An emergency response to Canada's opioid overdose crisis

To help address the opioid overdose epidemic, Canada should develop a regulated program to distribute opioids and prevent deaths, argues a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.171060

"The public health response to any poisoning epidemic should be to provide safer alternatives for people at risk," writes Dr. Mark Tyndall, BC Centre for Disease Control, Vancouver, BC. "In the case of the overdose crisis, this would mean providing a regulated supply of pharmaceutical-grade opioids to people at highest risk of overdose."

In 2016, it is estimated that there were 2458 deaths from opioid overdoses, and more than 1000 overdose deaths reported in British Columbia, "ground zero" for the crisis in Canada, in the first 8 months of 2017.

A drug supply contaminated with the synthetic opioids fentanyl and carfentanil is fuelling the crisis. Although it is recognized that widespread opioid prescribing has also contributed, efforts to reduce opioid prescribing are forcing people to turn to illegal and potentially deadly sources of pain relief.

"We are now faced with the very real possibility of a protracted epidemic of overdose deaths that encompasses an ever-widening swath of the Canadian population, many of whom fall outside our usual targets for harm reduction programs," writes Dr. Tyndall.

"We cannot simply give up on the current group of chronic opioid users who are playing a form of 'Russian roulette' with every injection or inhalation."

Solutions include medically supervised dispensing of opioids, dispensing of slow-release oral morphine or large-scale dispensing of hydromorphone pills, which are inexpensive and available.

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