Fatal overdoses hit new high – Can Safe Injection Sites Help?

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  • Overdose deaths in the United States have reached new highs during the pandemic, and experts are looking for better ways to help people addicted to opioids.
  • Some US cities are investigating supervised injection sites, where people would be allowed to use opioids without being arrested.
  • These sites have been used in Canada to keep people who use drugs safe and to help them get in touch with services.

Drug overdose deaths reached a new high in the pandemic, with more than 97,000 deaths through April 2021, according to the Centers for Disease Control and Prevention (CDC).

Recent The data shows that the opioid crisis costs the United States about $ 78.5 billion a year for prescription opioid abuse alone.

State and federal authorities are now looking for ways to reduce the cost in human lives and medical resources.

Last month, Health and Human Services (HHS) Secretary Xavier Becerra announced a new overdose prevention program.

“Our new strategy is people-focused – placing the very people who have battled drug addiction in positions of power,” Becerra said in a statement.

“And thanks to the US bailout, we can deal with what so many people have seen in recent years: an increase in overdoses that can put a person’s life at risk – and affect their entire family.”

One approach is to provide people with substance abuse problems with a safe, medically supervised place to use drugs – a “safe injection site”.

Building on long-standing and successful supervised injection site programs like the Vancouver Insite facility, cities like New York and San Francisco are advancing plans to establish similar programs.

Recent research shows that long-term evidence from supervised injection sites has a “lasting impact” on reducing drug overdose.

However, this approach is controversial and there are already various treatment options available to help prevent overdose deaths.

Overdose deaths related to opioid use have been a long-standing problem. problem in the United States, but the CDC recently revealed that drug-related deaths have reached record levels.

In September 2021, the Drug Enforcement Administration (DEA) issued a public safety warning regarding an “alarming” increase in the sale of counterfeit pills containing fentanyl. Fentanyl is 50 times stronger than heroin and up to 100 times stronger than morphine, according to the CDC.

“The increased supply has led to an increase in reports of accidental overdoses across the country,” said Adnan Iqbal, MD, medical director of psychiatry at Texas Health Arlington Memorial Hospital and Texas Health Recovery and Wellness Center. .

Dr Shereef Elnahal, president and CEO of Newark University Hospital, New Jersey, said factors such as the long COVID, loss of loved ones from COVID-19 and the economic and psychological impact pandemic restrictions in 2020 had a “downstream effect” on mental and behavioral health, including substance abuse.

“We were making progress in 2018 and the first half of 2019 with the opioid addiction epidemic, unfortunately the COVID-19 pandemic has reversed that and we find ourselves behind where we were before,” he said. -he explains.

This crisis is a call to action and a reason to “double down” on resource commitments and investments to support addiction treatment and awareness, Elnahal concluded.

There are two parts to treatment for opioid addiction: safe opioid detoxification and maintenance treatment commonly known as drug-assisted treatment (MAT), Iqbal told Healthline.

“During the safe detox component, the patient is monitored and rated typically using a scale known as the COWS or the Clinical opioid withdrawal score“, explained Iqbal.” The patient is also given medication to relieve the symptoms of opioid withdrawal. ”

There is a wide range of medications available to treat withdrawal symptoms. Iqbal noted that these included clonidine, lorazepam, Suboxone (a mixture of naloxone and buprenorphine) and methadone.

He explained that Suboxone and Methadone are used to treat cravings and prevent relapse of opiates. When used with relapse prevention therapy, MAT increases the likelihood of sobriety.

Elnahal recounted his experience with MAT from his time as the New Jersey Health Commissioner.

“I have authorized the New Jersey emergency medical services to use this drug [buprenorphine] to avoid withdrawal immediately after naloxone, ”he said.

“And that’s the reason I have EMS telling me that they would sometimes give it to the same people three, four, five times in one night.”

Elnahal pointed out that these people would overdose several times because once resuscitated they had withdrawal symptoms that forced them to use opioids again.

Elnahal stressed that treating overdoses is not the only option. Drugs can also help people overcome their addiction. He said it is currently the “gold standard” for treating drug addiction.

“We relied on rehabilitation, we relied only on psychosocial services to get people out of this cycle, and it’s much less effective,” he said.

“The evidence is that combining psychosocial counseling and treatment with medication will allow people to wean themselves off their addiction over time.”

“This [addiction] is definitely a disease that there should be no stigma against, ”Elnahal said. “Peer support and psychosocial and behavioral health services combined with medication-assisted treatment are the way to help people get through this time. “

He stressed that the environment in which people live and work, and their social environment, is a “huge determinant” of their relapse into sobriety.

“This is why peer support is so important, to have someone who has crossed the path, and frankly, what recovering people tell me is that they are always on the way,” he said. said Elnahal. “Because the risk of relapse is still there. “

Elnahal said not everyone is immediately willing to start treatment for their addiction, so more measures are needed until they are.

“The concept of harm reduction allows users to create a safer environment that protects their health while they are experiencing addiction,” he explained, adding that exchanges of clean syringes are another option.

“As the health commissioner I was a big supporter of the statewide clean syringe exchange, we had six at the time,” he said. “Sadly, many cities have closed theirs, which has been a huge loss to New Jersey and to public health.”

Elnahal added that setting up a sufficient number of safe syringe exchanges in a jurisdiction could reduce resistance to locating safe injection sites in communities while helping to prevent the spread of diseases like hepatitis C and HIV.

Some cities are considering innovative “harm reduction” measures, such as medically supervised injection sites, to reduce overdose deaths.

Experts say that while drugs can treat overdoses and blunt drug addiction, finding ways to get people with drug addiction to access treatment is crucial, and safe injection sites are one way to do so.

They also say other options, such as exchanges of clean syringes, can help prevent the spread of disease while making it easier to convince communities to allow safe injection sites.


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