CCBI News: Pope Francis and Dr Lam—Practical Actions in the Opioid Crisis, Decriminalization, Naloxone, Safe Supply and Closeness to Those Suffering

September 22, 2023

Dear Friends of CCBI,

Pope Francis and Dr Lam:
Practical Actions in the Opioid Crisis

Pope Francis stated in 2018: “Fighting addictions calls for a combined effort on the part of various local groups and agencies in enacting social programmes promoting health care, family support and especially education. In this regard, I readily support the desire expressed by this Conference for a better coordination of policies aimed at halting the growth of drug abuse and addictions — isolated policies are of no use: it is a human problem, it is a social problem, everything must be interconnected — through the creation of networks of solidarity and closeness to those suffering from these pathologies.”

Decriminalization

One way of showing such support is illustrated by the province of British Columbia, which was recently granted an exemption from the Controlled Drugs and Substances Act to help combat the overdose crisis that has claimed over 11,000 lives there since 2016. People who carry the permitted amount of drugs will not be arrested or charged, and police can no longer seize their substances, but will focus on, “… those doing the most harm in this crisis – persons and organized crime groups who import, manufacture and distribute these toxic substances.”

Opioid Reversal by Naloxone

Another way of helping those with drug addictions is through countering overdose through the use of Naloxone. This opioid antagonist is available without prescription in Canada, so that anyone can try to reverse opioid overdoses. Student campuses, restaurants, bars, etc., in Canada are recommended to have it available for overdose situations, and this is also backed by the U.S. National Institutes of Drug Abuse.

Some, though, argue against this practice, thinking it encourages use of toxic drugs since some drug users might feel reassured that an overdose reversal is possible should matters go awry, given, of course that someone with Naloxone (Narcan in the U.S.) is on hand. Others argue that it is better to provide it since its use has saved so many from death, even if, sadly, that does not guarantee that people will stop being users.

Safe-Supply

In a carefully balanced article in the The Globe and Mail, Dr Vincent Lam, a famous author and an addictions-medicine physician in Toronto, writes that: “Despite continuing research into other classes of medications, opioids are still the mainstay of treatment for opioid addiction at this time, and those that are used for this purpose are called opioid agonist therapies (OAT). In terms of saving lives, nothing else has proved nearly as useful. A 2021 meta-analysis, a type of study that combines results from multiple studies to give us a bird’s-eye view, examined 15 randomized controlled trials of methadone and buprenorphine, and found that the chance of dying from any cause was roughly halved during times when a person with an opioid addiction was receiving one of these treatments, as compared with times when they were not receiving them.”

From these statistics he advises us that, “At this time, the best medications we have for treating opioid addiction are opioids.” In some ways this seems counterintuitive, but he points out that, “… many people initially use opioids to escape anxiety, pain and distress. Once addicted, people become further afflicted with anxiety, pain and distress in the absence of opioids. The solace that opioids provide transform into the stricture of their necessity. OAT (opioid antagonists) medications don’t break this bond, but they stabilize it, making it possible to take daily medications – or, now, an option that is injected monthly under the skin.”

He is concerned about the long-term benefit of a safe-supply approach to drug use, where drugs are issued free of charge to users, saying this continues a ‘street drug’ effect that is short acting but increasingly less effective, meaning even higher doses are required, with greater risks of overdose and death. Dr Lam’s major point is that supervised, clinical approaches involving opioids have been shown to reduce the deaths of people who suffer from opioid addiction and are long-acting, with longer-term effects in the body. “They hold the physiology steady, thus relieving withdrawal. In some patients, OAT (opioid antagonists) keeps things steady for years – in some cases, they offer this benefit for the remainder of the patients’ lives…”

He is clearly against safe-supply policies for medical reasons, going so far as to challenge the idea, “ – that simply providing pharmaceutical-grade short-acting opioids to people will save lives – (and that ) has captured the imagination of the media and dominated recent public attention around addictions treatment. The narrative is appealing, although after six years of PSAD being practised in Canada, there is no clear evidence that it actually reduces overdoses and deaths.” His last point is extremely important, since the whole point of any exercise in this field is to reduce not only the numbers of overdoses, but, most importantly, the number of deaths.

He notes that, “… (in) most conditions, whether it is heart disease, diabetes or cancer, treatment is about changing trajectory, and improving quality of life over a time horizon of years. The same is true of addictions.” This is advice that should be heeded. Dr Lam is aware of the many social problems involved in addictions: personal trauma, unsuspecting overuse of prescription drugs, homelessness, chronic physical and emotional pain and so on, and he advocates for more and better multidisciplinary, publicly funded systems to counter these problems that bedevil society. He writes, “We have to help families access useful tools, the resources to get through tough times, and workable responses to problems.”

Which brings us back to Pope Francis (above) who is in agreement about addictions: “… it is a human problem, it is a social problem, everything must be interconnected — through the creation of networks of solidarity and closeness to those suffering from these pathologies.”

To participants at the International Conference on “Drugs and Addictions: an Obstacle to Integral Human Development” (1 December 2018) | Francis (vatican.va)
B.C. ‘fight continues’ during decriminalization amid safe supply calls, advocacy group members say – The Globe and Mail
Increased Narcan availability evokes ethical debate (healio.com)Opinion: The solution to the opioid crisis can’t be a quick fix – The Globe and Mail

Pope Francis’ Intentions for September

Let us pray for those people on the margins of society in subhuman living conditions, that they may not be neglected by institutions and never be cast out.

Moira and Bambi