I could write an opus on drugs; explain how our brains are wired with neurotransmitters or discuss how different chemicals have different rates of bioavailability, half-life, and pharmacokinetics. I could explain how the therapeutic index (TI) of a drug – the prescribed dosage – is the ratio between the effective dose (ED) and the lethal dose (LD) in 50% of the population; but, it’s time, Niagara.
We need to talk some real shit.
At least three people have died following suspected opioid overdoses in the Niagara Region between Valentine’s Day and February 20th, 2018; at least one opioid death in February could have been avoided if St Catharines had a safe injection site.
According to Niagara EMS, they responded to 155 suspected drug overdoses in 2016 and 520 in 2017. Preliminary death data, released by the province, shows 40 people died from opioid overdoses in Niagara in 2016 while numbers for 2017 are expected to at least double.
For the three months available (May-July 2017), there were 7 suspected opioid deaths in each month – 16 confirmed and 5 probable opioid overdoses – for a total of 21 deaths. In 3 months. Compare that to 40 the entire year before.
If we look further, we discover Niagara emergency departments treated 43 overdoses in July 2017, 7 of whom died (6 confirmed opioid, 1 probable). While the death data is not yet available, if the death to ER visit ratio was 7:43 (1/6) in July, and data shows 62 people were treated for opioid overdoses in both August and September, statistically speaking, 10 people probably died in each month.
That would mean we surpassed the total opioid deaths in 2016 in just 5 months of 2017 (May through September); the total lives lost to opioids in 2017 is probably around 87… if not higher.
People are dying; this is no longer a problem to be swept into the darker corners of the region. Niagara needs wider-sweeping harm reduction initiatives including a supervised injection site. Mayor Sendzik, of St Catharines, has been vocal in his support, stating he’d like to see a site open in his city as quickly as possible.
“Everyone knows someone who has struggled with addiction. Just like lifting the stigma of mental health, we have to lift the stigma around addictions to tackle the opioid crisis.”
– St Catharines Mayor Walter Sendzik
The City of St Catharines, which has one of the highest overdose rates in Ontario, is currently working with the Region of Niagara Public Health and a coalition of local organizations – known as the Overdose Prevention & Education Network Niagara or OPENN – to open a temporary safe injection site in St Catharines.
Public health officials anticipated the ‘nearly complete’ application for a temporary supervised injection site, once submitted, will take approximately 10-12 weeks (although I was unable to ascertain when, exactly, submission was anticipated to occur).
What Is A Supervised (or Safe) Injection Site?
Supervised injection (SI) sites are a safe place for someone to use their IV drugs; when someone uses their pre-purchased drug in a controlled environment, it allows for the immediate detection and treatment at the onset of overdose symptoms.
Administering Naloxone (formerly Narcan®), a compound which binds at the opioid receptor sites in the brain displacing the drug molecules from those receptors, in combination with respiratory and cardiac support, at the onset of overdose symptoms, saves lives.
In fact, the data shows in 86% of opioid overdoses, Naloxone is effective, and, within 10 minutes the person is conscious.
Here’s where the supervision comes in: how do you self-administer Naloxone if you have lost consciousness? How do you self-administer chest compressions? or call for EMS?
Efforts to train and pass out Naloxone kits are having a positive impact within the community but that doesn’t save the life of the man who uses, alone, in a Tim Horton’s bathroom, does it?
Benefits to the Community At Large
Don’t supervised injection sites encourage drug use? Studies show this to be false, nobody starts shooting heroin because they can do so while supervised; to say otherwise is ridiculous and contrary to the data.
A recent study in Toronto found that 36% of people who use drugs reported injecting in public places such as washrooms and alleyways. In St Catharines, we could replace alleyways with parks.
Supervised injection sites promote safety and hygiene while discouraging inappropriate disposal of used needles. Proper disposal of paraphernalia, such as needles, reduces the risk of accidental needle sticks for first responders, and in our public spaces including parks.
With some simple changes to the way we treat addiction and narcotic abuse, we can reduce the overall costs to our healthcare system – including emergency rooms and EMS resources. We end up with a net positive for the entire community.
We are not going to solve age-old issues of narcotics use, and abuse, by providing harm reduction programs and safe environments to addicts, but we may regain some of our humanity.
Every interaction a worker has with an addict or at-risk client is another opportunity for non-judgmental conversation and education; every interaction is another chance to build trust and, when the person is ready, change.
We created the stigma, the hair shirt, addicts wear; it’s time we share the burden.
UPDATED: February 26th, St Catharines Council unanimously voted to support OPENN’s application for a temporary supervised injection site to be opened at Positive Living.
This is the first in a series on opioids; check out The Sound online for more on this topic. Up next, Social Indicators: Mental Health, Substance Abuse, and Poverty. Emily Spanton, @FEW_Niagara