“The people using and abusing opioids (and dying as a result) are not all stereotypical ‘junkies’ shooting up in alleys. They are also grandmothers who take too many painkillers, labourers who get addicted after treatment for a back injury, teenagers who raid their parents’ medicine cabinet, kids who mistake pills for candy and recreational users who can be anyone from Bay Street brokers to squeegee kids.” (Andre Picard, Globe and Mail healthcare correspondent)
Did you know that more people die from accidental overdose than motor vehicle accidents in Toronto?
This is just one fact that sparked the Apathy and Overdose Forum on June 18th in downtown Toronto. The topic of the evening was quite timely, particularly after the CBC coverage on the rise of opiate use. Tonight’s forum was called “Apathy and Overdose,” focusing on accidental drug overdose, and was broken down into two speakers and one panel with individuals who had experience in some way with overdose.
The event was planned by Walter Cavalieri, the founder of the Canadian Harm Reduction Network, and a core group of others who made this forum possible. Dr. Philip Berger was the moderator for the evening– a physician, social justice activist and Medical Director of the Inner City Health Program at St. Michael’s Hospital.
The first presenter was Donald MacPherson, the founder of the Canadian Drug Policy Coalition. Donald worked with other like-minded Canadians to start CDPC to create a national voice for ending the war on drugs and moving a public health approach to drug policy forward. CDPC just recently released their policy brief on overdose, and copies were available for everyone who attended. We discussed some of the recommendations that address what can be done to save lives now. He explained it as an “advocacy document” that should be circulated to everyone – politicians, public, front line workers, etc. Some of the major points of the document included suggestions such as reducing barriers to calling 911 during a drug overdose event (i.e. Good Samaritan type legislation). This is so important because, as we learned, opioid overdose can be reversible though timely administration of naloxone coupled with emergency care. These kinds of strategies are important because they can be implemented with little cost, saving both lives and resources.
Dan Biggs was the second presenter of the night, all the way from Chicago and director of the Chicago Drug Recovery Alliance. A very charismatic guy, he started his talk by asking the audience who had been personally affected by overdose, where just over half the audience put their hand up. Then, he asked if anyone knew that naloxone was essentially the reverse for overdose – a “pure antidote to opioid poisoning,” and almost all the audience put their hands up. Lastly, he asked if anyone thought it should be made available everywhere – to which the entire audience raised their hands. “Alright we’re done here!” he joked.
All joking aside, Dan spoke to the 188 programs in the United States, since 1996, which have been dispensing naloxone kits. Dan showed us three variations of a naloxone kit. He showed us the first version (even demoing it – a recording which walks you through the steps) developed by a pharmaceutical company, costing over $500 for only one. The US government has not put any funding towards developing this initiative, so it can get quite costly to distribute something like this. He also showed up an intranasal naloxone device that mists into each nostril, a preferred method for police who are resistant to carrying the injection kit. The intranasal version costs only $42. Lastly, he showed us the “cheap guy from Chicago’s” version of the kit, costing less than $3 a kit. This version has the potential to really make an impact because it becomes much more affordable and thereby accessible. I’m always pulled in by simple and effective solution that could really save lives – I think sometimes it’s easy to get caught up in “fighting the entire system and its flaws” rather than reaching for smaller, but also important, solutions that can change things right now as the bigger initiative continues to develop. One person asked a question I had been wondering, “what if you inject naloxone into someone who doesn’t have opioids in their system?” Dan responded that this would actually have no effect, similar to injecting oneself with saline.
The second panel was really interesting because it focused on four people who have had first hand experience with accidental overdose. Peter Leslie, a former paramedic who now works in harm reduction, discussed some of the “miraculous” recoveries he had seen using naloxone. Another man spoke from a drop-in harm reduction shelter in Toronto, a pretty unique program in Canada. This started an interesting conversation about police and EMS’ response to overdose. One woman, Donna, shared an emotional story about the loss of her daughter due to an overdose. She spoke to the last time she saw her – underweight, broken bones, and barely recognizable. What was really captivating for me was her discussion about the discourses we draw on when discussing addiction and the barriers this creates to support and services. She had labeled her daughter as a ‘dirty junkie’ – and spoke to this type of thinking and labels that prevented her from trying to understand her daughter’s experience. Labels that she believed work to dehumanize her daughter, “destroying her at her very core.” She framed this as a lack of education and understanding, and shared this story in order to advocate, “doing better” in the future – by, for example, advocating for effective Good Samaritan policies and advocating for naloxone to be widely available.
Many people stayed for the networking period after the discussions, sparking some really interesting conversations. Overall, I am happy it was such a successful event, filling the seats, raising awareness and getting a dialogue started about overdose prevention in Toronto.