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Is Atlantic Canada facing an opioid crisis?

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At least 348 people have died due to opioid overdoses in Atlantic Canada since 2016.
The phrase "opioid crisis" has creeped into our conversations and naloxone kits are common in our communities. But how bad is it and what are we really facing?
Over the next four weeks, we're taking a closer look at how Atlantic Canadians are responding to a rise in opioid use and how health-care systems are working to treat and prevent addiction.

PREVALENCE IS GROWING IN ATLANTIC CANADA

Carah Ross has been dealing with addiction her entire adult life.

Last year, the 33-year old had ended up homeless, living in the “Surrey strip,” a tent city based in the Lower Mainland suburb in British Columbia. She started using drugs at age 12. By her late 20’s, she had cycled through several attempts to get clean.

"I had tried detox, I had tried Lacey House,” Ross said, referring to the drug-free care facility in Charlottetown.

“I had tried going to rehab. I tried all that. It wouldn't stick.”

She moved to B.C. in 2013 to try another rehab program. This too failed.

Carah Ross found herself living homeless in a suburb of Vancouver after years of addiction. After returning to P.E.I., she began receiving suboxone treatment. She has been clean for over a year, and credits this harm reduction program with helping to save her life. Stu Neatby photo.

Then a traumatic event pushed her to try one more time. In 2017 her boyfriend was killed. The police told Ross he had overdosed, that his body was dragged to a shed and then lit on fire. She does not know who might have done this.

In March of 2018, she booked a flight back to P.E.I. This time she was ready.

"My actual plan was to come home and give it one honest shot,” Ross said.

“And if it didn't work, I was going to kill myself.”

Opioids?

Opioids can be prescribed medications —codeine, fentanyl, morphine, oxycodone, hydromorphone and medical heroin —prescribed for acute to severe pain, chronic pain, moderate to severe diarrhea and moderate to severe cough.

Ten days after returning, Ross started an opioid replacement therapy program at the Queen St. clinic in Charlottetown. She was put on suboxone, a medication used to treat opioid addiction, and began attending Narcotics Anonymous (NA) meetings six times a week.

Since then, she’s stayed clean and has begun working as a merchandise supervisor at several retail outlets. She still attends NA meetings almost daily.

“I think it absolutely saved my life,” Ross said of the opioid replacement therapy program.

The opioid crisis has not yet hit the Atlantic coast as hard as the West Coast, where 4,049 souls have been lost in overdose-related deaths since 2016.

But hundreds are dying here; Statistics Canada reports at least 348 people have died due to opioid overdoses in Atlantic Canada since 2016.

Warning

Misusing opioids can lead to overdose including extended-release opioid tablets meant to be swallowed whole. Crushing or breaking these pills may release too much drug at once causing an overdose.

In response, health-care officials in each province have adopted a harm reduction approach, which involves treating addiction as an illness rather than a failure of will.

Across the region, 13,300 free naloxone kits have been distributed to pharmacists, individuals and community organizations. The kits can be used to reverse an overdose. Clinics offering opioid replacement therapy have popped up in all four provinces over the last five years.

But some argue these harm reduction measures are not going far enough.

Matthew Bonn is the president of HaliFIX, a group working to set up a supervised drug consumption site in Halifax.

Bonn said an overdose prevention site could cut down on the spread of hepatitis C and HIV, and could reduce the risk of accidental overdoses. Illegal drugs could also be tested on-site to detect unintended — and potentially fatal — substances such as fentanyl.

The most at risk

According to Health Canada, Canadians aged 15 to 24 are the fastest-growing population requiring hospital care from opioid overdose.

“There is no overdose prevention site in the Atlantic region and it doesn't seem like anyone is jumping to be the first. There's a lot of stigma around it," Bonn said.

"There's decades now of evidence that shows that safe consumption sites save lives, so we need to start thinking outside the box."

Ross says harm reduction programs have helped her on both coasts.

