Side Event: Health Responses to the Opioid Poisoning Crisis: On-the-Ground Experiences and International Implications

Organized by Canada, and Canadian Association of People who Use Drugs, Canadian Drug Policy Coalition, Canadian HIV/AIDS Legal Network, Centre on Drug Policy Evaluation and International Drug Policy Consortium

Fatal drug-related overdose is a pressing health crisis in North America. Highly potent synthetic opioids, including fentanyl and analogues, are increasingly present in the unregulated opioid supply and have contributed to unprecedented increases in overdose deaths. Several countries in Europe have also recently experienced a rising loss of lives from accidental opioid overdose. While the expanding opioid poisoning crisis has been a focus of international attention in recent years, discussions have primarily focused on supply reduction, rather than health, interventions.

Speakers will discuss emerging and established health responses to address the ongoing high incidence of opioid overdose fatalities in their countries, including scaling up harm reduction services and reducing barriers to the regulated opioid supply. Reflecting upon their on-the-ground experiences, speakers will also highlight relevant implications for the CND and other international bodies at the UN.

Speakers:

Moderator: Marie Nougier, Head of Research and Communications, International Drug Policy Consortium

Very timely event. Increase in poisoning deaths, particularly in Nth America. Liked to toxic drug supply. International response has focused on supply reduction. Efforts may exacerbate programs – when you prohibit substances, other substances come to the market. Scaling up harm reduction does not seem to do enough. The responses you’ll hear about today are innovative.

Asma Fakhri, Coordinator, UNODC Opioid Strategy, and Programme Management Officer, UNODC Laboratory and Scientific Section

We have a presentation. UNODC strategy pulled together in response to opioid crisis. 5 pillars for balanced framework to respond to opioids.

1.Early warning and trend analysis: generating evidence in support of effective policy decisions and operational responses

  1. Rational prescribing and access to opioid for medical and scientific use: promoting interagency cooperation in addressing the non-medical use of opioids
  2. Prevention and treatment programmes: strengthening and supporting prevention and treatment programmes related to opioids
  3. International law enforcement operations to disrupt trafficking: enhancing operational activities to prevent the diversion and trafficking of synthetic opioids
  4. Strengthening national and international counternarcotic capacity: raising awareness, sharing best practices and promoting international cooperation

Comprehensive approach is needed. This is an international effort. Here are the key organisations we collaborate with:

  • Global SMART Programme
  • Global Forensic and Scientific Progrmmes
  • Regional Office for Southeast Asia and the Pacific – Precursors Programme
  • Global Cybercrime and Anti-Money-Laundering
  • Advocacy section
  • Secretariat to the Governing Bodies
  • CRIMJUST Programme
  • Global Container Control

Early warning and trend analysis: identifying the most prevalent, persistent and harmful synthetic opioids. Reporting to UNODC Early Warning Advisory. We’re focusing on health in this side event – identifying the kinds of synthetic drugs

UN Toolkit on synthetic drugs: developed last year. Can’t just focus on supply reduction. Looking to cover 5 pillars. We have active modules to guide member states to practical implementable resources to. Legal module, forensics module (resources from broad UN system), mail security, precursors module. Adding new modules – rational prescribing and access, prevention and treatment, overdose prevention, stigma reduction (following Canada’s 2018 resolution).

How can access to medicines be made balanced etc. 86 countries have active users to the toolkit. Thematic areas supported.

Carol Anne Chénard, Director, Office of Legislative and Regulatory Affairs, Controlled Substances Directorate, Health Canada

Novel approaches that Canada is taking. It’s a complex health and social issue that’s been devastating across Canada. Over 14,000 OD deaths across Canada in past few years. Most are due to street drug use. Increase in fentanyl being found. In response – Canada has committed to addressing this problem through evidence-based interventions – I’m going to focus on harm reduction. Evidence based harm reduction measures has played a significant part. Don’t focus on reducing drug use, but harms from drug use by providing safer forms of use. Existing measures cannot fully address problems posed by adulterated drug supply. Safer supply – seeks to provide safer, quality control alternatives to street drug supply to reduce accidental OD deaths. This can help establish pathways to care and treatment. People can focus on other aspects of their lives such as housing etc. Hydromorphone trials have been shown to be successful. Most of our provinces have opioid agonist treatment (OAT), but now injectable OAT such as hydromorphone and diacetylmorphine is available in many provinces. This has typically occurred under medical models. Difficult for people to stay in programs. We aim to meet people where they are – flexible eligibility. British Columbia Centre for Disease Control (BCCDC) will provide oral hydromorphone along with counselling, healthcare and treatment. This will build on existing OAT. Connects people to other treatment. However, our model is still under development. We are looking at multiple safer supply programs. All pilot projects are required to be evaluated. This will be done through peer review projects. Canadian Inst of Health Research will provide funding opportunities. CIHR funds 4 large regional teams of researchers and people with lived experience – include harm reduction and treatment. One example – funding announcement last week. Pilot project at overdose prevention sites (OPS) that with offer tablets that can be crushed and injected. Will help form an evidence base as novel harm reduction project. Frontline HR initiatives aimed at opioid supply, but also methamphetamine.

