Keep Calm and Carry Naloxone

Recent media reports highlight new research calling for increased access to naloxone as a safe, effective and evidence-based public health strategy.  Distribution of naloxone, often referred to by the brand name Narcan, has been described as a cost-effective method to “cut the death rates from overdose nearly in half” while reducing long-term public health spending on overdose related interventions^1,2.

What is Naloxone?Naloxone is a non-toxic, non-addictive medication that works as an antidote to opioid overdose. Opioids include commonly used drugs such as heroin, oxycontin, and morphine.  Naloxone works to “reverse” an opioid overdose by counter-acting the often fatal depression of respiratory and central nervous systems. If there are no opioids in a person’s system, naloxone has no effect.  Naloxone is administered through injection or nasal spray.

Is Naloxone a new development?Naloxone has been used in clinical settings across Europe, Australia, Canada and the United States for over 40 years.  The World Health Organization has included naloxone on its List of Essential Medicines³ .

Who has access to Naloxone?In some countries, naloxone is available over the counter, but in Canada it is controlled under the Food and Drug Act as a prescription-only medicine.  Naloxone has been available through Edmonton’s Streetworks Program and at Insite in Vancouver.  Take-home and peer-based naloxone access programs are gaining support in a number of areas across the world.

Why is Naloxone access important? According to a 2012 article in the British Columbia Medical Journal, “the current lack of naloxone availability outside primary care, hospital, and ambulance settings limits its lifesaving potential”. The article “seeks to increase physician awareness about the safety, effectiveness, and evidence that increasing access to naloxone saves lives” and describes how access initiatives “can provide an opportunity to engage in meaningful dialogue and empower people who use opioids to take responsibility for themselves and others” ⁴. 

Sources

1. Szalavitz, M. Wider use of antidote could lower overdose deaths by nearly 50%. Retrieved from http://healthland.time.com/2013/02/05/wider-use-of-antidote-could-lower-overdose-deaths-from-by-nearly-50/#ixzz2LZAjnyda

2. Coffin, P., Sullivan, S. (2013). Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Annals of Internal Medicine.  158(1).  Retrieved from http://annals.org/article.aspx?articleid=1487798

3. World Health Organization. Model lists of essential medicines. Retrieved from http://www.who.int/medicines/publications/essentialmedicines/en/index.html

4. Buxton, J. et al. (2012). Increasing access to naloxone in BC to reduce opioid overdose deaths.  BCMJ. 54(5).  Retrieved from http://www.bcmj.org/bc-centre-disease-control/increasing-access-naloxone-bc-reduce-opioid-overdose-deaths

HIV in the World Today

This article was written by AIDS Calgary’s Case Manager.

As some of you may know, this year’s theme in the world of HIV is “Getting to Zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS Related Deaths.” The United Nations (UN) recently published their World’s AIDS Day Report and there have been some great improvements in reducing the rates of HIV. The number of new annual infections has decreased by 21% in the past 15 years, much of this due to advances and accessibility of antiretroviral treatment. The UN estimates that over 700,000 deaths were prevented in 2010 due to the availability of medications and the incident rate of HIV has decreased in 33 countries around the world. Great news indeed!!

While there have been significant improvements in many countries to decrease the transmission and deaths from HIV, there are some areas of the world where this is not the case. Rising rates in Eastern Europe and Central Asia are due to injection drug use and has led to a 250% increase of people living with HIV. It is reported that Russia and Ukraine have contributed to 90% of new infections in the region of Eastern Europe and Central Asia. There are agencies in this area that recognize the value of harm reduction and are working with communities and injection drug users (IDU’s) to decrease the risk of HIV and HEP C transmission.

The Eurasian Harm Reduction Network (EHRN) works in 29 countries and their mission is to “to promote humane, evidence-based harm reduction approaches to drug use, with the aim of improving health and protecting human rights at the individual, community, and societal level.” The EHRN advocates for Opioid Substitution Therapy (OST), such as methadone, as a way to decrease the rates of HIV and HEP C and to improve the lives of some of the most marginalized populations. They estimate that the majority of IDU’s in the regions that they serve are opioid users, though there are still barriers (government and societal) in ensuring that the IDU’s are receiving the treatment they need. The introduction of OST treatment centres has been shown to have a positive impact on reducing the transmission rates in the short amount of time that they have been operational in a number of countries. Unfortunately the benefits of OST are not being seen in Russia as they have not been legalized for use.

