synthetic opioids in counterfeit pharmaceuticals and other illicit
TRANSCRIPT
www.ccsa.ca • www.cclt.ca
Synthetic opioids in counterfeit pharmaceuticals and other illicit street drugs: The situation in
Canada
Matthew M. YoungNDEWS Webinar
July 20, 2016
About CCSA
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• CCSA is Canada’s only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadians.
• Created by an Act of Parliament in 1988, CCSA has provided national leadership and expert advice, advanced knowledge, and prepared information and resources based on the latest evidence in order to inform policy, practice and programs that bring forward solutions.
• Together with our partners, we help mobilize individual and collective efforts to achieve collective impact on the major health and social issue of problematic substance use.
• Ensuring access to a range of quality services to address alcohol-and other drug-related harms is at the core of what we do everyday.
We believe that hope and recovery are real
Why CCSA’s Work Matters
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Health• Substance use disorder is a disease and should be treated like other
chronic diseases and health conditions• Contributes to the co-occurrence of mental health conditions, family
violence and suicide• Major contributor to 60+ diseases like cancer, heart disease, diabetes,
HIV/AIDS• Illicit drug dependence directly accounted for 20 million disability adjusted
life yearsPublic Safety• Significant factor in the commission of crime; as many as 80% of federal
offenders have a history of problematic substance use issues• Impaired driving accounted for 9,000 deaths in Canada from 2000–2010 Economics• Substance abuse costs over $40 billion per year in Canada
National Priorities and Areas of Action
Canada’s National
Framework for Action
Children & Youth
Problematic Substance use & Co-occurring
Issues
Canada’s Indigenous
People
Monitoring & Surveillance
Workforce Development
Treatment & Recovery
Impaired Driving
Alcohol
Prescription Drugs
Cannabis
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National Framework for Action (2005): Collective action for collective impact
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How we got here
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1990s – 2010s - Increase in opioids prescribed and dispensed in Canada
- Many people became dependent
2013 - Pan-Canadian Strategy to address problem
2013 to present - A great number of interventionsintroduced to respond to crisis
- decreased availability of diverted opioid pharmaceuticals available in the illicit market
- unintended consequences
Deaths Involving Fentanyl
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Between 2009 and 2014, there were at least - 655 deaths in Canada where fentanyl was determined to be a cause or a
contributing cause. - 1,019 drug poisoning deaths in Canada where post-mortem toxicological screening
indicated the presence of fentanyl
Seizures and anecdotal reports suggest overdoses occurred among individuals who thought they were using - oxycodone- heroin- cocaine or another substance
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British Columbia
Alberta
ManitobaToronto
Nova Scotia
Newfoundland and Labrador
Saskatchewan
Montreal
Quebec
Ottawa
CCENDU is a sentinel surveillance network made up of representatives from sites across Canada. Each site coordinator collects quantitative and qualitative information on drug harms from: • Local data sources (e.g., poison control centres,
coroners); • Anecdotal reports from those directly
working with drug-using populations (e.g., law enforcement, harm reduction programs) and people who use drugs.
This information is then collated and assessed for risk at the national level. If warranted, CCENDU issues alerts to:
• Law enforcement • Harm reduction programs• First responders• Healthcare practitioners • Treatment providers • People who use drugs • Others
These bulletins and alerts provide information regarding new drug trends and
advise what can be done to prevent and reduce harms.
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Alerts and Bulletins
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Alerts and Bulletins
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Alerts and Bulletins
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Alerts and Bulletins
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Alerts and Bulletins
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W-18U-4770
Fentanyl and fentanyl analogues
AH-7921MT-45
Implications…
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For public health and harm reduction:
• The presence of these synthetic opioids in tablets and powders dramatically increases the risk of overdose because people using them do not know
• what substances they are using or• how much is included
Information provided by CCENDU members
Implications…
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For public health and harm reduction:
• When warning people who use drugs about novel synthetic opioids it should be made clear that it is the variability of the dose from one tablet or powder to the next that increases the risk of overdose not simply the potency or toxicity.
Information provided by CCENDU members
Implications
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For those with access to naloxone:
• Although the efficacy of naloxone has not been evaluated for all the novel synthetic opioids, in theory it should temporarily reverse the effects and so it should be administered immediately if an opioid overdose is suspected
• administering naloxone when not indicated will not hurt the person
• Higher or repeated doses of naloxone might be required to reverse the toxidrome
Information provided by an emergency physician from The Ottawa Hospital and the Canadian Association of Emergency Physicians
Implications
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Bulletin also includes implications for:
• Poison Control Centres
• Laboratories
• Law enforcement
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Contact Information
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Adjunct Research Professor,Department of Psychology, Carleton University, Ottawa, ONwww.carleton.ca
Senior Research & Policy Analyst500–75 rue Albert Street, Ottawa, ON K1P 5E7Tel / Tél : 613-235-4048 x 222 | Fax / Téléc : 613-235-8101 Email / courriel: [email protected]
Matthew M. Young, Ph.D.