May 10, 2024
by Hala Ghoson, Pharm D
The opioid crisis has evolved rapidly and continues to worsen over the years starting with the “first wave” in early nineties by the over-prescription of pharmaceutical opioids for pain quadrupling overdose deaths followed by a “second wave” of addiction deaths in 2010-2013 and was caused by rapid escalation in number of overdose deaths due to Heroin. A “Third
wave” hit in 2019 and was marked by the use of the ultra potent opioid known illicitly manufactured fentanyl or synthetic fentanyl. This increase in fentanyl deaths was not driven by diverted medical fentanyl but it was related to illicitly manufactured fentanyl used to replace or adulterate other drugs of abuse.
A small amount of fentanyl or fentanyl analog supply could lead to a very rapid opioid overdose and eventually death. Packets of herion being sold but were adulterated with illicitly manufactured fentanyl could cause unintended accidental overdose due fentanyl’s high potency about 50 times more potent than herion and 100 times more potent than morphine. Add to that many users are unaware that the drug of abuse contains or is adulterated with fentanyl.
Over the years our perception of addicts has changed. Addicts are considered victims of drug addiction disease and not criminals as traditionally were classified. Therefore, a new approach “harm reduction approach” is now being adopted. This approach accepts that people are going to misuse substances and recognizes that some individuals may continue to use opioids despite efforts to stop it. This initiative tries to protect addicts and keep them safe from drug overdose and acknowledges that complete abstinence may not be achievable or desirable for everyone immediately. For this reason, the focus is on minimizing the negative consequences and reducing the harms associated with drug use and providing support and resources even if that is the choice these individuals make. By doing so, this aims to improve overall community health and safety although the effectiveness and acceptance of harm reduction strategies may vary across different regions and cultures.
Here are some key aspects of the harm reduction approach to opioids:
- Needle Exchange Programs: These programs provide clean needles to individuals who inject drugs, reducing the risk of HIV/AIDS and hepatitis transmission and other infections associated with needle sharing.
- Naloxone Distribution: Naloxone is a medication that can reverse opioid overdoses. Harm reduction initiatives distribute naloxone to opioid users, their friends, family members, and community members, enabling prompt response to overdose emergencies.
- Supervised Injection Sites: These facilities offer a safe and hygienic environment for people to use drugs under medical supervision. Staff members are available to provide assistance in case of an overdose and offer resources for treatment and support.
- Access to Treatment: Harm reduction recognizes the importance of providing accessible and evidence-based addiction treatment options for those seeking help to reduce or stop opioid use.
- Education and Counseling: Harm reduction programs offer education on safer drug use practices and provide counseling services to individuals struggling with addiction.
- Supportive Services: This approach may also include social and housing support to address the underlying issues contributing to drug use.
