Harm reduction & Safe supply

The pool of people at risk of overdose from a new type of super-strength synthetic opioid is widening.

Once linked to contaminated batches of heroin, nitazenes are increasingly being found in counterfeit medicines, including benzodiazepines and oxycodone. In December 2023, a report from the Advisory Council on the Misuse of Drugs (ACMD) noted that nitazene opioids can be sold as powders or in nasal spray form and can be given intravenously or by the sublingual or nasal routes, or even by vaping​[1]​.

The risk now is such that a national patient safety alert advised in July 2023 that NHS staff across primary and secondary care should be made aware of nitazenes’ high potency and toxicity to help avoid further overdoses​[2]​.

Looking at these statistics, I thought back to something that addiction specialist Sarah Wakeman told me when I was reporting on the opioid crisis five years ago. “Most people get better,” Wakeman, who is the senior medical director for substance use disorder at Mass General Brigham, said then. “That’s what we don’t ever talk about in the opioids conversation.”

When she says “most people,” she means most people who get long-term medication-assisted treatment (MAT), widely considered the gold standard in addiction care. It combines regular counseling and behavioral therapy with the medication methadone or buprenorphine (often prescribed under the brand name Suboxone). Both contain synthetic opioid compounds, which prevent withdrawal and cravings, and they can lower overdoses by as much as 76 percent. (A third medication, less often used, is naltrexone, which blocks the high from opioids.)

The philosophy of MAT — a departure from the moralizing, abstinence-based rehab and 12-step programs that dominated addiction care for most of the 20th century — began to take shape in the early 2000s, when the Food and Drug Administration approved buprenorphine and a federal law authorized primary care physicians to prescribe it.

As the number of overdoses rise in Ontario, there are calls by municipal and health-care leaders for the provincial and federal governments to do more to stop the crisis.

Belleville, Ont. was hit with 23 over the course of two days this past week. In Guelph, there were seven drug poisonings Thursday. In Hamilton, officials warned paramedics had seen a rise in suspected drug poisoning where some "required three or more rounds of naloxone administration."

Groups working to reduce the harm caused by illegal drug use on P.E.I. say their work is being hindered by misinformation, some of which is promoted by Charlottetown city councillors.

Members of the Native Council of P.E.I. and PEERS Alliance who are involved in harm reduction say their staff have found themselves the target of anger over drug addiction in the province.

"Many of them have received death threats, as well as other threats of violence toward them and of harassment," Bradley Cooper, chief policy analyst of the Native Council of P.E.I., told Island Morning host Mitch Cormier during a live panel discussion on harm reduction.

“For those who have been using fentanyl, their tolerance is such that even maximal doses of Dilaudid (hydromorphone) have little effect except withdrawal management,” says the review. “This leads people to continue to use street fentanyl, as the Dilaudids do not approximate the effect they get from fentanyl.”