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There are many challenges in addressing the opioid crisis in Atlantic Canada. Some of the most common concerns among those who are working on the frontlines are funding for and access to proper resources, including mental health supports, and the creation of safe consumption sites. Many are also concerned that people who are living with addiction aren’t adequately included in the decisions that affect them.
RESPONSE HAS BEEN A 'SLOW CHANGE'
By Juanita Mercer
In Stratford, Prince Edward Island, Chris Craig says he’s witnessing “a slow change.” As a youth community liaison with the Reach Foundation, his work supports youth in addictions recovery. He says one of the biggest challenges in the province is accessing treatment in rural areas. An agreement between the province and the federal government, however, brought more than a million dollars to the island this year to improve access to opioid replacement therapy. Craig said subsequent initiatives such as telehealth and mobile access — in which treatment can be provided in people’s homes or out of community health centres — is one part of improving access for rural Islanders. “But we still have a long way to go,” he said.
Challenge: FundingAn officially-declared opioid crisis in Canada opened access to emergency federal funding that was critical in expanding services to rural areas.
However, obtaining funds to provide services is still a challenge, says Craig.
“We still struggle. We don’t know where next year’s funding is going to come from.”
It’s not a uniquely rural problem and it’s not unique to any one province either.
In Halifax, the organization HaliFIX is trying to implement the first overdose prevention site in Atlantic Canada, but its president, Michael Bonn, says sustained funding from the provincial government is preventing the idea from implementation.
“This isn’t a service you want to give to substance users and take it away after three months, six months, (or) a year. We want this long-term.”
He said such a site — where people can use their substance of choice in a safe, monitored environment — will prevent overdose deaths. For example, he said drugs brought to the site would be tested for the presence of fentanyl.
“They’re disguising fentanyl in all kinds of different substances —making them look like old OxyContin or Percocet or Dilaudid. They’re even putting it into cocaine and meth.
“So, we’ve seen a lot more of it and I know it’s extremely bad in Boston, and Boston’s not that far away. So, I can see it getting worse before it gets better, and we just want to save some lives and eventually — hopefully — there’ll be some sort of safe supply that substance users will be able to access instead of having to turn to the black market.”
Despite funding struggles to set up the overdose prevention site, Bonn said he is seeing a change “slowly but surely.”
Bonn used to use fentanyl intravenously himself. When he began methadone treatment in 2012, he recalls the waitlist was around 18 months due to funding issues. Today, he says there’s no waitlist for opioid agonist treatments (OAT) in Nova Scotia.
“Our needle exchange programs have been expanded (with) more locations, but we’re still missing that crucial piece of the puzzle which is having a safe consumption site because that’s where you can intervene and save the most lives.”
Challenge: DestigmatizationAnother critical issue related to opioid use is addressing mental health supports, something that can again be challenging in rural, isolated parts of Atlantic Canada.
In Bell Island, Newfoundland and Labrador, grassroots groups are filling some of those gaps.
Wabana, Bell Island, N.L., mayor Gary Gosine says he formed the group Unity in Our Community after his nephew died of an overdose in 2017.
The weekly group meetings offer a place for people who use drugs to talk with one another and receive support from different guest speakers.
“Our group is filling the big gap of support,” said Gosine.It’s the kind of peer inclusion that needs to happen at all levels of policy and practice, says Memorial University of Newfoundland critical drug studies professor Chris Smith.
He says people who use drugs aren’t adequately included in the decisions that affect them. Smith believes that’s the biggest change that could address challenges faced in Atlantic Canada.
His argument is simple: “People who have been there will have more insight into it than people who haven’t.”
To see real inclusion, however, Bonn says it requires addressing the more systemic issue of stigma.
“We have been criminalizing people who use substances ... criminalizing people for health-care issues.”
Destigmatization is at the forefront of St. John’s physician Dr. Melanie Van Soeren’s work.
“The folks that I am caring for are fundamentally good people who have fallen on hard times, who have experienced trauma, who have chronic pain issues and who are simply trying to get through their lives and trying to survive.
“And in some cases, the rational thing to do, the only option that people have in order to be able to get through the challenges in their lives, is to resort to substances.
“We as health-care providers need to not only be treating the addiction, but we need to treat the whole person and look at our patients as people who are suffering and are needing not just medical support but compassion.”
Did you know?The risks associated with opioid use span from coast to coast, impacting young and old Canadians from all walks of life.
Canada’s opioid crisis is not a far-off problem, but a serious issue that repeatedly results in devastation close to home.
“It’s in all of our communities,” said Dr. Robert Strang, Nova Scotia’s chief medical officer of health.
In the last decade, Strang said, there have been an average of about 60 opioid-related deaths in Nova Scotia per year.
“Sixty deaths a year is still a lot in Nova Scotia and we need to take that very seriously, even if we’re staying stable at 60,” he said.
Ongoing harm-reduction initiatives focused on making naloxone kits available in more homes throughout Nova Scotia is a significant step in increasing overdose prevention.
“We also have naloxone now at no cost at virtually every pharmacy in the province,” said Strang, who stressed that using opioids alone poses a major risk.
“Going back all the way to January 2016, we’ve distributed about 5,200 naloxone kits and there’s been well over 100 reported overdose reversals.”
He said the majority of overdoses occur when opioids are used in combination with other prescribed or illicit drugs, contaminated street drugs or alcohol.
He’s noted a spike in incidents related to highly-concentrated synthetic opioids, such as fentanyl, produced in what Strang describes as “backroom laboratories.”
“That right away puts people at much higher risk,” Strang said.
He stressed the government investments geared at addressing the nation-wide public health crisis through harm reduction and improved access to health services must continue.
“Opioids are, for reasons of how they work in the brain, highly addictive.”
