Episode 15: Apocalypse Prescribing

Written By Crackdown Podcast .

(Art by Garth Mullins)

Drug users in British Columbia are facing two overlapping public health emergencies: COVID-19 and the overdose crisis. Now that countries are closing their borders–the price of street drugs have also started to rise.

It’s a grim time. Vancouver just saw the largest spike in fatal ODs since last year.

But there’s also a glimmer of hope: the government has finally agreed to provide us with safer prescription alternatives to street drugs. If you have a “Substance Use Disorder” in British Columbia, you can now access a bunch of prescription opioids, benzos and stimulants –something we’ve been demanding for years. So far, this doesn’t include diacetylmorphine (heroin), cocaine or prescription fentanyl. And it is unclear whether or not the new policy will remain in place after COVID-19 has passed.

On Episode 15, we dig deep into the new policy and tell the story of advocacy that made this possible. We ask Minister of Mental Health and Addictions Judy Darcy why this wasn’t done at the start of the overdose crisis. We also speak with editorial board members Laura Shaver and Dean Wilson about getting their new meds. And we talk with Guy Felicella about writing the new clinical guidelines. 

Transcript

A full transcript of this episode is available here.

Call to Action

Get access to the drugs you need through B.C’s new clinical guidelines

Talk to your doctor, and bring a link to the guide if you can.

GET THE PDF HERE

The new guidelines DO NOT cover heroin, fentanyl, or cocaine.

Drugs Available

  • oral hydromorphone (DIlaudid / Dillies).

  • M-Eslon

  • Dexedrine

  • Methylphenidate (Ritalin)

  • A range of benzos, including xanax/clonazepam.

There are options for smokers and drinkers too. 

What do the new Health Canada guidelines actually mean?

  • Your pharmacist can extend a prescription

  • Your doctor can call over the phone to extend or refill a prescription

  • You can get it delivered at home

  • You can get carries up to 23 days

  • They don’t have to watch you take it

If you don’t have a doctor

If you’re in B.C., you can call:

  • Rapid access addiction clinics (RAACs) may be able to provide telehealth support.
    Victoria: 250-381-3222
    Vancouver: 604-806-8867
    Surrey: 604-587-3755

  • Rapid Access to Consultative Expertise (RACE) for Addictions is available Monday-Fri 8am-5pm for consultation and support: http://www.raceconnect.ca/
    Local calls: 604-696-2131
    Toll free: 1-877-696-2131

(https://yale.app.box.com/v/COVID19HarmReductionGuidance)

BE AWARE that some early symptoms of withdrawal and COVID-19 infection are similar. These include fever and muscle soreness. If symptoms include a persistent cough, it could be COVID-19.

YOU ARE AT AN INCREASED RISK OF BECOMING SERIOUSLY ILL OR DYING because

  1. COVID-19 infection will worsen breathing impacts of opioids, benzos, and alcohol

  2. Opioid withdrawal may worsen breathing difficulties

  3. Smoking, including drugs like crack or meth, makes breathing problems worse

DIFFICULT TO INHALE: If you smoke drugs, like crack or meth, cigarettes or vapes, COVID-19 infection will make it more difficult to inhale smoke. Smoking drugs, cigarettes, or vapes will worsen breathing problems.

IF YOU THINK YOU’RE GETTING SICK: Avoid going to your local harm reduction and addictions programs – HAVE THEM DELIVER SUPPLIES TO YOU. Tell them you are sick so they can take steps to keep themselves safe.

BE PREPARED FOR INVOLUNTARY WITHDRAWAL: Be ready to go through involuntary withdrawal. Your dealer might get sick or the drug supply might be disrupted. Try to be prepared by stocking up. Talk to a medical provider about starting methadone or buprenorphine. Make sure you have all the necessary medications, food, and drinks needed to help detox. Try to have protein-based and electrolyte drinks like Pedialyte or Ensure on hand.

STOCK UP ON THINGS YOU MAY NEED TO MANAGE YOUR SUBSTANCE USE AND PRACTICE HARM REDUCTION.

DRUGS: If you have money and are able, stock up on your drug(s) of choice before things deteriorate. AVOID BINGEING on drugs that you are stockpiling so you have access to a supply. Try to buy from people you trust and have as many WAYS TO CONTACT DEALERS in your area as possible.

ALCOHOL: If you have an alcohol use disorder, the money, and are able, stock up on enough alcohol to last a few weeks. AVOID BINGEING on stockpiled alcohol so that you have access to enough to avoid alcohol withdrawal, and things like seizures. One way to do this is by MANAGING YOUR ALCOHOL USE by consuming an amount of alcohol equivalent to one can of beer, 1.5 ounces of rum, or 5 ounces of wine hourly as needed. Try to avoid bootleg alcohol.

HARM REDUCTION SUPPLIES: Be prepared for the POSSIBILITY OF SYRINGE EXCHANGES AND DRUG TREATMENT PROGRAMS CLOSING DOWN. If you are able, stockpile enough harm reduction supplies to last you a few weeks – longer if you are at higher risk of infection or complications. This includes things like: naloxone, syringes, cookers, pipes, and straws. Get a Sharps container to get rid of used syringes. If you can’t get one, use something like a plastic laundry detergent bottle or soda bottle. Label these bottles “SHARPS CONTAINER”. Do not recycle them.

NALOXONE: Stock up on naloxone in the event of an unintentional overdose. Emergency services are likely to take longer than usual during a pandemic.

