Bold changes and a dramatic expansion are coming to safe supply efforts in B.C. in response to an increasingly toxic drug supply and the deadly overdose crisis. Eligibility for safe supply — prescribed untainted drugs or alternatives — will expand to nearly all people who access the street drug supply, even intermittently, under a policy directive from the B.C. Centre on Substance Use being finalized with the province. And registered nurses and registered psychiatric nurses will soon be able to prescribe controlled substances under a public health order from provincial health officer Dr. Bonnie Henry. Previously, only doctors and some pharmacists were allowed to prescribe safer alternatives to illicit drugs.

Psiquiatra especializada no tratamento de dependentes de álcool e drogas, Nicola Worcman observa com olhar crítico a mudança de foco da Política Nacional de Drogas — da chamada redução de danos para o modelo exclusivo da abstinência , como consta do decreto que definiu o novo rumo, assinado no início deste mês. Ela procura sintetizar o que são a redução de danos e a abstinência. E propõe que um modelo não seja contraposto ao outro, mas que haja uma dialética entre ambos, para assim entender os diversos níveis de complexidade no tratamento de dependentes químicos. (Leia também: Ministro ataca Fiocruz e diz que 'não confia' em estudo sobre drogas, engavetado pelo governo)

Fentanyl testing strips as well as the opioid-reversal drug naloxone (commonly known as Narcan) are becoming the sine qua non of the party scene, distributed everywhere cultural denizens hang out: nightclubs, art galleries, downtown streetwear stores, even housewarming parties in Brooklyn. Fentanyl has turned into an indiscriminate spectre in the club scene. The deadly synthetic opioid has been flooding the street market as dealers bulk out recreational drugs like cocaine and heroin with fentanyl. No one can say exactly why it has become so common. Many clubbers now see recreational drug use akin to a game of Russian roulette, and as nightclubs reopened this year, warnings spread through social media about bad batches causing accidental overdoses in these communities.

COVID-19 and the lockdown have obviously hit many different groups in different ways, but few as severely as street-homeless people who use drugs. There are the obvious health impacts that make them more vulnerable to any disease, the impossibility of self-isolating when you don’t have a home, and the constant need to source the drugs you rely on—or face the nightmare of going into withdrawal in the midst of a pandemic. But in fact, the problems are even more complex. The increase in risky behaviors is an alarming aspect of the coronavirus-drug use nexus. In the case of fentanyl, Europe has thus far been largely spared the nightmarish situation of North America.

We’ve already witnessed the havoc of coronavirus as panic-buying compromises supply and distribution of food and some medicines. The illicit drug market is not immune to coronavirus either. We are a net importer of drugs like cocaine and heroin, so when borders are shut moving drugs becomes more difficult. People don’t behave rationally, whether it’s about the supply of toilet roll or cocaine. When one drug is in short supply, another takes its place. If, for example, heroin is substituted with fentanyl – fifty times more potent – the potential for overdose is clear. If ever there was a time to introduce drug consumption rooms, it is now. (See also: Impact of Covid-19 on drugs trade likely to hit recreational cocaine users most | How coronavirus is changing the market for illegal drugs)

"La abstinencia no lo es todo", dice Heino Stöver. Tal vez, esa frase del investigador de adicciones de Fráncfort podría resumir las más de 200 páginas del séptimo "Informe Alternativo sobre de Drogas y Adicción”. Stöver presentó el informe en Berlín en su calidad de presidente de la asociación "Akzept", junto con la Asociación Alemana del Sida y otros expertos del campo de la investigación de drogas. Bajo el lema "proteger en lugar de castigar", el informe se centra en la reducción de los daños, también mediante la "distribución regulada por el Estado de sustancias ilegales", es decir: cannabis en las farmacias. El informe, explica Stöver, quiere crear una "vía alternativa al estancamiento de la política de drogas" en Alemania.

For a forgotten moment, at the very start of the United States’ half-century long war on drugs, public health was the weapon of choice. Before long, the funding ratio between public health and criminal justice measures flipped. The results of that shift are clear: Drug use is soaring. More Americans are dying of overdoses than at any point in modern history. It’s time to reverse course. Drug use and addiction are as old as humanity itself, and historians and policymakers likely will debate whether the war on drugs was ever winnable, or what its true aims even were. In the meantime, it’s clear that to exit the current morass, Americans will have to restore public health to the center of its approach.

Canada remains in the grips of a deadly toxic drug crisis that has claimed the lives of tens of thousands. It’s a crisis that has been blamed on a war — the war on drugs — fuelled by what policy experts and people who use drugs say is a mix of prohibition, criminalization, lack of supports and stigma. In the face of what is called government foot-dragging on providing the tools needed to stem the tide of death, activists are taking action, recently launching a fulfilment centre and compassion club in Vancouver, which procures, tests, repackages, and distributes drugs to people at high risk of overdose. The group is risking their liberty in the process, as the club is not legal — but they’re fighting the federal government in court so that it can be. They haven’t been shy about publicizing their activities, and have even been visited by the federal minister for addictions.

