this post was submitted on 24 Feb 2024
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Former Vancouver safe supply program saved lives, new research says (vancouversun.com)
submitted 8 months ago by [email protected] to c/[email protected]
6 comments fedilink hide all child comments
 

cross-posted from: https://lemmy.ca/post/16062938

cross-posted from: https://lemmy.ca/post/16062930

Substance-users who got drugs vetted for fatal contaminants from a now-closed compassion club significantly reduced their overdose rates, keeping them alive during the fatal drug overdose crisis, says a University of B.C. professor involved in newly released research.

The findings, published Thursday in an international drug-policy research journal, tracked 47 participants of a compassion club run by the Drug User Liberation Front (DULF), which received Vancouver Coastal Health funding to test drugs in a University of Victoria lab before selling them to members in a Downtown Eastside storefront in Vancouver

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[–] [email protected] 1 points 8 months ago (1 children)

Why is the end-point a reduction in deaths, rather than how many people stopped doing drugs?

Keeping people alive and in a state of constant drug-abuse isn't a goal we should aspire for.

Yes, save lives, but do it with a purpose. Fast track survivors into rehab or mental health services, so they can stop almost dying.

B.C. budget had no new money to expand safe supply or address the toxic drug, mental-health and homeless crises.

Yes, it's easy to run out of money when the problem isn't being addressed.

[–] [email protected] 1 points 8 months ago (1 children)

I am going to assume you honestly don't know and are asking a legitimate question.

We are in the middle of an toxic drug crisis, in British Columbia almost 7 people a day are dying. Now this may surprise you, but dead people don't recover. Therefore the most important thing we can try to do in the short term is save lives. Rehab and treatment are obviously part of the solution, but they don't work for everybody and in fact the data suggests Abstinence-Only Opioid Treatment Is Deadlier Than None.

Incidence rates for opioid poisoning deaths for those exposed to treatment ranged from 6.06±1.40 per 1000 persons exposed to methadone to 17.36±3.22 per 1000 persons exposed to any non-medication treatment. The estimated incidence rate for those not exposed to treatment was 9.80±0.72 per 1000 persons. With no exposure to treatment as referent, exposure to methadone or buprenorphine reduced the relative risk by 38% or 34%, respectively; the relative risk of non-medication treatments was equal to or worse than no exposure to treatment (RR = 1.27–1.77). https://www.sciencedirect.com/science/article/pii/S0376871623012784?via%3Dihub

Now as many people with lived experience and people who study the subject will tell you the majority of people will age out of addiction on their own in time. The key is providing the resources they need to do that and of course keeping them alive.

We have treatments for opioid addiction that work. https://www.vox.com/the-highlight/2024/1/16/24033590/treatment-opioid-addiction-crisis-2024

[–] [email protected] 1 points 8 months ago (1 children)

I appreciate the response.

I live in a city (in Ontario) where many of the region's addicts come to because we are the only place around that has addiction help, homeless shelters, etc.

As I've witnessed my fair share of overdoses by these addicts, having to call for help many times, so I'm acutely aware of the problems faced by my own community and others across the country.

Now this may surprise you, but dead people don’t recover. Therefore the most important thing we can try to do in the short term is save lives. Rehab and treatment are obviously part of the solution, but they don’t work for everybody and in fact the data suggests Abstinence-Only Opioid Treatment Is Deadlier Than None.

Obviously, you can't get help if you're dead. But "prolonging life" as an addict just gives someone more opportunities to die.

The problem at hand is that "saving lives" without a follow-up, that is, not addressing the reasons why people are taking these drugs in the first place, is quite literally unsustainable.

If B.C drags out a program that isn't getting results (i.e. getting people off drugs), then it will not be able to continue the program without constantly pouring in more and more money every year. This money might be critically needed to help the homeless or mentally ill, which is why I ask if a reduction in death is the appropriate marker for success.

Since addiction can be seen as a health concern, let me reframe it: would it make sense for a government to spend money on health programs designed to prolong someone's illness, or to offer treatments which cure those illnesses, instead?

So, would it be better for Vancouver to reduce resources to this program while simultaneously increasing resources that help end addiction or the reasons why people end up addicted to begin with? I'm only asking because it really sounds like the program cannot continue the way it is, so what are the alternatives that can get better results?

[–] [email protected] 1 points 8 months ago* (last edited 8 months ago) (1 children)

I think you read my response, but perhaps didn't understand it.

But “prolonging life” as an addict just gives someone more opportunities to die.

People are dying because they are consuming drugs of unknown purity and strength. That is, you don't know what's in your drugs and you don't know how strong the drugs are. There are simple solutions to these problems. Best solution is to provide a safe supply. Second best solution have safe consumption sites and drug testing available.

the reasons why people are taking these drugs in the first place.

There are as many reasons to take drugs as there are people taking them. The reasons aren't our concern. Obviously poverty, housing and employment are things we can help people with, but beyond that it's up to the individual user. As I pointed out the majority of people using drugs will quit on their own in time. https://www.npr.org/2022/01/15/1071282194/addiction-substance-recovery-treatment

If B.C drags out a program that isn’t getting results (i.e. getting people off drugs)

How successful do you think treatment is? Would it surprise you to learn that faith based recovery has a success rate of about 5 to 10%? There are other programs that have slightly better results but in general abstinence based treatment is a dismal failure.

