July – How I Changed My Perspective on the Drug Poisoning Crisis 

Written by Comms Team, July 4, 2024

“We did a lot of fun things in the 60s,” my patient explained to me in 2018. I was working at a family clinic at the time. My patient was in for a vaccine but like all good primary care physicians, I wanted to check on his overall health. In this case, I was probing for information that may indicate a Hepatitis C risk.  

In 2018, guidance on Hepatitis C screening had just been adjusted and it was recommended that anyone born between 1945 and 1975 be tested for Hepatitis C. The reason? Due to potential Hepatitis C risk from intravenous drug use that has always been prevalent but often forgotten.  

So I had asked, “Hepatitis C can be transmitted by exposure to blood, such as sharing injection drug use equipment. Have you ever used injection drugs?” and he replied with a smile, “We did a lot of fun things in the 60s.” 

Ahh the 60s. While infectious disease risk from sharing sharps was and still is a large concern, the drugs were not. You see, there was no drug poisoning crisis. Drug supply was far more predictable. Sure, there were people who consumed in excess and were harmed due to this. But most people could be confident that what they were consuming was what they had been told it was. A stark contrast between the tainted supply, and people dying that we see today. Today using drugs is like a game of chance. 

As a medical professional, I have seen drastic changes to medical guidance around prescribing opioids. I went through medical school when the medical community was cracking down on opioid prescribing. “Nearly never prescribe opioids”, I remember one professor saying. This messaging was a rebound to the previous two decades, where the medical community had been convinced of the safety of opioids such as Purdue Pharma’s OxyContin, thanks to sinister and misleading advertising for which they have been convicted guilty. 

Today, we are in a completely different and complicated landscape. In Ontario, we are seeing a high demand for drugs due to multiple factors, like previous over prescribing, followed by a 180 flip to under prescribing. For people with a substance use disorder, being cut off by your physician coupled with a cost of living and mental health crisis, drives people to self-medicate. At the same time, we’re seeing a very tainted and potent supply largely due to the lack of supply leading to the introduction of fentanyl, xylazine, benzodiazepines, and other substances. 

“We’re never going to police our way out of this” a police chief recently told me. Given the context we are in, it is easy to see why. And as the context has shifted, my perspectives have shifted over the years on how we must respond.  

People have always, and will always use drugs. 

Like the unregulated drug landscape, the medical literature has taken another 180 from the teaching I received as a medical student. Today evidence clearly supports life saving effects of harm reduction interventions including overdose prevention sites, “safer supply”, drug testing and decriminalization so that we can approach the use of drugs from a health perspective, not push the use dangerously underground as a criminalization approach does. 

While we see access to alcohol, an important and deadly carcinogen, being liberalized, we see more stigma and political rhetoric mounting against harm reduction. But from listening to people who use drugs I’ve clearly learned the opposite of harm reduction is not treatment. The opposite of harm reduction is harm. 

One medical school lesson, from Hippocrates hasn’t changed: “first do no harm”. 

That patient I told you about that we screened – turns out he was positive for Hepatitis C and had no idea he had even been at risk. If my patient had been born in the 2000s and engaged in the same behaviour, he would have likely been poisoned and may not have survived. 

Today, the “fun” things can be life threatening. Luckily, there are strategies we know that can help keep people alive.  

 

Dr. Thomas Piggott
Medical Officer of Health and CEO
Peterborough Public Health