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Ethical Analysis of Two Opioid Harm Reduction Interventions in Quebec: The Distribution of Fentanyl Detection Strips and the Distribution of Naloxone to Youth Under the Age of 14

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View Myriam Ben Moussa's poster presentation in this video recording:聽

Abstract

The opioid crisis in Canada continues to evolve, with 2020 being recognized as the deadliest year regarding opioid-related deaths. As such opioid harm reduction interventions continue to hold significant weight on the policy agendas of Canadian provinces. In Quebec, several strategies have been implemented since the publication of the Strat茅gie national 2018-2020 pour pr茅venir les surdoses d鈥檕pio茂des et y r茅pondre, and interventions continue to be considered to this day. In this context, it is relevant to study two potential interventions: the distribution of fentanyl detection strips and the expansion of the naloxone distribution programme to youth under the age of 14. Fentanyl detection strips have been utilized by different regions and provinces, but no official recommendations pertaining to their use has been released by the INSPQ or the MHSS. Naloxone on the other hand is a well-known tool, but it鈥檚 use in younger cohorts has seldom been analyzed. Harm reduction is often the subject of ethical controversy, and therefore the ethical analysis of these two interventions is the first step in the wider-scale consideration of these interventions. We analyzed these interventions through a two-fold approach, first surveying regional public health units across the province to establish baseline knowledge of use and perception of these interventions, and second, the use of the INSPQ ethics committee methodology for the ethical analysis of public health actions. This analysis revealed that the use of fentanyl detection strips is supported by the values of beneficence, equity, and autonomy, so long as efficacy is maximized, and the use of naloxone among youth under the age of 14 is supported by the same values but is undeniably opposed by the value of professional accountability and the complex legal nature of interventions among this cohort. These findings suggest that while the implementation of fentanyl detection strip distribution programs would promote health among consumers, it is currently not justified to permit naloxone access to youth under the age of 14.聽聽

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