1 in 5 people in Sarnia were prescribed opioids last year, but when most think about addiction, they don’t generally associate it with acquiring legal drugs in legal ways by prominent members of our society. Popular culture often references the “junkie” as someone shooting up in a back alley; a violent and aggressive individual who was “doomed from the start.” And while you may find a small handful of folks with substance dependence who could potentially fit this category, any introductory level addiction class will teach you that this stereotyped impression is immensely untrue.
In order to understand addiction, its helpful to have a basic understanding of the way the human brain works. Biologically, we are driven to eat, drink, and procreate by experiencing pleasure. This is due to the brain’s reward system releasing a neurotransmitter called dopamine. From an evolutionary standpoint this makes complete sense: we experience a desire for sex and food and our brain releases a “feel good” chemical that rewards us for the activities that ensure the survival of our species, while simultaneously motivating us to repeat these actions. Food equals staying alive, sex equals procreation and the passing on of our genes, and nature has a built-in system that chemically rewards us for seeking out these behaviours. Unfortunately, addictive substances hijack this same reward system, rewiring the communicative neural pathways. So when you hear the misinformed but well-meaning question of “Why don’t they just stop?” – its really not a simple matter of willpower. Addiction isn’t just in the mind: addiction is in the brain, enforced by the same rewards system that motivates the survival of our species. Addicts aren’t just fighting thoughts: they are fighting their own biochemistry.
Paula Reaume-Zimmer, Integrated Vice President of Mental Health and Addiction Services at Bluewater Health, explains that addiction is characterized by the “4 C’s” – compulsion, craving, consequences, and control. Unlike a habit or a dependency, someone who is abusing or addicted experiences a strong compulsion and intense craving to seek out and consume the substance regardless of consequences, and this compulsion cannot be controlled.
As for theories? There are a lot of those, too. The self medication theory proposes that people use substances to cope with stress, pain, or untreated mental illness, with the substance providing relief for physical or mental anguish. The biopsychosocial theory of addiction suggests a complex interplay of biological, psychological, and social factors leading to substance abuse. Still some health and social workers approach addiction from a disease model, with the idea that addiction is chronic, progressive, and can be fatal if left untreated.
While there are many theories of addiction and many potential substances one could form a dependence on, its opioids and methamphetamine that are the most rampant in our community. Det. Sergeant John Pearce, head of Sarnia Police Services’ Vice Unit, says it comes in from prescription medication in the form of oxycontin, morphine, fentanyl, and carfentanil. The next issue here is crystal methamphetamine, (not an opioid), which can be “home made” with potent chemicals including corrosive hydrochloric acid (used to remove rust from steel), lithium (an explosive chemical that can burn skin on contact, found in batteries), sodium hydroxide (a chemical known to dissolve flesh), acetone, anhydrous ammonia, and sulphuric acid (used in sewer lines as a drain cleaner) to name a few poisons involved in its manufacturing. Pearce explains we have a large populous that is not very well off, and it’s a lucrative business for high end dealers: it doesn’t cost a lot to make, it’s in high demand, and it’s a hard drug to get off of. He notes there are still people alive from 28 years ago when he started on the force, well into their 50s and 60s abusing the drug. “No work, no sleep, no life, a limited ability to conduct day to day operations… but its what they live for. That’s what their life revolves around.” Pearce goes on to say that while meth has been a problem for years, beginning with biker meth in the 1960s in liquid form only, its now evolved into the crystal form that is prevalent in our community today. The more potent the drug, the more difficult it is to get off, and the higher the chances of overdose. And its this continued evolution of drugs that has caused the epidemic to worsen.
And it’s not just meth that has evolved. Opioids have been a game changer. Gone are the days of just heroine and morphine: fentanyl has hit the streets, a synthetic drug originally created for cancer patients, with a potency 100x stronger than morphine. And now we have carfentanil, a cousin of fentanyl, with some reports showing a potency thousands of times stronger than heroin. According to the National Institute of Drug Abuse, 86% of injection drug users had used opioid pain relievers prior to using heroine, with 75% of users reporting that their first opioid was a prescription drug.
