You’re at a party, and suddenly someone falls to the ground. It’s an overdose caused by drugs laced with fentanyl, a synthetic opioid 10 to 100 times stronger than heroin. Depending on the dosage, there might be mere minutes before the damage is permanent — or even fatal.
The solution is naloxone, a powerful opioid antagonist administered via injection or nasal spray that can offset the effects of an overdose for 30 to 90 minutes.
But does anyone have a kit?
Sampath Satti is a biomedical engineering student at UBC. He’s part of a team developing a wearable device that detects the initial symptoms of an overdose.
“What our device does is — in a very non-invasive way — look at pulse rate and calculates the respiration rate, an early mark of onset of an overdose,” he explained. The device then connects to the user’s phone, using GPS capabilities to call for help.
The speed of Satti’s device is crucial. Fentanyl was designed for use in palliative care and we have little idea how long it takes for the drug to cause permanent damage in the real world.
“There is no information on this,” said Satti. “It’s always been done in a controlled setting in operating rooms … there’s naloxone right beside you if something happens. No one has figured out the pharmacology of fentanyl in the black market.
“No one knows how long you have.”
The BC Coroner’s service reports that over 1,200 people in BC have lost their lives to fentanyl this year alone — more than suicide, motor vehicle accidents and homicides combined. A recent survey from InSite, a harm reduction centre in the Downtown Eastside, found that 40 per cent of cocaine in Vancouver is tainted with fentanyl. The numbers are similar for MDMA.
Getting naloxone where it needs to be has now become the top priority of health services throughout the province — but it’s easier said than done. Student Health Services, the AMS, drug users and campus associations are using their own methods of harm reduction to curb the threat of fentanyl.
This is the health crisis that UBC confronts — and it’s one that traditional health services aren’t prepared to face.
Toxic stigma
When The Ubyssey spoke to Student Health Services (SHS), it had only handed out 63 naloxone kits over the course of 18 months on a campus of 54,000 students.
Why have so few kits been handed out?
It’s not for lack of trying. Even before the fentanyl crisis was declared an emergency by BC Health in April 2016, SHS was distributing naloxone kits for free.
But for several months, nobody wanted one — because getting a kit meant signing a form stating that you use or planned to use substances.
John, a third-year student at UBC, has been using MDMA and cocaine occasionally since his teens. He said he isn’t keen to publicize his drug use — especially with university staff, regardless of their assurance of confidentiality.
The Ubyssey agreed to use only his and others’ first names due to the illicit nature of their activities.
“I’m not going around telling people in classes, ‘Hey, I did cocaine this summer,’” said John. “If it was like an official record saying that I had a drug kit or that I knew users, I don’t think I’d feel comfortable giving the university that information.”
As directed by the BC Centre for Disease Control, SHS is meant to hand out kits “to people at risk of opioid overdose” — they can’t simply give kits away for free.
But if owning a kit identifies you as a user or requires filling out a form, users automatically feel stigmatized.
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Dr. Lindsey Richardson, an associate professor at UBC specializing in medical sociology, said that while stigma we attach to substances can sometimes reduce usage, it can also cut off users from seeking help.
“Stigmatization in some instances prompts reductions in use,” she explained. “For example, tobacco smoking is down because it’s been stigmatized in a widespread way.
“However, stigma [can also] have significant negative consequences … often related to people’s willingness to seek out care and treatment for what they are dealing with.”
When it comes to drug use, Richardson indicated the latter is more common.
“Stigma will often remove people from treatment systems and services because they don’t want people to know,” she said.
Aside from the mental barrier of stigma, users were concerned that revealing their drug use would result in consequences from UBC itself.
Stephanie Lake, a PhD student at the UBC School of Public Health and the chair of the Vancouver chapter of Canadian Students for Sensible Drug Use (CSSD), said that UBC students can face severe penalties for drug possession from the university as well as legal authorities.
“When you’re a student, there are added things you have to worry about,” said Lake. “If you’re in residence and caught with an illicit drug, that could lead to a number of consequences ... including expulsion.”
Dr. Marna Nelson, the current director of Student Health Services, said that any information given to SHS won’t be shared with UBC Housing or other UBC services.
“It’s completely confidential,” said Nelson. “We have arranged with [BC] public health so that we don’t actually have to record this in a student’s chart.”
Nelson stressed that concerned students could either phone or visit the clinic anonymously. There, they could arrange to be trained and pick up a kit without providing information — but this process is only advertised in a UBC FYI blog post, and very few have taken advantage of it.
In the winter of 2016, Nelson changed SHS’s policy around naloxone kits. Now, interested persons only have to indicate that they know someone who uses or plans to use substances.
But even for students willing to sign the form, the road to getting a naloxone kit has been long.
Getting a kit from SHS requires taking two training sessions — the first on how to recognize an overdose, the second on how to administer naloxone. While the sessions are simple, booking them isn’t.
When Satti went to SHS, he met a backlog that forced him to leave empty-handed.
“To get a kit you need training, and I think they only give it to you if you’re at a risk of overdosing,” said Satti. “But the training slot was over the course of two weeks, and they didn’t have any slots available when I went in.”
