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Some medications can have dangerous interactions with recreational substances. It can be hard to find information on these interactions, since many doctors will simply advise their patients to "avoid illegal drugs altogether." Below is a list of known interactions some of the most common illegal substances have with common medications; this list is taken from a research paper found here.

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doi: 10.1080/03602532.2019.1697283.

Affiliations

¹ Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.

² Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA.

³ College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA.

⁴ Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA.

⁵ Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA.

doi: 10.1080/03602532.2019.1697283.

Affiliations

¹ Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA.

² Auburn University Research Initiative in Cancer, Auburn University, Auburn, AL, USA.

³ College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA.

⁴ Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA.

⁵ Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA.

Abstract

Adverse pharmacokinetic interactions between illicit substances and clinical drugs are of a significant health concern. Illicit substances are taken by healthy individuals as well as by patients with medical conditions such as mental illnesses, acquired immunodeficiency syndrome, diabetes mellitus and cancer. Many individuals that use illicit substances simultaneously take clinical drugs meant for targeted treatment. This concomitant usage can lead to life-threatening pharmacokinetic interactions between illicit substances and clinical drugs. Optimal levels and activity of drug-metabolizing enzymes and drug-transporters are crucial for metabolism and disposition of illicit substances as well as clinical drugs. However, both illicit substances and clinical drugs can induce changes in the expression and/or activity of drug-metabolizing enzymes and drug-transporters. Consequently, with concomitant usage, illicit substances can adversely influence the therapeutic outcome of coadministered clinical drugs. Likewise, clinical drugs can adversely affect the response of coadministered illicit substances. While the interactions between illicit substances and clinical drugs pose a tremendous health and financial burden, they lack a similar level of attention as drug-drug, food-drug, supplement-drug, herb-drug, disease-drug, or other substance-drug interactions such as alcohol-drug and tobacco-drug interactions. This review highlights the clinical pharmacokinetic interactions between clinical drugs and commonly used illicit substances such as cannabis, cocaine and 3, 4-Methylenedioxymethamphetamine (MDMA). Rigorous efforts are warranted to further understand the underlying mechanisms responsible for these clinical pharmacokinetic interactions. It is also critical to extend the awareness of the life-threatening adverse interactions to both health care professionals and patients.

Keywords: CYP; Illicit substances; MDMA; adverse drug interactions; cannabis; cocaine; drug-metabolizing enzymes; drug-transporters.

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national center for biotechnology information

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Adverse pharmacokinetic interactions between illicit substances and clinical drugs - PubMed

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Adverse pharmacokinetic interactions between illicit substances and clinical drugs are of a significant health concern. Illicit substances are taken by healthy individuals as well as by patients with medical conditions such as mental illnesses, acquired immunodeficiency syndrome, diabetes mellitus a ...

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Cocaine is known to interact with the following prescription medications in potentially dangerous ways:
- Antipsychotics: potentially fatal
- Antihistamines: potentially fatal
- Opioids: potentially fatal
- Certain heart/blood pressure medications (propranolol, lofexidine): increased risk of heart attacks
- Disulfiram: raises blood pressure and heart rate
- Isradipine: raises heart rate
Additionally, cocaine reduces the effectiveness of certain opioid agonists (methadone and buprenorphine) when combined.

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Heroin is known to interact with the following prescription medications in potentially dangerous ways:
- Benadryl (diphenhydramine): potentially fatal
- Methadone: interaction causes strokes
Do not combine these medications.

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MDMA is known to interact with the following prescription medications in potentially dangerous ways:
-  Antidepressants: potentially fatal; see endnote 1
- Antiretroviral medications: potentially fatal; see endnote 2
-  Ritalin, Concerta (methylphenidate): increased blood pressure & heart rate
- Buproprion: increased levels of both drugs in the bloodstream

Endnote 1: Antidepressants are known to interact with MDMA, but specific side effects vary. Moclobemide is known to have fatal interactions, while others (phenelzine) are known to elevate blood pressure and reduce mental clarity. Still others (paroxetine, reboxetine) have only been definitively observed to increase the levels of MDMA in the bloodstream. Regardless, due to the fact that MDMA and antidepressants operate by elevating the same variety of brain chemicals, exercise caution when combining them, as it can at the very least increase your risk of antidepressant "overdose" (e.g., MDMA + an SSRI may cause serotonin syndrome).

Endnote 2: MDMA is known to interact with the variety of antiretroviral medications used to treat HIV/AIDS, but the range of consequences varies wildly. Some studies (observing ritonavir, taken alone) report fatal outcomes, while others (observing ritonavir taken in combination with saquinavir) only reported that the effects of MDMA were prolonged. It seems likely that these interactions boil down to the same mechanism: antiretroviral medications reduce your ability to metabolize MDMA. This can mean it takes longer to break down in your system (prolonging its effects), or - depending on individual dosage and metabolism - it can mean the toxic effects of MDMA are not effectively countered by the body's resilience, and end in death. Exercise caution when combining MDMA with antiretrovirals, and avoid doing so to the extent that you are able.

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Methamphetamines are known to interact with the following prescription medications in potentially dangerous ways:
- Haloperidol (antipsychotic): induces Parkinsonism
- Ritonavir (antiretroviral): potentially fatal
Do not combine these medications.

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Indigiqueer & Two-Spirit Mental Health Support

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Indigiqueer & Two-Spirit Mental Health Support

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https://static1.squarespace.com/static/5f3550c11c1f590e92ad30eb/t/6109b2f9d66ea10365dd929f/1628025613807/You+Are+Made+of+Medicine_FINAL.pdf is a resource created by the Native Youth Sexual Health Network, designed to address the intersectional challenges, traumas, and strengths of Indigenous LGBTQ2S+ youth. It includes information about the factors that affect Indigenous LGBTQ2S+ youth in specific, often traumatic ways, as well as strategies you can use to protect your own emotional wellness, and resources to connect you with others in your community.