But she also says that P.E.I. is, in some areas, woefully unprepared. Basic awareness of harm reduction is often lacking, while opioid overdoses have been on the rise in recent months.

“We’re going to start seeing people dropping like we’re seeing in B.C.,” she said.

STARTLING STATISTICS

11,500That’s how many apparent opioid-related deaths occurred in Canada between January 2016 and December 2018, according to the Public Health Agency of Canada. That breaks down to a total of 3,017 deaths in 2016, 4,100 in 2017 and 4,460 in 2018.

348The number of people in Atlantic Canada who died due to opioid overdoses in the last three years, according to provincial statistics. That breaks down to a total of 16 in Prince Edward Island, 61 in Newfoundland and Labrador, 97 in New Brunswick and a staggering 174 in Nova Scotia.

75The percentage of opioid-related deaths in Canada between 2016 and 2018 that were males, according to data from the Public Health Agency of Canada.

OPENING UP ABOUT OPIOIDS

Opioid use in Atlantic Canada impacts nearly everyone – health-care workers, non-profit sector employees, addicts and their friends and families. The effects are devastating and the decisions are tough, no matter what vantage point you are coming from.

Danny MacKillop, 39, of Sydney spent 19 years battling addiction before entering the Together We Can addiction and recovery rehabilitation centre in Vancouver, British Columbia. Since completing treatment in May, MacKillop has been living a drug-free life that includes plans to go back to school.

DANNY MacKILLOP
CONNECTION: Recovering addict

Danny MacKillop of Sydney, N.S. is living a clean, drug-free life since completing the program at the Together We Can addiction and recovery rehabilitation centre in Vancouver, B.C.

His path to addiction is terrifying. MacKillop, 39, was 13- or 14-years-old when he started drinking. He then started using hash oil, marijuana, ecstasy and mushrooms. By age 20 he couldn’t stop using drugs.

“I spent 19 years saying, ‘I’m done,’ making sweet promises to family, friends and employers,” he said. By the time MacKillop was 33, he was hardcore addicted to crack cocaine and got into opioids.

“Opioids is something when I first tried it I really enjoyed it,” he said. “A week or so into it I was doing it every day. I needed to have them and that’s when things became even more scarier because I’d get crazy ideas of hurting people or it wouldn’t matter what I’d do. I’d go to any length to get more.”

Dr. Melanie Van Soeren

Dr. MELANIE Van SOEREN
CONNECTION: Family physician who provides addictions treatment

“It can be incredibly devastating,” said St. John’s-based Dr. Melanie Van Soeren about her patients who struggle with opioid use disorder.

“A lot of the people that I see have had breakdown of families, they’ve had run-ins with the law and perhaps periods of incarceration. They’ve lost jobs, housing, and many people might be dealing with homelessness, and even just struggling to have enough money for food.”

Van Soeren said those patients are good people who have fallen on hard times, experienced trauma, or have chronic pain issues and “are simply trying to get through their lives and trying to survive.”

She said in some cases the only option people have to deal with their challenges is to use substances, and therefore it’s important to treat not only the addiction, but the whole person.

Grant Matheson

GRANT MATHESON
CONNECTION: Retired doctor, recovering addict and best-selling author

Grant Matheson has seen addiction from both sides of the health-care system.

The former physician from P.E.I. recovered from his own battle with opioid addiction. His battle is the subject of The Golden Boy, a best-selling book he published in 2017.

Matheson has seen improvements in how addiction is treated in the region. It is increasingly being seen as an illness, one that can afflict respected physicians as much as anyone else.

Still, he says many family doctors see addiction as a personal failing.

"If you saw someone, and let's say they had diabetes, you'd have them back to check their blood sugars in a while after you treated them," Matheson said.

"Addiction in general isn't being handled as the medical condition that it should be.”

Matheson believes more skills-building and recreational programs are also needed.

“When I was getting sober, it was like 'God, man, I'm over here playing ping-pong. I haven't played ping-pong in ten years,’" he said.

"It gave me those positive things to be able to experience to replace all of the unhealthy activities I was doing before.”

