Tackling overdose: Addressing vulnerabilities, empowering communities

By Cyril André* and Juan Fernández Ochoa

Across the globe, overdose deaths are skyrocketing. Only in the United States, the number of lives lost to overdose reached a staggering 70,237 in 2017; an almost twofold increase in just a decade. In Canada, the death toll has broken a terrible 4,000 mark. And, similarly, in northern Europe, a worrying increase in deaths, particularly among people in situations of vulnerability, has rightfully raised alarms and stirred rage among communities and allies. While North America and Northern Europe account for the majority of recent overdose deaths globally, the challenges posed by overdose are not limited to the northern hemisphere. Non-fatal overdoses are several times more common than fatal opioid overdoses, which imposes an incredible life, health and emotional burden on communities worldwide.

Both the latest UNODC’s World Drug Report and the EMCDDA’s European Drug Report outline current trends in drug control, markets and related health outcomes, emphasising the importance of tackling the overdose crisis. In North America and Western Europe, a number of states are [slowly] starting to realise the need to shift policies to centre the health and human rights of affected populations. But change isn’t happening fast enough and stemming the tide of thousands of deaths requires radical action.

Scotland is currently a sad example of how failure to recognise the value of community knowledge and scientific evidence, which point to the importance of well-funded prevention, treatment and harm reduction services, leads to dire results. The country now experiences a number of overdoses so important that it actually reduced the mean life expectancy of people aged 35 to 54. Across the Atlantic, in the US, the risk of dying of overdose has surpassed the risk of dying in a car accident.

Do these shocking figures (and the life stories behind them) translate into public uproar or decisive State action? Only tepidly. Stigma against people who use drugs and overdose remains rife. Not only that, but we also know that the people most likely to experience overdoses face intersecting vulnerabilities and forms of marginalisation, such as poverty, homelessness, untreated physical and/or psychological distress (often due to past and deep-rooted trauma), unemployment and incarceration.

These socio-economic factors that drive overdose deaths often, contradictorily, contribute to rendering invisible and/or expendable those most affected. In the meantime, reactionary voices can continue to deflect responsibility by blaming China, unscrupulous small-time dealers, methadone or individual life "choices". But it is the deep-seated understanding of drug use as immorally deviant, which reaches its paroxysm with criminalisation, that is at the heart of a vicious cycle of death and neglect.

This neglect entails the de-funding, or sheer absence, of prevention, treatment, harm reduction and welfare services that are known to be effective and cost-effective. In the absence of safety nets and resources for resilience, the growing potency and adulteration of street drugs has led to disastrous outcomes (incl. as a result of the irruption and relative omnipresence of fentanyl in some markets).

There is an array of responses that could help curb the number of overdoses and overdose deaths around the world (see, for ex., the EMCDDA's infographic below). Studies have shown that several “environmental factors increase the risk of drug overdose death including, in the case of people who use opioids, disruption of treatment provision or discontinuity of treatment and care”. Services and research should focus on creating, and demonstrating the value of, inclusive environments (incl. community-led) in order to reach and establish lasting relations with people in need. In this effort, a better allocation of funds should see a shift away from punitive responses towards harm reduction, treatment and welfare services.

State responses could also seek inspiration from communities and their allies, who are often nimbler and bolder in responding to crises, deploying services such as overdose prevention and safer consumption sites, heroin-assisted treatment/safe supply, drug checking services, peer-led outreach, among others.

An emphasis must also be put on the access to social and health services in prisons and upon release, as people formerly incarcerated are several times more likely than other groups to experience a fatal overdose after release.

Access to naloxone, which is an opioid antagonist that has already saved countless lives, should be broadened. People who are likely to experience or witness an overdose, their relatives, as well as medical professionals should be allowed and trained to use this substance.

Much like when the seatbelt was invented, some critics and governments argue that broadening access to naloxone – and other harm reduction services - would encourage users to take drugs more often, and in a more dangerous manner. But like with seatbelts, these arguments do not respond to the lived experiences of those most affected. Keeping people alive, acknowledging that use and dependence are complex and multifaceted phenomena, and that the potential of relapse or adverse consequences should not trump continuing support and care, should always be a priority.

Every preventable overdose death is the preventable death of someone’s parent, sibling, friend…a valuable human life. Those who have experienced this trauma deserve all the compassion and support we can offer. Ending overdose necessitates building more resilient, supportive, caring and empowering societies. We need to talk about overdose, and demand change.

This blog post is published on the occasion of the International Overdose Awareness Day, a global campaign commemorated on 31 August to raise awareness of overdose, reduce the stigma of a drug-related death and stimulate discussion about evidence-based overdose prevention and drug policy. Please, consider also reading and supporting the pieces produced by our brave colleagues from the Eurasian Harm Reduction Association (EHRA), the International Network of People who Use Drugs (INPUD) and the European Network of People who use Drugs (EuroNPUD). And browse the hashtags #OverdoseAwarenessDay and #IOAD for more information.

* Cyril André recently volunteered with IDPC and is a student of International Cooperation and Multilingual Communication at the University Grenoble-Alpes.