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https://www.fnha.ca/ is the website of the first Indigenous-run branch of the Canadian healthcare system. It provides extended health coverage to any individual with Indian status, and serves the Indigenous community of Vancouver and BC as a whole. Look here for more information on health and wellness in urban spaces: https://www.fnha.ca/what-we-do/health-system/urban-and-away-from-home-health-and-wellness

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first nations health directors association

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The BC First Nations Health Authority (FNHA) is the first province-wide health authority of its kind in Canada.

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Vancouver Coastal Health provides a list of its relevant services here: http://www.vch.ca/your-care/mental-health-substance-use/community-mental-health-services. Conventional medicine can be intimidating, but it can also provide life-changing intervention and care. A few resources that may be useful are re-listed in this padlet, so you don't have to go sifting through the list all on your own!

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We offer a wide array of multidisciplinary services, activities, resources, and health care professions to adults and older adults in a variety of settings including outpatient, inpatient, and in the home. Clients primarily fall into one of two categories:

Schizophrenia and other psychotic disorders

Mood disorders, i.e. bipolar and major depressive disorders.

Services are also provided to people who have co-occurring disorders such as personality disorders, substance abuse/misuse, mental challenges, etc.

Our community mental health teams provide individual and group rehabilitation services in the areas of personal life, leisure, education and work. Our services involve the client and, if appropriate, their significant other and family members. Our services include:

Individualized mental health screening and assessment

Rehabilitation goal-setting

Basic support (access to activities)

Rehabilitation readiness assessment (exploration of service options, building confidence)

Rehabilitation processes (assistance with goal achievement)

Referral to other services and advocacy

Our Geriatric psychiatry outreach team provides comprehensive geriatric psychiatry assessment and treatment. Our program is intended for patients greater than 65 years old and suffering from dementia, delirium, disruptive behaviour, incontinence, failure to thrive as well as those with increased risks of institutionalization.

Our Vancouver/ Richmond Early Psychosis Early Intervention Program provides early identification and treatment for psychosis so symptoms don't become unmanageable and disruptive to your life. Some of the services we provide are:

Youth living in Richmond and Vancouver, aged 13- 30, are eligible for our program. We also work with families of people who are experiencing psychotic symptoms for the first time.

VISU provides intensive supervision and services to clients with mental illnesses serving adult provincial sentences in the community. Assistance with treatment, housing, living skills, financial management and health care is provided in addition to supervision of court orders.

Our Assertive Community Treatment (ACT) team provide community treatment and rehabilitation for clients struggling with mental illness who may also have severe substance use addictions. Our program provides long-term, 24/7 health care and life skills supports including:

The Assertive Outreach Team (AOT) supports patients who suffer from severe addictions and mental health issues and transition them from local emergency departments in Vancouver to appropriate community services.

Our programs serve clients over the age of 19 who are diagnosed with a major mental illness and experiencing significant problems that interfere with their functioning in the community.

These services are free-of-charge.

Our services can be accessed with a referral through the Access and Assessment Centre (AAC), or by a family physician, psychiatrist or nurse practitioner. The Vancouver/ Richmond Early Psychosis Intervention Program also accepts self-referrals. For more information on how to access a specific service, contact the program below:

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We offer a wide array of multidisciplinary services, activities, resources, and health care professions to adults and older adults in a variety of settings including outpatient, inpatient, and in the home. Clients primarily fall into one of two categories: Schizophrenia and other psychotic disorders Mood disorders, i.e. bipolar and major depressive disorders.

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Clinics Near You: Vancouver Access & Assessment Centre

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Clinics Near You: Vancouver Access & Assessment Centre

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Many clinics in the Vancouver area can provide effective care that accommodates individuals dealing with complex health concerns, including substance abuse, personality disorders, HIV and hepatitis, and other overlapping conditions that can make it harder for individuals to find medical services tailored to them. An assortment of clinical teams within Vancouver Coastal Health can be matched to your needs via the Access and Assessment Centre, which provides free evaluations for individuals who may be experiencing psychosis, mood disorders, substance abuse, and any combination of the above. Look here for more information: http://www.vch.ca/locations-services/result?res_id=1186

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Clinics Near You: Early Psychosis Intervention

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Clinics Near You: Early Psychosis Intervention

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Vancouver Coastal Health has a clinic at 2750 East Hastings Street dedicated to providing early intervention for symptoms of psychosis. They do not require a referral, and offer evaluation and effective treatment to individuals who suspect they may be experiencing psychosis - a treatable condition that is characterized by hallucinations, delusions, and unpleasant, hard-to-control patterns of thinking that make it hard to understand "ordinary" concepts and information. You can learn more about the clinic here:  http://www.vch.ca/Locations-Services/result?res_id=814

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For individuals in crisis, https://crisiscentrechat.ca/ provides a text-based online service, active every day between noon and 1AM. It also includes a list of active phone numbers and resources aimed at adults (as well as a link to its sister site for youths), and can help you manage a crisis situation by providing expert information, advice, and support in the ways that work best for you.

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We're here to help.

Chat with one of our crisis responders now.

Crisis Intervention & Suicide Prevention Centre of B.C.

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Clinical Support for Safe Use in Vancouver

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Clinical Support for Safe Use in Vancouver

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Toward the Heart (https://towardtheheart.com/) provides information for substance users, healthcare professionals, and anyone looking to learn more about treating overdose and facilitating safe drug use. They also offer up-to-date warnings when toxic substances enter the public drug supply, and they have multiple clinics in East Vancouver which are dedicated to distributing supplies to facilitate safer drug use. You can find a clinic near you via their site finder: https://towardtheheart.com/site-finder

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#PeerLife

Stories from a day in the life of a peer.

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Naloxone at Pharmacies

Free to people who use opioids or likely to witness an overdose

Find a pharmacy

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Why Give Breaths?