Wayne Bishop

WAYNE BISHOP
CONNECTION: Manager of opioid treatment centre

Wayne Bishop is manager of the Provincial Opioid Dependence Treatment Centre of Excellence in St. John’s which was opened after an agreement last year between the government of Newfoundland and Labrador and the federal government.

It was the first province to sign a federal agreement to fund innovative treatment options. The agreement meant $4 million to improve access to opioid dependency treatment (ODT) in the geographically vast province.

Now, the centre is implementing a new ‘hub and spoke’ model of ODT that positions the four regional health authorities as hubs of service delivery, and physicians and nurses as the ‘spokes’ who deliver services to the many rural parts of the province.

“We’ve had access issues to treatment services, and we really need to find ways, and this hub and spoke model is one opportunity to certainly identify ways to increase access to treatment services for people,” said Bishop.

TIMELINE: Opioids at a glance

Atlantic Canada is far from immune from the opioid-related harms plaguing a nation in the midst of a national public health crisis.

1992:

The Canadian subsidiary of Purdue Pharma files a patent for the highly-addictive prescription painkiller OxyContin.
Source: Globe and Mail: “How a little-known patent sparked Canada’s opioid crisis”

1996:

OxyContin, offering long-lasting pain relief via oxycodone in tablet form, is approved by Health Canada.

2012:

Purdue Pharma pulls OxyContin, referred to as a blockbuster drug from a commercial standpoint, from the market in 2012 amid mounting concerns about addictions and deaths relating to its use. The company replaces it with OxyNeo, which was designed to be difficult to crush, snort and inject.

2013:

Reports started to come in regarding highly-potent illicit fentanyl in Canada’s black market.
Source: Canadian Institute for Health Information

2014-15:

At 13.4 per cent, Newfoundland and Labrador’s age-adjusted rates of hospitalizations due to opioid poisonings increased by 5.6 per cent per 100,000 population from 2007-08. New Brunswick, at 14 per cent, was close behind in noting a 5.5 per cent spike but Alberta’s rates saw the largest climb, jumping 6.4 per cent to 18.6. Six per cent of the hospitalizations were linked to synthetic opioids, such as fentanyl and tramadol.
Source: Hospital Morbidity Database, Canadian Institute for Health Information.

2016:

British Columbia declared a state of emergency in response to the growing number of opioid-related overdoses. This same year, doctors wrote one opioid prescription per every two Canadians.
Source: The Canadian Encyclopaedia, Canada’s Opioid Crisis

April 2017:

Purdue Pharma settles a lengthy class-action lawsuit involving about 1,500 Canadians hooked on prescribed OxyContin by agreeing to pay $20 million.
Source: The Canadian Encyclopaedia, Canada’s Opioid Crisis

August 2018:

British Columbia’s government files a lawsuit in an attempt to sue more than 40 opioid manufacturers, including Purdue Pharma, based on allegations that the risks associated with the products were downplayed when reps marketed the drugs to doctors.
Source: The Canadian Encyclopaedia, Canada’s Opioid Crisis

2018:

Available data shows that 4,460 apparent opioid-related deaths occur in Canada, reflecting an increase from 3,017 in 2016 and 4,100 in 2017. Seventy-three per cent of the accidental deaths were linked to fentanyl or fentanyl analogues.
Source: Public Health Agency of Canada, “National Report: Apparent Opioid-related Deaths in Canada”

2018:

Federal data states that the number of apparent opioids-related deaths in the Atlantic provinces was: 10 in Newfoundland and Labrador, 27 in New Brunswick, 57 in Nova Scotia and seven in Prince Edward Island. The death rates per 100,000 population ranged from 5.9 per cent in Nova Scotia to 1.9 per cent in Newfoundland and Labrador.
Source: Public Health Agency of Canada, “National Report: Apparent Opioid-related Deaths in Canada”

NEXT FRIDAY

A closer look at challenges and successes related to opioid treatment.
Share your own experiences at deepdives@saltwire.com


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