A quest to disrupt the opioid crisis

Dr. Dan Werb turns a spotlight on interventions that protect vulnerable populations — like marginalized kids — from injection drug use.

Allison’s eyelids flutter open and closed as she struggles to answer Dr. Dan Werb’s gentle probing into her battle against addiction.

It is 2012, and they are sitting across from each other in a small, non-descript office at the headquarters of the Vancouver Area Network of Drug Users. Dr. Werb has just introduced himself to Allison as an epidemiologist researching HIV and addictions, up the road at St. Paul’s Hospital. Allison apologizes for her lack of focus, explaining that she injected moments ago.

Dr. Werb will eventually bring this scene to the pages of The Walrus magazine – where he will tell Allison’s story and the story of others like her. A powerful tale of the human misery caused by drug use and our health system’s reaction to it, the article will win him a national magazine award. As a writer and as a scientist, Dr. Werb’s goal is to find interventions that stop intravenous drug use, and to bring attention to the many factors that cause people to become entrenched in street life. The stakes are high: Last year, nearly 4,000 Canadians died of an opioid overdose. Deaths, that in his view, were entirely preventable.

Today, Dr. Werb is a scientist with MAP Centre for Urban Health Solutions at St. Michael’s Hospital. He is also the principal investigator of a five-year study that looks at how to stop people from injecting drugs for the first time. Dr. Werb’s project appeared as an interactive installation at Brookfield Place last year, part of a group of installations that looks at the detrimental effects of poverty on people’s health. The exhibit marked the launch of a $25-million fundraising campaign in support of St. Michael’s MAP Centre for Urban Health Solutions.

Working with a team of international researchers, Dr. Werb is examining the experience of people who inject drugs in seven cities – Vancouver, Toronto, San Diego, Calif. Tijuana, Mexico and Paris, Strasbourg, and Bordeaux, France. The study is part of a harm-reduction strategy based on the notion that injecting is contagious. That is, new injectors of drugs become desensitized when exposed to others who inject.

“Despite constant hand-wringing over drug use, the least developed part of our strategy is preventing people from starting to inject drugs,” says Dr. Werb. “And yet, if you can do this, you also reduce the risk of overdose, Hep C, HIV, blood poisoning and substance use disorders.”

Part of the problem, says Dr. Werb, is the dilemma veteran injectors face when someone asks for help injecting for the first time.

“You might say no initially. But then your friend says, ‘If you don’t help me, I’ll go to that sketchy guy down the street,’” he says.

His research already suggests a solution: expanding programs such as Vancouver’s Insite, North America’s first supervised drug injection site. At Insite, medical staff provides first aid in the event of an overdose, and addiction treatment when people who use drugs are ready. Previous research shows that people in Vancouver who inject drugs and visit Insite are significantly more likely to access addiction treatment than people who inject drugs but do not access the site.

Further, Dr. Werb’s recent study of more than 1,700 people who inject drugs found that among those enrolled in addiction treatment, there was a 50 per cent reduction in the odds they would initiate others into injection drug use.

He believes part of the reason is that staff helps veterans of drug use to manage their withdrawal symptoms, reducing their vulnerability to the lure of shared drugs that comes with initiating others. While they may not abstain, veteran users of drugs enrolled in addiction treatment often reduce their use of injection drugs. And when they do inject, they do it in the privacy of a supervised site, out of view of others who might be influenced to try it themselves.

Dr. Werb suspects this may be key – fewer opportunities for people who have never injected to watch veteran injectors could reduce their likelihood of trying it themselves.

As Dr. Werb recounts in his magazine piece, Allison had mixed feelings while watching her friends inject. But she eventually became desensitized to it. When Allison finally decided to try it, she asked for help from someone she trusted: her grandmother – a longtime user of drugs.

“That was really harrowing to hear about,” says Dr. Werb. “But that’s what happens. You turn to people you trust to help you do it. And there are rational and compassionate reasons why people make the choice to help.”

Dr. Dan Werb’s new book, City of Omens: A Search for the Missing Women of the Borderlands, came out in June 2019. It is a scientific detective story based on his research into drug policy in Tijuana, Mexico, revealing what happens when a border city’s lifeline is brutally severed.

Click here to see how St. Michael’s MAP Centre for Urban Health Solutions is tackling the urban health crisis head on. Or make a donation here.