Fentanyl a small part of drug crisis

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This article was published 14/12/2016 (3233 days ago), so information in it may no longer be current.

If you want to know about drug trends in Winnipeg, Shelley Marshall is the woman to talk to.

The clinical nurse specialist works with Street Connections, a mobile public health service aimed at reducing drug-related harms. The Street Connections van, which is staffed by public health nurses and outreach workers, drives around the city every evening but Sunday, providing judgment-free care to people who need it. The Street Connections office is open weekdays from 8:30 a.m. to 4:30 p.m.

Street Connections has been tirelessly delivering front-line care during an opioid crisis that is claiming lives across the country. It is the only provider of free, take-home overdose kits that include naloxone, the opioid antidote. So far, Street Connections has distributed about 200 kits, and 24 of them have been used successfully in overdose events.

Before fentanyl hit the streets and the naloxone program was built to respond to it, opioid overdose was a major concern for Street Connections. Overdose is the No. 1 cause of death for injection-drug users.

“Opioid overdose is very immediate and media-worthy harm, but there are many other drugs in use and things going on that kind of get waylaid by that situation,” Marshall says.

A major drug trend that’s being eclipsed by fentanyl is the growing prevalence of crystal meth use in Winnipeg, particularly among youth.

“It’s cheap, and you’re high for a long time — but because you’re high for a long time, it’s very common to talk to people who haven’t slept in five to seven days,” Marshall says. “I’d never heard that before in my history as a street nurse. There are quite a few acute psychiatric issues that can arise from that kind of sleep deprivation.”

More young people are injecting crystal meth as opposed to smoking it, and many of them have picked up harmful injection practices from peers. “There’s lots of needle-sharing among young meth users. We are seeing a bit of an outbreak of hepatitis C.”

Crystal meth is very accessible, she says, adding it has replaced crack in many road-accessible First Nation communities. But for a drug that’s everywhere, crystal meth isn’t making headlines. “It’s not on the radar because people aren’t dying in the same way, and the harms are more invisible, maybe,” Marshall says.

A second concerning trend in Winnipeg is an uptick in injection-drug use. Marshall estimates Street Connections used to give out from 400,000 to 500,000 needles per year. “In the last year and a half, demand for that supply has doubled,” she says. “We’re on track to give out one million needles this year.”

Both an increase in crystal meth use and an increase in injection-drug use dovetail with the opioid crisis. Opioids are appearing in stimulants such as cocaine and crystal meth — and opioids are getting stronger.

Trying to stay one step ahead of an ever-changing drug scene is a near-impossible challenge for front-line community health care providers. Take naloxone, for example. While getting naloxone kits into the hands of drug users — who also receive training from Street Connections in how to use them — has indeed saved lives, there is already concern the kits will be no match for stronger opioids.

“The amount of naloxone in the kits was enough to handle your average overdose,” Marshall says. “Now with these new products, such as carfentanil, there are some overdoses that our overdose kits will not have enough naloxone to handle them. This is the new world of drugs.

“Naloxone is a great drug. It’s safe and effective — but it’s very downstream,” she adds. “You have to wait until you stop breathing before it takes its place. But in terms of interventions, it’s saving lives and it gets us interfacing with people we didn’t see before,” she says, including stimulant users who now have fentanyl appearing in their drugs.

Providing supplies such as clean needles and naloxone kits is just one part of harm reduction. “It needs to look at structural interventions and it needs to look at changing the social conditions that create those conditions of harm,” Marshall says.

Drug-related harms are not limited to disease and death.

“Criminalization is a very serious harm with drug use,” she says, by way of example. “You get a drug charge and you’re cast into an underclass forever, where you don’t necessarily have the same access to employment and opportunities as you had before that criminal charge. We have to keep that in our purview of what a drug-related harm is.”

jen.zoratti@freepress.mb.ca