“SHS has also developed first-step training for security and others on overdose awareness (roughly 300 have completed),” wrote Matt Ramsey, director of strategic communications at UBC Public Affairs, in an emailed statement. “The second step for training is using the kits and SHS is working to complete that training as soon as possible.”
Will Shelling, the vice president of risk management at the UBC chapter of the Delta Kappa Epsilon (DKE) fraternity, also had difficulty procuring a kit. When word spread last year that a shipment of fentanyl-laced drugs was arriving on campus, his predecessor immediately prepared for the possibility of an overdose at a DKE party.
But when Shelling himself tried to get a kit, the process took him a month.
“After I officially took on my position, I contacted the Vancouver Board of Public Health,” said Shelling. “I was referred down the line over and over — when I finally got it, it was a month later.
“The system isn’t intuitive.”
Since then, Nelson said the process has sped up significantly — training can usually be given within the course of a week.
But many users have already been turned off by the service. Those interviewed expressed concerns about confidentiality and an unwillingness to jump through bureaucratic hoops.
More importantly, many of them didn’t know the service existed at all.
No questions, no answers
How many kits is enough, and how many students are at risk? No one knows, and no one seems to want to talk about it.
Dr. Michael Krausz is an addictions specialist at the Centre for Health Evaluation and Outcome Sciences at UBC. He said assessing drug use in student populations is difficult because of its association with mental health — and the resulting stigma around it.
“University is a time of great transition,” said Krausz. “Young people are under enormous pressure and stress … they need to make big decisions and are not really prepared for it.
“[Drug use] is not really a topic which is openly discussed as a problem.”
And data on student drug use is incomprehensive and incomplete. Simply put, there is no information on how many UBC students are using drugs, at what frequency they’re taking them and why.
“We are not measuring the amount of people who have severe problems at UBC who are getting support, what the waiting times are or how many are dropping out,” said Krausz.
“We can only rely on international and national data and guess the numbers will be similar.”
The most recent national survey on substance use among students was published in 2011 by the Canadian Centre on Substance Use and Addiction, a government-funded project aiming to assess the severity of drug use across the country. It reports that 7.1 per cent of BC students have used ecstasy, and that 3.9 per cent have used cocaine.
These statistics indicate that more than 2,500 UBC students have used cocaine and close to 4,000 for ecstasy. These numbers are likely rising.
Krausz said rising rates of anxiety and stress among students are causing more to “self-medicate” with substance use. What might seem like “blowing off steam” can quickly develop into addiction and dependence.
Jeremy is a third-year student. For the past two years, he has been dealing cocaine on campus. He said a large number of his clients are often people working high-pressure jobs — whether that be in Vancouver’s nightlife industry, in kitchens or as full-time students.
“Slowly, the drugs are being more and more accepted, and people are starting to use early,” said Jeremy. “A lot of people are finding [drugs] in their workplace because they’re surrounded by people who’ve deemed it okay.
“It’s sad to see kids who are 16 starting to think it’s okay.”
Dr. Krausz said this is a hybrid health problem that UBC simply isn’t prepared for.
“There is counselling and Student Health Services — but they’re not really prepared for anything substance-use specific,” he said.
No harm done?
In the absence of a comprehensive university-run initiative, student organizations and users are taking harm reduction into their own hands.
Marium Hamid is the AMS student services manager. This year, one of her standout services has been AMS VICE, a student-run addiction support service that has distributed over 200 naloxone kits in the the fall of 2017 alone.
Hamid said the idea behind VICE is to make participants feel welcome, avoiding barriers of judgement or stigma that discourage them from accessing other services.
“Going to places where you don’t feel like a peer is connecting to you is often one of the biggest barriers to accessing a service,” said Hamid.
Rather than treating substance use as a problem, VICE tailors its services to help users “find their balance” with substances — no matter where, what and how much they’re using.
“One good thing that Alexander [Dauncey, VICE’s coordinator] said is, ‘Meet people where they’re at, not where you want them to be,’” said Hamid. She added that no matter their community, the fentanyl crisis could affect any student at UBC.
“UBC consists of a large number of commuter students,” said Hamid. “This crisis is not centred towards one population ... it’s a problem that people in our campus will take back to their own communities.”
In the past month, VICE has hosted two naloxone “training parties” with roughly 120 and 80 participants, respectively. There, participants received simultaneous naloxone training from Karmik, a partner harm reduction organization operation in Vancouver’s Downtown Eastside. After two to three hours, each participant leaves with a kit.
Lake, who was a speaker at VICE’s first event, said “low-barrier” events like training parties are key to helping at-risk students access their services.
“They can see there are other people who are concerned about this issue, who care about their neighbours,” said Lake. “It breaks down barriers.”
But it hasn’t all been smooth sailing for AMS VICE. In September, UBC barred the service from directly discussing substances at Imagine Day in September to keep the event “family friendly.”
Hamid said this came down to a misinterpretation of the service.
“The interpretation regarding VICE not being able to booth with their materials was the result of [UBC’s] guidelines written years ago,” she said. “There’s an ongoing relation between us and everyone at UBC.”
