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PART III: IDEAS AND SOLUTIONS
There’s no exact science to treating or preventing opioid addiction. There are many philosophies and a limited amount of concrete evidence to support any one idea over another. Should opioid use be decriminalized? Are sufficient community supports in place? Are rural residents at a disadvantage compared to others in larger centres? This week, we explore ideas and solutions from near and far.
DRIVEN BY DRUGS
Nova Scotia father says jail is not the right place to treat addictions
By Ashley Thompson
Carl Baltzer doesn’t mince his words when he says jail was never the place for his youngest son. “I remember when my kids were small, and I always used to tell people that I never worried about Andrew. It was the older one,” Carl recalls.
It pains the Centreville, N.S., resident to see the irony in this statement now.
Andrew was lively, regularly lauded as a social butterfly and old soul. His older brother was quiet, more reserved.
Neither boy wound up in too much trouble — nothing out of the ordinary.
That was until things changed for Andrew around 13.
He started experimenting with drugs and experiencing psychosis. He told his father he heard voices. He said he felt different from his classmates.
“When he smoked marijuana, he felt that those things went away,” Carl says.
The underlying mental health issues, however, were never addressed.
By 15, Andrew was using OxyContin and hydromorphone.
“He got introduced to opiates through a doctor’s son,” says Carl, estimating that Andrew was battling an addiction at 16.
Nine years later, Andrew is now a hardened version of the boy his father never worried about.
Rehabs, overdoses, court, jail – he’s lived it all.
The 25-year-old recently finished a period of federal incarceration with a metal plate in his jaw and a prison-ink tattoo sprawling down the front of his neck.
Andrew served time for one count each of unlawfully producing methamphetamine and mischief, charges he pleaded guilty to while enrolled in the Court Monitored Mental Health Program (CMMHP) in Kentville.
He was sentenced to two years and 30 days in a federal penitentiary on Jan. 18, 2018.
At the time, Carl held out hope that his son would get the help he needed in prison.
Andrew had already proven to be wily in finding ways to get out of both public and pricy private treatment programs Carl is still paying for.
“He’s OD’d twice,” says Carl, thinking back to his son’s early 20s. “They almost lost him once.”
He believed jail would mean Andrew had a roof over his head every night, food to eat, distance from opioids and access to treatment programs.
Carl’s partner, Lesley Sweet, helped advocate for her stepson to be placed in a long-term rehab program, rather than jail.
Justice officials overseeing Andrew’s case were agreeable to a voluntary, court-monitored treatment option but, in the end, Andrew was not.
“The root of his problems is the mental, you see,” Sweet says.
Carl says his son violated the conditions of the arrangement offering an alternative to jail by crushing a pill and snorting his own prescription medication while under surveillance.
Andrew served his time in Burnside, Springhill, Pictou in Nova Scotia and in Dorchester, New Brunswick. He suffered a broken jaw after a surprise kick to the face in Springhill.
Carl now wishes he challenged the advice that prompted Andrew’s guilty pleas.
He remembers the pangs of regret he felt while driving a newly-released Andrew home from jail.
“It was exciting to start with and then, after being with him a couple hours I’m thinking, ‘well, not much has changed.’”
Andrew continues to refuse to seek help.
The Annapolis Valley couple believes Andrew’s story is one that highlights the importance of long-term, court-ordered rehabilitation programs becoming a treatment option throughout Canada.
“There’s got to be a place where these kids can go because their crimes are driven by the drug,” says Sweet, stressing the importance of having live-in programs spanning one to two years in place for qualifying offenders who are not ready to voluntarily seek treatment for a substance use disorder.
As it stands, they’re left hoping Andrew will find the motivation to voluntarily commit to an existing treatment program – sooner rather than later.
“I’d like to see him settle down, fall in love… have a family, and get on with life,” Sweet says.
Justice Canada spokesperson Ian McLeod said the federal department has provided funding for the administration of Drug Treatment Courts – a provincial responsibility – in Nova Scotia and Newfoundland and Labrador so far in Atlantic Canada.
Participation, however, must be completely voluntary.
The first Drug Treatment Court in Newfoundland and Labrador launched Nov. 30, 2018.
“It is an alternative approach for offenders with serious addictions to illicit drugs, who commit non-violent, drug-motivated offences,” said Danielle Barron, a spokesperson for the Department of Justice and Public Safety for the Government of Newfoundland and Labrador.
“It brings together judicial supervision and treatment services for substance abuse and establishes long-term supports outside the criminal justice system.”
Multi-disciplinary teams of health professionals are made available to inmates serving terms of incarceration, but Barron noted that “responsivity to program participation is of paramount importance to a program’s effectiveness.”
- Carl Baltze says son isn’t getting help for mental health, addiction issues
- Carl Baltze hopes son with addiction, mental health issues sentenced to federal time will accept help he needs
More support needed to address root causesNova Scotia has Drug Treatment Courts in Dartmouth and Kentville — Andrew’s hometown.
Dr. Robert Strang, Nova Scotia’s chief medical officer of health, says progress has been made in terms of public awareness, harm reduction and improving access to treatment for opioid use disorder.
