Opioid-related emergency department visits in the region have doubled over the last decade.
Overdoses can be “immediate” and “irreversible,” which is why various government officials and community partners in Wellington County and Guelph are working to address the problem.
“I think there’s a lot of factors that are at play … one being the introduction of carfentanil and fentanyl into the black-market drug trade,” said Rita Sethi, director of community health and wellness at Wellington-Dufferin-Guelph Public Health.
“The problem with an opioid overdose versus other types of drug overdoses is that the results are immediate and irreversible in a lot of situations, so people … don’t have a lot of time to survive the overdose.”
She said illegal drugs are often laced with carfentanil and fentanyl so users don’t know exactly what they’re taking – “the end result being pretty final and dramatic in a very short period of time.”
Opioids include codeine, heroin, methadone, fentanyl, morphine and oxycodone and are often used for pain management.
Adrienne Crowder, manager of the Wellington Guelph Drug Strategy (WGDS), explained opioids suppress breathing and an overdose can shut down the respiratory system.
In August, the opioid crisis became personal for Arthur resident Joy Hisey.
After hearing about opioid use moving east from Vancouver, she was gearing up to possibly help form a local plan. Then she found out her 27-year-old daughter had been using opioids.
“I had been planning to get together with the business association in Arthur and the town council and try to work out a plan that Arthur was ready to meet when this hit … and say … we’ve got something in place, we can save lives,” said Hisey.
“At that time is when I found out my daughter was using, so it became not just helping them, it became protecting me, protecting us. We need to do this because it is now personal.”
Hisey discovered her daughter, who she describes as effervescent, had stolen prescription medication.
“I went and checked my pills and my pills were all gone,” she said.
“I could be really righteously angry … but if I had taken that path, all I’d have done is alienate her from the love of her family and what she needs now more than anything is the love of her family.”
In an open letter to the public, the WGDS and United Way Guelph Wellington Dufferin explain the opioid crisis was once thought to be a big-city problem, but now it’s a national concern affecting “communities large and small.”
“In Ontario, there is one opioid-related death every 10 hours,” the letter states. “This reality has impacted individuals, families and neighbourhoods in Guelph and Wellington County.
“Opioid dependence can develop when someone is using opioids for medical or non-medical purposes.”
In an interview with the Advertiser, United Way spokesperson Colleen Murdoch compared the opioid crisis to the AIDS epidemic.
“Each generation … has its public health crisis,” she said.
“I’m not sure … the numbers in Canada have reached this point yet, but the stats coming out of the [U.S.] are that deaths related to opioids are actually, right now, higher than they were at the peak of the AIDS epidemic – and that is actually really scary.”
In Wellington-Dufferin-Guelph region, the number of opioid-related emergency department visits has nearly doubled since 2003, according to a September pubic health unit report.
In 2007, 16.9 of every 100,000 emergency department visits were opioid-related. That number reached 34 of every 100,000 visits last year.
However, Sethi said the data doesn’t tell the whole story.
“It’s really hard to get a picture of what’s happening in our community outside of who’s going to the emergency room,” she said.
“We want to have more information on … the people that aren’t going to the emergency room so that we understand how broad and how big our actual issue is.”
In June public health received a $150,000 grant from the Ministry of Health and Long-Term Care to do just that.
The health unit is working to create a surveillance system that will allow data on all opioid incidents in Guelph and Wellington County to be shared in a format that’s usable and understandable.
Sethi explained public health officials have heard anecdotally from first responders that have “used four kits of naloxone” in a week but the person “took off” before emergency personnel were able to transport him/her to a hospital.
“We don’t have those numbers in our [stats],” she said. “So, we need to start to collect that from everyone that’s involved in this crisis.”
Naloxone is a short-term antidote to opioids that is now available, free of charge with a health card, to opioid users and their family members and friends.
Sethi said using naloxone is like putting the user into immediate withdrawal.
“Naloxone comes in, pushes the opioid molecule off the receptor and the naloxone molecule fits on that receptor for about 30 minutes to 40 minutes, which gives it a long enough time for 911 [and emergency medical services] to arrive,” Crowder explained.
However, if the user doesn’t receive medical help within that time frame, “respiratory function will shut down again.
“So, naloxone is like a first aid process,” she said. “It’s not a final answer.”
Stephen Dewar, chief of the Guelph Wellington Paramedic Service, said paramedics prefer not to use naloxone, but instead assist with ventilation and take the user to the hospital.
If needed the paramedics can administer a titrated dose of naloxone (adjustment of the dose until the desired effect is achieved).
“The reason that people die is that they are so sedated they stop breathing,” said Dewer.
“The reason to reverse the effect is to get them to breathe again, but if you provide them with naloxone, then all of the effect is flushed out and somebody who is sedated to the point where they are completely unconscious becomes instantly alert, and again probably anxious, probably frightened, and it might cause them to strike out, to hurt themselves, to hurt somebody else or run away, all of which obviously is not a positive thing.
“We need to make sure they get to the hospital … because the effects of the naloxone probably will not last as long as the opioid that they’ve taken.”
Dewer said local paramedics have seen a significant increase in “overdose” patients but he cannot say how many were opioid users.
While naloxone is available at certain pharmacies and at Sanguen Health Centre in Guelph, Sethi said within the next few months public health is hoping to make it more available.
Hisey went in search of naloxone kits as soon as she found out her daughter was using.
“I wanted my daughter to have one of these in her backpack, at her bedside, whatever,” she said.
“I wanted one at my home for when she came in case she had been using … I wanted to have the antidote right at hand.
“That was my thinking – I had to protect her.”
But Hisey had trouble finding the kits in the area.
“The fact that I had to go through so much to get a naloxone kit tells me … it’s not getting through to where it needs to go, which is the people that plan,” she said.
Sethi noted physicians have been given new guidelines for reducing the number of opioid pills dispensed at any given time and “pharmacies that dispense this medication have new requirements for reporting narcotic prescription fills and for releasing the prescription to others.”
Every opioid user has a different story.
They could be experimenting with drugs and not understand what they’re buying. It could be someone who relapses back into the drug scene. They could be using a prescription incorrectly.
It could be someone who had a prescription and continued using the opioid once the prescription was complete.
“Our bodies love opioids,” Crowder explained. “They like them because they make us feel good. They take away pain, physical pain and emotional pain.
“That’s pretty attractive and anybody suffering … experiences relief and of course that feels good.”
However, over an extended period of use, the body builds up a tolerance so more of drug is needed to get high.
“Then over time … if you don’t get the drug your body starts going into withdrawal, which is a horrible experience,” Crowder said.
“At that point you’re pretty motivated to get that next opioid into your body because you do not want to feel that bad so it becomes a vicious cycle.”
She said this is something the public doesn’t often understand.
“By the time someone’s in the physiological state you don’t have the option,” she said. “Like if you or I were in that state we wouldn’t have the option to go ‘I don’t think I’ll have that drug today.’
“Physiologically it’s not an option.”
Hisey said she is still passionate about helping those with opioid addictions.
“Why am I even interested in helping? It’s the people that I know who hurt as much as I hurt, that I want to see cared for,” she said.
“I want to see them have a way out of their grief and their pain and their desolation.”
*The Advertiser has refrained from publishing the name of Hisey’s daughter to protect her identity.
