overdose – Matters of Substance

As returning students head back to campus and new students set foot on campus for the very first time, one thing we can all count on is that this is a time we’re looking to make new friends and solidify old bonds. While not all students like to party, and even fewer use drugs when they party, some do. It’s important for students to consider the risks of using substances these days, when fentanyl has become part of our drug supply.

First of all, what is fentanyl?

Fentanyl is one of a class of drugs called “opioids”, drugs that bind to receptors in our brain and alter our perceptions of pain. There are many different opioids, including prescription drugs like Tylenol 3, OxyContin, and Percocet. When prescribed, they are often used after surgery or for moderate-to-severe pain treatment.

Some opioids that are available by prescription or used in hospitals are also manufactured in illicit labs, or “kitchens”. These drugs can be made to look like prescription drugs, and can also be sold as, or show up in, party drugs, like cocaine or MDMA.

Different opioids also have different potencies (strengths). It has been reported that fentanyl is 100 times stronger than hospital-grade morphine. And the even newer carfentanil is said to be 100 times stronger than fentanyl.

What’s important for students to know (when it comes to fentanyl and other opioids)?

The real challenge with the drugs that students are using at parties is that they’re part of an uncontrolled supply chain. When drugs are manufactured and obtained outside of a regulated system, it’s impossible to be sure about the contents of the drug and amount they’re taking.

When people can trust what they’re taking, they can better manage their risk. Like alcohol. This is important to remember because fentanyl is often not the drug the person is intending to take. Many people who have overdosed believed they were taking MDMA, cocaine, another type of opioid or something else altogether—but the substance contained some fentanyl.

Haven’t we already talked about this enough?

Open conversations create trust, reduce fear, and make it possible for us to learn from one another.

Engaging in thoughtful, open-ended conversation helps us to develop the skills to assess risk, think critically, and make better decisions. Once we’ve considered something carefully we’re a lot less likely to act out of impulse, habit, or in response to influences like peer pressure.

And we can apply these takeaways to other aspects of life—like how to help a friend going through a rough patch, recognize the signs of overdose, respond in a crisis, and how to be true to ourselves. But we need to take care not to lecture.

Is there anything we can really do to prevent overdosing?

Understanding the risks and how to mitigate them can go a long way!

Risk is central to our growth and development, and we often embrace ones with the potential for reward because the pay-off helps us lead fulfilling lives.

Ever tried or considered rock climbing? In order to get the most out of it, you would take time to identify safe practices that mitigate the risk, such as bringing a buddy and testing the quality of your harness.

Many of us think that the opioid overdose crisis only affects people who use drugs regularly, or have an addiction. But even a single occasion that (accidentally) involves fentanyl can lead to overdose.

So it makes sense to use the same care and thoughtfulness when going to a party where you and your friends will likely encounter new opportunities, and risks.

What do you suggest then?

You can still have a good time out, while managing your risk! A few tips to keep in mind:

It’s safest to only party with friends or people you trust (i.e., use in a safe environment).
If you are using a drug in a group, it can be useful for one person to try the drug first. You can also “test it before you ingest it” using these fentanyl test strips.
Know your source (but remember there are no truly safe sources for uncontrolled substances!).
Stick to one substance and pace yourself so you don’t get in over your head (you can always do more, but you can never do less).
Avoid mixing alcohol with other drugs, as they can interact in unpredictable ways. You can also learn more about how different drugs can interact using this drug combination chart.
If you or someone you know does overdose, it helps to know the signs and symptoms of overdose and how to respond. Most campuses now offer overdose training and naloxone kits.
If you find yourself using more often, it might be time to ask yourself why—are you using substances to cope with life or maybe feeling pressured by others?

Learn more >>>

Catriona Remocker, Campus Projects Consultant, Systems View Consulting

Tanya Miller, Provincial Coordinator, Healthy Minds | Healthy Campuses

Kristina Jenei, Research Assistant, Canadian Institute for Substance Use Research, Opioid Dialogues

“Our government has a zero-tolerance policy for drugs in our institutions.” This comment comes from Canada’s Public Security Minister Vic Toews, responding the 2012 Federal lawsuit filed by four HIV groups and a former Canadian Correction inmate seeking a supervisory injunction – a court order that would force Ottawa to establish Canadian prison-based syringe access programs (PSAPs).

You may be asking yourself: “Drugs are illegal and prisons are drug-free, so why would we give inmates needles to commit a crime?”

The reality is prisons are not drug-free and needle-free; never have been, never will be.

Contrary to the assumption that prisons are a highly restricted, secure environment, virtually no prison in the world has been able to keep drugs completely out. Needles are easily smuggled in or can be made from various items already in prisons (see example here). These needles are shared, often for a fee, between anywhere from 10 to 20 inmates.

Roughly 80 percent of inmates arrive with substance use problems and incarceration has absolutely no effect on reducing injection drug use. The Correctional Service of Canada itself admitted that 17 percent of male and 14 percent of female inmates reported injecting drugs while in prison – 60 percent of the time with a used syringe.

The danger here is that our prisons have become hot spots for HIV and hepatitis C virus (HCV) transmission. To begin with, HIV and HCV prevalence rates in prisons are at least 10 and 30 times higher than the population as a whole. A Vancouver study estimated 21 percent of all HIV infections among people in Vancouver who inject drugs were acquired in prison.

In the face of our government’s “zero tolerance” policies, Canada has acknowledged that drug use does exist in its institutions. Currently, bleach kits, which inmates can use to sterilize syringes, are available upon request. Advocates for PSAPs see bleach kit programs as a step in the right direction. But these programs have also come under scrutiny. Research shows inmates report limited access to such programs, particularly because they come with increased surveillance and stigmatization from correctional officers.

In addition to principles based on prohibition, the reason the Correctional Service of Canada has not moved forward with PSAPs is because of the concern that inmates may turn syringes on officers and use them as weapons. What is the evidence behind this?

In the 60 PSAPs across 12 countries introduced since 1992, there have been no reports of needles from PSAPs being used as weapons. Rather, evidence shows:

Reduced needle sharing
Reduced needle pricks
Decreased HIV and HCV transmission (also safer for officers if they do get pricked)
No increase in drug use or injecting
Reduced drug overdoses
Increased referrals to drug treatment programs
Effectiveness in a wide range of institutions

Despite this compelling evidence, PSAPs remain a tough sell in Canada. One possible reason why prison health has not been prioritized by the public may be due to a misconception that people stay in prison forever. But prisoners (including those who have contracted HIV and HCV) do not stay behind bars forever. Over 95 percent of people are eventually released back into the community. They are our brothers and sisters, mothers and fathers, sons and daughters. They are part of our communities – making prison health a vital component of public health.

Ignoring this fact not only harms public health more broadly, but, by definition, also violates human rights. HIV advocacy groups argue many rights are violated by refusing PSAPs, including the right to the highest attainable standard of health.

If not evidence, what will it take to introduce true public health and human right standards for Canadians behind bars?

Author: Alissa Greer, Research Project Coordinator at Rocky Mountain Poison and Drug Center

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Tag: overdose

Focusing on fentanyl: If you party, plan ahead