FENTANYL: FACT AND FICTION Catriona Remocker, Centre for Addictions Research of BC Dan Reist, Centre for Addictions Research of BC
What is an OUTBREAK and what is an EPIDEMIC? Why is the opioid crisis being called an epidemic? ■ Out utbreak break and Ep Epidem emic: c: The occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time ■ Both technically have the same definition, but an epidemic is considered to be more serious than an outbreak, which is usually quick to contain
Is the opioid crisis really an epidemic? 21 21 914 BC-CDC, 2016
What do opioid deaths indicate about the scope of the crisis?
Wh What at CAUSES ES an ‘outbreak’ or ‘epidemic’? ■ RARELY are outbreaks and epidemics caused by just 1 factor ■ Usually an accumulation of multiple factors - > the “straw” that breaks the camel’s back ■ Not always the same factors ■ Epidemics are generally much more complex than outbreaks to address and often require new resources, strategies and responses from multiple agencies/angles
What is fentanyl? Synthetic • Opioid analgesic • Several types and forms Fast • Rapid onset, short duration Potent • 50-100x more potent than morphine Controlled • Controlled Drugs and Substances Act, Schedule I Therapeutic • Cancer pain, severe/continuous pain (opioid tolerant patients), anesthesia
THE THE STOR ORY Y OF FEN OF FENTANYL ANYL (A (A SHOR SHORT T HI HISTOR ORY Y OF OF TH THE E OP OPIOID IOID CR CRISIS) ISIS)
In the beginning … ■ Opioids have been around for a very long time – Opium – Early nineteenth century: morphine – 1874: Heroin invented – 1960s: Fentanyl developed
A shift in perspective … ■ Early 1990s: Promotion of the prescription of opiates by family physicians began – Pharmaceutical companies began marketing opioids as safe – American Pain Society Championed opioids as the “Fifth Vital Sign” ■ GPs were often poorly trained in pain management and/or misinformed about how to safely prescribe these drugs – Often found conflicts of interest in physician education ■ “Doctor shopping” practices began among patients ■ Poor regulation and little monitoring by government of prescriptions
As use increases, so do related harms … U.S. data
Taking action! Interventions on opioids ■ Noticing the trends, governments realize they must step in ■ How to fix the problem blem of opioids? – Crack down on/restrict the substances – Remove the ability to tamper with them – Retrain/educate doctors – Crack down on pharmaceutical marketing practices – Introduce monitoring systems – Crack down on doctor shopping
The result? Opioid prescriptions decline, but we see people increasingly turning to street heroin and synthetic “fake” opioids BC Coroner’s Report, 2016
Why the recent spike in overdoses?
IS THIS REALLY THE WHOLE STORY?
What are we missing? ■ Outbreaks happen all the time ■ For an epidemic to occur, the conditions have to be favourable ■ Drug epidemics are similar, but more complex
What are the trends in BC? Males es more than females ales Males:Females 3:1 in 2007, now 4:1 Increa easingl singly y younger ger In 2007, those most affected were aged 30-49, with highest rates in in the 40-49 category. In 2016, the numbers have shifted with highest rates in the 30-39 category and equal rates in the 19-29 category as the 40-49 category
What are the trends in BC? Decrea easingl singly y urban an Over the last 10 years, the risk of overdose outside of major municipal centres in BC has increased by 20%. The Central Island (Greater Nanaimo) has seen an 80% increase in its share of overdose related deaths compared to the rest of the island over the last 10 years. South Island (Victoria) has seen a 34% decrease comparatively.
How do we make sense of this data? How do the reasons relate to social and physical environmental conditions? Context How does the context influence the results of use? People use … … to feel good Drug Person … to feel better … to do better … to explore
WHAT CAN AND SHOULD WE DO? An Open Space Dialogue
Sample solution elements ■ Restrict the supply of drugs in the community ■ Provide better education about drugs ■ Educate the public about how to respond to overdose ■ Study factors that may explain changing/different patterns of harm ■ Engage people who use drugs as partners ■ Change drug laws to focus on reducing harm ■ Provide more/better treatment ■ Invest in building healthy communities
Framework for Exploration ■ Question 1: How would this element contribute to a solution? ■ Question 2: What is the evidence to support our convictions about this? If we don’t have enough evidence, where/how could we find it? ■ Question 3: What can we do to move this forward in our communities?
Resources Inform ormati ation about Fenta tanyl yl Towar ward d the Heart: General information about fentanyl in BC, including FAQs, tips for reducing the risk of overdose and information about where to get help. http://towardtheheart.com/fentanyl/ HeretoHelp’s Safer Use Injecti cting ng: : A harm reduction pamphlet http://www.heretohelp.bc.ca/sites/default/files/safer-injecting-heroin-crack-and-crystal-meth.pdf Naloxone ne Kits ts/Inf nforma rmati tion on B.C. Pharmaci cists ts: Includes education, handouts and training information relevant to the use of naloxone. http://www.bcpharmacists.org/naloxone Towar ward the Heart: Information about BC’s take-home naloxone kits and information about training to administer naloxone. http://towardtheheart.com/naloxone/
Resources Health lth Promoti tion on Resour urces ces HeretoHelp’s Un Under ersta tanding ding Substa tance ce Use: a health th promotion tion perspect ctiv ive http://www.heretohelp.bc.ca/factsheet/understanding-substance-use-a-health-promotion- perspective HeretoHelp’s Helping ing People le who Use Substanc tances es: a health lth promoti tion on perspecti ective http://www.heretohelp.bc.ca/factsheet/helping-people-who-use-substances-a-health- promotion-perspective Selkirk College’s Dinner Basket Conversations: A promising practice tool from Selkirk College on the application of community dialogue on substance use in the campus setting. https://healthycampuses.ca/resource/promising-practice-selkirks-hosting-a-dinner-basket- conversation/
Bottom line ■ This too shall pass ■ We need to consider response beyond the current crisis ■ What will the legacy of the opioid crisis be? ■ How can we support our community members for a better future?
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