It's important to keep giving breaths to prevent brain damage in a person who is experiencing an overdose. It can also save their life.

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Language Matters

Creating a safer space with less stigma. Let's change the dialogue to health and treat everyone as people.

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In Memorial

We are deeply saddened by the loss of Doug Nickerson ("Little Doug") who reversed 148 overdoses with his naloxone kit.

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Be there for each other

This short video is dedicated to the memory of people who have lost their lives to overdose.

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Naloxone at the Festivals

Festival-goers learn how to respond to opioid overdoses.

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Naloxone Wakes you Up

We teamed up with Inner City Youth to create an art booklet with street-involved youth in Vancouver.

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Get safer sex and drug use supplies

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It's important to keep giving breaths to prevent brain damage in a person who is experiencing an overdose. It can also save their life.

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https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use/non-medical-cannabis/safer-cannabis-use provides a guide to best practices when using cannabis, to ensure you're using it safely and getting the best results from your use. The FNHA also provides a holistic overview of the use of cannabis within an Indigenous framework: https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use/non-medical-cannabis

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Using Cannabis safely

People have been using cannabis for a long time, in many ways, and for many reasons. Some people use cannabis recreationally similar to how they use alcohol - to help them relax and to be more social. Some people have used cannabis medicinally to treat a number of medical conditions. Like many drugs, cannabis is not without risk.

While using cannabis may be safer than using some other unregulated drugs, there are things about using cannabis that can be harmful. It is important to create a plan to reduce these harms. Here are some things you can do to reduce your risk of harms and negative experiences.

Before you start using cannabis

Consider: why you are choosing to use cannabis? Is it going to help you in some way? It is out of curiosity? Is it something you use frequently? Have you informed yourself on the risks as well as the benefits?

Is it legal to use cannabis?

For adults over age 19, cannabis for personal use is now legal in Canada. Legal cannabis products are regulated and tested for quality in BC. Legal cannabis products are safer to use than cannabis you may get from your dealer or a friend. Avoid using cannabis if contaminants like mold and mildew are visible.

Safer Practices

Try a small amount first. Some strains of cannabis may have higher THC content and may have a stronger effect than you were expecting so be aware of the potency of the cannabis you are choosing to use. To be on the safe side, start small and use less. Smoking less helps reduce smoke and toxins in our lungs. You'll notice the full effects of smoking cannabis within 30 minutes of smoking a joint. Most physical and psychological effects of smoking cannabis will wear off within 5 hours but this can vary from person to person.

Understand the laws

If you are 19 years or older, possessing up to 30 grams of cannabis for your own use is legal in Canada. Cannabis is regulated by the province of BC. You must be 19 or over to purchase, possess or use cannabis or cannabis products. Minors in BC (people under the age of 19) are not allowed to possess any cannabis. Be sure you know where and when it is safe and legal to use cannabis​

Prevent burns on your lips or fingers

Use a small piece of rolled unbleached cardboard as a filter. Avoid using cigarette filters-they do not remove toxins in the smoke.

Take shallow puffs, not deep inhalations

About 95% percent of the THC in the smoke is absorbed in the first few seconds so you don't need to puff hard or hold your breath.

Don't mix cannabis with tobacco

Tobacco contains nicotine, a highly addictive substance, and many cancer-causing toxins so it's safer to smoke cannabis on its own.

Eating or drinking cannabis products

Take your time. It can be hard to find the right dose when eating cannabis cookies or drinking cannabis tea. You may get much higher for much longer than you wanted to. To prevent this, use a small amount and wait at least one hour to feel the effects before using more. Feeling the effects of edibles takes longer than for smoking cannabis, and it is common for people to consume too many edibles in a short amount of time and regret it.

Cannabis and driving

Stay away from the steering wheel. Cannabis can impair your motor coordination, judgment and other skills needed to drive safely. It's safest to wait 6 - 8 hours after using cannabis before driving or operating machinery. This guideline varies from person to person as cannabis can impair your body for up to 24 hours in some cases. Impaired driving under the influence of cannabis can also result in heavy fines, license suspensions, and other legal consequences.

Mixing cannabis with other substances is risky

It's not uncommon for people to mix cannabis with other substances to experience different feelings or offset unwanted side effects. But there are risks to combining cannabis with other substances, including intensified effects that may last longer than expected or wanted. Here are some common combinations and their related effects:

Alcohol and other depressants. These are substances that slow down the body's heart rate and make us feel more relaxed. Depressants affect coordination and other skills needed for safe driving. Cannabis in combination with even small doses of alcohol impairs our driving ability more than either drug used alone.

Stimulants. These are substances such as energy drinks or cocaine that increase the body's heart rate and make us feel more energetic. Combining cannabis with stimulants may cloud our judgement about how intoxicated we may be, potentially leading to poor decision-making and risky behaviours.

Tobacco. Tobacco smoke contains many cancer-causing toxins. The healthiest choice is not to smoke either commercial tobacco or cannabis.

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Using Cannabis safely People have been using cannabis for a long time, in many ways, and for many reasons. Some people use cannabis recreationally similar to how they use alcohol - to help them relax and to be more social. Some people have used cannabis medicinally to treat a number of medical conditions.

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At https://www.nativeyouthsexualhealth.com/indigenizing-harm-reduction, you can find resources created by and for Indigenous youth. These resources work to address the flawed framework of a colonial healthcare system, and create an alternative, holistic model of harm reduction.

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Harm reduction is a key area of work for us at NYSHN. This means keeping each other safe while using substances or having sex, but also as a daily practice that lots of people use to reduce the everyday risks and harms while trying to create some safety in unsafe situations. This can apply to individual things we do but also to systems, structures, and realities we face like racism and colonialism that actually make our lives less safe.

We created our Indigenizing Harm Reduction model as an attempt to address how mainstream harm reduction practices aren't all there is to choose from and how different Indigenous communities can reclaim self determination over our health and bodies.

