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Official: Harm reduction one part of opioid response

July 24, 2018

The manager of an office that supports the drug policy implementation for Canada’s largest city said “harm reduction” is one part of a comprehensive response to the opioid epidemic, but it can’t be the only one.

People often focus on needle-exchange programs and supervised injection sites because they’re controversial, said Susan Shepherd, the manager of the Toronto Drug Strategy Secretariat at Toronto Public Health.

“Nobody, certainly not here in Toronto and anywhere, is suggesting that this is the only response,” Shepherd said. “We need prevention. We need to build resiliency in our children so they can make good decisions for themselves, healthy decisions regardless of whatever risks they encounter.”

And, Shepherd said, treatment options and law enforcement are part of the response.

“We need treatment options that are effective, that are evidence-based, and that means not only abstinence-based options because that’s not always effective for everyone,” Shepherd said. “We need a whole range of options for folks. And of course there’s a role for enforcement and police in dealing with this — we see their role as dealing with the high-level traffickers in the current illegal market.”

Shepherd is the keynote speaker at two upcoming opioid epidemic forums in Charleston and Huntington.

The first, “Moving Beyond Fear: Saving lives and protecting neighbors,” will be at 7 p.m. Thursday at St. John’s Episcopal Church, 1105 Quarrier street in Charleston.

In Huntington, Shepherd also will speak at “Responses to the Opioid Epidemic: Lessons Learned and Best Practices,” from 9:30 a.m. to noon Saturday, July 28, in room BE5 of the Memorial Student Center at Marshall University. The Huntington event is part of the Center on Budget and Policy’s 2018 Summer Policy Institute.

Both are free and open to the public.

The city of Toronto has operated a needle-exchange program for more than 25 years.

The city’s drug strategy, approved in 2005, is based on a framework used around the world and referred to as the “Four Pillars”: prevention, harm reduction, treatment and enforcement, Shepherd said.

“The idea is that you need all those things working together to address harmful substance use, including alcohol,” Shepherd said. “That’s the drug that causes the most harm, except for tobacco.”

She said the primary goal of harm reduction isn’t to get people to stop using drugs. That’s a challenge for some people, she said.

“It is to reduce the harms of their drug use for them and supporting them in whatever their goals are,” she said. “For some people they do want to get into treatment. They may even want to get into treatment for a short period of time, to take a break ... The primary goal is to reduce health harms and save lives and improve health outcomes for people.”

Shepherd said that, like in Charleston, issues with needle litter come up in Toronto from time to time. Shepherd said the best response to needle litter is to address the needle litter.

“So, do people have the ability to safely dispose of their supplies?” Shepherd said. “Are they given containers? Are there needle drop boxes where people could drop things off? Is the police presence so dominant that they’re afraid to carry any of their equipment on them even to dispose of it?

“That’s one reason people sometimes throw away their needles,” Shepherd said. They [are] afraid they will encounter police when they’re carrying. So people need to feel safe in carrying their supplies so they can also safely dispose of them.”

In November, Toronto opened its first permanent supervised injection service. The city now has four supervised injection services and five overdose prevention sites. Both are places where residents can inject drugs under medical supervision, but the latter are smaller and more short-term.

With 303 opioid deaths in 2017, Toronto is in the midst of an “overdose death emergency,” Shepherd said. The number is a 64 percent increase from 2016 and a 121 percent increase from 2015, she said.

In light of that, the city’s boa rd of health recently approved two recommendations from the top medical officer that it call on the Canadian government to decriminalize the possession of all drugs for personal use and that it call a task force to look at options for the legal regulation of all drugs.

The idea is that “we should be looking at drugs as a health issue, not as a criminal issue,” Shepherd said. “Sending people to jail simply for having drugs is an inappropriate response to a health issue.”

Going to jail is harmful to a person’s chances of finding work or finding a job, she said.

“And it’s not stopping people from using drugs — the fact that it’s against the law,” she said.

Reach Lori Kersey at lori. kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.

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