The Hurlburt auditorium at St. Paul’s Hospital was packed for BC Addiction Research Day on May 31. Familiar themes were present throughout the day: fentanyl’s hold on BC and stigma’s challenge in providing care. Dr. Mark Lysyshyn began with a keynote followed by oral and poster presentations throughout the day.
Fentanyl Changes the Curve of Overdose
Dr. Mark Lysyshyn began the day with a presentation of data from Vancouver specifically looking at the Downtown Eastside (DTES). He noted that the last major overdose (OD) crisis in BC was in 1997 and focussed in the DTES, whereas the current OD crisis is in all areas of BC. This causes an obvious problem in providing services to all who need them. For those who aren’t near the DTES, services may be lacking or absent. For those who want to get out and yet still need services, they may feel trapped. Those who live outside the Lower Mainland may have real challenges finding what they need, as activists in the room pointed out.
Illustrating the overdose rate over the last few years, Lysyshyn showed attendees that BC would have a stable OD rate were it not for fentanyl. Found in numerous drugs, it is causing the number of overdoses to increase dramatically. It may be mixed intentionally with heroin to increase profits, and it is also contaminating other drugs such as cocaine. Either way, people are getting too much without their knowledge.
Lysyshyn spoke about the benefits of drug testing services both pre or post use. His research found that testing before use meant people could decide to reduce their dose. For those who couldn’t wait to test; testing post-use was also worthwhile because they could make decisions about how they might use the rest of the drug that remained.
Lysyshyn likened the purchasing of drugs these days to walking into a pharmacy and saying ‘Give me any high blood pressure medication in any dose’- it’s anyone’s guess what the effect will be. The “know your source” recommendation can’t be trusted these days. His suggestion to all who are using or providing care to those who are is to use with someone else around; use only one substance at a time, use at an overdose prevention site; and have Naloxone available should it be needed.
Shaping Approaches to Harm Reduction
Two interesting presentations looked at youth who use drugs. As was said at several points, overdoses in 2016 occurred most often in the 30-39 age group. Reaching youth who are using and youth who are at risk is vital if this is to change. One piece of research looked at youth attitudes to opioid antagonist therapy (Suboxone). One respondent found it disheartening that their substance use pattern already warranted this approach, given their age. Another said they didn’t want the commitment of having to take treatment every day as their life didn’t lend itself to regularity. Social issues like street-involvement and lack of stable housing can complicate reaching and supporting youth.
Dhagan Celis (Cultural Rehabilitation): Canadian Somalis Approach Youth Substance Use, presented by Mohamed Ibrahim, outlined gaps in the resettlement system for refugees that put youth at risk for drug use. For youth arriving in Canada after what may be years of unsettled living, culture shock, challenges in education (being placed by age, not educational background), racism and bullying put kids at extreme risk for drug use. Kids stop attending school regularly or at all, and get involved in drug culture. Parents feel that after surviving battles to get to Canada, they lose their kids to drugs. “In Canada, the only easy thing to do is drugs,” was the comment of one father.
Dhagan Celis is cultural rehabilitation for youth; parents pay for a return to East Africa for the program. There is no medically managed detox, but herbs are used, as well as cultural storytelling and dance. Despite the program’s good intentions, youth can experience stigma nonetheless. Not only are they stigmatized for using drugs, but also because they are seen as wasting their chance at a better life in Canada. Ibrahim says changes are needed in the resettlement system to recognize the vulnerability of youth coming to Canada and providing them with substance use and mental health support.
Cody Callon presented data from over 1800 participants who were part of research exploring whether Indigenous-oriented treatment was desired among PWUD. Over 50% of the respondents who identified as Indigenous were interested in treatment that would include cultural approaches to healing; 30% of the non-Indigenous respondents indicated interest as well. A discussion of stigma followed this presentation too, with the recognition that some traditional Indigenous ceremonies require abstinence.
It was a great day for education, discussion and debate, and I look forward to the next one.
Questions? Feedback? Get in touch!
Janet Madsen, Capacity Building and Knowledge Translation Coordinator, [email protected]