The respected, certainly by me, community activist and writer for Our London, Eric Sheppard, wrote a rebuke to Medical Officer Health Dr.Chris Mackie’s warning to Londoners that a lab report showed fentanyl in a urine test of a person/people who reported they only used marijuana or cocaine. So the Middlesex London Health Unit put out a warning suggesting that people who use marijuana carry naloxone kits which can counter the overdose effects of fentanyl.

There then came a vigorous reaction in the media and social media by a those saying this was an over-reaction by MLHU; Eric was one of those strongly critical in both mediums. Eric shared his criticism in his weekly Our London article. While I have a lot of time for Eric and the many good things he does for our community, encouraging voting and his advocacy of cycling among many others, I cannot agree with the criticism of MLHU or the reasoning that informs it. So I have reposted his article here, in italics and quotes ,with my response between each paragraph ( Here is the original post of Eric’s article in Our London and the warning posted by the MLHU)

“Recently the Middlesex-London Health Unit issued a warning about fentanyl appearing in other drugs. Fentanyl is a synthetic opiate painkiller, many times stronger than heroin. Already fentanyl and the even-stronger carfentanil have claimed many lives across Canada.”

Totally agree here and an important reminder about the effects of this synthetic drug and its dangers.

“Most people who use opiates do so safely. They know their regular dose, and ingest enough to get the high they seek. Overdoses happen when mistakes are made — either overestimating tolerance or underestimating potency. Because of its potency, unscrupulous dealers have been known to add fentanyl to poor-quality heroin to make it appear stronger. Fentanyl-laced heroin makes a risky dose far more likely, possibly resulting in respiratory arrest.”

I am not sure how Eric know that most people who use opiates do so safely nor do I know where his knowledge of the cause of overdoses come from. When i google “common reasons for drug overdoses” there are 2,060,000 results returned and the first five results are:

• • Most Common Causes of an Overdose – Mountain Laurel
  • Drug Overdoses Are the 9th Leading Cause of Death in the US
  • Drug Overdose Deaths Top 10 | Time.com
  • Most Commonly Overdosed Drugs | 12 Keys Rehab
  • Drug overdose among the top 10 causes of death in B.C. | Global News 

On clicking the 6th result I learn that the US Centre for Disease Control ( CDC) says “The majority of drug overdose deaths (more than six out of ten) involve an opioid.  Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled”. Health Canada reports that there were 2,458 opioid related deaths in 2016. So I’m unsure as to whether users know their tolerances or not or know how to use opioids safely. What is certain is that a substantial number of people have lost there lives due to opioid overdose. Eric rightly points out that unscrupulous dealers lace opiates with fentanyl increasing potential risk.

“Thankfully, the drug naloxone can counteract the harmful effects of opiates. In an emergency, a naloxone injection could save the life of someone who has overdosed, or accidentally been exposed to a potent opiate. Naloxone kits have already proven successful in reducing mortality, and are a key component of harm reduction.”

Excellent points by Eric, especially as it relates to harm reduction, which is a proven way of helping addicts.

“But something about this warning doesn’t sit right. The MLHU statement claims that local cannabis might be laced with fentanyl as well, which doesn’t make sense. Fentanyl is far more expensive than weed, so there’d be no reason to do this. The evidence for this claim is a positive urine test for the drug in people who claim to have only used cannabis — hardly an airtight case. No actual reports of laced cannabis have surfaced, but public fretting about it keeps popping up. Classic urban myth moral panic.”

Here is where i lose my way in understanding Eric’s argument and I begin to disagree. I’m not sure that saying something doesn’t sit right adds to a meaningful criticism of a public health warning or saying that the “claims” MLHU make don’t make sense because fentanyl is more expensive than pot. Some times people do things for no reason than the pure mischief of doing it. Or the same unscrupulous dealers Eric points to earlier in the article could as easily continue to be unscrupulous in putting it in low grade pot to make it seem more powerful. Unlike Eric the LMHU, CMHA, London Police, and Addictions Services Thames Valley take the users ,who’s urine returned a positive result for fentanyl, at their word when they say they didn’t use the drug and had only used pot or cocaine. I they chose to believe these users at their word as therapeutic relationships, including harm reduction, is built on trust. As to the claim that there has never been a case of fentanyl in pot I cannot say. but when I do a google search on it I get 428,000 results with the top 5 being:

• • Fentanyl-laced pot: threat or myth? | The London Free Press
  • Fentanyl and marijuana – The London Free Press
  • Is Weed Really Being Laced with Fentanyl? – VICE
  • Premier Clark’s claim pot laced with fentanyl not true, say police …
  • Mass. police concerned about reports of fentanyl-laced marijuana in …

I am not sure how Eric equates the warning of the MLHU and other agencies as  being an urban myth moral panic. I think it was a responsible action of these agencies to put out a warning reporting the possible risk from what they found in testing. How that equates to a moral panic or urban myth makes no sense.

