Why harm reduction could help win the fight against fentanyl

Dr. M-J Milloy, a research scientist with the British Columbia Centre for Excellence in HIV/AIDS, says harm reduction efforts could be an important first line of defence in controlling the abuse of fentanyl and other opioids.

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Winnipeg police believe fentanyl is responsible for at least three deaths so far this month. Police also suspect the powerful opioid was ingested by an infant, sending the child to hospital in critical condition last week. 

In an effort to address the crisis, Winnipeg police officers are beginning to carry the overdose remedy naloxone and a pharmacy in the city will be selling $5 fentanyl testing kits. The Winnipeg group Street Connections hands out about 500,000 clean needles in the city a year.

In a recent interview with CBC Ismaila Alfa, Milloy said efforts like this save lives and can enable drug users to seek treatment. Their conversation has been edited for length and clarity.

Alfa: Why is harm reduction an important part of treating addictions?

Milloy: Well, it really grew out of the beginnings of the HIV pandemic back in the 1980s. Attempts to stop the transmission of the virus were really floundering because people would not take up the interventions that were offered.

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Out of that grew the recognition that it’s important, not only to encourage people to stop the dangerous misuse of some substances, but also try to reduce the harms that can come from the use of those substances.

Fentanyl is between 50 and 100 times more powerful than morphine, according to the Centers for Disease Control. (CBC)

So, since then, we’ve seen things like, for example, needle exchange programs which serve to reduce the risk of HIV infection and things like opioid treatments which try to lower the risk of death and other problems that come from the use of heroin, fentanyl and other opioids.

How do drug testing kits help keep people safe?

Many of the people who are dying of fentanyl-associated overdoses never knew that they were taking fentanyl in the first place.

One of the problems with having an unregulated drug market like we do in Canada is that people can never be sure what is in that white powder. Drug test kits then are a way for people who are concerned about what might be in their opioids.

Some critics say harm reduction efforts enables drug users and makes addiction worse. What do you say to that?

That is a common view but it’s not based on any real medical evidence. Let’s remember what’s happening here — many of the people who are using these opioids suffer from dependence on opioids.

Quite simply, they are addicted to using heroin or using fentanyl as often as they can. And if they do not use it, they will go into withdrawal which is a very painful and possibly fatal condition.

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Because of that, there is a need not only to provide treatment to people who might want to reduce or eliminate opioids use but also there is a need to keep people alive.

There is a saying inside a safe injection facility that dead people don’t go into detox. Safe injection sites and drug testing kits provide a means of keeping people alive until they can hopefully move into recovery.

So harm reduction, in your view, is really just about keeping people alive?

That’s correct. We’re dealing with here not the failure of someone’s character but rather a brain disease.

We know better and better, that brain disease is characterized by the uncontrolled use of substances. People who are addicted to opioids, as I’ve said, if they do not expose their brains to that substance regularly, every eight hours or so, they will go into withdrawal.

And withdrawal is something that is dangerous and it is something that is remarkably unpleasant for the people who are experiencing it.

That is why, in addition to addictions treatment, it’s really incumbent on people who are interested in lowering the numbers of our neighbours and friends who are dying of overdoses, it’s important that we also provide things like drug test kits, like naloxone kits, safe injection sites, as way of trying to reduce that toll of death and disease.

How much impact do these programs actually have?

At the safe injection site in Vancouver Insite, I did a number of studies using data from the facility and it showed that over the first three or four years of the site it was responsible for saving approximately 60 lives.

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We have very good medical evidence that providing these sorts of things lower the risk of HIV infections, it helps to keep people on their HIV medications, it lowers the risk of overdose, lowers the risk of Hepatitis C.

It’s also important for our health care budget. We estimate, for example, each HIV infection costs the Canadian economy and the Canadian taxpayer $250 million dollars over the life of that infection. So reducing rates of HIV infection using simple things like a needle exchange is a very cost effective way of improving the nation’s finances.

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