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Indigenizing Harm Reduction - Native Youth Sexual Health Network

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Harm reduction is a key area of work for us at NYSHN. This means keeping each other safe while using substances or having sex, but also as a daily practice that lots of people use to reduce the everyday risks and harms while trying to create some safety in unsafe situations.

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For a more medical approach to safe use practices, check out the BCCDC's list of resources: http://www.bccdc.ca/health-professionals/clinical-resources/harm-reduction. These resources cover the details of injection prep, safer smoking practices, and more top-down resources addressing overdose response procedures and achieving a safer supply for the Vancouver community.

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SOURCE: Harm Reduction Clinical Resources ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © BC Centre for Disease Control. All Rights Reserved.

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Toward the Heart is the main website for BCCDC's Harm Reduction Services Program that provides harm reduction and overdose prevention information and resources for a diverse audience. It features support for registered harm reduction and Take Home Naloxone distribution sites, including training materials and other educational tools.

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Vancouver Coastal Health offers a variety of up-to-date clinical services here: http://www.vch.ca/your-care/mental-health-substance-use/substance-use-services. These clinics support individuals who are seeking to transition out of patterns of substance abuse, especially those experiencing opioid abuse. The majority of these services require no referral or qualifications; the clinics listed as "Addiction Medicine" and "Addiction Services" are particularly tailored to helping individuals access the medication and treatment they need to eliminate substance abuse from their lives.

Note: Some of the other clinics in this list, which do not have titles like "Addiction Medicine," prioritize "detox" and offer primarily or exclusively withdrawal-based treatment; for example, "Onsite" and "Adult Withdrawal Management Services" are both clinics that take this approach. These techniques are now known to be, in general, more dangerous and less effective than multidisciplinary, medicine-based treatments that operate within a framework of harm reduction. Be sure you select a clinic that will best meet your needs; and, as always, don't be discouraged if a particular approach doesn't work for you!

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Skip to main content

We provide a range of services that can help those struggling with substance use or addiction, including detox, group therapy, counselling and medication. Treatment can help people cope with the anger, frustration, sadness, and disappointment that often happen when a person tries to stop using drugs.

All of our treatment programs are free and supply medications and services like counselling, specialized treatment planning, aftercare, and follow-up. We have many different options so all of your medical, psychological, social and spiritual needs can be taken care of.

Withdrawal management, or detox, is the process of removing toxins (drugs) from the body. There is no set timeframe for detox to be completed. For some, the process will take a few hours or days. For others, it may take weeks to completely clear the body of the drug.

Generally, people with opioid addiction can go through detox as an outpatient (during the day, patients don't have to stay overnight). Example programs include the START program, Vancouver Daytox, St Paul's Rapid Access Addiction clinic, and Downtown Eastside Connections clinic. Treatment and medications are available after withdrawal is finished.

Overnight stays for withdrawal are available at Vancouver Detox. Everyone is offered follow-up treatment.

There are risks with "detoxing" from opioids too quickly. When people go through withdrawal management alone with no other treatment, research shows they are at a higher risk for overdose (since they have less tolerance to opioids), HIV and Hepatitis C infection and relapse to opioid use. For most people, it is safest to have a period of stabilization with medication rather than a "rapid detox".

Addiction to opioids, also known as opioid use disorder (OUD), like heroin, fentanyl and oxycodone, is one of the most challenging forms of substance use disorder to overcome.

Medications that treat opioid addiction are sometimes referred to as opioid agonist treatment (OAT), opioid substitution treatment (OST), or opioid replacement therapy (ORT). These include buprenorphine/naloxone (brand name Suboxone), methadone, sustained release oral morphine (brand name Kadian), and injectable OAT (iOAT) using hydromorphone (brand name Dilaudid) and diacetylmorphine (heroin).

iOAT is prescribed to people who have tried oral OAT but found that it didn't work for them. iOAT requires daily supervised injections with hydromorphone or diacetylmorphine (heroin), like at a pharmacy or medical clinic.

All of these medications have been scientifically proven to decrease cravings and withdrawal symptoms, reduce the use of illicit opioids, prevent overdoses and death, and improve overall health and wellness.

Supervising patients taking medication ensures the safety of patients and people in the community, and provides an opportunity for patients to receive other types of health care they may need.

Services may have restrictions related to age or residency.

These services are free of charge.

For information and to be connected to services near you, call the Access Central-Detox Referral Line at 1 (866) 658-1221. Or read more about services below:

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Skip to main content We provide a range of services that can help those struggling with substance use or addiction, including detox, group therapy, counselling and medication. Treatment can help people cope with the anger, frustration, sadness, and disappointment that often happen when a person tries to stop using drugs.

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Indigenous Services for Opioid Replacement Therapy

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Indigenous Services for Opioid Replacement Therapy

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The First Nations Health Authority provides a guide to accessing opioid replacement therapy here: https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use/opioid-agonist-therapy

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Overdose Prevention and Harm Reduction

The FNHA's “Increase the Support. Re​duce the Harm." video series features Indigenous people talking about harm reduction and the impact of toxic drugs in their lives and the lives of their loved ones.

​​​​​​​​​​​Introd​​​uction

At the FNHA, we see drug use as a health issue rather than a moral issue. We encourage you to adopt a harm reduction approach in your life and to have conversations about how to keep yourself, family members and friends safe.​​

First Nations peoples are disproportionately represented in overdose deaths in BC. The FNHA is responding to this public health crisis with ways to get informed, get help and support others – with facts, services and compassion.​​

I ncrease the Suppor t. Reduce the Harm

The FNHA's “Increase the Support. Reduce the Harm" video series features Indigenous people talking about harm reduction and the impact of toxic drugs in their lives and the lives of their loved ones. Choose an individual video from the list or go to the complete playlist.