“The rationale here seems to come out of the idea that it’s better to be safe than sorry, which holds some value. Encouraging more people to be equipped with naloxone is a noble goal, but the ends don’t justify the means. Misinformation like this is not just unhelpful, it actively undermines harm reduction strategies.”

I agree with Eric re being safe rather than sorry but believe it holds more than some value. If it prevents even a modicum of suffering then i’m all for it. I further agree with Eric that encouraging folks to carry naloxone is a good thing but would strongly disagreeing re ends justifying means.. The ends, no death or overdoses, do justify the means, which is a suggestion to carry a naloxone kit if your going to use street drugs. How this is unhelpful, or in any conceivable way undermines harm reduction, is frankly unfathomable. it also makes no sense how a public health warning that suggest carrying naloxone could in any conceivable way undermine HARM reduction. This in his argument Eric creates cognitive dissonance against the point he tries to make. There is no sense in it..

A major benefit of legalizing cannabis is removing the moral stigma around use, allowing a more nuanced conversation about drugs. Bold, scary warnings like these do the opposite. Scared parents will try to scare their children, who will see right through the deception — or worse, become numb to other warnings. Instead of establishing a trustworthy learning relationship, the opportunity to convey important information about developmental risks and best practices will again fall on deaf ears. This warning serves only to discredit the MLHU and the good work it does.

Really agree with Eric here that there does absolutely need to be a more nuanced conversation about drugs and their use. What I don’t understand is why he isn’t using one himself here. His assumptions as to the actions parents will or won’t take, or judging the efficacy of the warning, seems to be more about trying to defend pot use than having a nuanced conversation on drug use, addictions, or legalization. Eric has been a stalwart 420 ally and has advocated for pot legalization, something I agree with, but he seems to confuse this public warning with a negative judgement on the safety or use of pot. This sadly discredits his argument rather than the MLHU’s warning. The MLHU did not say pot use is bad. They did not say people who use pot are bad. They pointed out that this was the test result they received from this group of users and it was enough of concern to post a public warning. That is all. The moral outrage seems to becoming more from Eric and others on social media rather than the agencies involved in issuing the warning.

Should cannabis users carry naloxone kits? Absolutely; the more the better. Anyone who uses recreational drugs, or who has contact with people who do should consider getting one. They’re free, and the training takes less than an hour. Accidental overdoses do happen, and being equipped to save a life is well worth the effort.

Absolutely 100% agree with Eric here. Do this if you use any street drugs.

But if promoting the distribution of naloxone is what the MLHU is trying to accomplish, then they should do so without pretence. This practice is an inherent good for the health of our society; no further reason is needed.

Again Eric seems to be assigning motive when there is none demonstrated. What pretence? They posted a public health warning for the good of the public. Where is the pretence in this? And why do many pot legalization supporters on my Facebook and twitter feeds seem to think that this health warning is a judgement on them and their habits?

As the opiate crisis unfolds, we’ll need to start taking other steps to mitigate harms. Renewed talk of a supervised injection site in London has surfaced lately — arguably one of the best tools to ensure public health. Providing a safe, clean, well-equipped facility for people to inject will reduce overdoses, ensure proper needle disposal, provide wound care, and connect clients with social services they may need

Absolutely agree with Eric here!

It’s important we address these issues with clarity and pragmatism. If our goal is a healthy societal relationship with drugs, then we cannot rely on sweeping claims and fear mongering. Each drug is different, and knowledge is a powerful protective force.

Yes, please, lets address issues with “clarity and pragmatism!”! Eric’s article at times does do this but he ascribes motivations to MLHU that seem to be assumptions at best and attacks to further an acusation of an unspecified and unproven prejudice at worst. The result of the hue and cry by Eric and others is that it confuses the conversation. The conversation should be about drugs, their use, the truth of their effects, the legalization (or not) of them, and most importantly the assistance of those who suffer under the yoke of addictions. It should not be a vague attack that tries to discredit the honest motives of the MLHU or it’s officer of health..

“Drugs don’t kill people; ignorance does.” .

Sadly ignorance of a potential problem can kill people and the MLHU chose to not leave anyone ignorant of a potential danger even if at the slightest chance for harm.