‘Safer opioid distribution’ as an essential public health intervention for the opioid mortality crisis – Considerations, options and examples towards broad-based implementation

Addressing the Syndemic of HIV, Hepatitis C, Overdose, and COVID-19 Among People Who Use Drugs: The Potential Roles for Decriminalization and Safe Supply

“…Because the vast majority of overdose deaths in North America nowi nvolvet oxic doses of illicit fentanyl and fentanyl analogues (Katz et al, 2020), access to pharmaceutical-grade drugs would ensure that theya re appropriately dosed and not adulterated,a llowing PWUD to reduce their risk of unintentional overdose from at oxic illicit drug supply ( Fischer et al, 2020;Ivsins et al, 2020). Within the COVID-19 pandemic, sufficient safe supplyf or individual use could facilitate physical isolation by preventing an eed to seek funds to purchase unknown substances from unregulated drug markets (Bach et al, 2020).…”

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

“…Given the high degree of adulteration and contamination of street-level psycho-stimulant supply, and modelled on the concept of 'safer opioid supply' initiatives of which some have been locally initiated, some commentators have advocated for 'safer stimulant supply' for persons involved with psychostimulant use [45,[132][133][134]. There, however, remain fundamental questions, including general feasibility in respect to the distinct use ('binge') profiles that commonly characterize psycho-stimulant use yet also which existing pharmaceutical replacement substances would be suitable for such an intervention, and whether individuals with related substance use would be willing in practice to utilize such programming if offered [132,134,135].…”

“…The excessive and persistent burden of opioid-related morbidity and mortality led to the implementation and/ or expansion of a series of prevention and treatment measures targeting individuals with at-risk opioid use in Canada, including: widespread naloxone availability and distribution (for opioid overdose reversal); officially sanctioned, and informal 'supervised consumption sites/ facilities; 'drug-checking' services, an increasingly diverse range of opioid pharmacotherapy options for the treatment of opioid use disorder, and initial efforts of 'safer opioid supply' programming that were offered to an increasingly large proportion of the 'at-risk' populations involved in opioid use [39][40][41][42][43][44][45]. The twenty-first century's second decade (2010-2019) became the decade of the 'opioid crisis'.…”

“…The (re-)emergence of psycho-stimulant use and harms By 2018, global indicators suggested that psychostimulant use has steadily increased, with an estimated 0.4% (18.2 million) of the global adult population using cocaine and 0.7% (34.2 million) using amphetamines; regional estimates, however, for both drugs (1.9 and 2.0%, respectively) are highest for North America [47,48]. An estimated 0.58% (326,000) global all-cause deaths were attributed to amphetamine dependence, and 0.32% (178, 000) to cocaine dependence in 2017, with higher regional rates (approximately 1.5 and 2.5%, respectively) for North America [45]. Psycho-stimulant use has been generally confirmed to be associated with a variety of (physical and mental) excess morbidity outcomes [49][50][51]; specifically, substantial proportions (up to 25-30%) of incident HIV and HCV transmission, depending on region and use prevalence, have been assessed to be globally attributable to psycho-stimulant use [47,52].…”

Some notes on the use, concept and socio-political framing of ‘stigma’ focusing on an opioid-related public health crisis

“…Tangibly, federal government authorities, for considerable time, have refused to formally call a 'public health emergency' (under the Emergencies Act in Canada) in response to the opioid crisis that would have allowed considerably more flexible and substantive measures to address and reduce related health risks and adverse outcomes, including the massive overdose mortality toll [18,19]. Related, federal authorities have long resisted the implementation of broadbased, systematic provisions and measures for comprehensive 'safer opioid' distribution programming towards better protecting the numerous 'at-risk' opioid users from increasing exposure to highly toxic/ potent, illicit opioid supply and elevated risk for overdose and death [20][21][22]. Both types of measures reflect and mimic standard interventions applied and enacted elsewhere (e.g., for vaccinations for influenza, or acutely extensive transmission control measures COVID-19 etc.…”