Juanita – Cree and Dene Treaty 6 Territory (2.38 mins) – “Culture saved my life. It was the missing link and it helps me on my journey in sobriety and spiritually in life."

Saige – Lutsel K'e Dene Nation (2.31 mins) – “What helped in my healing journey was looking up to other Indigenous people."

Sekani, Dakelth First Nation (3.10 mins) – “We need bigger conversations about how to save lives from overdose."

Lisa, Leq'á:mel First Nation (2.08 mins) – “I grew up surrounded by addiction and lost people who were close to me."

John, of the Wolf Clan (3.21 mins) – “I want to say to anyone who is out there struggling with addiction, you are not alone. I care about you."

Eva, Thunderchild First Nation (2.34 mins) – “If you come from a life of addiction, you know the importance of trust."

Melanie, Saddle Lake Cree Nation (3.10 mins) – “I've lost friends and family to overdose. I want to do my part to keep people alive."

Raymond, Cherokee (2.41 mins) – “While healing from drug use I learned that I don't have to suffer. I don't have to carry that pain."

Ken, Yale First Nation (2.16 mins) – 'When your friends drop beside you, be sure Naloxone is close by."

Candice, Dene and Cree Nation (2.30 mins) – “Don't be afraid to ask for help with your addiction. That's what's going to save your life."

Corina, Nazko First Nation (2.15 mins) – “I did my homework and I found people and resources to connect with."​

Toxic Drug Crisis an​​d FNHA Response

20​​21

Situation R​e​​ports

Community Situation Report (December 2021)

​Community Situation Report (October 2021)

​Community Situation Rep​ort (September 2021)​​

​Community Situation Rep​ort (August 2021)

​Community Situation Report (July 2021)​

​Community Situation Report (June 2021)​

Community Situation Report (May 2021)

Infographics (Jan. to Dec.)

First Nations and the Toxic Drug Poisoning Crisis in BC (Jan. to Dec. 2021 data infographic)

Toxic Drug Poisoning Death and Events Data: Fraser Salish Region​ (Jan. to Dec. 2021 data infographic)

Toxic Drug Poisoning Death and Events Data: Interior Region (Jan. to Dec. 2021 data infographic)

Toxic Drug Poisoning Death and Events Data: Northern Region (Jan. to Dec. 2021 data infographic)

Toxic Drug Poisoning Death and Events Data: Vancouver Coastal Region (Jan. to Dec. 2021 data infographic)

Toxic Drug Poisoning Death and Events Data: Vancouver Island Region (Jan. to Dec. 2021 data infographic)

​Infographics (Jan. to Jun.)

First Nations and the Toxic Drug Crisis in BC (Jan. to Jun. 2021 data infographic)

Toxic Drug Poisoning Deaths and Events Data: Fraser-Salish Region​ (Jan. to Jun. 2021 data infographic)

Toxic Drug Poisoning Deaths and Events Data: Interior Region (Jan. to Jun. 2021 data infographic)

Toxic Drug Poisoning Deaths and Events Data: Northern Region  (Jan. to Jun. 2021 data infographic)

Toxic Drug Deaths and Events: Vancouver Coastal​ (Jan. to Jun. 2021​ data infographic)

Toxic Drug Poisoning Deaths and Events Data: Vancouver Island Region (Jan. to Jun. 2021 data infographic)

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First Nations Toxic Drug Deaths Doubled During the Pandemic in 2020 (May 27, 2021 news story)​​

First Nations in BC and the Toxic Drug Crisis (Jan. to Dec. 2020 data infographic)

Toxic Drug Deaths and Events: Fraser Salish (Jan. to Dec. 2020 data  infographic)

Toxic Drug Deaths and Events: Interior (Jan. to Dec. 2020 data  infographic)

Toxic Drug Deaths and Events: Northern (Jan. to Dec. 2020  data infographic)

Toxic Drug Deaths and Events: Vancouver Coastal (Jan. to Dec. 2020 data infographic)

Toxic Drug Deaths and Events: Vancouver Island (Jan. to Dec. 2020 data infographic)

​COVID-19 Pa​ndemic Sparks Surge in Overdose Deaths this Year (Jul. 6, 2020 news story)​

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​First Nations Overdose Data: Preliminary Findings (booklet)

FNHA Harm Reduction Policy

FNHA Harm Reduction ​Policy Statement

FNHA Harm Reduction Policy Supplement 1 of 3: The Context for the FNHA's Policy on Harm Reduction

FNHA Harm Reduction Policy Supplement 2 of 3: Why Harm Reduction?

FNHA Harm Reduction Policy Supplement 3 of 3: What Is Harm Reduction?

F ramework for Action

​A Framework for Action: Responding to the Overdose/Opioid Public Health Emergency for First Nations (poster)

Please Note

​This material may trigger unpleasant feelings or thoughts. Please contact the 24 Hour KUU-US Crisis Line at 1-800-588-8717 if you need emotional support.​​

Public Health Info Lines

​B C Drug & Poison Info Centre (Anonymous Non-Emergency Assistance): 1-800-567-8911

Healthlink BC: 811

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Below are a list of resources for friends and family, to help them understand how best to act as part of their loved ones' support networks. You can use these resources to better understand the people who lean on you, or you can pass them along to help the people you're leaning on better support you without hurting either you or themselves in the process. No one can survive alone, and these resources help communities grow stronger and healthier together!

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https://www.heretohelp.bc.ca/infosheet/supporting-people-who-use-substances-a-brief-guide-for-friends-and-family#path links to an extensive guide directed at members of a support network for any individual who uses substances. You can scroll through all the very helpful advice provided, but the specific section linked here ("A Supportive Path") is a great place to start, laying out the basics of what it means to be emotionally healthy and supportive in any kind of relationship.