Moderator: Safer supply meets conventions under medicinal needs.

Frank Crichlow, Acting President, Canadian Association of People Who Use Drugs

I am going to focus on the black (African and Caribbean and black) community in Canada. Forced removal from traditional lands has overburdened our communities. Overload on public health and harm reduction programs. Current program focuses on people who inject drugs (PWID). Little research on how safer supply can help black community, especially those who don’t inject. Black Canadians and other racialized communities are overrepresented in criminal justice programs. HIV is overlooked in prisons. HIV disproportionality affects black people in Canada. We need to look to existing interventions and how they have harmed out community in programs. Interventions are usually focused on white populations – medicalised racism. This is further compounded by colonisation and residential school programs in Canada. This crosses several generations. Our communities are scared of being targeted by law enforcement. Black youths 3x more likely to be stopped by law enforcement than white. 1/10 inmates in Canada are black, but only 3.5% of general population. This imbalance needs to be corrected. Less arrests if safe supply program was truly developed for black community. We should no longer be unfairly targeted. Projects must meet the needs of our communities. Some solutions might be to expand outreach programs to educate. Black and indigenous communities need to be engaged, with ongoing dialogue. Harm reduction language needs to be brought back to the street. Needs to be more research on black community – how does colonisation, stigmatisation affect our outcomes? We need to feel respected – we need to address interpersonal and structural racism.

Maria Plotko, Senior Program Officer, Eurasian Harm Reduction Association

Context from our region – it’s quite different to Canada!

Use of drugs is not criminalised but possession is. Legal threshold for possession of substances is very low. Low quality of existing services., shrinking spaces for communities and civil society. OST only introduced in 2008 in some of our countries. Some resistance from doctors – polydrug users sometimes aren’t admitted to OST programs. Drug registry – in order to access harm reduction services, you must be registered as person with drug dependence – this then affects your employment and influences child protection. Harm reduction sometimes seen as propaganda of drug use. OST coverage and NSP coverage is very low in our region. Problems with take home OST, take home naloxone access limited. NPS use is causing a lot of overdoses. Strong communities in our region are fighting to strengthen harm reduction programs.

Questions:

Scott Bernstein CDPC: Regulation Project – initiative with Canadian and international organisations. High rates of stigmatisation on this issue. We’ve developed a safe supply game – which is a role-playing game to leave behind moral prejudices. The game is in the Health Canada booth in the rotunda. Regulationproject.org.

Mexico: We’re trying to open supervised injecting centres – what’s the view of UNODC?

UNODC: I’m unfortunately not the right person in the UNODC to ask – but I can get you your answer by email.

Frank, CAPUD: I work in a consumption site. We consulted local community – had an open house with media, everybody for people to ask questions.

Carol, Health Canada: we approved supervised consumption sites – we have exemptions in our legislation. There are now 39 sites across Canada. We’re trying to reduce burden on these sites. We also have OPS: much lower barrier sites in areas of great need. Might not even be fixed building – aim to meet needs of communities.

Alex, CSSDP: punitive policies tend to make things worse: in terms of fentanyl and fentanyl analogues – all have been scheduled in Canada since 60s – how can these mechanisms be effective if they haven’t prevented a fentanyl crisis?

Carol, Health Canada: this is why we’re looking at different approaches

UNODC: focus on comprehensive approach – can’t just do supply reduction. Scheduling of different substances gap . once a substance is scheduled, does that mean that a MS can actually identify it.

HRI: I’d like to suggest: we also consider best form of harm reduction is legalisation – I ask you to be courageous – push out this discussion.

Q: side event on heroin and ibogaine. Is it similar in Canada that there was oversupply in medical opioids, such as in America? Patients should not be left alone.

Health Canada: yes overprescribing has contributed to the problem. Medical professionals can get scared and cut off patients too soon instead of tapering off. Guidelines have been launched – and Canadian Pain Taskforce. Consulting broad groups to best serve community. One approach can create an imbalance – we need a combined approach. Access to safer supply is important – we can still take additional steps, and find the right balance.

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