“One of the principal harms of the drug war is that society fails to treat people with dignity. And to me, a prosecutor disrespecting the wishes of a person who dies of drug overdose would just be one more act of turning their backs on people who needed help” - Grey Gardner, a lawyer with the Drug Policy Alliance

He got on Buprenorphine in February
Clinic screened urine
No problems until last week
They found THC; kicked him out
He couldn’t find Bupe; only heroin
He was 24 years old
When someone says: “the system is killing people,” this is what they mean”

“There can be many reasons for overdose, such as stronger batches of heroin, ageing users with health issues, or former prisoners on release whose tolerance has dropped. Whatever the reason, anyone can save a life with Naloxone. It is low-cost, easy to use, has zero potential for misuse and it can save lives.”

After she revived the woman by the road, Haven Wheelock made her way back across the road and lit a cigarette. She is known for being calm — even bossy — in a crisis. “Then, as soon as everything is taken care of, I cry,” she says. “Every time.”

It's not that I'm 'passionate' about it. I'm 'passionate' about art. I'm not 'passionate' about people dying in the streets, I'm fucking angry! Don't romanticise my anger!

Fewer supervised injection sites could mean increased demand for an already understaffed Paramedic service. Closing or underfunding these facilities is an attempt to sweep a crisis under the carpet.

It was clear people were going to use it, so we decided not to scare people by saying that fentanyl will definitely cause an overdose. Instead, we said they should use it with caution. Use less of it, use it slower, use it with other people, and keep Narcan with you. - Kristen Marshall

So much of our time and energy seems to be spent refuting inaccurate information, speaking out against stigmatizing policies, and dealing with reactionary policy makers who seem incapable of simply saying "We're sorry, we were wrong." The worst part is that this takes away from the life-saving work that needs to be done.

This is an incredibly important moment nationally, and locally, to ensure we invest in strategies that we know work and not allow hysteria to guide our solutions to the overdose crisis. These stories cause very real harm: they perpetuate fear and stigma against people who use drugs resulting in negligent care, isolation and diversion of resources towards law enforcement and away from life-saving programs. A culture of increased criminalization, hostility and shame–all while wearing expensive hazmats suits, will do nothing to save lives.

I know people have heard stories about shooting them up with milk or salt water, that doesn’t work. Naloxone works. - Steve Kamenicky

Making naloxone available over the counter is a smart solution. However, much work needs to be done to tell everyone that naloxone can save lives.

Clearly the statistics used to promote the Singapore myth either do not exist, or fall apart under scrutiny. As a result, any attempt to use the Singapore model as evidence of the effectiveness of the death penalty for drug offences is ludicrous. Given the unprecedented overdose crisis in the US, Americans deserve an evidence-based response. Pursuing myth-based drug policies will only make the problem worse.

The paper consistently makes use of negative clichés and stigmatising language to describe people who use drugs. In one instance, the authors describe their hypothesis of how “saving more addicts' lives increases the stock of drug users and the pool of people who need to fund their addictions”. Note to researchers: if you find yourself referring to any group of people as stock, as if they were goods on a warehouse shelf, you’re doing something seriously wrong.

Local authorities should remove any unnecessary requirements to receive take-home naloxone, particularly requirements to engage with services providing take-home naloxone.

Local authorities should make take-home naloxone available to any person requesting it, particularly to groups that are at risk of having an opiate-related overdose or are likely to witness someone having an opiate-related overdose.

The biggest failure in the public health aspects of the fentanyl crisis is that we’re treating it as a drug epidemic and not a poisoning epidemic... Imagine if this was a poisoning outbreak in infant formula and the only thing we did was test the dead bodies of the infants and tell the public: 13 dead bodies last week in San Francisco. - Dan Ciccarone

We need to ramp up supply of naloxone. We currently have the highest levels of opiate deaths for the fourth year running, so the risks for people using opiates are greater than ever... ... we really need to start being more proactive in making sure that there is enough naloxone in the community - that means supplying people with multiple kits and helping peers to be supplied as well. - Nigel Brunsdon

In my view, here’s what ought to be happening: we should be openly talking about the overdose antidote naloxone in recovery circles. If we see someone who’s new and has a history of opioid use, we should try to get naloxone into their hands. If we find out someone relapsed back to opioid use, we should ask if they have naloxone. And if not, we should try to get some naloxone into their hands.

It means we believe in saving the lives of people who might use drugs again. And again. And again. To many people, this outcome is unacceptable, so they propose policies like limits to the number of times Narcan can be administered to the same person, or forcing people into treatment after an overdose and other measures that imply that only a person who does not use drugs (or will stop immediately) deserves to be saved.

But more counselling and more kits aren’t going to end the crisis. Surveyed front-line workers were clear that the problem isn’t fentanyl – it is a combination of poverty, homelessness, and a lack of mental health supports that is fuelling the crisis.

