‘Worldwide, overdose is the leading cause of avoidable death among people who use injection drugs.’ United Nations Office on Drugs and Crime, 2013
In newspapers, on social media, and on tv, the death of actor Philip Seymour Hoffman is being framed as a tragedy. We have heard this narrative before. Someone famous dies from an overdose, and they are discussed as a troubled genius meeting a sad but perhaps inevitable end. But, while Hoffman’s death is indeed tragic, there are many ways it could have been avoided. Framing his loss as a preventable death – as opposed to simply a regrettable event – will move us closer to solutions.
While Hoffman’s life stands out – he was rich and famous – the way he died is not unique. Researchers have estimated that between one and three percent of people who inject drugs die each year due to an overdose. In general, people who use injection drugs have mortality rates that are much higher than the general population. They are also at increased risk for contracting blood-bourne diseases like HIV and hepatitis C.
It doesn’t have to be this way. A number of evidence-based approaches are available to save lives, reduce infections and decrease harm to communities. Let’s start with naloxone, a drug that can be administered to people who are overdosing to revive them (they will still require immediate subsequent medical treatment). ‘Take home’ naloxone programs train people who use drugs, their peers and families on how to recognize the signs of overdose, and respond using naloxone. According to a recent United Nations discussion paper, community-based naloxone distribution programs exist in more than 12 countries, and, in the US, naloxone-based prevention programs have been correlated to significant declines in unintentional heroin deaths. Programs have also responded to overdoses specifically related to prescription opioids by providing pain patients and others with overdose education and naloxone.
Supervised injection facilities (SIFs) are another evidence-based way to reduce overdose fatalities and harm. SIFs are places where people can use drugs under the supervision of health professionals without threat of arrest. Canada currently has one official SIF – Insite, in Vancouver. In 2006, a three-year scientific evaluation of Insite found that people who use its services are more likely to be referred to detoxification treatment. It also found that Insite leads to reduced use of injection drugs in public places and fewer publicly discarded needles. In 2008, a peer-reviewed study estimated that Insite prevents between two and 12 overdose deaths per year.
While other cities in Canada are still waiting on SIFs, the research is promising. In 2012, scientists at the Centre for Research on Inner City Health and the University of Toronto used evidence from a range of sources along with mathematical modeling to predict what would happen if SIFs were introduced in Toronto and Ottawa. They found that new SIFs are likely to reduce new hepatitis C and HIV infections and cut down on public drug use.
Supervised injection facilities and community-based naloxone programs fall under the umbrella of what is referred to as ‘harm reduction.’ Health care providers and community services that take a harm reduction approach do not require people to stop using substances in order to receive care or services. Harm reduction practices can include the distribution of clean needles and syringes and safer crack kits (which can help reduce the incidence of burned or cracked lips leading to infection from blood-bourne diseases), methadone programs, or simply the provision of services like medical care, homeless shelters and end-of-life care to people who are currently using substances.
But while harm reduction is a practice grounded in reality, in Canada, policy is lagging behind. According to a recent article in the Canadian Medical Association Journal, despite its documented success in reversing overdoses in a community setting, naloxone is not available on all provincial formularies, making it more difficult for individual health care providers to offer kits to patients, their families and their peers. (Compare this to Italy, where naloxone is available without a prescription.) It is also widely feared that the recent federal ‘Respect for Communities Act’ will make it more difficult for cities to make informed decisions about new supervised injection facilities. On the international front, the federal government is opposing efforts to enshrine harm reduction in United Nations drug control policies.
As long as these barriers are in place, we should not call fatal heroin overdoses ‘tragedies,’ as if there were nothing more we could do. We should call them preventable deaths, and push for evidence-based policies to make sure we don’t lose one more precious, irreplaceable person who doesn’t need to be lost.