On Sunday 31st August the global drug community marked International Overdose Awareness Day (IOAD). Globally, the day is an opportunity to gather as ‘one big family’ to support people who use prohibited drugs (PWUPD) and are at risk of overdose.
Importantly, it is a time of remembering and reminding. Across the world, IOAD is a day to remember those we have lost, and support those left behind. It is a time to remind people of the risks of the unregulated drug market, how to keep each other safe, and how to build communities that can keep us safe.
The IOAD drew attention to the fact that, globally, 5.6% of 15-64yrs olds used an illicit drug in the past year, and that opioids account for over two-thirds of drug overdose deaths. Drug agencies took the opportunity to remind people PWUPD of important harm reduction strategies such as: carry naloxone; don’t mix drugs; start little and slow; if available, get drugs checked; don’t use alone; and don’t delay calling for help.
These important harm reduction strategies have made a significant contribution to reducing harm and saving lives. However, the central focus of attention sees ‘drugs’ as the problem when the situations we are seeking to address have less to do with drugs and everything to do with the War on Drugs.
The War on Drugs nightmare
The War on Drugs naively imagines we can (or should, in its moralising spirit) stop people using certain substances by fiercely outlawing their possession and supply. The War on Drugs punishes people, urging them to ‘just say no’ – a knowledge-eradicating policy that has not only failed to reduce the demand for drugs, it has kept people dangerously unaware of how to stay alive.
The War on Drugs has not only failed in its aim, it has generated drug markets of unprecedented size and harm. It has spawned dangerous environments and adulterated drug markets that significantly increased the risk of overdose – situations that harm reduction strategies try to address.
Today, the overdose crisis is a drug policy crisis – not a drug use crisis.
No consumer protections leads to deaths
Unlike those using state-approved substances, people using prohibited drugs have no way of purchasing a quality controlled regulated supply. What’s bought in the illegal market can be an unknown risk, potentially produced by criminal network groups that are often more interested in maximising profit than disclosing purity and contents to the end consumer. Today, drugs can be so strong that they kill.They could be mixed with unknown or lethal contaminants. They could have other drugs inside them that cause adverse reactions.
Further, to avoid severe penalties and stigma, illegal drug use will often happen in isolated places and sometimes alone, such as alleyways, derelict buildings or under bridges. This means people are vulnerable to anything that can happen to them. In dangerous situations – whether caused by an overdose, – those using drugs are often reluctant to call emergency services for fear of arrest for possession, supply or even possibly murder.
To circumvent global drug prohibition, those producing or supplying substances are constantly innovating ahead of law enforcement, altering the drugs of choice to select those less bulky, easily produced or more potent. Consequently, in many places, heroin markets are increasingly replaced by fentanyl or nitazenes. Synthetic stimulants produced in massive labs are now prevalent across the globe.
These high-risk situations that fuel overdose are created not so much by the drugs, but by our punitive drugs policies. If alcohol was prohibited, similar issues would be faced and we’d witness a significant increase of fatal alcohol overdose triggered by prohibition. It’s happened in the past, and can happen again.
So we need to openly acknowledge, talk about and address the key cause of overdose – prohibition – and develop immediate steps to address the symptomatic risks created by drug law enforcement.
Pragmatism over ideology
In the immediate term to avoid an overdose crisis we need to develop a full suite of pragmatic harm reduction services, including:
- Low threshold patient-centred substitute prescribing of a range of drugs so people who struggle with addiction can get help, know exactly what they are taking, and are no longer dependent on the illegal market to get drugs.
- Drug Consumption Rooms or Overdose Prevention Centres in major cities where people who use drugs can do so in a safe and medically supervised environment. These exist across the world: the OPC in Sydney, established 24 years ago, has overseen over a million injections; over 11,000 overdoses have been successfully managed without a single person dying.
- Easy and free access to naloxone should exist, including distributing it to friends and families of those who use drugs. Naloxone should be available to purchase at a pharmacy without a prescription.
- Good Samaritan Laws should be implemented to remove the threat of arrest when calling for help. This includes not sending police forces to respond to medical emergencies, like overdoses.
- Easy, free and widespread access to Drug Checking is crucial, just as it happens in New Zealand. This means no risk of surveillance or arrest when using these services, so that people can know what’s in their drugs before they use them, and where they can get more information.
These are just some steps that we know that work and can save lives right now. But the most significant impact that could be made to deal with the cause of drug deaths is ending the War on Drugs.
Harm Reduction Coalition Aotearoa (HRCA) is seeking to rescind failed drug laws in Aotearoa New Zealand and replace them with a new fit-for-purpose Psychoactive Drug Act overseen not by the Criminal Justice System but by the Ministry of Health – a single law that legalises all adult personal possession of psychoactive drugs and responsibly manages and regulates social and commercial supply, so people can know what they are taking, the content, the purity, and not have to use in secret, and without fear of calling for help if needed.
On IOAD, we remember who we’ve lost, and we’re reminded of what needs to be done.