So the Toronto Harm Reduction Alliance got itself a basic white tent, erected it in Toronto’s gritty downtown Moss Park, and put all that stuff inside it. Presto: A safe, supervised injection site... Organizers say one patron overdosed Monday night, and was revived. He was just as alive the next morning … he would have been just as dead had he fatally overdosed in an alley or bathroom or apartment.

People like me and my wife have to confront the fact that their children are dead. At the moment drugs are in the hands of criminals. We need to get a grip on the situation. It would be lovely if we could say that the current legislation is working, and that education is working, and the law is preventing dealers. But unfortunately it’s not the case.

It used to be that when a cab driver asked what I did for a living, I mentally geared up to fight and defend my work & people against reactionary stigma and ignorance. These days, though? Its like opening a fucking floodgate of grief and trauma. Without fail the response is stories about kids, lovers, siblings, or friends who've OD'd or disappeared to the streets or into the judicial system. Its no longer about defending my work, but providing 5am ministration to the survivors of our failed drug policy.

Any drug treatment service considering providing a child or young person under 18 with training on overdose management or on the use of naloxone, or considering direct supply of naloxone, should act in line with established clinical principles for the treatment of children and young people. This is the case whether the goal of such consideration is to reduce risks to a young person who is using drugs or to reduce risk for others (such as an opioid-using parent).

The best way to make people understand the need to stay with you if you OD is to let them know you'll stay with them if they do. Think about the people you use with from day to day and week to week, have you had that kind of conversation with them? Maybe now is the time. Make a promise to people that if either of you overdose the other one will help.

‘They Talk, We Die’ is a powerful message and call for action. Yet for too many countries with staggering rates of overdose deaths – including the UK – the talking isn’t even happening. Only the dying. International Overdose Awareness Day offers a stark reminder of the collective failure to act decisively to end this global crisis.

Fentanyl kills for the same reasons that opiates kill – they slow respiration until it stops. Death is by suffocation. Drugs administered by prescription or in hospital environments are quality controlled and used where the effects can be monitored and action taken if something goes wrong. By definition there is no such control in the illegal drugs trade. What is sold on the street could be anything from a little heroin, diluted with something fairly innocuous, to pure fentanyl.

Asked about who'd be liable if someone died at the site, Gagnon asked who's liable for the drug users currently overdosing and dying on the streets with no supervision. "If people don't come to our site they have nowhere to go. So I would say, who are we holding accountable for people dying on our streets? No one," she said

Naloxone on the shelf of a nurse’s office or in the cupboard of a health center is not the optimal place to store the drug ... ...It is imperative that naloxone be placed directly with the people who are most at risk of an overdose or are most likely to witness an overdose: the roommates, family members, friends and even relative strangers. - Jennifer Plumb

Fentanyl is about 100 times stronger than morphine and over 50 times stronger than pure heroin. Fentanyl dissolves in your body fat. This means that your body absorbs it quicker than other similar drugs and the effects can come on much faster.

If you inject heroin, methadone treatment reduces the risk of overdose. Heroin injectors who are not in methadone treatment are around 11 times more likely to die than those who are in treatment! Methadone takes a few days to build up in your system at the start of treatment, so don’t expect it to work instantly.

Rather than telling people that they are powerless in the face of the drugs they use, naloxone shows people that they can be in control of their own health promotion, and the promotion of their peers. Given access to naloxone drug users will (and do) support each other.

‘Fentanyl=death’ messages are inadequate as, without access to licit compounds, people will still access the street market and so harm reduction is also essential.

There is a real issue with private residential rehab providers who are not willing to give people naloxone when they leave, as they fear that could make people think "This idea that we've sold you might not work".

If you’re using drugs of unknown strength (and you are every time you purchase from a different dealer or new batch), do a tester shot first to see how strong they are. You can always do more later. Many people overdose when they do a full hit of a strong drug.

We need to update the 'Don't use alone' message to one that says 'Don't use out of peoples sight' (to further reduce overdose risk).

We want our safe consumption spaces the way we want our abortions... ...not in a back alley.

Here's a thought... Had we got a drug consumption room my friend may not have died in a toilet by himself....

I was really nervous giving someone naloxone in such an open space because, at that time, we did not have a Good Samaritan law in effect,” Wright said. “However, I don’t care and, clearly, that didn’t stop me. Overdose is preventable, and I had the medicine on me to do it. Substance use comes in all shapes, forms, and sizes. Upper class to middles to right down on the street.

“Better safe than dead” – Test your gear, start with a small amount to reduce your risk of overdose, use with a buddy, one at a time, keep NALOXONE on/near you when using, it’s no good at home if you are at a mate's place.

While 1571 people died from a heroin overdose in the UK in 2015, no one has ever died from an overdose in a SIF anywhere - despite the many thousands of overdoses that have occurred in them. Opiate overdose is easily reversed if attended to quickly, only becoming deadly if people don’t have rapid access to emergency care.