In its fight to curb ever-climbing overdose death rates, middle-class drug users have been a challenge to reach for health officials.
Part of fighting the overdose crisis means getting the right messaging across to the right people, according to IH medical health officer Dr. Silvina Mema. That includes letting people know help is available and conveying tried and true safety precautions when using drugs, such as not using alone and keeping naloxone on hand.
That can be an uphill battle, according to Mema, who said many people still believe the overdose crisis mostly or exclusively affects homeless or lower-class people.
“That is really a myth. It is true, in terms of many of those are dying. Being homeless is a risk factor, for sure,” Mema said. “But they are not the only ones that are being affected by this crisis.”
For those on the street level, Mema said there have been some successes in getting some of the messages out to drug users.
“We’ve been giving hundreds of naloxone, so people are understanding that they need to carry it, but at the same time there is more people dying than before,” Mema said. “The crisis is not stopping in a sense. … This is a lot deeper problem than anybody imagined, really.”
Mema said there are changes beyond messaging that need to be enacted to try to halt the overdose crisis — particularly noting that the illegality of drugs has led to a number of issues, including a deregulation of drug purity and quality, as well as a demonization of drugs, and by extension drug users.
“The war on drugs is what led us here. This is where we are, because drugs are illegal, and because people who use drugs are stigmatized, and they cannot talk about it, and because they have to use in a back alley or in a bathroom by themselves,” Mema said.
“Now, we are beginning to talk about it, and people are beginning to be more comfortable.”
Particularly, Mema said health officials have been talking with homeless people about safe drug practices for so long that it has become less stigmatized for that social group.
“They have their friends, and they also use, but then there is a lot of people that are middle class that are marginalized in terms of they can’t speak with their friends in a pub about their drug use because it’s not what the other friends do,” Mema said.
In places like Vancouver’s Downtown Eastside, it’s easier to provide help because of the open nature of the drug issue there.
“We’ve been doing a lot of work toward these lower classes … and they get it. They get it because we’ve been putting a lot of emphasis. They are comfortable going into an agency and asking for naloxone, because they are assumed to use drugs,” Mema said.
“The other classes, where it’s not normal to use drugs — and it shouldn’t be; I’m not trying to say that using drugs should be normal, but having a problem and being able to reach out for help — that should be normal.
“These other classes, the higher classes, they are more isolated in their use. And that comes especially when they’ve gone through detox, or they’ve done treatment, and then they relapse. That’s the most isolated.”
Part of that is because treatment will often encourage users to put up a wall between themselves and their old friends who use in order to keep away from drugs.
“Then if you relapse, then you’re alone. Because you don’t want anybody to know that you’ve relapsed,” Mema said, adding that those who have relapsed are often most at risk, having lost some tolerance.
“Now, there is a big emphasis in trying to reach those who use alone … the people who have not opened up to help, and how to bring those people out from the shade and offer them help and what help they need — that’s the most difficult group to reach.”
A group of health officials is beginning to get together to try to determine how to reach those particular drug users, according to Mema, who is part of the group of officials.
“We’ll be exploring these groups in more detail, doing research projects there to understand how to reach them better.”