The Opiate Crisis in North America

smoking, smoking cessation, cessation, quit smoking

Last week I presented at the 7th International Conference on Addictive Disorders, Addiction Medicine and Pharmaceuticals in San Diego, California, USA. Much of the focus at this symposium was the Opiate Crisis in North America.  Nearly 4000 Canadians died from apparent opioid overdoses in 2017, up from nearly 3,000 in 2016, and the latest national report tracking deaths linked to opiates from January through March of 2018, was 1,036 (primarily in BC, Ontario, and Alberta). This is a 5% increase from the same period in 2017 and a 44% jump from the first three months of 2016.  The crisis is far from over, and these numbers are alarming, but per capita, second only to the USA with a documented 72,000 overdose deaths in 2017. 

Fentanyl (50 to 100 times stronger than morphine) and Carfentanil (10,000 times stronger than morphine) are being used to cut other street drugs such as heroin, cocaine, methamphetamine, and benzodiazepines. Both are involved in nearly three-quarters of the deaths earlier this year. About 94% of all deaths are accidental, or unintentional overdoses, and the demographics are changing.  Most overdoses are occurring in 30 to 39 year old’s, primarily men, and these are not drug addicts, but rather first time users, or those living in chronic pain.

Let’s put this in perspective, though shall we?  Each day of the year,11 people in Canada and about 200 people in the USA die from an opiate overdose.  The loss of even one life puts an undue burden on their friends, family members, and on their community. The work being done to prevent these deaths is crucial and we all need to stand behind and support the plans that will make a difference. However, there is an ongoing crisis in tobacco cessation as well, one that has been going on for many years, and I just don’t want our efforts to get lost in the noise.  I mean no disrespect, but why can’t we work on both?

The World Health Organization reports there are 1.3 Billion tobacco users in the world and if left unattended, that number will climb to 2 Billion by the year 2025.  About 37,000 Canadians die from tobacco use each year (10x more than opiates), and in the USA, about 500,000 die each year (14x more than opiates).  Tobacco use may be a much slower death than opiate overdose and much less visible, however, it is no less of a crisis, and it deserves our attention.  

The problem is that tobacco cessation is not “sexy”.  Bringing up the importance of cessation at a health region planning meeting is met with rolling eyes, and folded arms, even though there is considerable evidence that it can reduce hospital admissions as well as the length of stay costs.  Decision makers are just not interested, and yet cessation is one of the most cost-effective preventative treatments out there.  Not to mention the fact that we have done extensive research on what works to help people quit, and those working in cessation now are obtaining amazing results. 

There is so much more we could be doing.  Imagine entering a hospital, identifying as a tobacco-user, and during your admission, a tobacco cessation specialist pops in to visit, outlines the benefits to remaining tobacco-free to your care, provides accurate information about drug therapies used to help with cravings and withdrawal, obtains an order for those said drug therapies if required, and follows up once you are discharged to see if they can encourage you to remain tobacco-free for good.

Or how about providing connections to a tobacco cessation specialist in the community, so that even if you aren’t quite ready to quit smoking now, you would be given the details about your options for when you are ready.  Informed decisions make all the difference, and you will feel good about taking control of your own health.

I have worked in cessation for a very long time, and I use a combination of best practice and mindfulness techniques as well as coaching mastery in my work to help people quit.  Those I help quit tell me how amazing they feel, and abstinence rates a year later are better than when I was using just best practice alone. It is very rewarding work and I can teach you how to provide cessation services just as I do, or if you are a tobacco user, I can show you how to quit with amazing results.  

Let’s support the opiate crisis – it’s extremely important, and we all need to work together to do the best we can to save lives.  But let’s also support the tobacco crisis.  Despite how we might personally feel about tobacco users and opioid addicts, these people are our family, friends, and neighbors.  We owe it to them to have the conversations that will make the difference.  They deserve accurate information and referrals to those that can assist them in their recovery.   

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