which they have never seen before. What is different in small communities is that the people using substances are much more dispersed and invisible (for more information, see “Below the Radar”). While it may be reasonable in large cities to focus overdose prevention in places where there are high concentrations of drug users, small towns need a more widespread system of interventions because the people affected are not to be found in a few highly visible areas.

    For example, Peterborough ranks seventh highest in the province for opioid related deaths.  Peterborough Police Chief Murray Rodd has warned that “already we are seeing an increase in heroin and fentanyl in our city,” which he is concerned will lead to “even more overdoses in the coming months”.  A network of Peterborough agencies is poised to roll out an evidence-based overdose prevention program, which includes naloxone training – the first for an Ontario county which includes many rural communities where 911 response times are longer than is common in large cities.  Supported by the local Medical Officer of Health, the police service and EMS, it will only reach the people it needs to if local health care providers get behind the initiative. One hopes that they will do so without delay, as the project will undoubtedly save lives and provide a model for other small and rural communities.

    One of the reasons we study epidemiology (what is causing injury and death) is to use that information to plan programs which will prevent unnecessary injuries and deaths. Health providers have an obligation to understand evidence based interventions available around opioid addiction and to use them to reduce deaths. Some may ask “is this really needed?” but when overdose death rates are so well documented, the answer is obvious. Saving even one person from a needless overdose death should be considered important. She is someone’s daughter, maybe someone’s mom. While the needs of opiate users may not resonate with health care providers in the same way as the needs of people severely allergic to bee stings, when we have an evidence-proven lifesaving intervention, we are obligated to offer it widely and without delay.

    -Kathy Hardill

    Kathy Hardill is a Primary Care Nurse Practitioner at a clinic which includes patients whose health is made vulnerable through homelessness, poverty and other risk factors. This blog post was originally published on HealthyDebate.ca
  • Breaking the Taboo

    Breaking the Taboo

    The CDPC is proud to join together with the Beckley Foundation, Virgin Unite, Sundog Pictures, Avaaz.org, The Global Commission on Drugs, and civil society NGO’s from around the world in calling for a fundamental review of global strategies in response to drugs.

    Breaking the taboo is a bold new international challenge. At the heart of the initiative is a groundbreaking documentary film that uncovers the UN sanctioned war on drugs, charting its origins and its devastating impact on countries like the USA, Colombia and Russia. Narrated by Morgan Freeman and featuring prominent statesmen including Presidents Clinton and Carter, the film follows The Global Commission on Drug Policy on a mission to break the political taboo and expose the biggest failure of global policy in the last 50 years.

    www.breakingthetaboo.info

    We encourage you to get involved, read the Beckley Foundation letter, sign the AVAAZ Campaign, and join the conversation on twitter using the hashtag #breakingthetaboo.

    Global commissioner on drug policy Richard Branson hopes “this film will open people’s eyes on the war on drugs and the failed war on drugs and make it easier for people who want to be brave and do something about it.” Among those featured are Colombian president Juan Manuel Santos and former US president Bill Clinton, who admits bluntly that the US-led war on drugs in Colombia “hasn’t worked”. Clinton also talks about the need for rehabilitation rather than incarceration when dealing with people with addictions. Sir Richard said countries such as Portugal and Spain, where drug users receive treatment rather than being jailed, provide a template. He believes that legalisation of cannabis is “inevitable”. “I have hardly ever come across a politician that won’t say – off the record – what needs to be done … in the end they just need to be brave,” he said.

  • Supervised Consumption Services and Community Support

    Supervised Consumption Services and Community Support

    Supervised injection sites help save lives and protect communities. This was the conclusion of over 30 research studies on Vancouver’s own supervised injection site (SIS) known as Insite. And Canada’s Supreme Court agreed in September 2011, ordering the federal Minister of Health to grant a Section 56 exemption to the Controlled Drugs and Substance Act to allow Insite to continue to operate.

    To scale up harm reduction and support the development of similar services throughout the province, the BC Ministry of Health has now revised its “Guidance Document for Supervised Injection Services.” Written for health care professionals, it provides advice to health authorities and other organizations considering supervised injection services in their local areas.

    According to provincial policy, anyone who wants to offer this service will need to consider how they will sustain the support of local groups like medical health officers, police departments and other potentially interested groups. The decision of Canada’s Supreme Courts makes brief mention of future applications for a section 56 exemption:

    [153] The CDSA grants the Minister discretion in determining whether to grant exemptions. That discretion must be exercised in accordance with the Charter. This requires the Minister to consider whether denying an exemption would cause deprivations of life and security of the person that are not in accordance with the principles of fundamental justice. The factors considered in making the decision on an exemption must include evidence, if any, on the impact of such a facility on crime rates, the local conditions indicating a need for such a supervised injection site, the regulatory structure in place to support the facility, the resources available to support its maintenance, and expressions of community support or opposition.