NOVA SCOTIA WOMAN SHINES LIGHT ON DARKEST DAYS TO HELP OTHERS
By Ashley ThompsonDilaudid. OxyContin. Methamphetamine.
There was a time Kelly Stoddart would do what she long considered to be inconceivable things to get her hands on opioids.
“From doing so many and so much, it ate a hole from the inside of my stomach out… it was just a big, black, scabby hole that ate me from the inside out,” the Nictaux, N.S., resident said in a recent interview.
“It ate a toonie-sized hole through my liver. It totally ruined my life.”
She started experimenting with illicit opioids in at 14. The lifelong Middleton-area resident quickly learned that she didn’t have to travel far to find what she was looking for.
“It was everywhere,” she said.
Stoddart noted that pockets of the Annapolis Valley with higher rates of poverty and unemployment appeared to be particularly vulnerable.
She saw the harsh realities of people willing to do anything to make a dollar firsthand.
And she counted herself among them.
“It was easily accessible. To be on it, it felt incredible. It made you not feel anything at all. You had no care in the world. You were totally numb,” she said.
“You worried about getting that pill. You worried about getting that high, and each day it only got worse and worse — and worse.”
She starts to weep seconds into thinking back to moments she discovered how far she would go to feed her addiction. At the worst of it, she estimates she was consuming 30 to 40 pills a day.
“When you’re an addict you do whatever you have to do to get your fix. In that moment you don’t care what you’re doing. You’re doing what you need to, to get high,” she said, pressing on between deep breaths. “I’ve done so many wrong things.”
She found people all too willing to turn her pain into their gain in her seven-year battle with addiction.
“I would trade sexual activity just to get high,” she said, breaking into sobs. “Those are things that you’ll never forget that you done.”
“Don’t listen to them when they tell you that they want you. And don’t listen to them when they tell you that they’ll give you everything you want because, at the end of the day, they’re only giving it to you because they’re getting what they want.”
Rock bottomHer turning point came in the form of a residential search warrant executed where she was living in 2012.
“It was my rock bottom. I had enough. If I continued to live that lifestyle, I was going to die,” she recalled.
“I woke up on March 6 and I said, ‘you know what, I don’t need pills. I need my life. I need my friends. I need my family. I need to be here.’”
Coming off the pills cold turkey — without the use of a professional addictions services or an opioid substitution program — was extremely difficult.
“I laid on my friend’s couch for three weeks puking, pissing myself — couldn’t even make it to the bathroom, just sweating, freezing,” she said.
“It felt like I was dying.”
She repeatedly reminded herself that continuing down the path she was on would result in her demise. Her friend washed her, brought her cold clothes, fetched her water and offered constant support throughout the grueling withdrawal period
“It’s just so embarrassing to let yourself go that far,” Stoddart said.
Today, she shares the details of her darkest days in hopes of making a difference.
“Maybe it will help somebody else. Maybe it will change somebody else’s life. Maybe it will open someone else’s eyes,” she said.
“Maybe someone will follow my lead.”
Living proofFear of judgement will not hold her back. She’s lived through worse.
“I’ve lived my whole life being judged,” she said.
She hopes her success in overcoming addiction will serve as proof that it can be done. She encourages anyone struggling at the hands of problematic substance use to seek out professional services, peer support — whatever works.
“Once I became clean, I had more energy. I had more drive to be a better person. I wanted to help people. I wanted to let people know that there is more options out there,” she said, listing discussion groups, meditation and mindfulness as a few examples.
Stoddart works at Smokey Quartz Emporium, a specialty shop in Middleton that sells smoking accessories and a range of spirituality-related products. She is a firm believer that cannabis is a better option for her than opioids, but she acknowledges that what works for her won’t work for everyone.
She is, however, willing to hazard a few guesses about important points everyone should keep in mind before passing judgement on someone suffering as a result of problematic substance use.
“They’re still human. They still need help. They still need support. They still need somebody to be there,” she said.
“The person they want to be is still inside, they just need to find it and fight for it.”
RCMP says law enforcement can’t curb the crisis aloneAdapting operations to put an end to emerging, profit-driven trends in organized crime is nothing new for law enforcement officials.
But Federal RCMP media contact Cpl. Caroline Duval calls the Government of Canada’s Actions on Opioids Strategy from 2016 a game-changing moment.
“It recognized that no one level of government or single sector can address this complex social, health and safety issue alone,” she said.
Law enforcement officials are teaming up with municipal, provincial and international partners to disrupt the flow of illicit opioids to, and within, Canada. Multiple agencies — Canada Border Service Agency, Canada Post, Health Canada and law enforcement partners — are working with the RCMP as part of a national investigative strategy combatting organized crime contributing to the opioid crisis, Duval said.
“A 30-gram package could contain 15,000 fatal doses,” said Duval, later noting that “illicit fentanyl and its analogues increasingly taint illicit drugs, causing the majority of unintentional opioid-related deaths in Canada.”
In 2017, Bill C-37 brought forth changes in the Controlled Drugs and Substances Act, granting border officials with reasonable grounds the authority to inspect international mail weighing less than 30 grams.
“As a public health crisis, the illegal use of synthetic opioids puts people at risk of overdose, or from inadvertent exposure to these potentially lethal drugs,” she said.
“In the fall of 2016, on-duty operational members of the RCMP began carrying naloxone kits for use on fellow members and employees who are at risk of accidental exposure and as first aid treatment for citizens in an emergency situation.”
Read more in Opioids and the many faces of addiction
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- Non-practising doctor details his harsh, humbling life as drug addict
We explore a range suggestions and solutions for addictions treatment. We will look at what is working in our country and beyond and find out what those living with addiction in our own communities would like to see implemented.
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