We have to keep people alive before we can help them fight addiction
No one disputes that the ideal outcome is for people to stop using drugs. But that can't happen instantly
To those uninitiated in the global fight against the opioid crisis, the idea of delivering safe opioids through vending machines might sound ridiculous, counterintuitive and even dangerous.
The idea was raised late last year by Dr. Mark Tyndall, executive medical director of the B.C. Centre for Disease Control, who suggested that machines could dispense pills at supportive housing facilities or supervised consumption sites.
Many Canadians — including one of my medical school classmates who wrote a column on the topic for the National Post — believe that the government's focus should be getting people off drugs, not supplying them with them. Alberta United Conservative Party leader Jason Kenney echoed that sentiment recently, saying in an interview that, "Helping addicts inject poison into their bodies is not a solution to the problem of addiction."
But a mountain of research and rooms full of professionals will tell you that it is, in fact, part of a solution: that addressing addiction is a long-term effort. The opioid epidemic is killing at least eight people per day in this country. And as we struggle to fight it, we don't always have time to fight the addiction first. We need to fight to keep people alive.
At its core, harm reduction is about showing compassion to people with addiction issues and removing the stigma that may keep them from seeking help. It recognizes that if people are going to use drugs, they might as well do so in as safe an environment as possible. Most importantly, it's about prioritizing a person's life ahead of their addiction.
I was born and raised in British Columbia, where I have seen firsthand the impact of harm reduction efforts. The work of the B.C. Centre for Excellence in HIV/AIDS (where, full disclosure, I completed my PhD) and other organizations have demonstrated again and again that harm reduction saves lives. The opening of Insite, Vancouver's supervised injection facility, has resulted in dramatically fewer overdoses — a 35 per cent drop in fatal overdoses in the Downtown Eastside.
What's more, the North American Opiate Medication Initiative (NAOMI) trial, based in Vancouver and Montreal, has demonstrated that providing safe sources of opioids can have a dramatic impact on users' lives. Patients who were provided medical grade heroin were more likely to remain in addiction treatment and less likely to use illicit drugs or be involved in other illegal activity. It is this high-impact peer-reviewed evidence that has helped form the basis for the supervised medical supply of opioids.
The issue at hand here is not of some theoretical academic debate; real lives are at risk if we continue with the status quo. In 2016, more than 2,800 Canadians died from opioid-related causes, and the number of deaths due to fentanyl more than doubled. Opioid deaths may have reached as high as 4000 in 2017.
Having compassion and realistic approaches for people who use opioids is not giving up on them. No one disputes that the ideal outcome is for people to move past their addictions and lead healthier lives. But that can't happen instantly.
Preventing the unnecessary deaths of Canadians should be at the forefront of our approach to the opioid epidemic. Allowing deaths to occur based on ideology or outdated notions about harm reduction is reckless and lacks humanity. We must do all we can to keep those who are struggling with addiction alive. We can't help them if they're no longer here.
Luke Swenson, PhD, is a final-year medical student who will soon be commencing his residency in psychiatry at the University of Toronto. He completed his PhD at the BC Centre for Excellence in HIV/AIDS.