A new book concludes that the success rate for Alcoholics Anonymous is between 5 and 10 per cent, one of the worst in all of medicine https://www.thestar.com/life/alcoholics-anonymous-has-a-terrible-success-rate-addiction-expert-finds/article_b8a76bb7-0d3c-565d-be99-d57d3337e491.html

This article was part of my first response to you.

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.

MAT shifted the treatment paradigm dramatically. Now, every overdose death is a tragedy, Wakeman told me, not because opioid addiction is unsolvable but because, like so many other chronic illnesses, it’s now very treatable. https://www.vox.com/the-highlight/2024/1/16/24033590/treatment-opioid-addiction-crisis-2024

https://www.psychologytoday.com/us/articles/200405/the-surprising-truth-about-addiction-0

The Surprising Truth About Addiction More people quit addictions than maintain them, and they do so on their own. That's not to say it happens overnight. People succeed when they recognize that the addiction interferes with something they value—and when they develop the confidence that they can change.

I keep editing to add more links.

The first step has to be keeping people alive. The second step is building a relationship with the people so that they feel comfortable accepting help. This can be done through overdose prevention centres and drug testing facilities. The third step would be medication assisted treatment, but not everyone will be receptive to the idea. Therefore we repeat step one and step two.

[–] [email protected] 1 points 8 months ago (1 children)

People are dying because they are consuming drugs of unknown purity and strength. That is, you don’t know what’s in your drugs and you don’t know how strong the drugs are. There are simple solutions to these problems. Best solution is to provide a safe supply. Second best solution have safe consumption sites and drug testing available.

You may call that a solution, but that sounds like continuing the problem (that is, substance abuse).

I think we both agree that safe consumption sites reduce harm. The evidence backs that up.

But if the government is saying there's not enough money to continue, what's the next step?

The reasons aren’t our concern. Obviously poverty, housing and employment are things we can help people with, but beyond that it’s up to the individual user. As I pointed out the majority of people using drugs will quit on their own in time.

You know what they say: "Prevention is better than cure."

If we don't know why people are abusing drugs, we will never be able to fix this problem.

It may be true that some people will simply stop using drugs in their own time (not likely with opioids), the rest die. "Saving them" merely prolongs their inevitable death if they aren't provided with medical treatment options.

Would it surprise you to learn that faith based recovery has a success rate of about 5 to 10%? There are other programs that have slightly better results but in general abstinence based treatment is a dismal failure.

I don't support "faith based recovery", simply due to the fact that there are more effective options (like MAT). However, getting 1 out of 10 people to sober up is much better than enabling continued consumption through "safe alcohol consumption sites", right?

The first step has to be keeping people alive. The second step is building a relationship with the people so that they feel comfortable accepting help. This can be done through overdose prevention centres and drug testing facilities. The third step would be medication assisted treatment, but not everyone will be receptive to the idea. Therefore we repeat step one and step two.

Yes, yes, yes, yes. I do agree!

My original question, however, has not been addressed. With the limited funds available, what approach would be most effective to tackle this problem?

Is it spending more on safe consumption sites? More on treatments like MAT? More on social programs that keep people from becoming addicts in the first place?

I think where the government is at right now, they can only pick one, or they can blend all three with less than adequate support for it all. What do we choose?

On a side note. Why is BC in such bad shape? Safe consumption programs in other cities have saved millions of dollars, further allowing those programs to continue. If BC hasn't been able to keep the program sustainable, why not??

[–] [email protected] 1 points 8 months ago* (last edited 8 months ago)

You may call that a solution, but that sounds like continuing the problem (that is, substance abuse).

Substance-abuse pales in comparison to death. I don't care if people are addicted to substances as long as they continue to live they have an opportunity to quit.

But if the government is saying there’s not enough money to continue, what’s the next step?

The government isn't saying that. The government is saying there isn't money to expand the programs. This is primarily political because people on the right have attacked evidence-based addiction treatment.

what’s the next step?

More deaths. Either that, or expand safe supply which as previously noted has political opposition from the right. Conservatives are playing politics with peoples lives.

You know what they say: “Prevention is better than cure.”

If you want to prevent deaths due to toxic drugs, the obvious answer is to provide non-toxic drugs. You have no control over whether or not people use drugs. The only thing you can do with 100% certainty is provide clean safe drugs.

It may be true that some people will simply stop using drugs in their own time (not likely with opioids)

Show proof that opioids is less likely.

getting 1 out of 10 people to sober up is much better than enabling continued consumption through “safe alcohol consumption sites”, right?

Not if the other nine are dead, right?

With the limited funds available, what approach would be most effective to tackle this problem?

Safe supply and harm reduction. Clean, safe drugs including stimulant would cost very little. In addition the money saved from policing, courts, incarceration plus reduced burden on paramedics and others in healthcare means that even after the government provided safe supply they would still be saving money.

Ironically the right wing libertarian Cato institute believes the same thing. https://www.cato.org/commentary/economic-moral-case-legalizing-cocaine-heroin#

As I previously explained, this is political. The NDP is worried about right wing backlash in the approach to an election. Instead of doing the right thing, they have caved to political pressure.