A recent study, published in the peer-reviewed journal Addiction, found that a trio of policies adopted to combat the opioid overdose epidemic saved, combined, an estimated 3,030 lives in the Canadian province of British Columbia alone, between April 2016 and December 2017. The findings are a ringing endorsement of the policies adopted by the government of the province hit hardest by the epidemic: promoting access to the overdose-reversing drug naloxone, expanding access to supervised consumption or injection sites, and providing access to treatment known as opioid agonist therapy.

Due to the increase in opioid overdoses, British Columbia declared a public health emergency in 2016. Fentanyl was in town, contributing to thousands of deaths. The nationwide overdose crisis killed about 11 Canadians a day between January 2016 and September 2019. An innovation pioneered by Dr. Mark Tyndall – helpful for any community impacted by drug-related problems, but more relevant amid COVID-19 social distancing – represents an step forward. Tyndall saw the need to provide a safe supply of drugs to people, removing the possibility of adulteration, in a way that supported drug-user autonomy. His idea was to make the opioid hydromorphone (Dilaudid) available through “vending machines” in a project called MySafe. (See also: MySafe: When technology and drug policy meet)

Swiss cities are adapting their drug policies in the face of new forms of drug use. Thirty years after the open drug scene in Zurich, experts say it is time to act. New ways of acting must also be developed because of new types of drugs, according to the organisation Addiction Switzerland. The arrival of ready-to-consume “crack rocks” in Geneva two years ago broke the relative stability of the drug landscape and consumption patterns in that canton, Addiction Switzerland deputy director Frank Zobel said. In addition, drug use in public spaces is on the rise again throughout Switzerland – from Geneva to Basel, Lausanne, Chur and Zurich. Mini-drug scenes are the result. This is related to the very high availability of cocaine. (See also: Geneva struggles with crack-cocaine epidemic)

The City of Vancouver voted unanimously in favour of supporting a peer-led program that would help get a safe supply of drugs to individuals at high risk of overdose. Coun. Jean Swanson called for the approval of North America’s first compassion club that gives access to prescription heroin, cocaine and methamphetamine. Swanson said that given the overdose crisis, blamed on tainted street drugs, federal approval is needed for the project run by the Drug User Liberation Front, which has teamed up with Vancouver Area Network of Drug Users to host giveaways of substances purchased from the dark web — “so they won’t be arrested for saving lives.” (See also: Vancouver votes to support application that would create safe drug 'compassion clubs' | Toronto’s bid to decriminalize drugs hangs in the balance)

There is a glut of research surrounding safer alternatives for people who use opioids. Less well researched are safer alternatives for crack cocaine use—though some argue that chewing coca leaf (a precursor to cocaine and, thus, crack) has potential. A kind of crack vape pen, yet to be developed, could be a valuable harm reduction tool, mitigating some of the health risks of consuming crack from illicit sources, according to a new paper. “It’s a thought I’ve had for a very long time,” Fabian P. Steinmetz, a toxicologist who co-authored the paper with social scientist Heino Stöver, told Filter. Steinmetz emphasized that this is an entirely theoretical concept—even setting aside legal barriers, there’s no prototype and no experiments have been done to make such a pen.

An ethnographic study of women and drug use in inner city neighborhoods in Kingston, Jamaica, revealed that cannabis is commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss.

Download the document (PDF)

An ethnographic study of women and drug use in inner city neighborhoods in Kingston, Jamaica, revealed that cannabis is commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss.

Download the document (PDF)

A Vancouver based drug policy researcher has been working for decades to get the federal government to regulate illegal drugs like heroin and cocaine. Don MacPherson authored the groundbreaking Four Pillars Approach to Drug Problems in Vancouver in 2001 — calling for this kind of regulation. Now, 16 years later, and in the midst of a year-long public health emergency in B.C. centred around overdose deaths, MacPherson continues to try to convince politicians that this is the only way out of the overdose crisis. "It's clear that every thing we are doing is not working. It's absolutely pathetic that we can not move beyond this paradigm that we have supported for so many years and at the cost of so many lives." (See also: And the band played on: Overdoses, death and a resistance to change)

In late 2020, a converted van appeared in central Glasgow. Inside were clean needles, sterilising equipment, mirrors, “sharps bins” for the disposal of syringes, and supplies of the overdose reversal drug naloxone. There were also boxes containing protein bars, tea, blankets and a defibrillator, as well as two chairs and tables where injections could be prepared. The van had been converted, and was being driven, by Peter Krykant – an ex-outreach worker with his own history of homelessness and injecting drug use. Frustrated with the fact that no overdose prevention centre (OPC) had yet opened in the city despite calls from the local NHS, he took the law into his own hands and, after a successful crowdfunding campaign, opened one independently.