While VICE aspires to hold more events in the future, it’s not likely they’ll be able to equip every at risk person with naloxone.
Instead, it might be enough to make sure naloxone is where it’s most often needed.
Life of the party
The BC Coroner’s Service reports that over 80 per cent of fatal overdoses in BC this year happened when the victim was using alone. But at UBC, users seem to be using substances in small groups, often in social settings.
“You do them because you go out, whether you’re going to a party or a club,” said John. “I doubt there are that many people doing MDMA and cocaine hanging out in their apartment alone.”
Clubs and organizations have caught onto this. Gradually, UBC’s party scene — including Greek societies, AMS events and Campus Security — are equipping themselves with naloxone.
But UBC has yet to pick up the pace.
While Nelson confirmed that Campus Security have been trained to recognize an overdose, talks to outfit them with naloxone are “ongoing.”
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“We’ve been meeting with [Campus] Security this fall for what form of naloxone they want to carry — they’re leaning towards the naloxone nasal spray,” said Nelson.
According to Ramsey however, campus security officers began their training on naloxone use on November 20, and “all members will be trained and carrying the kits 24/7 as of [December] 11.”
But the logistics are more complicated than simply giving an officer a kit. A single dose of nasal spray in Canada costs around $135 and it’s currently only widely carried by the RCMP and other professional first responders.
In comparison, DKE’s UBC chapter has had naloxone kits in the house for over a year. Of the 63 kits distributed by SHS, DKE holds three — or roughly five per cent.
“We have brothers living in the house or who come out for parties that are also trained in using a kit and first aid,” Shelling said.
But even though organizations like DKE have shown initiative in preparing for a potential overdose, Shelling and other trained naloxone carriers can’t be everywhere. This leaves the better part of harm reduction up to those most directly affected — the users.
To each their own
At UBC, users blocked from or unaware of other resources often count on each other and their dealers to keep their substance use safe.
Despite fentanyl having been found in nearly every substance in Vancouver save for cannabis and alcohol, none of the users interviewed for this article regularly used a test kit. Instead, they have specific dealers who they trust to sell them a clean product — although that’s not always the case.
Zach is a third-year student at UBC. For two years, he has used MDMA on a recreational basis. In all that time, he has never used a test kit, but said that he trusts his dealers’ products simply because his friends do.
“If a lot of friends use it and trust the dealer, and if they’ve been using his drug for a while, that’s my ‘test kit,’” he said. “If my friends already trust the person, then I’ll probably trust them too.
“It’s a little stupid on my part,” he admitted.
Some dealers claim to go the extra mile to keep their product safe. Jeremy said that his group tests their product before selling, knowing that an overdose could mean both police trouble and an end to their business.
“It’s a small environment of people we’re selling to,” said Jeremy. “It all gets back. You might as well sell a very clean product rather than an unreliable one.”
Just in case, Jeremy said designated members of his group carry naloxone kits to the point of sale — an extra security measure for the dealers as well as an emergency measure for the customer.
But even if dealers do test their product, that test’s accuracy is questionable. Most commercially available drug tests available online, or so-called “dip strips,” will identify fentanyl but might not be able to identify the drug’s 44 known “analogues” — slight variants of the original compound that are often much more powerful.
Richardson emphasized that no matter what a dealer says — online or in person — it might simply be a lie.
“It’s very difficult for dealers to guarantee that there isn’t fentanyl in the product that they’re selling,” he said. “The degree to which they are able to accurately test the drugs that they are selling would be something that I would ask about.”
At the end of the day, the trust between dealers and users is precarious at best. No matter what a dealer claims, there’s no way to know what they’re actually selling — something users are aware of.
“No matter what they [the dealers] tell you, you often both know it’s bullshit,” said Zach “The kids I buy it off of — they’re not the ones making it. They don’t know what’s in their own stuff.
“Nobody knows.”
Questions unanswered
When it comes to addressing the overdose crisis, UBC’s traditional health services have done little — but is it too late? In a nutshell, it’s complicated.
In an ideal world, every at-risk student would carry a naloxone kit, and UBC has admittedly done better than most Canadian universities in offering naloxone on campus. But getting those kits is challenging, both in terms of the stigma attached and the logistical feat of booking the appointment.
“Our drug policies are all based around prohibition,” said Lake. “Prohibition is what leads to things like fentanyl being found in our drug supply — we have no way of regulating and managing what people are taking.”
Ultimately, traditional health institutions aren’t prepared for a crisis of this size or nature, especially when its causes run deeper than simply preventing drug use or regulating the supply of recreational drugs.
“We do not really have a functioning mental health system that is integrated for university students,” said Krausz.
“What I think the overdose crisis tells us is that our treatment system is not equipped to deal with additional challenges.”
This article has been updated to include comment from UBC Public Affairs. UBC campus security officers will carry naloxone kits by December 11 and Student Health Services has not yet offered the second stage of naloxone kit training to all those who completed the first step. Since time of publishing, the total number of naloxone kits distributed by Student Health Services has risen from 61 to 63.