This is not to say that there is not work being done in Russia to combat the rising rates of HIV and HEP C; ESVERO is a grassroots organization founded in 2003 and works with IDU’s, activists and service providers to promote change through advocacy, community development and information exchange. Their aim is to promote harm reduction messaging in their country and they offer several training opportunities for outreach workers to increase their knowledge of harm reduction techniques when working with vulnerable populations. In the short amount of time that harm reduction strategies and programs have been implemented in Russia (since 1996), there are now over 70 harm reduction projects throughout the country. Hopefully the next 15 years can see an even larger network of harm reduction programming, as well as access to OST and laws that recognize and support harm reduction methods.

References
http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2216_WorldAIDSday_report_2011_en.pdf
http://eng.esvero.ru/
http://www.harm-reduction.org/activities.html

Harm Reduction - A lot to talk about

The subject of harm reduction has been a touchy one this month in Calgary – and across Canada. There have been several articles in local and national news revolving around this topic, voicing the opinions of police officers, psychologists, and other professionals. There have been strong opinions on both sides of the argument; however it appears that the focus on harm reduction as a health care practice has been lost.

There also seems to be a lot of sensationalism around this topic circulating in media all over the country, which may just be fuelling some misconceptions about harm reduction practices. To clarify what exactly harm reduction practices are and what they mean, we’ve identified some common concerns and explained harm reduction principles.

Our taxes shouldn't pay to support drug use.

Often the issue of cost can influence the public’s evaluation of a social program. A commonly heard concern is that non-supporters of harm reduction programs do not want their taxes used to support addicts. However, when the cost of safe-inhalation materials (roughly breaks down to about $0.30 per crack pipe) is compared to the long term cost of hepatitis C or HIV treatment (upwards of thousands and thousands of dollars), the difference is staggering. The latest hepatitis C drug approved by Health Canada, known as Victrelis, is approximately $50,000 for each afflicted individual (1). Victrelis is just one of many hepatitis C drugs that provincial governments are being asked to pay for (1). The list of expenses only gets longer if an individual is accessing HIV treatment and other associated medical costs into the equation.

Giving out free crack pipes only encourages drug addiction.

This argument is based on the premise that giving out free pipes enables drug users and decriminalizes crack abuse. Some people are unwilling to put their faith in harm reduction as it may not appear to treat addiction but only reduces harm. There have many studies that suggest that harm reduction can and has actually instigated drug rehabilitation. Unfortunately, not all addicted individuals want to quit using, and others may not be able to just simply quit their habit. When clients access programs or agencies that offer harm reduction materials, they begin to form a relationship with service providers who then can provide addiction referrals, basic needs and cessation support. All of these services are crucial in assisting, supporting and often times encouraging an individual through drug rehabilitation. However, if harm reduction services are unavailable or we suddenly discontinue services then these relationships become lost and these individuals may not find the support or counselling they need to find rehabilitation.

What’s the point?

In conclusion the true purpose of offering free harm reduction materials like crack pipes and needles must be reiterated: to mitigate the spread of hepatitis C, HIV and other blood borne pathogens. Harm reduction is not a new practice. In fact, our society actually uses other harm reduction practices every day, such as seatbelts, helmets, and of course condoms. For example, at AIDS Calgary we supply free condoms to promote safer sex and prevent the spread of HIV/AIDS, STIs and hepatitis C, and we understand that recent statistics suggest that in Alberta there is currently a high rate of syphilis which can be contracted through unprotected sexual activity (4); by handing out free condoms we are not intending to encourage everyone to have less sex, nor are we encouraging people to have more sex. We are acknowledging the fact that there are transmission risks when having unprotected sex, and in our province a significant risk of contracting syphilis, therefore wearing a condom and engaging in safer sex will significantly prevent the spread of infection and benefit our society as a whole. This is exactly the same principle behind the distribution of free crack pipes, needles and other paraphilia.

This article was written by Cory Waller in assistance with ACAA's Communications Coordinator.

Sources:

1. 2011, CTV News, New Hepatitis C drug exciting but expensive, http://www.ctv.ca/CTVNews/Health/20110805/hepatitis-c-drug-victrelis-treatment-110805/

2. Accessed 2011, InSite website, http://www.communityinsite.ca/science.html

3. 2011, Toronto Sun, Jerry Agar, Crack pipes and cracked arguments? http://www.calgarysun.com/2011/08/02/crack-pipes-and-cracked-arguments

4. 2011, Infectious Syphilis/Sexually Transmitted Infections (STI) http://www.albertahealthservices.ca/4895.asp