Ask anyone involved in front-line health care in Lindsay, and they will tell you the same thing: opioid overdoses in our area are rising at an alarming rate. There aren’t necessarily more people using drugs, authorities say, but those who do are endangered by a drug supply poisoned with fentanyl and its derivatives.
At the Ross Memorial Hospital in Lindsay, the number of emergency visits due to opioids has leapt from 27 between April 2016 and March 2017 to 50 between April and December of 2017.
As well, Ontario Drug Policy Research Network numbers show Kawartha Lakes ranking fourth out of 49 municipalities in the rate of opioid users in 2015, and fourth in the rate of opioid overdose deaths as of 2013, the most recent years for the statistics ODPRN provides. (These rates were measured among those who are eligible for the Ontario Drug Benefit program, not the general populace.)
Opioids are a group of drugs including legal pain relievers such as codeine, morphine, Percocet or Vicodin, as well as heroin. All reduce the perception of pain and produce a sensation of pleasure and wellbeing, even euphoria—the sensation people are chasing when they become addicted.
There are two common scenarios for those in our area struggling with addiction to opioids, according to Denise Smith, substance misuse prevention and harm reduction coordinator with the Haliburton, Kawartha, Pine Ridge District Health Unit.
The first sees an adult suffering from pain who is given a legitimate prescription for opioids, in many cases for a product that doctors recommended based on manufacturer’s assurances it was unlikely to cause addiction.
The patient continues using the drugs even after the pain is under control, whether to continue the sense of wellbeing, or because they were not properly weaned off the painkiller they were prescribed. They fall into misuse and then illicit use, ultimately seeking out drugs they don’t realize have been laced with deadly additives.
The other type of person is likely to be younger—someone who experiments with medications they find in the home, or who takes what they think is a safe street drug, often while their judgement is already impaired by alcohol or other drugs.
“Any use of a highly addictive drug can lead to misuse in some people,” Smith adds, noting that addiction shows up in a wide range of people. “The strongest predictive factors are a history of childhood trauma, and mental illness.”
Kim Dolan is the executive director of Peterborough-based PARN, which works to reduce HIV by giving injection drug users clean equipment. PARN’s expertise in harm reduction meant it was a logical partner when the province boosted its response to the opioid epidemic late in 2016.
“We can’t make any assumptions about who is addicted to opioids,” Dolan says. “It crosses all socioeconomic realities.”
PARN and the health unit are just two of several players working together in Lindsay and the larger Central East Local Health Integration Network. Others include the police, Fourcast Addiction Services and Ross Memorial Hospital.
Numbers from the health unit’s entire coverage area in 2016 show 74 emergency room visits, 23 hospitalizations and eleven deaths due to opioids. The crisis moves so fast that up-to-the-minute information is essential to ensuring prevention, treatment, enforcement and harm reduction—the four pillars of responding to drug addiction—are as effective as possible.
“We need better data to inform planning,” says Smith, something network members are working on. Police are also tracking the presence of fentanyl in street drugs sold locally. “That has created the biggest problem when it comes to overdoses and deaths,” says Dolan.
In September, 2017, Kawartha Lakes police chief John Hagarty told the police services board that officers in Lindsay responded to more than seven times as many opioid overdoses in one eight-week period as in the same period in 2016. Hagarty added he supports the basic income guarantee pilot underway in Lindsay precisely because he feels it can provide hope and at least some economic security. That might be enough to keep some people from trying opioids to combat despair, or to prevent them from turning to trafficking.
It’s easy to moralize about those in the grip of addiction, but that brings further danger, says Smith. “Whenever there’s a huge amount of stigma, that causes people to go underground and that’s when you run into problems with unsafe use.”
Each interaction between a health-care provider and someone who uses opioids is a chance to educate them and open a door if they want to reduce or quit. “We approach every person without judgement. When you have somebody in front of you, you have no idea what their particular circumstances are, whether it’s drug-seeking behaviour or whether it spiralled out from a prescription.”
Communities across North America have been crippled by the fast-developing increase in opioid addiction, overdoses and deaths. Employees miss work, emergency rooms are overtaxed, police time is stretched. There are other, less tangible costs, too, says Smith. “One death from whatever cause means grief reverberates throughout the community.”
Although local health-care organizations have been playing catch-up, they are harnessing increased provincial funding to tackle the crisis with tools such as Naloxone, which interrupts an overdose. The next few months will see two vans staffed by health care workers travelling the area to educate people and give out Naloxone kits. Those kits are also now available for free, without a prescription, at five Lindsay pharmacies and the health unit office. Find a participating provider here.
Community agencies that work with those who are addicted or at risk of addiction will be getting education and Naloxone kits to distribute. A popup distribution site at the Ross Memorial Hospital in 2017 saw 20 kits given out in just a few hours.
Although many people are uncomfortable with providing help for those who use illicit drugs, Smith points out that you can never know who is coping with an addiction. “You may not approve, but it’s all about safety and saving lives.”
And to those who question whether such help is needed in our community, she asks where they would put the threshold. “Is one needless accidental death enough to cause a concern?”