But he too sees the need for more social supports that address the root cause of problematic substance use.
He noted that there are some areas of North America with policing or justice systems that place a greater emphasis on directing offenders linked to addictions-related crimes to social programs right away.
“The whole principal is around treating people with health and addiction issues as a health issue, not as a criminal issue,” Strang says.
“There’s a lot more we need to do.”
No quick fix
Rebecca Jesseman, director of policy for the Canadian Centre on Substance Use and Addiction, says full and informed consent throughout treatment is a key factor in ensuring it is effective.
“The evidence supporting the efficacy of mandated or coerced treatment is mixed. One reason for this is simply the lack of good-quality studies. Another challenge is finding diversion programs that have reliable access to evidence-based treatment,” Jesseman said via email.
“If an individual is forced to access treatment, but there is no effective treatment available, the individual is being set up to fail.”
Court conditions imposed during probation or parole pose a challenge for individuals with complex needs and substance use disorders if treatment options meeting their individual needs are limited.
“Evidence-based treatment is available and accessible. Unfortunately, there are many gaps in access to treatment in Canada,” Jesseman said.
In addition to the Drug Treatment Courts available in seven provinces, she cited examples of several diversion programs offered through police or courts.
One example, the Project Angel model adopted by Abbotsford Police in B.C., originated in the United States.
“This approach provides police with the opportunity to refer individuals to a peer support worker who will connect them to community substance use, housing, and other health and social services,” Jesseman said.
The Prince Albert HUB and COR model in B.C., she added, served as a building block for a situation table approach that bridges health, social and criminal justice representatives together to discuss solutions for high-risk cases.
Work continues to develop and evaluate innovative, evidence-based solutions.
“Essentially, all jurisdictions in Canada would benefit from improving access to services that are grounded in evidence,” said Jesseman, listing low-barrier access, addressing physical, mental and social needs, and approaches that acknowledge trauma, gender, culture and age as best practices.
Calling for help is not a crime
Act exempts individuals who call 911 from being charged with possession
Politicians want you to know that if you call 9-1-1 from the scene of an overdose, you will not get busted for possessing drugs.
A law protecting individuals who call for help has been in place in Canada for two years, from coast to coast. The Good Samaritan Drug Overdose Act was established to ensure individuals who report a potentially fatal overdose without fearing the possibility of facing legal troubles themselves.
The act was introduced as a private member’s bill by B.C. Member of Parliament Ron McKinnon. At the time, McKinnon had said he was moved to introduce the act by the rising opioid overdose death toll in his home province. He had heard reports of young people panicking after witnessing overdoses, even depositing their friends anonymously in front of emergency rooms.
A 2012 study released by the Waterloo Region Crime Prevention Council found that only 46 per cent of respondents would call 9-1-1 in case of an overdose, largely due to a fear of facing prosecution.
"It seemed like there was a pretty obvious need for this,” McKinnon said, reached by phone from Ottawa.
"In circumstances like this, when someone is in medical crisis, seconds count. Seconds are the difference between life and death.”
The act also protects individuals who respond to an overdose from facing charges related to pre-trial releases, probation orders, conditional sentences or parole violations stemming from previous possession charges.
McKinnon acknowledges that more work needs to be done with law enforcement. No federal training protocol currently exists related to the law.
But McKinnon said police chiefs he has spoken to have been supportive. He said some municipal police forces, such as the Vancouver Police Services, have a policy of not attending 9-1-1 calls unless there is an obvious need for safety. They hope to avoid discouraging individuals from making these calls.
"It enshrines in law what many police services were doing anyway," McKinnon said.
PORTUGAL'S UNCONVENTIONAL SOLUTION
By Sharon Montgomery-Dupe
While politicians and academics around the world are struggling to find the best way to manage the growing opioid crisis, one country being lauded for its success is Portugal.
In the 1990s, Portugal faced not only one of the highest prevalence rates for addiction in Europe but also reported among the highest amount of overdose deaths.
At the time, Lisbon was known as the ‘heroin capital’ of Europe.
Since then, the country has gone from an estimated 100,000 heroin users to 25,000 and now boasts the lowest rate of drug-related deaths in Western Europe.
How did they get there?
In response to the crisis, the country’s government put together a committee of experts including psychologists, doctors, lawyers and social activists to dive into the problem. The outcome was a recommendation to end the criminalization of drugs, regardless of the drug.
In 2001, their new drug policy changed the country.
Alcina Lo, director of Addictive Behaviours and Dependencies in Lisoa Portugal, said the focus of this new policy was to take the focus off of justice and towards a clinical and social approach. It means drug users are no longer considered criminals but patients. Anyone who is intercepted by authorities and does not exceed the amount permitted by law for personal use is sent to an administrative council.
Health and social professionals then evaluate the individual’s situation with a goal of trying to combat their addiction. Individuals caught with bigger amounts of a drug still go to trial.
Lo said the Portuguese approach on drugs has widely been considered a model of best practices.
