What keeps you up at night? For me, it’s the discomfort of neglecting something important but complicated. When sleep won’t turn off the thought, I write it down, and place it somewhere prominent. Perhaps it’s a post-it note on the bathroom mirror facing me when I brush my teeth the next morning. It reminds me to take the next baby step (or three, or four) toward progress.
British Columbians are growing worried about dangerous street drugs, like fentanyl and other opioids, harming our communities. With at least 238 overdose deaths so far in 20161, it’s clear that this is a challenging problem. And there are, of course, other worrisome non-opioid drugs like cocaine also associated with addiction. Community impacts from addictions to street drugs can keep us up at night, because the issue is prevalent while the solution seems complicated. Law enforcement is not the main answer, and treatment can be expensive or inaccessible. So what baby steps could we take on that giant post-it note calling us to reduce community harms from addiction? This post suggests five things to ask all of our local elected officials to help make important progress on the matter.
1. Provide more integrated care approaches to help people with, or at risk of, an addiction. Addiction is complex –if it weren’t, many highly intelligent people who have struggled with it would have found a cure by now. Evidence suggests it has a complex array of causal factors, linked to both genetics and environment2. Complex problems need a cocktail, or array of solutions best found through integrative care approaches, which address basic health matters, the psychological aspects of addiction, and the physiological aspects. Most of you know that the InnerChange Foundation is collaborating with the Graham Boeckh Foundation and the St. Paul’s Hospital Foundation, plus the BC Ministry of Health by making a significant investment in an integrative care approach for youth. (Click here and here to learn more ) Adults also need more integrative treatment solutions –solutions which enable stable, productive lives that don’t rely on crime or self-victimizing behaviour.
2. Find more ways to empower family doctors (GPs) quickly to address people with, and at risk of, addictions. GPs are a trusted, and often first, treatment avenue and can be less stigmatizing. One in five British Columbians will confront addiction. Unfortunately, GPs are seldom trained to provide treatment. So we need to quickly raise their awareness of promising tools available for use now in Canada. For patients with an opioid addiction, methadone has been used for some time; but it does not work for all. Newer medications and treatment approaches exist. Family doctors could use these, and help more patients, with better access to information and training on related protocols.
3. Because environmental factors can increase vulnerability to addiction, prevent and intervene early in these factors by helping our most vulnerable: youth aging out of care. British Columbia, like many jurisdictions, supports children and youth whose families of origin are unable to help them grow up. Youth in care are among society’s most vulnerable, and are less empowered to take care of themselves as adults compared with youth who grow up in their families of origin. A joint report by the Representative for Children and Youth and the Office of the Provincial Health Officer noted that only one in five youth in government care actually graduate from high school, compared with four in five among the general population3. Without a high school diploma, available jobs will tend to be low-skilled and low paying, enhancing economic vulnerability. Compounding matters, the support to youth in care ends once they reach nineteen. They are not typically set up for successful adulthood when this occurs. A UK study found that only 3% of youth who aged out of care had successful outcomes, and nearly two-thirds was facing a mental health and/or substance use challenge4. Extending support to age 24- would help reduce a significant environmental vulnerability to addiction. It would also save our social safety net money over the long run.
4. More funded treatment services for youth with addictions who are in foster care—and aging out. As noted in point #3, youth in foster care are particularly vulnerable. When one of those youth is still in care, and facing a mental illness and/or an addiction, our system thankfully does provide added support. Often this takes the form of either clinicians directly provided through the BC Ministry of Children and Family Development or government funding to nonprofit service delivery agencies to expand their array of services to help youth in foster care who are in need. But when these youth do age out, access to these services typically disappears. While the BC Integrated Youth Services Initiative aims to help bridge this gap, more needs to be done across a wider array of communities at a faster pace. Here again, policy changes to extend funding support for treatment and prevention approaches targeting youth in care could make a tremendous difference.
5. Reduce unintended exposure to highly addictive substances through support for street drug checking programs. Illegal drug use involves an element of choice. Yet some substances are more addictive—and dangerous—than others. Many youth and adults who choose to experiment with street drugs try to reduce risks by using what they believe are less harmful / addictive substances. Unfortunately, past and present overdose records show that at least a portion of the problem likes with drug contamination, including extremely potent, addictive and dangerous drugs like fentanyl which many users do not expect. We also hear about non-opioid drugs like ecstasy and even marijuana being sold in our province with fentanyl mixed in (read more here.) This issue extends beyond BC. The Trans European Drug Information project (TEDI) found that 85% of cocaine samples analysed in drug checking programs contained other substances. And one-third contained a substance called Levamisole –commonly used to deworm livestock5. Street drug checking takes some effort and care – but it can be done. Several European countries and cities have initiated programs to check street drugs while also managing risks and harms. Services are currently provided in Portugal, Spain, Belgium, Austria, Switzerland and the Netherlands. Bogota, Colombia also provides this service directly in night clubs.
Community impacts from addiction are complicated and costly- but they need an urgent response. Everyone who currently faces an addiction is someone’s family member or friend, and deserves the help and dignity that prevention, treatment, and harm reduction can achieve. This issue keeps me up at night, along with many other British Columbians. It is also something we can act upon, appreciating that complex issues take time and investment to resolve. This blog post has identified five concrete steps that will make a difference in addressing and preventing harms, that arise from addiction, to communities and the people who inhabit them.
Footnotes/References
- BC Coroner’s Service. (2016). Fentanyl-Detected Illicit Drug Overdose DeathsJanuary 1, 2012 to June 30, 2016. Accessed August 29, 2016 from website: http://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/fentanyl-detected-overdose.pdf
- Mayo Clinic. (n.d.) Basic Risk Factors. Accessed August 29, 2016 from website: http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/risk-factors/con-20020970
- Representative for Children and Youth and the Office of the Provincial Health Officer. (2007). Special Joint Report. Health and Well-Being of Children in Care in British Columbia: Educational Experience and Outcomes. Accessed August 30, 2016 from website: http://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/special-reports/joint_special_report.pdfhttp://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/special-reports/joint_special_report.pdf
- Memarzia J, St Clair MC, Owens M, Goodyer IM, Dunn VJ. Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later [Internet]. BMC Health Serv Res. 2015 April;15(1):1.
- Lacey, Anna and Wallace, Arturo. (2013). A safer high? A night with the illegal drug checkers . BBC News. Accessed August 30, 2016 from website at http://www.bbc.com/news/health-23069825 .