METHADONE & BUPRENORPHINE: Check with your medical provider to see if services might be changing. Ask your program and provider if you can have take homes or more and longer refills on your medications. This means that you don’t have to go to your provider to get new doses after your first collection. IF YOU HAVE A PRE-EXISTING CONDITION that puts you at greater risk of infection, LET YOUR PROGRAM KNOW.

REMEMBER THAT PRACTICING HARM REDUCTION CAN HELP YOU TO AVOID COVID-19 INFECTION AND ADDITIONAL STEPS CAN HELP TO REDUCE YOUR RISK OF GETTING SICK

DON’T SHARE YOUR DRUG USE SUPPLIES: Injecting equipment; crack or meth pipes; rose or spoons (for smoking crack or freebasing), straws or other nasal tubes (for inhaling/snorting); bongs, vapes, joints; and drinks.

AVOID INJECTING ALONE: The illicit drug supply continues to be toxic. Be careful about the risk of overdose. Try not to use alone, especially if you inject drugs like heroin, fentanyl, or drugs that might have come into contact with them. There are a couple of things you can do to try to stay safe: (1) You can reduce your risk of COVID-19 infection by staying at least six feet away from other people, coughing or sneezing into your arm, avoiding touching your face, and washing your hands for at least 20 seconds with soap and water. (2) If you have a phone, call someone, preferably nearby, and ask them to stay on the line while you are injecting so they can act or call 9-11 (or the medical emergency phone number in your country) if you become unresponsive.

IF YOU RUN OUT OF SYRINGES: These can be disinfected and help prevent HIV and Hep C with 1:10 DILUTED BLEACH. If there’s a lot of blood, rinse once with water to remove it. If not, skip this step and rinse once with bleach. Load bleach fully into the syringe and keep it there for two minutes. Then expel it. Then rinse twice with clean water. If you don’t have bleach, at least three rinses with clean water can work almost as well. Dull syringes can be sharpened using the striker on a matchbook. Rinse after sharpening to remove any particles in the syringe.

IF YOUR SYRINGES ARE NO LONGER SAFE, you have a few options but be aware that these might be difficult with COVID-19 or make symptoms worse:

1. SNORT IT – Chop them into a powder finely and sniff slowly. It works but not as well as injecting does.

2. BOOTY BUMP IT – Dissolve with citric or ascorbic acid, put in a NEEDLELESS SYRINGE and squirt it up your bum/anus. Onset takes longer but you need less and the high lasts longer.

3. SWALLOW IT – Heroin/fentanyl will go via your liver BEFORE reaching your brain, resulting in a morphine effect – but stopping withdrawal.

4. SMOKE IT – Smoke drugs instead of injecting but keep in mind this can be hard to do with some drugs.

CLEAN YOUR SMOKING SUPPLIES: Use mouthpieces and pipe covers on your smoking supplies when possible. Frequently clean these mouthpieces and pipe covers using an alcohol-based cleaner (like Purell or some other brand) or wipe (minimum 60% alcohol concentration).

WIPE DOWN DRUG PACKAGES: Use an alcohol-based cleaner or wipe to immediately wipe down your packages. If your dealer carries drugs in their mouth, ask them if they can stop doing this. If they won’t, be careful handling the packages and do the cleaning as advised above. Remember that antibacterial washes don’t kill viruses but are better than nothing, especially if they contain alcohol.

DO NOT PUT DRUG BAGS OR WRAPS IN YOUR MOUTH, VAGINA OR ANUS: If you must carry drugs in your body, clean vigorously with an alcohol-based cleaner both before and after you take it out.

WASH YOUR HANDS with soap and hot water vigorously for at least 20 seconds (but longer if you can) every time you come into contact with others, after handling money and after you get your drug packages. Paper towels are preferred for drying hands, or at least use a clean towel. If you cannot wash your hands, clean your hands with an alcohol-based cleaner or wipes (minimum 60% alcohol concentration) – like the ones distributed by harm reduction programs.

PREPARE YOUR DRUGS YOURSELF: Don’t handle or touch other people’s drugs or equipment and don’t let them touch yours. Avoid buying and splitting packages of drugs with others during this pandemic, if possible, to limit the number of people handling drugs. If you must split the drugs, make sure the person who touches the drugs washes their hands.

REMEMBER that people who use drugs and the people in their lives commonly have weaker immune systems, respiratory (breathing) problems, and other conditions that place them at a higher risk of getting COVID-19 infection. Help keep everybody safe by following this advice.

Created in collaboration by the Yale Program in Addiction Medicine, Global Health Justice Partnership, and Crackdown. Adapted with thanks from a document produced by 3D Research.

Works Cited

Credits

Crackdown is produced on the territories of the Musqueam, Squamish and Tsleil-Waututh Nations.

You can support us at Patreon.com/crackdownpod.

Our Editorial Board is: Samona Marsh, Shelda Kastor, Greg Fresz, Jeff Louden, Dean Wilson, Dave Murray, Al Fowler, and Laura Shaver.

Rest in Peace Chereece Keewatin.
Crackdown’s senior producer is Sam Fenn. Our producers are Lisa Hale and Alexander Kim. With help from Polly Leger.

Our science advisor is Ryan McNeil. Assistant Professor & Director of Harm Reduction Research in the Yale School of Medicine.

Garth Mullins is Crackdown’s host, writer and executive producer. You can follow him on twitter @garthmullins.

Original score written and performed by Sam Fenn, James Ash, Kai Paulson and Garth Mullins. Our theme song was written by Garth and Sam with accompaniment from Dave Gens and Ben Appenheimer.

We make this podcast with funds from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. And from our Patreon supporters.

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