“Due to the fact that we recognize drug use as a health issue and drug addiction as a multi-factorial health disorder condition, which needs to be treated and not punished,” Lo said.
According to a report ‘Drug Decimalization in Portugal,’ by the Drug Policy Alliance (DPA) in New York, while several other countries have also had successful experiences with decriminalization – including Czech Republic, Spain and the Netherlands – Portugal provides the most well-documented example.
The council says since Portugal’s law was put in place:
• Overdose deaths decreased by more than 80 per cent.
• Prevalence rate of people who use drugs that account for new HIV/AIDS diagnoses fell from 52 to six per cent.
• Incarceration for drug offenses decreased by more than 40 per cent.
Close to home
Portugal’s model has caught attention in Canada. This past June, the standing committee on health made a presentation on Portugal’s model to the House of Commons urging the federal government to look at Portugal's decriminalization of simple possession of illicit drugs and examine how the idea could be positively applied in Canada. There’s been no further development on that proposal to date.
Opioids are everywhere
The Council on Foreign Relations, an independent, nonpartisan membership organization, think tank, and publisher, has studied what measures various countries are taking in response to opioid addiction.
Here is a closer look at their findings:
Speaking from experience
It’s not hard to find an expert opinion on what’s needed most for the treatment of opioid addiction in Atlantic Canada. But there’s a segment of the population that is sometimes overlooked when it comes to sharing ideas about how to change things for the better. We reached out to regular people who are living with addiction and asked them what they think would help the most. Here’s what they had to say:
In his battle with addiction, David Crowe, 48, of Sydney, says he is at a place where services offered for maintenance won’t work for him because of medical conflicts with respect to methadone and suboxone.
Crowe is encouraged that Health Canada recently changed the rules allowing doctors to prescribe medical grade pharmaceutical-produced injectable hydromorphone, the drug of choice for many, including himself, however, he feels it’s going to be “forever” before it’s implemented in Cape Breton.
What Crowe would like to see is a safe place with medical staff for overdose prevention, safe consumption and the ability to get prescribed injectable hydromorphone for maintenance. A safe place rather than a dirty spot or bothering someone in a public bathroom, he explained.
“When a person is suffering from withdrawal and is sick, sometimes you can’t get all the way back home. Sometimes you have to go somewhere it’s not safe, but you have to get your drugs in you.”
Bell Island, N.L.
“Information, information, information — and a lot of support. People that don’t have family support, or community support, or anything like that, they do end up not getting help. It ends up coming down to that.
They will not go to get help if they don’t have these supports available. … I was a drug user for two and a half years of opioids, and I found myself getting addicted to it more and more. ...I came up to the (Unity in our Community) meeting.
It took me a while to come up, but I did, and I got involved with these people — a good bunch of people.
With help from these guys — I talk to them individually on a day-to-day basis, I can phone any of them and they’ll talk to me, they take me out and do stuff with me in the community — it kind of keeps your mindset off (drugs) because you do need to keep your mind off of it, and they really did help me do that. ...I’ve been away from it now almost three years.
“I've been addicted to opiates since the young age of 12. No one told me what they were, and how addictive they could be.
The system that we have for opiates is moderate at best. They finally implemented doctors being able to prescribe methadone more freely, but also with more restrictions. The wait-time has been cut down to get help, but there’s no long-term rehabilitation.
You do your 30 days in rehab, then you get on methadone and then they just expect you to stay on methadone for the rest of your life.
I don't want to stay on methadone for the rest of my life. I want to be a normal person like you.
Nova Scotia should have long-term rehabilitation facilities, a place where you can go detox and stay and learn how to re-implement yourself into society over again… I'm talking a year, year-and-a-half, two years — as long as it takes.”
Roger Francis grew up in the First Nations community of Elsipogtog, an hour north of Moncton, N.B. He developed an addiction after being prescribed opiates for a herniated disc in 2013. He currently lives in Charlottetown.
He said his community, like many other rural regions in Atlantic Canada, often lacks the skills training, recreational activities or peer support programs needed for individuals in recovery.
“The No. 1 problem is there is no resources in their communities to help that person reintegrate,” Francis said. “When that’s not all in place, that person will stay clean for only a certain amount of time.”
Francis says these services are essential for individuals in rural towns to feel like they are contributing to society.
“A lot of times these people feel abandoned. They feel unwanted, unloved. In my experience, they take their addiction or their choice of drug as the love of their life. A lot people will tell you that,” Francis said.
“A person can only take so much of being alone.”
Read more in Opioids and the many faces of addiction
- Formerly homeless Reserve Mines man sentenced on theft charges
- Reserve Mines native turning life around in B.C. treatment centre
- Leaving addiction behind and coming home to Cape Breton
- Video: Back home in Cape Breton
- P.E.I. doctor’s journey with addiction has captivated public, medical community
- Non-practising doctor details his harsh, humbling life as drug addict
We know opioids pose a major challenge for governments, taxpayers and most importantly the individuals who are living with addiction. Next Friday, we will revisit and explore the roadblocks stakeholders must overcome before moving forward.
Share your own experiences at email@example.com