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A brief guide for friends and family

Author: Canadian Institute for Substance Use Research

A health promotion perspective

We are all linked to a larger world that includes our family, friends, schoolmates and coworkers as well as our past and present opportunities and experiences. This larger world influences us and we in turn influence it. Personal and social supports (or lack of supports) impact our opportunities and shape our choices. Our choices, in turn, shape our experiences and influence our opportunities.

Each of us can grow, change, and support well-being, affecting ourselves as individuals, our families and friends, and communities. We all want to feel good, in our minds, bodies, in our relationships with others, and the world. Taking responsibility for ourselves is often not easy, yet, it is a must. Sometimes the stories we tell ourselves about who we are, what we can do or cannot do, and how others see us can get in our way. Reflecting on and reframing our personal stories on a regular basis can help us feel better inside and be better citizens of the world. Each of us can always grow, change, and support the well-being of ourselves, others, and our communities.

When we are concerned about something someone we care about is doing, such as using psychoactive substances, we may wonder not only what we can do, but what is appropriate for us to do given the person's circumstances. Using a health promotion approach, helping someone better understand themselves or make changes is not about telling them how to manage or reduce risks and harms but more about supporting them to increase control over their health. This often involves encouraging them to reflect on their goals, desires, needs, strengths and resources.

All psychoactive or "mind-altering" substances, from caffeine to heroin, involve some risk. For thousands of years, people have been using these substances for their benefits; however, the risk of experiencing short- or long-term harms is always there. Many of us can and do use alcohol, cannabis, prescription medications or other substances in ways that carry minimal risk of harm. Sometimes we start using more, or more often, for a wide variety of personal, social or other reasons. These reasons may feed on each other, leading to a bigger issue with substance use, with a greater risk of harmful consequences to ourselves and others. Generally, when substance use starts to negatively affect a person's relationships, work performance, finances or health, they likely have an issue and may want to think about making some changes.

This guide is aimed at giving you, or any caring person, some basic information, ideas, strategies and resources that can help you understand and support someone who may be at risk of harm from using psychoactive substances. The strategies and techniques discussed here are not confined to the area of substance use.

A supportive path

Each of us has the right to live our own life, even if others do not agree with our choices. Managing our health and wellness, including making decisions around substance use, helps us live our lives with authenticity and dignity. Sometimes the stories we tell ourselves about who we are, what we can do or cannot do, and how others see us can get in our way. Reflecting on and reframing our stories with the support of a caring other, can help us feel better inside and be better citizens of the world. Each of us can grow, change, and support the well-being of ourselves, our friends, our families, and our communities.

Promoting well-being is about building capacity in people and communities to support self-management of thoughts, feelings, and behaviours. In this case, self-monitoring of substance use. Increasingly, health professionals and others are associating recovery with a person's ability to manage normal aspects of daily life, whether this involves substance use or not. In this context, supporting involves encouraging people to see themselves as key in any healing or growth process. It means both rejecting ideas of simplistic cures and discouraging people from passive acceptance of "expert" interventions. It means acknowledging that each one of us has a fundamental right and responsibility to manage our life.

For a long time, treatment experts believed that real change in people's lives can only happen after abstinence is achieved. That is, a person must stop drinking or "get off drugs" completely in order to change or improve their lives, or "get themselves together." We now understand that people often need to get their lives together in order to consider no longer using alcohol or other drugs. We also understand that some people may continue to use alcohol and other drugs in ways that others may consider risky but work for that individual. This may even include using an opioid substitute, an opioid, alcohol, or other drugs, on a daily basis.

Any intervention that helps a person deal with the physical, emotional and social harms related to their substance use may be considered supportive, even a form of treatment. Interventions (such as withdrawal management or counselling) are often helpful, but are just one part of a larger, comprehensive response that includes mutual aid and friendly support. While some experts will continue to prefer abstinence as an ultimate goal, a more respectful objective is to help a fellow human take control of their life. A healing path is varied and, for many people, abstinence may not be immediately realistic or desired, or even a goal for some.

According to Carl Rogers, there are three main aspects of providing caring support to another person. They are:

Congruence: as much as you are able, being self-aware, genuine, and authentic in your interactions

Unconditional positive regard: no matter what, holding the other person in high esteem, wanting what is best for them as they see it

Empathy: continuously working to understand the person's thoughts and feelings

Supporting a person involves a commitment to advancing their best interests as they determine those interests to be. The supportive process starts with the assumption that people are experts on themselves, and the acknowledgement that no one can be expected to have the answers for someone else. Helping or supporting someone is not fixing. It is a partnership in which we, as a supporter, are in touch with our own hopes as well as those of the other person. It involves accepting what the other brings to the relationship and respect for the other that makes exploitation much less likely.

Supporting also involves what Rogers called accurate empathy, that is, actively working to understand the other person's "inner world of private personal meanings as if it were your own, but without ever losing the 'as if' quality." This is not about identification with the feelings of the other person or pity for the other person or their situation. It is believing the other person's views are relevant, important and key in addressing any concerns they may have. The opposite of empathy is imposing one's own views on the other person.

Being a supporter is in many ways like being a friend. By learning and practising some of the basic skills of helping, you can become a more able supporter or friend and have a clear path to follow in providing that support.

Supporting another person: Nine tips

1. Your friend or family member, the person you want to support, needs you. Your caring and wisdom can foster a sense of self-worth that will aid the person through their life challenges and beyond.

2. What do you enjoy doing together? Discovering and exploring mutual likes and dislikes can help you better understand each other, building a deeper relationship between you as well as providing support.

3. What interests does the other person have? What do they want out of life? Understanding and supporting their interests and goals shows that you believe in them.

4. Share your life experiences and what you have learned. This can foster discussions that can help them solve issues other than substance use, building the confidence and resilience needed at any stage of life.

5. Life is a learning journey. Time and space are needed to reflect on what we have learned no matter what our age. Allowing space for the person to determine what experiences mean to them fosters a sense of ownership of their life and ability to decide what their next steps might be.

