'Long past time' to act on Canada's deadly opioid epidemic

Members of the health care and justice systems from across Canada are meeting in Alberta this week for a two-part conference on the deadly opioid fentanyl. The conference began in Calgary and moves to Edmonton Thursday and Friday.

Independent of the conference, three experts have written this guest column describing the "extraordinary measures" they say are necessary to combat what they say is an "unqualified public health emergency."

In public health, platitudes as 'key messages' are common, and the language around our opioid epidemic has been no exception.

"We are monitoring the situation." "We are looking at all available options."  "Our hearts go out to the individuals, families and communities affected."

With perhaps 20,000 Canadians now dead, it's long past time that words become actions. Patients, families and communities affected by this gathering emergency need help, not pity.

In clinical medicine, when faced with an urgent problem, we investigate, apply evidence-based interventions, and monitor the response. The opioid crisis is no different.

Here's what's needed:

Public health emergencies must be declared more liberally. Such declarations empower chief medical health officers to allocate resources and overcome legal or other barriers in the interest of public health. Opioids now exact an unprecedented toll, and extraordinary measures like this are needed to save lives.

Ongoing, coordinated surveillance. We cannot detect trends or monitor the impacts of interventions without timely data. Proper surveillance requires regular information from law enforcement, emergency medical services, hospitals, labs, addiction treatment sites and coroners. This is the greatest drug safety crisis in Canadian history and it is worsening. Proper surveillance is long overdue.

Naloxone, the antidote to opioid overdoses, saves lives. It's safer than Aspirin, and it should be available for free at pharmacies, nightclubs, convenience stores and gas stations, and all first responders should carry it. In communities where naloxone is distributed widely, opioid overdose deaths drop by almost half.

Supervised drug consumption services reduce overdose deaths and infections such as HIV, and increase the chance that someone who uses drugs will seek treatment for addiction. Canada needs dedicated safe injection facilities like Vancouver's InSite or spaces integrated into other health care facilities where people can use drugs with supervision. The federal Respect for Communities Act passed by the Harper government in 2015 imposes significant barriers to these programs.  The act should be repealed or circumvented using public health emergency provisions.

Medications for opioid addiction such as buprenorphine should be easy to access, especially for people at high risk of complications and death, including those who are pregnant, incarcerated, or have a history of overdose. Physicians who see these patients should be trained to provide medication therapy for opioid addiction. Expanding safe, effective treatment would not only save lives and money, it would reduce the demand for illicit opioids.

We must address overprescribing of opioids. The present epidemic is largely rooted in this practice, which stemmed from misinformation about the safety and effectiveness of opioids in patients with chronic pain. Overprescribing hurts patients and leaves millions of excess tablets in circulation each year. Provincial licensing bodies should mandate adoption of updated Canadian opioid prescribing guidelines expected in early 2017. Moreover, Health Canada should revise the approved indications for opioids to exclude chronic pain, because no studies demonstrate they afford more benefit than harm. Importantly, reduced prescribing must be coupled with effective treatment for opioid addiction, so that patients don't subsequently resort to illicit sources.  There has never been a more dangerous time to obtain opioids on the street.

Drug use should be considered a public health issue, not a criminal one. We cannot arrest our way out of this crisis. People struggling with addiction should be directed into treatment, not the correctional system. A focus on harm reduction rather than punishment will improve health outcomes and public safety while reducing costs. A more progressive drug policy will disempower organized crime, shifting drug markets away from the illicit fentanyl now killing thousands of North Americans annually.

These measures must be implemented simultaneously and immediately.

Canada is in the midst of an unqualified public health emergency, and leadership must not be preoccupied with vested interests and political concerns. Neither "monitoring the situation" nor pursuing stakeholder appeasement amounts to action.  Evidence-based solutions are at hand. It's time to implement them.

Hakique Virani is a public health and addiction medicine specialist physician and clinical assistant professor in the University of Alberta's faculty of medicine.

Rosalind Davis is president of the Changing the Face of Addiction Foundation.

David Juurlink is head of the division of of clinical pharmacology and toxicology at the University of Toronto.

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