On International Overdose Awareness Day, Aisling Hudson discusses the strategies necessary to reduce overdoses as part of a more effective, more progressive drugs policy.
Rarely a day passes without the media or politicians debating drugs and those addicted to drugs in our society. Too often these debates lack empathy, and they rarely discuss those strategies which have been shown to be effective in reducing harm, especially overdoses, and reducing the levels of addiction and abuse.
But Ireland must develop a progressive drugs policy to ensure a safer society for all, and quickly. The longer we ignore our social problems, the greater the risks faced for more families.
A drug policy that reduces the harms of drugs and eliminates deaths from overdoses requires a complete change of perspective towards drug use. Safe consumption sites, walk-in or post-in test centres for testing drug quality, and an empathic response from the health service towards problematic drug use are all necessary elements of such a provision.
Reducing Fatalities
Adults should be able to engage with other adults, peers, or professionals and safely use their drugs. When people can use their drugs safely, the risks of overdose are significantly lessened.
Some of the most effective ways to reduce overdose fatalities, therefore, include peer-based regular interactions, drug consumption rooms, and safe consumption sites (SCSs), all as a necessary component of a national health system.
SCSs provide a safe space for adult drug users to access clean needles, have their drugs tested for purity and contaminants, seek medical attention, get referrals to recovery supports, access daily prescriptions and support each other without interfering with non-drug users. SCSs are a logical place to start tackling challenges relating to problematic drug use, and they also reduce crime rates.[efn_note]Belackova, V., Salmon, A.M., Day, C.A., Ritter, A., Shanahan, M., Hedrich, D., Kerr, T. & Jauncey, M. 2019, “Drug Consumption Rooms: A Systematic Review of Evaluation Methodologies”, Drug and Alcohol Review, 38(4), pp. 406-422.[/efn_note]
Many people currently use drugs alone which increases the likelihood of overdose. People often prefer a peer to respond to their distress rather than medical staff. In this context, the recent disappointing turnaround of planning permission for an injection room at the Merchants Quay complex is a severe blow to the battle we face against unintentional overdose.
Providing safety and security for those at risk is a more effective and compassionate response to problematic drug use. Facilities and services – for example safe accommodation, needle drops, SCSs and more — should be generously funded and transparent. But these supports must also provide more focussed healthcare services after a non-fatal overdose, as death is more likely within the following twelve months.
Overdose deaths, and the use of prescribed or unprescribed opioid agonists, such as methadone or other prescription drugs, can also be brought down by effectively regulating the cannabis market. Cannabis has been used in Canada to relieve symptoms of withdrawals without the risk of fatal overdose, and in one study, legalisation is associated with a fall in injection rates among a section of the country’s youth.
Another potential strategy is allowing community peers to be registered as holders of Naloxone. Naloxone has been shown to significantly reduce overdose deaths from heroin, methadone, morphine, and fentanyl. It is available to Irish emergency staff, but more awareness needs to be created.
As all this makes clear, there is much that can and should be done. And each day which passes without action leaves a stain on the current government.
Canada vs. Ireland
The outcome of our national drugs policy can be critically assessed by comparing British Columbia (BC) in Canada and Ireland in 2016. BC has a comparable population to the Republic of Ireland but has a very different drug scene. Its overdose crisis has been extremely serious, with the province suffering roughly 1000 overdose deaths in 2016, leading to a public health crisis being declared. Canada, like America, has been scourged with the introduction of fentanyl to street drugs, making them more lethal. Fentanylis a synthetic opioid that is often illegally made.
In 2017, Canada’s first supervised SCS was established in BC. In 2018, cannabis became widely available in the province and was commonly used by people who wish to decrease their use of opioids.[efn_note]Lucas, P., Boyd, S., Milloy, M. & Walsh, Z. 2021, “Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study”, Pain Medicine (Malden, Mass.), 22(3), pp. 727-739.[/efn_note] Death from overdose decreased in the years 2018 and 2019 but increased again in 2020 and has risen since. Youth deaths from overdose are stable but males over 50 are continuing to die at greater rates. It could be that Covid-19 and isolation is causing the rise in overdose deaths, and if services were returned to normal drug users might die less.
In Ireland, the National Drug-Related Death Index of 2016 reports 354 deaths from poisoning. Of those, 132 involved alcohol poisoning, while 55 deaths were caused by just alcohol poisoning. Also among the causes reported were Prescribed Methadone (103 deaths), diazepam (96 deaths), Pregabalin (65 deaths) and Alprazalam (46 deaths); 41 deaths were associated with cocaine, and 5% (37 deaths) were people who injected drugs.
These figures refer to a period before fentanyl made a significant appearance on Irish streets. However, a growing number of cases have been reported over the past few years, according to Smarmore Rehab Clinic.
The Importance of Data
Researchers warn of the adverse consequences of a time-lag between reporting statistics and the overdose occurrences. The up-to-date release of statistics, in places other than Ireland, relating to fatal and non-fatal overdoses, trends in street drug use, and drug potency, reveals a fast-paced world.
All the same, access to data relating to problematic drug use in Irish society is essential to designing the right facilities for Ireland. Services and strategies need to be guided by the data being collected by others on the front-line such as ambulance, first responders, emergency departments and once established, the SCSs.
In global terms, the Irish state falls far below average in relinquishing data for research purposes. The latest data relates to 2016/2017, and so much has changed since then. We have seen how data can be collated and released daily, as with Covid figures, so why can’t this critical data about overdoses be shared in a much timelier manner?
Collection collation and quarterly data publication should be provided to researchers until deaths from overdoses have been significantly reduced. Drug-related seizures affect the quality of drugs available, and for this reason, data should be made available relating to seizures and sentencing. If the data are not made available, the energy used to store them is wasted, and the opportunity to correct social behaviour without using force, or prison is lost, and more innocent victims will die from overdoses.
The failure of consecutive Irish governments, led by Fianna Fáil or Fine Gael, has led to a situation where activists and frontline workers are working can only imagine how bad the big picture is, relying instead on anecdotal figures.
Furthermore, without updated statistics researchers and policymakers cannot know whether a drug is taking a foothold, what aspects of drug policy are working, or if any approaches are making the situation worse. We cannot know how drug trends are changing or whether deaths from overdoses have increased or decreased. Should Ireland be declaring a public health emergency?
The government needs to adjust its moral compass. It needs to stop hiding behind the excuse of an absence of research when it is the cause of that gap.
International Overdose Awareness Day
The way we interact with drugs can be generational. Our behaviour and emotional attachment to drugs can define our relationships with family, friends, neighbours, and landlords, causing upheaval and reducing life chances, not just for the drug user, but also for others.
The more effective way for society to deal with drug misuse and addiction is to support drug users and their dependants on a journey back to a state of health and wellbeing, instead of the current approach of sweeping the problem under the carpet. The state must meet the emotional and social needs of at-risk drug users until such time that they can look after themselves or no longer want support.
Total healthcare, dental and wellbeing services for drug users at risk of overdose or homelessness, can all be accessed through the rollout of SCSs. The evidence is clear that SCSs are the most effective places to address problematic drug use and the antisocial behaviours that often accompany it. The regulation of cannabis can aid recovery without any risk of death and therefore also needs to be considered. While new approaches to our drugs problems are explored, data should be constantly flowing to researchers to make sure that the desired effects of policy are being achieved.
On International Overdose Awareness Day, we should all be aware that compassion, sufficient resources, and proper data usage are all required to reduce overdoses and have a more humane approach to drugs in Ireland.
