The War on Opioids: All Bets Are Off

The silence is as broken as the glass and I am wide awake. Torn from the recesses of sleep, I light a smoke and try to sort reality from the dream I am still lost in. Nightmare, really; let’s not mince words at this dark and lonely hour. I struggle to wipe the cobwebs, trapped in the labyrinth of memory. Weary of shadows, real and imagined, I lean back and exhale, watching the smoke swirl to the ceiling.
Ubiquitous, it overwhelms you; consumes you. Unable to breathe under the weight, you drown on sudden waves of emotions. You can’t name it, give a word to explain it; you simply cry, sob until you sleep, too exhausted to rage against it.
Shattered, body and soul; fractured mind, scattered by the winds; consciousness, the realization who you were is GONE; dead and gone.
Sadness and pain, a twist in the vein; anger, acrid fire deep within, alcohol annihilates the bad taste forever in your gullet; wild and uncontrolled, unchecked, it will ravage you; leaving nothing more than ashes, scorched.

When speaking about the current opioid crisis all bets are off – Canadian Patent No. 2,098,738 (OxyContin) created addicts of all socioeconomic backgrounds; it is best to look at forward at solutions than try to find commonalities between those affected by opioid addiction in the twenty-first century.

The Region of Niagara and the Office of the Chief Coroner of Ontario have both recently released updated 2017 statistics on the opioid crisis in Niagara and they are not pretty. As expected, the number of deaths, in Niagara, as a result of opioid overdose rose from 40 in 2016 to 70 confirmed deaths in 2017. That number is still subject to change; probable deaths are still under investigation and could potentially raise the number to 75. Niagara further saw a total of 521 emergency room visits (up 75% from 297) and 123 hospitalizations (up 50% from 82) for opioid overdose in 2017.

Using December 2017 opioid data:

• In Niagara, 34 people were seen at an ER and there were 10 confirmed (1 probable) deaths.
• Province-wide, 453 people were seen at an ER while there were 82 confirmed (29 probable) deaths.
• Niagara’s death rate per 100,000 was 2.4, provincially it was 0.8.
• Niagara has 3% of Ontario’s population and between 9-12% of opioid deaths.

If you aren’t scared yet, you should be – 2018 is not shaping up to be any better despite increasing harm reduction strategies. Between January and April 2018, approximately 175 people were seen in a Niagara ER for opioid overdose, on par with 2017, yet our death rates are soaring. Fentanyl continues to infiltrate our street drug supply as access to mental health services in Niagara continue to be limited through wait times, and a general lack of cohesiveness.

Niagara is failing on most of the social determinants of health: employment, income, public transit, addictions, mental health services, other health and support systems, food security, and safe and affordable housing; Niagara is considered one of the poorest regions in the province with some of the highest welfare and disability rates in addition to our high opioid overdose rates.

Services are scattered throughout the Region and can be difficult to access by transit with many services only being offered by NGO’s. Mental health services wait times are killing people, literally; half of all assaults are caused by intoxicated people and, according to Health Canada, in the first 9 months of 2017, 92% of opioid overdose deaths were accidental (euthanasia laws, as expected, have lowered intentional overdose rates since taking effect).

• People with a mental illness are twice as likely to have a substance use disorder.
•Those with an addiction are three times as likely to have a concurrent mental health disorder.
• 1 in 5 Canadians is currently experiencing a mental illness.
• By the age of 40, 1 in 2 Canadians will have, or have had, a mental illness.

A full HALF of Canadians will have experienced a mental illness by the age of 40; look around you, form an imaginary line through the room and let that shit sink in.

In order to truly stymie the opioid epidemic, we need to work on the mental health crisis we are facing and treat opioid addiction as a symptom of the larger institutional crisis.

Lack of access to a case manager is one of the top reasons people give as a barrier to finding housing and accessing mental health and addictions services in Niagara. One worker who helps coordinate the various service providers, particularly when they are interdepartmental within the provincially funded regional framework such as welfare, affordable housing, public health, and mental health. Services that were downloaded to the municipalities from the province under Mike Harris in the 1990’s have never recovered – municipalities simply do not have the tax base to run these programs without upper-tier funding.

Current provincial funding for inpatient addictions treatment is 21 days, nothing more than glorified detox – statistically, half will drop out and between 50-90% of those who do complete treatment will have relapsed within 90 days. For many users, it takes multiple true attempts at sobriety and a holistic approach to services including long term psychotherapies, pharmacotherapies, life skills, employment opportunities, and stable housing, in order to maintain sobriety long term.

While many of these issues need to be addressed through better leadership at the Region, they can’t be solved without cooperation, and funding, from the provincial and federal governments. On June 7th, we have a choice, and make no mistake, this election is life or death.
We are clawing our way to a tipping point in the battle with opioids; we can’t afford voter apathy this election, we won’t survive further Conservative cuts.

Canadian Patent No. 2,098,738 (OxyContin) created addicts from all socioeconomic backgrounds; it is only a matter of time before you lose someone you love, or yourself.

This is Emily Spanton’s fourth article in a series about the war on opioids. You can read previous articles here.

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