February 18th, 2018

New approach to fentanyl availability needed in Alberta

By Medicine Hat News Opinon on February 2, 2018.

Sadly the number of deaths from overdosing on an illicit substance continues to grow in our province and it is time to re-evaluate the best way to address the crisis.

Alberta Health Services reported 462 people died from a fentanyl overdose between Jan. 1 and Nov. 11, 2017, compared to 293 in 2016. A new advertising campaign will encourage Albertans to learn about naloxone, rescue breathing and harm reduction measures.

Perhaps it is time to recognize that the naloxone kits are not having the impact that was expected. In May 2017 a total of $44 million was announced to address the “opioid crisis” including $30 million in new funding.

Naloxone kits are only addressing a life-threatening situation after an overdose.

There is also a fundamental problem with reports of overdosing on fentanyl or other opioids. The vast majority of these situations are from the use of “illicit” fentanyl and other “illicit” drugs.

In January 2017 the News interviewed Dr. Nick Mitchell, senior medical director, addictions and mental health strategic clinical network with AHS. He revealed the majority of males in emergency departments because of an overdose are young people without a history of prescription opioid use.

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.

A program to get physicians to stop prescribing opioids is not keeping people away from “illicit” drugs 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.

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.

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.

Barry Ulmer, in a guest column published in the News March 17, 2017, said if you want to reduce opioid addiction you have to target the real risk factors such as mental health, unemployment and childhood trauma.

(Gillian Slade is a News reporter. To comment on this and other editorials, go to http://www.medicinehatnews.com/opinions, email her at gslade@medicinehatnews.com or call her at 403-528-8635.)

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