6. We are human and we all make mistakes. Mistakes are opportunities to learn together.

7. The other person will challenge you! This is a natural part of lifelong growth. Engaging them in a mutually respectful way demonstrates you appreciate them, their needs, and their values.

8. Making time to listen shows that you value communication and that their thoughts and concerns matter to you.

9. Being a supportive friend or caring person to someone can be challenging. Engaging in conversation, letting the person know you are doing your best and are interested in their thoughts, demonstrates that you are a person too. Perfection is not required.

The essence of support-caring dialogue, non-directive language

Supporting means relating to the person in a collaborative way, without confrontation and coercion. It involves confirming the person's self-efficacy-building their confidence to face a task and succeed. Instead of fixing or solving things in their life, the emphasis is on assisting the individual to express their feelings, identify their goals and devise plans to reach those goals, if that seems appropriate. The items below reflect this spirit of helping that is about being alongside another person on their journey, through caring conversation between equals-dialogical exchange.

Building a relationship

Every relationship begins with engaging the other person. The process of engaging helps to establish a partnership. Supporting a person to explore their substance use or any other behaviour is not a matter of doing something to the person, like giving medicine. Rather, it is a collaboration between equals. Aspects of both people, and the context and culture in which they interact, can affect the level of connection. Informal chatting can help create a level of comfort; however, the conversation should move to a focus on more personal concerns if it is to be truly supportive. Along the way, attention to several basics is helpful.

Real acceptance of the other person is essential. This does not mean approving the person's behaviour or choices. It means believing the other is valuable simply because they exist and that they have the ability to make changes in their life if they wish to do so. Acceptance is about being respectful and non-judgmental in your approach to talking. It involves trying to understand the person's point of view, expressing concern and acknowledging their experience. Expressing acceptance helps develop trust and protects the person's self-esteem. Acceptance also means commitment to the person's right to self-determination-the freedom to be and to choose. Without such a respectful relationship, it will be difficult for the person to feel good about your discussions.

Effective listening is fundamental. The most powerful force for change is within the individual. Good listening helps a person explore their experiences and reflect on them, thinking about if, when, and how to move forward. Listening also helps avoid the tendency to give advice. Good listening is also active. It shows sincere curiosity and involves reflecting back the meaning the person is communicating in a way that helps the person clarify their thoughts and feelings, and focus on the issues that most concern them.

Affirmation is another essential ingredient. To affirm someone is to accentuate the positive, to acknowledge their worth and autonomy. To affirm is also to support and encourage, and express confidence in the person's ability to manage their life. When offered sincerely, this can generate a positive connection between yourself and the person. People are more likely to trust someone who sees and affirms their strengths, and more willing to attempt change when they feel more confident in their own abilities.

Exploration-Discovering the possibility for change

Most people who want to make a change know reasons to change and, not to change. Other times, people may not know if they want to make a change, and they feel the need to talk to someone about it. Sometimes people get stuck and don't know how to move ahead. A signal that someone wants to explore their thoughts or feelings or perhaps make a change comes in many forms. Some people experience a growing willingness to look at alternative ways of seeing a situation (my partner sees it differently, my friend said maybe I could), examine feelings (I am not sure how I feel, I am mixed up/confused) or consider change (I want to, I can, or I need to). Others express a decision (I will) or identify thoughts or actions, an orientation toward a commitment to change. How can you help them explore their thoughts and feelings around their substance use?

Open questions invite a person to think a bit before responding. They also encourage conversation. Open questions do not often have "right" answers, meaning it is not easy to predict how the person will respond. Closed questions ask for specific information or short answers. Open questions allow the person to explore their thoughts and feelings, and reflect on them. This reflection allows the person to continue their explorations while having you to support them as they go.

Active listening, restating and feeding back your understanding of what the person has said shows you want to understand how the other person sees things. the person's thoughts and feelings in a slightly different way may help move the conversation forward. It also helps identify what the person means by what they said. Self-motivating statements can help the person find their own reasons to do something. Asking, "What makes you interested in possibly changing...?" can help someone reflect on why they use substances. Paraphrasing answers ensures you understand the person, and helps their thinking on the topic evolve. Affirmations. Acknowledge the other person's contribution to the conversation. For instance, "I really appreciate how seriously you're taking this conversation."

Sharing inconsistencies. Inconsistency is the perception that what someone says or does fails to match their feelings, a value they hold, or goal they wish to achieve. It may be that the person expresses a desire to make a change of some sort, yet they do not make such a change. Observing this inconsistency and feeding it back to them in simple and supportive language can help them see a difference between what they want and what they are doing. For example, the person may express a desire for stable relationships and yet their substance use behaviours are currently damaging their relationships. Asking open questions about this, or drawing attention to it by restating what was said, can support further reflection and promote clarity. This is a more complex skill that may take time to master. Don't feel pressured to use it if you do not feel ready or wish to do so.

Avoid arguments with the person. They may not feel, or be ready to accept, they need to change. This means acknowledging that the person is ultimately the one who will make decisions about their health and well-being. Showing respect for what the person thinks and feels is more helpful than trying to force or convince them. Sometimes you can agree with the person and then reframe the issue in a way that opens up avenues for exploration. For example, if they don't see an issue with their alcohol use yet have difficulty getting to work on time due to sleeping in, you might reframe the issue by asking how they might avoid problems that may arise from arriving late to work too often.

Summarizing the conversation. This consolidates a discussion and helps the person develop a context for potential change. Here, you use two or three sentences to review the main things talked about. If goals or next steps were outlined, this is a great way to ensure that you both understand what happened or are agreed on how to proceed from here.

