Secondary -The Other Health Emergency
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secondary - February 2021
The Other Health Emergency
While BC continues to respond to the COVID-19 pandemic, it is important that we recognize that this is not our only health crisis. The opioid overdose crisis continues to have a major impact on the province. In the five years of this public health emergency, more than 6,500 families have experienced the grief and sadness of losing a loved one to a drug overdose.

From January to June 2020, 97% of apparent opioid toxicity deaths were accidental and 85% of those deaths involved a non-pharmaceutical opioid.

The information in this Snapshot is meant to help parents become informed about the opioid crisis. It important that youth receive accurate information, not just what they read online or hear from peers. It is critical they understand that overdoses do not discriminate. 

Ending the Stigma
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Stigma matters because it can prevent people who use drugs from getting help. People who are stigmatised often feel ashamed, alone and judged. Together we can help end stigma.
Opioids are depressant drugs with pain relieving properties. Opioids can also induce euphoria, which gives them the potential to be used recreationally. 

The most common Opioids are:  codeine, fentanyl, morphine, oxycodone, hydromorphone, and heroin. 

Short term side effects include:  drowsiness, nausea and vomiting, euphoria, difficulty breathing, headaches, and/or overdose.

Long term side effects can include:  increased tolerance, dependence, liver damage, worsening pain, withdrawal symptoms, and/or overdose.

Opioid overdoses can occur when an individual consumes more opioids than the body can handle. 

Symptoms of an overdose may include:
- being non responsive
- slow or stopped breathing
- choking or gurgling sounds
-  blue lips or nails
- cold or clammy skin
- tiny pupils  
Overdose risk increases when:
- Tolerance is lowered (after a period of non-use, or first time users)
- An individual has been sick, dehydrated or has liver issues
- Substances are mixed
- Substances are stronger than the body is used to
The consequences of an overdose may be short term, particularly if lifesaving interventions such as Naloxone are used quickly for support, but there is also the possibility for long term brain damage or death.
Naloxone can save a life
Naloxone (pronounced na-LOX-own) is a fast-acting drug used to temporarily reverse the effects of opioid overdoses. Naloxone can restore breathing within 2 to 5 minutes.

While naloxone is only active in the body for 20 to 90 minutes, the effects of most opioids last longer. This means that the effects of naloxone are likely to wear off before the opioids are gone from the body, which causes breathing to stop again. So it is important to call for emergency medical attention. Naloxone may need to be used again, depending on the amount, type, or how the opioids were taken (for example: oral, injection).  

Naloxone is available without a prescription and can be picked up at most pharmacies or local health authorities. It is available in an injection or a nasal spray format.

 Adolescents, like other groups, may use opioids for a variety of reasons.

Some people use opioids for pain treatment or for temporary relief from anxiety, adverse experiences or difficult life circumstances.

Others use opioids to experience a feeling of euphoria or out of curiosity about drugs that are perceived as risky or out the mainstream; conversely, others may be using because it is accepted in their peer group.

Some users unintentionally expose themselves to opioids mixed into another type of drug they buy from an unregulated supplier.
Strategies for talking to youth about Opioids:

Educate yourself so you can answer questions

Become informed about substances commonly used by young people

Be a good listener

Stick to the facts - avoid scare tactics and  exaggeration

Focus on heart felt concerns

Discuss the concepts of harm reduction:  avoid, delay and reduce (more on harm reduction below)
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Fentanyl is an extremely potent synthetic opioid that can be prescribed for the treatment of acute and chronic pain, and it is approximately 100 times more potent than morphine, and 20 - 50 times more potent than heroin.

Legal fentanyl comes most commonly in a patch and liquid form and is administered in a hospital setting.

Illicit Fentanyl is a white, crystallized powder substance with no distinct odour. This powder is mixed with other drugs (i.e. heroin) to increase its potency, sold in its powder form, or pressed into counterfeit pills resembling various medications like Oxycontin, Percocet or Xanax
Carfentanil is a synthetic opioid normally used as a sedative for large animals such as elephants. It is an analogue of fentanyl and can be 100 times more toxic than fentanyl. It looks similar to table salt - ingesting one or two grains can be fatal to humans.
Data on the overdose Crisis
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While Western Canada continues to be the most impacted region of the country since 2016, rates have increased in other Canadian regions, including Ontario. At least five provinces and territories observed record-breaking numbers of deaths from April to June 2020.
Between January and June 2020, 86% of all opioid toxicity deaths occurred in British Columbia, Alberta or Ontario.
In November 2020, there were 153 suspected illicit drug toxicity deaths in BC. This represents a 89% increase over the number of deaths seen in November 2019 (81). The number of illicit drug toxicity deaths in November 2020 equates to about 5.1 deaths per day.

The total number of deaths from illicit drug overdoses now eclipses any other unnatural cause of death in BC, including suicide and motor vehicle incidents. 

The majority of deaths are caused by opioids such as fentanyl, heroin, morphine, and oxycodone often combined with other drugs and alcohol; most deaths occur in private residences. 

what has contributed to the crisis?
The Canadian Centre on Substance Use and Addiction states that the following factors have contributed to the current crisis:

* A misunderstanding of the addictive risk of prescription opioids
* Frequent opioid prescribing and high amounts being prescribed for pain relief
* Lack of awareness of alternative treatments for pain
* Theft of prescription opioids by friends and family members
* Lack of access to prescription opioids leading to illicit opioid use
* Illegal drugs that are laced with other substance, such as fentanyl
* Stigma towards substance use disorders, discouraging individuals from seeking help
* Psychological, social and biological risk factors like genetics, mental health, trauma, poverty and other social determinants of health
More recently experts say COVID-19 has exacerbated the situation as the supply of illicit drugs became more toxic when the border was closed and more drugs were made or altered in Canada. The pandemic has also impeded access to key harm reduction services, such as supervised consumption sites.
Opioid Harm Reduction Strategies
Research shows that harm reduction activities do not encourage substance use; in fact they are more likely than other methods to encourage people who use substances to start treatment.
In the Greater Victoria School District, we view harm reduction as a continuum with the safest harm reduction strategy being:

Avoidance moving to the concept of delaying use, and at the other end of the continuum, reducing use. 

All students should attempt to reduce, delay or preferably avoid opioids, as there is the very real risk of overdose with each use.
Other harm reduction strategies can include: 
only using with others
using safe injection sites
testing substances
carrying Naloxone if around any potential opioid users
discussing options with a physician or substance use counsellor
further education and conversations about potential risks 

It is important to remember that addiction is a complex illness with many contributing factors and no easy solutions.
Where to find help for problematic substance use
february school poster
Several copies of this poster have been delivered to all secondary schools for student learning.

The goal of this poster is to make teens aware of the Good Samaritan Drug Overdose Act which provides some legal protection for individuals who seek emergency help during an overdose.

The hope is that the Act will help to reduce fear of police attending overdose events and encourage people to help save a life. 
Resources and Sources

Family Support Institute of BC

FSIBC Zoom sessions are a safe space for families, caregivers and professionals to come together for support, learning, inspiration and connection. Some sessions are by theme/topic while others are for general conversation and engagement. Whatever you might be feeling — overwhelmed, sad, confused, fearful, anxious — you are not alone

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