Det. Sgt. Pearce believes the problem is systemic. Last year, 14% of the population of Ontario legally filled opioid prescriptions, amounting to over two million people. That led to over 1000 deaths in 2017, with 7600 opioid overdose related emergency room visits. As for Sarnia? We rank #2 in the province for opioid use, and like most cities faced with this devastating epidemic, there is some debate regarding treatment.
The first supervised injection site in North America opened 15 years ago at Ground Zero of the opioid crisis: Vancouver’s Downtown Eastside. The facility named Insite is exempted from the federal Controlled Drug and Substances Act in order to allow for users to inject street drugs under medical supervision, supporting a model of harm reduction. The idea is that using intravenous drugs with sterile equipment in a medically supervised environment reduces the acquisition and spread of dangerous diseases. Furthermore, medical and health professionals are onsite and able to offer counselling and addiction services on request. Also, overdoses are able to be treated on the spot: a 2017 Maclean’s article reports that of the thousands of ODs that have happened at Insite, none were fatal due to the prompt intervention. Yet, in 2008, Stephen Harper’s Conservative administration refused to extend Insite’s Health Canada exemption from the Controlled Drug and Substances Act. He then commissioned an advisory committee to conduct a report on the facility. The committee ironically found there was no evidence of increased drug trafficking, loitering, petty crime or open drug use and determined that providing users with sterile equipment and treating overdoses right on the premise not only reduced the burden for paramedics and hospital emergency room staff, it actually saved taxpayer’s dollars in health care. Despite facts, the government refused to update its stance, prompting Insite to launch a case before the Supreme Court of Canada. The court ruled in favour of Insite in 2011. The same article reports that the result of ignoring public health officials’ suggestions for additional longer-term measures, such as better addiction treatment services, follow up procedures, and greater attention to trauma, poverty, homelessness and mental illness, the result will be people continuing to push poison into their bodies with band aid responses and daily horror in the Downtown East Side and beyond.
While Sarnia does not host a safe injection site, Lambton Public Health does provide free access to sterile, single use injection and inhalation supplies, safe disposal of used equipment, and education about safer drug use practices. They also provide free opioid overdose kids under the Ontario Naloxone Program, also used by Sarnia Police and Sarnia Fire. The Sarnia Police have championed the “Patch For Patch” fentanyl exchange program, decreasing fentanyl overdoses in the area. Bluewater Health’s Mental Health and Addiction Services offer the inpatient unit along with a number of outpatient programs and services both on and offsite, including community treatment orders, crisis intervention, social work, assertive community treatment, and addiction and problem gambling services. The Withdrawal Management services supports abstinence based and harm reduction approaches, acknowledging that harm reduction is a continuum: it includes supporting individuals with clean needles to avoid the spread of disease and infection, up to and including abstinent based recovery plans.
But it is not enough.
In the last three years, the number of people who have accessed Bluewater Health’s Community Withdrawal Treatment services has tripled. There is a growing need for addictions healthcare: when the temporary seven residential withdrawal management beds opened in Sarnia in January 2018, 91 individuals were served within the first 3 months of operation. The process of finding a permanent Withdrawal Management site is underway, again sparking division amongst community members.
What can be done from a citizen standpoint?
Sgt. Pearce: “There is no single right answer. Education is important, enforcement is important, we need more funding, and we all need to work together. Its our role as a city to become educated, and you have to educate yourself and raise awareness.”
As for an end? The drugs just keep getting worse and worse. Many have an image of what an addicted person “looks like,” but the truth is, addiction can happen to anybody. And as more and more information is collected on opioid use and dependence, we are seeing the systemic issues that factor into the abuse. With 2 million people in Ontario alone filling opioid prescriptions and 1 in 5 people in Sarnia doing the same, its time to start bringing the legal dealers into the conversation, too.