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How stigma can kill - LTRI researchers argue that destigmatization is a key strategy to fighting opioid overdose

January 20, 2017


by Meghan Krizus

Drugs, especially opioid painkillers, are an essential tool in modern medicine. However, drug overdose is a significant cause of death worldwide, with the World Health Organization estimating that opioid overdose alone causes 69,000 deaths a year (as of 2014). This death rate is growing, driven in large part by the availability of powerful opioids such as fentanyl. This opioid molecule is far more potent even than drugs like heroin and has become a formidable killer.

Despite our progressive healthcare system, Canada is by no means immune to this growing crisis. The CBC reported in December 2016 that fentanyl alone has killed at least 2,000 Canadians, with 755 killed in British Columbia between January and November 2016. Numerous studies have shown the effects of the drug to be spreading east with significant increase in fentanyl-associated deaths in Toronto in 2016.

A key weapon in the fight against opioid overdose is a fast-acting antidote called naloxone, marketed under the brand name Narcan. Able to save a life in under three minutes if administered in time, naloxone’s efficacy and speed make its distribution to first responders a common element in the worldwide attempt to treat opioid overdose. But also key to preventing death by overdose is the distribution of this life-saving drug to members of the public, including those who are themselves at risk of overdose.

Such a program exists in Scotland, and is the focus of a recent work describing “take-home naloxone” (THN). In a THN initiative, members of the public are given access to naloxone, taught how to administer it to a person suffering from an overdose, and instructed to call emergency services after its administration. In a new publication by researchers affiliated with the LTRI, authors Aaron Orkin and Dr. Daniel Buchman analyze research conducted via this program. Their investigation of the successes and failures of THN is particularly timely given that Health Canada recently approved naloxone for non-prescription use.

Orkin and Buchman state that while there has been a documented rise in administration of naloxone in overdose cases in Scotland, this has not been an unqualified success in treatment of these overdoses. Indeed, while it may be a positive move that naloxone is readily available to the public to treat opioid overdose, the researchers describe how these programs still face problems in effective implementation.

A primary concern is in the persistence of stigma around drug use. Orkin and Buchman note that the authors of the original study observed that after distributing naloxone to the public, there was a rise in its administration but no corresponding rise in ambulance calls, despite the fact that there was no significant drop in opioid overdoses. As this program stresses to the public that naloxone is only first aid and that an ambulance must be called in conjunction with its administration, a fully effective THN program would have ensured that as naloxone administration rose, so too would the number of ambulances called to treat overdoses. Since in many cases emergency services were not called, vulnerable overdose victims continued to suffer without access to emergency medicine that could prove vital in their overall treatment.

Orkin and Buchman identified stigma as the main reason for this failure. The failure to notify emergency services was not observed when a member of the public administered other types of treatment either to themselves or to another; for instance, the authors noted that following a lay person’s use of a defibrillator or an epinephrine auto-injector, a patient would almost always subsequently gain access to emergency responders. They suggest that stigma around drug usage is to blame for this discrepancy, and argue that in order to ensure that those who have overdosed receive proper medical treatment, narcotic drug usage must be destigmatized. The study authors also highlighted how Scotland’s THN program reveals a schism in how we treat emergency use of naloxone versus emergency use of other tools of first aid, and why this must change in order to improve care for overdose sufferers.

The study by Orkin and Buchman is key to the patient-centred and integrated care and innovation. This work was enabled by members of the Schwartz/Reisman Emergency Medicine Institute at Mount Sinai Hospital, the Lunenfeld-Tanenbaum Research Institute, and Bridgepoint Active Healthcare and illustrates the powerful impact of collaboration within the Sinai Health System.

Stigma is a powerful disincentive for behavior. All too often, this means that those who are ill often forgo medical attention because of prejudice toward their illness. Society has come far in destigmatizing topics that were once hidden, but there remains much to be done to remove stigma from important conditions, especially those associated with mental health and addiction.


Concerned about the opioid crisis? There are ways to learn more.

Remember: if you or someone else is in immediate danger from a mental health crisis, call 911 at once or find the nearest Emergency Department.


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