Homeless people may seem like the front line of the opioid crisis in Chilliwack but there’s a hidden population driving up the number of local fatalities.
Despite the visible side effects of drug use on the streets, only nine per cent of the 35 fatal overdoses last year in Chilliwack involved so-called street people.
That was the biggest myth about opioids that doctors were trying to bust at a community talk Tuesday night, at the Neighbourhood Learning Centre.
Dr. Marc Greidanus said the majority of people who died from opioid overdoses were in homes that were owned or rented, at a whopping 71 per cent. The rest of the overdoses, about 20 per cent, were people who had some sort of supportive shelter, including group homes.
Further to that, he said, of those who died last year, 44 per cent had a job.
One of the tasks of local health professionals is to reduce the social stigma connected to opioid use. The more people understand about addiction, the easier it is for addicts to access and accept help. And over time, they say, that will lead to fewer people dying from overdose.
Taking part in Tuesday’s talk, which was part of the Mini Med School sessions hosted by the Chilliwack Division of Family Practice, was one way of the ways they’re trying to smash social stigma about opioids and addictions.
Dr. Nathan Toh, a family medicine resident in Chilliwack, explained how addiction is formed from different kinds of trauma. That includes single incident trauma, complex repetitive trauma (such as continued sexual abuse), development trauma (including child abuse and neglect), and historical trauma, which is when an entire group of people are subjected to abuse as in the case of residential schools.
Addiction can also be caused when physical pain is poorly managed, he explained. While Toh is a resident doctor with fresh training, Greidanus recalled being told in training that if opioids didn’t work “double the dose.” And when that didn’t work, “double the dose” again. Years later, he said, they realized the mistake they’ve made, and doctors swung hard the other way, not prescribing opioids at all.
Now, they are trying to treat pain from somewhere in the middle. If they don’t prescribe pain meds to those who truly need them, he said, “they’ll just go down the street and get something for $10.”
So now they’re trying a whole menu of treatment types, in conjunction with each other, to get patients back to sobriety and dealing with both trauma and pain in a healthier way. But once addiction starts, Toh said, the onus is on the user to get clean.
“Treatment doesn’t really work unless we have a comprehensive approach,” he said. “And the person dealing with the addiction is the most important person, to drive their own recovery.”
Fentanyl isn’t a drug that will go away, Greidanus added. Heroin, only a slightly altered form of the medically used morphine, is a complicated and expensive drug to make. Fentanyl on the other hand, can be made in a kitchen. And the people making it aren’t really worrying about the lifespan of their customers.
Cpl. Deanna Hawes of the RCMP’s drug division was also on hand for Tuesday’s talk.
She said the drug is given a few spins in table top mixers with cheap filler, and then pressed into tablets labelled Xanax, mixed with heroin, and other drugs. This creates “hot spots” in a dose, which causes drug users to over medicate. And often, people aren’t even aware there is fentanyl in their drug of choice.
“Pretty much any drug you will find on the street in Chilliwack will have fentanyl in it now,” she said. Someone in the audience asked her to clarify if cannabis has also been found with fentanyl, and Hawes said it has. The safest way to purchase is now through the government, she said.
A lot of the evening focused on questions on how exactly to adminster naloxone to someone who may be overdosing. Dr. Arden Barry, a pharmacist with the Primary Care Clinic said practice is important. They had someone overdose recently just outside the doors of their clinic, and he was the one to have to load the needle with the naloxone from their kit.
“I noticed that even my hands were shaking,” he said, from the adrenaline of the situation. Everyone on the panel urged people to get informed about administering naloxone, especially if they are going to be using drugs recreationally, even once.
“We have a poisoned drug supply,” said Liz Miller, a local public health nurse. “Just like you choose a designated driver, you have to say, ‘If we are going to be doing this, what is the safest way? Because nobody has to die.”
To find out more about naloxone, visit a pharmacy and ask for a demonstration. The next Mini Med discussion is Tuesday, March 12 at the NLC and focuses on palliative care. Doors open at 6:30 p.m. with the talk beginning at 7 p.m.