Opioids put new face to addiction

Canada’s opioid death toll has escalated to unprecedented levels during the COVID-19 pandemic, and those most critically affected seem to be defying conventional beliefs about addiction.

Data collected by the federal government shows a substantial increase in opioid-related harms and deaths since the beginning of the pandemic. A simulated model of opioid-related fatalities suggests the number will remain high and could even double by June.

The alarming death rate is being attributed to several factors, including higher stress levels as people deal with COVID-19. 

A common misperception is that the opioid crisis is most severely impacting the street-entrenched populations in Canada’s major cities, but health officials are seeing the demographic most impacted are those using in their homes.

British Columbia’s most rural health authority, Northern Health, looks after the needs of about 300,000 people across the province’s north. Here, overdose fatality rates are as high as in Vancouver, says Kevin Hollett, associate director of communications at the B.C. Centre on Substance Use. It’s a problem fuelled by a lack of access to services. 

“The most impacted are young men,” said Hollett. “Most of them working labour and are using alone in their homes. The public health messaging ‘don’t use alone’ and ‘carry Naloxone’ (the overdose reversal drug), those things used at supervised injection sites are not reaching this population.”

It’s a segment of the population most wouldn’t associate with opioid addiction, notes Hollett.

“These individuals maybe had an injury in the workplace and so on the weekend are using opioids to manage the pain. They’re using it alone, not socially,” he said. “There’s so much stigma around substance abuse that they don’t think they should be going to a supervised consumption site or an overdose prevention site which is usually directed towards the more street-entrenched population.”

In Kitchener, Ont., St. Mary’s Parish has been feeding those who go without basic needs as a result of their addictions. Since 2020 the parish has provided tiny homes as an alternative to the tent cities that have sprung up, a common site in cities nationwide.

COVID-19 has revealed and exacerbated brokenness that has always been present, says Fr. Toby Collins. People battling illness as a result of the virus, the grief of losing loved ones, risking their lives on the frontlines, isolation, financial challenges, stresses around parenting and relationship challenges that would otherwise be manageable have intensified. Parishioners have stepped up with donations, prayers and letters of support, said Collins. For people of faith seeking to help, opioid addiction must be a call to action.

“The opioid crisis is one of many crises that we have to face squarely,” said Collins. “What does our faith call us to? We always talk about praying together and discovering meaning when we gather in prayer but there’s always a call that it leaves us with. When facing that particular crisis I think it’s more than anything a call for everybody to walk with those directly affected or those helping with this crisis.

“We may not have the capability of working on the front lines for whatever reason, and that’s perfectly legit. It may not be safe at times but it does mean for us to support through prayer, through resources, through affirmation and listening to those who are directly working with people suffering from all these addictions and the mental illness often associated with it. That’s a big help.”

Back in B.C., Vancouver’s St. Paul’s Hospital has been working with care practitioners and clinicians to be more protective when prescribing opioids for non-acute or non-cancer pain. During the pandemic, the hospital launched the Opioid Stewardship Program to ensure prescribing opioids is done in a way that minimizes future addiction. Whereas in the past, a drug like OxyContin, used to treat severe pain, might be prescribed for minor dental surgery, Hollett says that would not be recommended today.

"I could take you into a room of 30 people and you would not be able to tell which one is an addict."

- Silvana Tibollo

“When the alarm was raised around over prescribing, there was an opposite response that led to not adequately managing people’s pain,” explained Hollett. “The St. Paul’s Opioid Stewardship Program is providing support for prescribers to more confidently prescribe opioids for people who need it for pain, in a way where that person is not going to be vulnerable to developing an addiction.”

The problem has been exacerbated over the past five to 10 years with a change in the illicit drug supply. Drugs like heroin have increasingly been contaminated with the much more addictive opioid fentanyl. Due to the impact of COVID-19 on the restrictions on the transnational organized crime drug supply chain, fentanyl — cheaper and easier to obtain — has become even more concentrated in the drug supply.

The coroner service in B.C. puts out a monthly report on fatal drug overdoses which include toxicology reports. Particularly in urban centres like Vancouver, people are dying of overdose with higher concentrations of fentanyl in their system. Users who already knew that fentanyl was in the drug supply and were making adjustments to how they might be consuming substances are suddenly dying because there’s even more fentanyl than they anticipated. Ontario is showing the same drug supply changes over the past year of the pandemic.

Furthermore, opioid drug supplies are increasingly being cut with benzodiazepines, which are highly addictive substances that impact the brain differently than opioids, complicating the overdose response. Naloxone doesn’t work on benzodiazepines, causing people to overdose — fatally and non-fatally — at higher rates.

The number of individuals and families seeking help has been overwhelming throughout the pandemic, says Silvana Tibollo, program manager and policy and outreach coordinator at Caritas School of Life founded by Fr. Gianni Carparelli. The Toronto-based organization takes a multidimensional holistic approach to supporting those suffering from addiction, which includes residential treatment programs.   

At one point during the pandemic, there was 70 people on a waiting list and more than 20 waiting for a subsidized bed. With many services having gone virtual due to the pandemic, some no longer have access and are self-medicating at home, said Tibollo.

While their residential programs are currently only available for men, with the increase of addiction challenges in women, that might need to change as well.

Again, Tibollo says the perceived addict might surprise people.

“I could take you into a room with 30 people and you would not be able to tell which one is an addict,” said Tibollo. “People still have this preconception of what an addict is supposed to look like but they’re coming from all walks of life. It’s not just homeless people. There’s a lot of people that are suffering even while they’re at school and while they’re in their jobs.”