Ongoing exploration

Change happens when a person wants to change, feels able to change and develops a plan to achieve that change. Any plan must be developed by the person who will be doing the changing, not imposed by an expert. If the person is not ready or interested in making different choices, you can support them by continuing to explore their thoughts and feelings using the techniques discussed above. At some point they may wish to make changes in their life. People often feel most ready to consider change around those who do not pressure them to do so. If and when they are ready to change, they may well seek you out for support to discuss their plans.

Supporting another person to review and consider their life experiences can be a positive experience for both people. A relationship can develop or deepen as conversations take place. Supporting another may also lead us to consider our experiences and where we may wish to make changes in our own lives.

Strategies for a good conversation

1. Natural settings work well for conversations about substance use-for instance, while preparing a meal together, at a restaurant, on a walk or when doing other activities together.

2. Choose a time when you can talk and listen calmly and respectfully-conversations about difficult subjects go much better when everyone is at ease, and free from anxiety.

3. Respectfully end the conversation when all the cues suggest the other person is not willing to talk-forced conversation is not likely to be helpful.

4. Be prepared to reflect on your past experiences and how they may have shaped your thoughts and feelings-this kind of open reflection and sharing where appropriate encourages mutual empathy and helps the other person be reflective about their own experiences.

5. Check in on yourself during the conversation-Do you sound interested in the other person's thoughts and feelings? Does your body convey that you are interested in the conversation? Are you listening at least as much as you are talking?

6. Ask questions that further the conversation and encourage the person to tell you more about what they are thinking and feeling.

7. Make your responses to the person short, to the point, and demonstrate you understand what they are saying. This helps the person stay on track, retaining their train of thought and feeling, and move forward in their exploration.

A word about inclusion

The spirit of helping crosses cultural boundaries. Ways of engaging may differ across cultures, but respectful listening and accurate empathy provide a universal foundation. By recognizing people as experts on themselves, we can avoid the presumption of superiority implicit in many cross-cultural conversations. Cultural competence, when it comes to exploring the potential for change, is less about having a pre-understanding of the other person's culture and more about awareness of the cultural norms of politeness and practices related to negotiating and planning. Cultural communication skills can often be learned in the conversational process when one begins with a deep sense of respect for the other person. If you don't know what the practices are, ask! Most people will be happy to tell you what is normally done within their culture. For example, you might ask how to politely introduce a topic, and carry through on your learning in the conversation. This demonstrates both a deep respect for the person and their cultural practices.

To thrive, people need to belong to, and be an active part of, a community. Healthy communities provide a rich variety of ways to promote connectedness and inclusion. Building relational capacity, the ability to engage in meaningful conversations with each other, is not only about providing opportunity, but also about nurturing skills. A focus on enhancing relationships (e.g., parent-child, child-school, family, neighbourhood, staff-clients, dialogue between various sectors or among faith communities, etc.) builds capacity for health and well-being by embracing the assets of the entire community.

Health promotion in practice

Supporting people who use psychoactive substances begins with a commitment to supporting them to feel in control of their lives. This involves attention to both healthy settings and the health capacity of individuals. Healthy settings are nurtured by careful action that ensures policies and procedures at all levels of responsibility contribute to a well-functioning community. Building a sense of inclusion so that all members of the community (including those who use substances) feel they can contribute in meaningful ways is crucial. Healthy people develop in contexts and communities that support personal responsibility and nurture individual and social capacity.

This guide focuses on nurturing a person's ability to make choices that foster their well-being through supportive dialogue with another person. Such dialogue involves engaging someone in a collaborative conversation aimed at strengthening their understanding of themselves. Exploring thoughts, feelings, and behaviours in an empathic dialogue can help a person consider their choices, think about change, and define healthy boundaries that balance their needs and those of the community.

Policies also play a role in how communities identify and support people who may be at risk of developing problematic substance use patterns. Policies related to early childhood development, for example, can promote resilience. Likewise, policies that reduce isolation and build connectedness can increase social cohesion and foster a sense that we are all part of a community. Community policies can also problems have ready access to a range of supportive services. An in-depth discussion on substance use policy is available in Understanding Substance Use.

Sometimes our stories can get in our way. Reflecting on and perhaps reframing these stories with the support of a caring person, can help us feel better about ourselves and the world. Each of us can grow, change, and support the well-being of ourselves, our friends, our families, and our communities.

Further information

Resources

Further options for learning more about supporting people who use substances and refining your skills as a supporter:

General resources for providing assistance to someone who may be in crisis or is seeking counselling around their substance use:

Sources

Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change, 3rd ed., New York: Guilford.

Rogers, C.R. (1965). Client-Centered Therapy. New York: Houghton Mifflin.

Stokols, D. (1992). Establishing and maintaining healthy environments: Toward a social ecology of health promotion. American Psychologist, 47(1), 6-22.

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Supporting People Who Use Substances | Here to Help

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Author: Canadian Institute for Substance Use Research We are all linked to a larger world that includes our family, friends, schoolmates and coworkers as well as our past and present opportunities and experiences. This larger world influences us and we in turn influence it.

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The Canadian Institute for Substance Use Research has drafted a short guide outlining the importance of community for individual health and wellness. It addresses the alienation imposed on individuals by a profit-oriented society, and sets out some basic first steps we can take together to cultivate a safer, more relational community. Link: https://www.uvic.ca/research/centres/cisur/assets/docs/community-guide.pdf

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https://vch.eduhealth.ca/media/VCH/DB/DB.500.S341.pdf links to a brochure we also handed out this afternoon during session B1, "Drugs 101." It provides details on what to expect when smoking crack or crystal meth, as well as how best to safeguard your own health while smoking, and what to do if you experience adverse reactions or overdose.

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https://vch.eduhealth.ca/PDFs/DB/DB.500.S34.pdf links to a brochure we also handed out during Session B1, "Drugs 101," this afternoon. This brochure details what to expect when using injected substances like heroin and crack/cocaine. It also provides details on how to safeguard your health while using, and what to do if you experience an adverse reaction or overdose.