The Alarming Rate of Overdose Illicit Drug Fatalities

In recent years, illicit drug overdose deaths have increased rapidly and have affected every part of the country. A key issue that communities across Canada are facing today is the use of Heroin illegally especially among youngsters and they are getting attracted towards more and more consumption of Heroin which is affecting their health and lives. Drug overdose can be accidental or intentional. An overdose occurs when a person takes more quantity of a drug that his/her body could afford or sensitive to certain substances.

A 2019 National Report: Apparent Opioid-related Deaths in Canada by Public Health Agency of Canada, more than 11500 deaths occurred during January 2016 and December 2018. Specifically, 3017 deaths occurred in 2016, 4100 deaths in 2017 and 4460 deaths occurred in 2018, which means that every two hours 1 person is dying of an overdose. 94% of deaths are accidental and a majority of the people dying are between 20-30 yrs of age. Overdose deaths are not only happening among people with long term substance use, even who use the substance occasionally or for the first time could be a victim.

According to the tests of thousands of samples conducted by Canada’s Health regulators, the amount of positive tests of fentanyl in illegal street heroin has jumped enormously. Fentanyl is entirely synthetic and easy to smuggle because of its chemical makeup which makes it hard to detect at customs. It is cheaper and extremely potent, 50 to 100 times more potent than heroin, so it becomes an attractive substitute for drug dealers to mix it into costly heroin to stretch their supplies so they can make large profits from it. As fentanyl is a very powerful and lethal drug but street dealers are not skilled enough to keep the dose in a survivable range, even a small mistake in cutting active ingredients into consumable doses can easily become a deadly overdose. That is the main reason behind the growing numbers of overdose deaths. According to Dr. David Jurrlink, head of clinical pharmacology and toxicology at Sunnybrook health sciences centre in Toronto, 'The illicit drug supply has never been more dangerous because of the profusion of fentanyl-related compounds. This is why so many people are dying. They are dying because the drug they're using contain, you know, much more opioid than they thought.'

Whereas on the other hand when heroin gets legalize under the Canadian health care system, then pharmaceutical companies would take a keen interest in it and start making these drugs. The most important benefit would be here is that when these kinds of drugs have been prepared by medical professionals with all the quality control testing, there will be no chance of contamination of deadly toxic substances. Definitely, it will be a costly option and it will increase the drug cost when we consider all the extra costs on top of it get involved, like research cost, approval and licensing cost, medical devices and equipment cost to buy or rent, safety monitoring, Staff salaries, other operating costs. In a book named 'A Call to Action' by Hank McKinnell, a past CEO of Pfizer, wrote under the heading “The Fallacy of Recapturing R&D Costs”: 'How do we decide what to charge? It’s basically the same as pricing a car … A number of factors go into the mix. These factors consider the cost of business, competition, patent status, anticipated volume, and, most important, our estimate of the income generated by sales of the product. It is the anticipated income stream, rather than repayment of sunk costs, that is the primary determinant of price.'

Some people who overdose while consuming drugs are alone and they have no one nearby who could help them. It is also possible that if they have consumed in the presence of someone who is not aware of the symptoms of an overdose and may be unable to the response. According to the one participant of “National study on opioid and other drug-related overdose deaths: insight from coroners and medical examiners” - “Most of the people that I go to have died alone. They die in their bedroom or in their living room or in their bathroom and the majority of them [have] no one there to call 911 and sound the alarm.”

Supervised injection sites are legally sanctioned locations to provide a secure and non-judgemental environment for people to inject previously obtained drugs in the presence of trained medical professions while reducing the visibility of drug consumption on the street. People usually come here with their own dose of drugs which sometimes result in overdosing. The main purpose of these sites is to provide a safe and hygienic space with clean needles and syringes to reduce the number of overdose deaths. Registered nurses and other health care professionals are available to monitor the injection process and they could intervene with the overdose reversal medication such as naloxone and oxygen if something goes wrong. According to the Vancouver Coastal Health website: “More than 3.6 million clients have injected illicit drugs under supervision by nurses at Insite since 2003. There have been 48,798 clinical treatment visits and 6,440 overdose interventions without any deaths.” Other than that these places can also provide an opportunity for multiple contacts with health care staff, social workers, and other individuals who can help users move toward healthier choices, such as drug treatment programs, primary health care, and other social services. These sites can also help in reducing HIV and hepatitis C transmission and ensures that injecting equipment remains inside and is not discarded in the community. The establishment of these sites would have the high support from communities and this support would keep on growing as these sites will save the cost of Emergency visits/calls that would otherwise make an extra charge on the public services. Injection sites would provide treatment and life saving medical help at the same place on an immediate basis, saving the time and lives of overdose individuals. If all the circumstances are undertaken from the point of humanity, the cost and expenses (which includes placement of injection sites, medically trained staff, the equipments and extra services that would be provided) are all pointless, as it saving someone’s life and helping our communities grow without the fear and burden of fatal and non-fatal deaths due to overdose.

Regular drug intakers hesitate to go injection sites as medical practitioners would put a limit on their drug intake and that would not make them as high as they want to. Some regular heroin consumers even like the contamination of the fentanyl because it gives them more joy, while their bodies get used to of the actual heroin and there is no more excitement left there. They have their personal preferences and they trust their regular dealers and try to buy from the same person. And if they get it from unfamiliar sources or somebody else that they have not met before then they take more precautions and try some sampling techniques before taking it as their regular dose. Regular users became aware of these overdose risks by facing them personally, witnessing others, learning from peers, public campaigns or harm reduction workers. According to the study “Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency” by Sarah G. Mars, Jeff Ondocsin and Daniel Ciccarone published online dated 16 May 2018, “The use of drug sampling as a means of preventing an overdose from injection drug reduces the quantity absorbed at any one time allowing users to monitor drug strength and titrate their dose accordingly”. There are few methods of sampling of heroin, sometimes used in combination like snorting, smoking and tasting in a small amount before injection, injecting partial “testing shots” or “slow shots” and then wait for some time before proceeding to a full shot. They prefer to do it in pairs or groups and then take feedback from others or observing them using the same batch to judge the amount that they can intake for intending results for themselves. But professionals completely disagree with this tasting sample technique and have a different opinion on it. Linda Richter, Ph.D., director of policy research and analysis for the National Center on Addiction and Substance Abuse, “It only takes a tiny amount of the drug to cause a deadly reaction.”

Conclusion

Illicit drug overdose deaths increased sharply in Canada nowadays and have broken records year after year. This is only possible if the legalization approach is adopted and integrated into the system so that it benefits society and addicts. Few proactive and preventive measures like putting control over illicit street drugs, providing the safe and reliable legal source to buy and medically professional supervised injection sites to inject, keeping stronghold on the pricing policies of legal heroin, educating people about the deadly outcomes even with very small amount of contaminated drugs, encouraging them to enroll for addiction programs can be taken into consideration to reduce the occurrence of overdose events and prevent fatal outcomes in overdose situations.