    This last sentence has raised concerns about the likely success of future supervised consumption services. Despite overwhelming evidence of their successes, harm reduction services continue to generate public controversy, meaning that some members of a community are likely to object to supervised consumption services. But the existence of opposition does not necessarily mean that potential applicants must halt their efforts. In fact, the Supreme Court’s judgment is not a checklist of requirements for a successful application but rather a description of the factors the Minister must consider when making a decision. Potential applicants must be able to demonstrate that they have gauged public support and can offer evidence that it exists. Applications, as the B.C. provincial government suggests, must include evidence of positive support along with opposition.

    It is important to remember that Insite did not necessarily start out with full community support. Rather, over time, and as the facility continued to operate, the surrounding community felt its positive effects and researchers were able to demonstrate its effectiveness in terms of health and social order. This does not mean that if one group objects then the application will necessarily fail. Potential applicants for an exemption will need to describe what efforts will be made to respond to community concerns and they will need to consider how they plan to educate their community about the positive effects of these services.

  • Coalition Spotlight: Canadian HIV/AIDS Legal Network

    Coalition Spotlight: Canadian HIV/AIDS Legal Network

    The HIV epidemic is one of the most crucial public health issues of our time. What at one time seemed to be an insurmountable challenge has been abetted by education, research, innovation, and an immeasurable amount of hard work. The tools to curb the spread of HIV and improve the lives and health of those living with the disease are now more widely available, but the possibility of fostering an AIDS-free generation still faces a number of obstacles, most of which relate to unrealized human rights, access to medicine, harm reduction, and unjust laws.

    One of most prolific groups working on solving the problems that are currently hindering the fight against HIV/AIDS is the Toronto-based Canadian HIV/AIDS Legal Network. Celebrating its 20th year of operations this December, the Canadian HIV/AIDS Legal Network is Canada’s leading advocacy organization dedicated to legal and human rights issues related to HIV/AIDS. The network’s mission is to promote the human rights of those living with and vulnerable to HIV/AIDS, in Canada and abroad, through research and analysis, advocacy and litigation, public education and community mobilization.

    One such issue that the Legal Network is currently working on is the matter of syringe exchanges in Canadian prisons. Syringe exchange is critical to any comprehensive strategy to prevent the spread of infectious diseases, but the distribution of sterile injection equipment is not currently permitted within any Canadian prison — despite the overwhelming evidence of the benefits of prison-based needle and syringe programs (PNSPs) around the world

    To challenge this policy, the Canadian HIV/AIDS Legal Network, along with Prisoners with HIV/AIDS Support Action Network (PASAN), CATIE, the Canadian Aboriginal AIDS Network (CAAN) and Steven Simons, a former federal prisoner, launched a lawsuit on September 25th against the Government of Canada over “its failure to protect the health of people in prison through its ongoing refusal to implement clean needle and syringe programs to prevent the spread of HIV and hepatitis C virus (HCV) in federal institutions.”

    Rates of HIV and hepatitis C among Canadian prisoners are 10 to 30 times higher to that of the overall population. Although illicit drug use is strictly prohibited within correctional facilities, its prevalence is an undeniable fact.

    While the question of giving prisoners access to clean injection equipment might at first glance seem counterintuitive, it’s actually quite straightforward given the evidence that PNSPs benefit prisoner health, and in turn, the public health at large.

    For more information on the court case and PNSPs, visit the Canadian HIV/AIDS Legal Network’s website for the campaign – Prison Health Now.

    In addition to matters directly related to drug policy such as PNSPs, the Canadian HIV/AIDS Legal Network deals with issues such as discrimination, Aboriginal communities, women’s rights, sex work, income security, and so forth (click here for a complete list).

    Other current campaigns and activities include:

    Positive Women: Exposing Injustice

    A 45-minute documentary film that tells the personal stories of four HIV-positive women, “Positive Women Exposing Justice” explores the reality of the criminalization of HIV non-disclosure in Canada. For more information, visit the film’s website.

    HIV Non-Disclosure and the Criminal Law

    On October 25th, the Legal Network released several publications analyzing two recent Supreme Court rulings on cases of HIV non-disclosure. A summary of the decisions and a longer analysis are available here.

    Making Good on Canada’s Pledge: Affordable Medicines for All

    For many years, the Legal Network has spearheaded a global campaign to reform Canada’s Access to Medicine Regime (CAMR), which would allow Canada to ensure greater access to affordable, generic medicines for AIDS and other health issues in developing countries. Central to this campaign is Bill C-398, which if passed will fix and streamline CAMR, allowing medications to get to those most in need.

    For more information on Bill C-398, visit the Canadian HIV/AIDS Legal Network Medicines for All website.

    On December 4, 2012, at 7:00 p.m., philanthropists, funders, members, community organizations, people living with HIV/AIDS, and allies will gather at the Law Society of Upper Canada (Convocation Hall) in Toronto to celebrate the Canadian HIV/AIDS Legal Network and honour the recipients of the 2012 Awards for Action on HIV/AIDS and Human Rights. Click here for more information on the event.

    The Canadian HIV/AIDS Legal Network is a Canadian Drug Policy Coalition partner in change, working towards a better drug policy for Canada based on evidence, human rights, social inclusion and public health.