Injection sites can prevent deaths, not overdoses

by George Le Masurier | Feb 14, 2017

Not many people who moved to the Comox Valley for its small-town feel, access to recreational opportunities or the lively arts scene imagined heroin addicts injecting themselves in public places or one person dying almost every month from an opioid overdose.

But these things are happening here.

The Chambers of Commerce and elected officials don’t want to draw undue attention to this grim reality, but it has become too big to ignore.

More than 150 people died from opioid overdoses on Vancouver Island last year. Although more people died in the larger centres of Victoria and Nanaimo, the North Island (including the Valley) had the highest rate of increase — up 156 percent over last year — in overdoses. Ten people died from overdoses over the past 12 months in the Comox Valley.

And Island Health believes the overdose statistics are actually worse, and that many overdoes go unreported. And heroin kills more people than official death certificates indicate. That’s because heroin metabolizes as morphine, so toxicology reports in overdose cases often list morphine or an opiate as the cause of death.

Opioid deaths have increased sharply because most street heroin today contains fentanyl, which is up to 100 times more powerful than heroin. Just a speck of fentanyl the size of a few grains of salt can kill a 113-kilogram (250-pound) person.

Island Health Medical Health Officer Charmaine Enns told the Courtenay City Council this week that her agency hopes to reduce the Valley’s overdose death rate by opening a safe injection site where trained personnel could administer rescue breathing or Naloxone, a drug that can reverse an opioid overdose.

But these sites are misnamed and give the public a false impression. Island Health staff cannot prevent someone from overdosing, which occurs nano-moments after the drug is injected. They can only prevent the overdosed person from dying.

Enns said the supervised injection site at the offices of Island Health or some other provincial agency will allow staff to interact with users and offer mental health counselling and other services. That’s a good thing, and so is giving people a chance to live another day and get their life back on track.

But there are potential downsides.

To keep people suffering from addiction coming back to the clinics, Island Health staff might have to offer users less addictive drugs, such as methadone, and potentially dispense stronger drugs. If that does occur, the public may have a strong reaction.

The sites also put staff at risk because even a small amount of fentanyl is deadly if it’s absorbed through the skin or inhaled when airborne. Fentanyl’s potency has already harmed first responders from New Jersey to Vancouver.

The public should know what safeguards are in place to prevent this from happening here.

City of Courtenay firefighters have agreed to voluntarily respond immediately to serious medical calls, which includes overdoses. But they will only do so if they are equipped with Naloxone nasal spray, supplied by either the province for free or if the City Council agrees to purchase it.

They will not, in other words, participate in using needles to inject Naloxone, sometimes known by its commercial name, Narcan. To do that increases the chance of contacting fentanyl or needle injuries.

The extent of the heroin addiction problem has been partially hidden because today’s users are often middle-income, white, and no longer habitues of the gritty alleys of urban areas. The use of heroin and other opioids has moved into suburbs and small towns.

Island Health reports that overdose occurrences are widespread across the entire Comox Valley.

All over the province and across North America, people hooked on prescription painkillers find heroin easier to acquire and less expensive. If that wasn’t alarming enough, heroin use has become popular among school-aged teens. U.S. studies show that 3 percent of high school students are using heroin today.

The province was right to declare a public health emergency over the opioid problem. But whether the ministry’s plan just treats symptoms, or provides a lasting solution remains to be seen.

Even though safe injection sites raise troubling questions about enabling addiction rather than treating it, doing nothing is not an option when so many deaths can be prevented.

At the very least, we can learn from this effort, change course based on what is learned, and, at the same time, start thinking a whole lot harder about what it would take to prevent people from becoming addicted in the first place.