August 31 marked International Overdose Awareness Day. IOAD began as an annual event in Australia in 2001. At its core it is a day for remembering and a day for dialogue. For an increasing number of people the issue of overdose and overdose death is very close to home. I personally know far too many people who have died from opiate overdose. Although it seems inconceivable to most of us, overdose deaths are nearly tied with car crashes as the leading cause of accidental death in Ontario. In other parts of North America more people die from overdoses than car crashes. What is most tragic about these statistics is that overdose deaths are preventable.
There are many things we can do to reduce overdose death rates. Practices like community naloxone distribution and supervised substance use services are now known to be scientifically sound and have proven to dramatically reduce overdose death rates. In order to for these programs to be successful we must first remove the moral lens through which substance use is viewed. I’ll delve into this more in a moment.
Human use of perception-altering substances is pre-historic. Substance use is associated with many cultural, religious, social and health related activities. Since the dawn of the Industrial Age when social, geographic and economic displacement became common-place in most European cultures, substances like alcohol and opioids have been used for relief of both physical and emotional pain. In the last three-hundred years our use of these substances has become increasingly compulsive. Scientists tell us this compulsion is related to diminished production in our brains of naturally occurring chemicals like dopamine and serotonin which are related to feelings of well-being, joy and peace. When we experience stressful events such as poverty, sudden loss and psychological trauma the brain becomes less capable of producing these feel-good chemicals. Humans know what to do when our serotonin and dopamine are depleted: we seek pleasurable activities, including compulsive eating of sweet and fatty foods, television watching, computer gaming, extreme sports, sex, online pursuits, shopping, gambling and the consumption of alcohol and other substances like opiates, cocaine, cannabis, amphetamines and chocolate.
So, since all of these activities produce the same results for different people, why is the use of opiates, cocaine, cannabis and amphetamines judged as immoral or a sign of weakness by those of us who seek our dopamine and serotonin via other activities? It is because these substances are illegal. And why are they illegal? Surely it can’t be because they are bad for you – there are so many other compulsions we enact legally which are equally or perhaps more dangerous. Since this is not the time and place for me to go into a lengthy thesis about the utter failure of the so-called War-on-Drugs, I will leave these questions for you all to ponder at a later time.
Although we are not going to solve the War on Drugs today we should, at the very least, look at ways to remove the moral judgment that is applied to the use of these drugs. In doing so we can accept that harm reduction practice is the least good thing we can do to reduce overdose deaths. Education about the dangers of using these drugs as the sole measure of prevention is, despite its good intentions, a woefully inadequate measure. It is no more effective than any other campaign to prevent any cause of untimely death. Although abstinence works for some people for many others it is neither realistic nor desirable. This is especially true for people living in poverty and who experience homelessness and are deprived of safety and any sense of emotional well-being. People in these circumstances often find their best source of solace for a mountain of distress is the chemical alteration of their consciousness. To find fault in this very human response to seemingly inalterable turmoil is both indecent and hypocritical.
What is needed to reduce the high rate of overdose deaths, particularly among people who live in poverty and use opioids, are measures like community naloxone distribution programs and supervised substance use services. Once we remove our moral lens about substance use this much becomes crystal clear: finger pointing, blame and shame are not helpful and will not prevent overdose deaths from occurring.
Naloxone is an opioid antagonist. It temporarily reverses the effects of opioids and keeps opioid overdose victims alive until medical intervention is available. Naloxone is found in every ambulance, every emergency room and in many doctor’s offices throughout the world. Given Ontario’s growing epidemic of non-medical opioid use, naloxone should be available in every home. Community naloxone distribution is a practice that has already been in place for nearly twenty years. It involves training people who use substances like opiates, methamphetamine and cocaine, and their loved ones to administer naloxone. Participants are trained in CPR and learn how to properly administer naloxone where ever it is needed. Once trained, participants carry naloxone, along with a certificate showing they have been trained to administer naloxone.
Naloxone works for the sole purpose of temporarily reversing the effects of opioids, including respiratory arrest which is what causes opioid overdose death. It has no other use and is only dangerous to the one in a million persons who are allergic to it. Community naloxone distribution programs have saved many thousands of lives. Participants in the training also feel more a part of their communities and have often reduced their substance use to a more manageable level. Community naloxone distribution makes sense on every level. I think Londoners should demand such programs here.
Most of us are aware of supervised substance use programs such as Insite in Vancouver. These services prevent overdose deaths every day. They should be regarded as essential services for people experiencing poverty and homelessness who use illegal substances. Many of us in this city see the need for such a program here. I firmly believe that the presence of community naloxone distribution and supervised substance use would have prevented the deaths of just about all the people whose loss we grieve on International Overdose Awareness Day. Please look inside your hearts and consider what may be possible if we look at this issue in the absence of judgment and misunderstanding.
For more information please visit our Topic - Substance Use & Addiction.