Saturday September 16, 2017

What will stop the deadly march of opioids and fentanyl?

An injection of naloxone, seen her in this kit, can prevent death due to a heroin, morphine or fentanyl overdose.

An injection of naloxone, seen her in this kit, can prevent death due to a heroin, morphine or fentanyl overdose. (Monty Kruger/CBC)

Listen to Full Episode 49:59

When Mandy Richard recalls her past opioid addiction, her mind is no longer in the room.

She looks outwards as if she's been lifted from her basement apartment in Fredericton, N.B, not far from St. Thomas University where she's finishing her last year, and back to her home reserve in northern Ontario.

She pinches her fingers together when she recalls her 16-year-old self, as if she's trying to hook the memories in.

Mandy Richard

Mandy Richard said she started snorting opioids when she was 16 to self-medicate. (Facebook)

"I realized it was a problem, not when family members said they would disown me if I didn't stop, or losing a job or getting my front tooth knocked out because I was messed up on drugs. It was my education," she said. "I was a role model. I was student council president."

As a teenager in foster care, Richard began snorting Percocet and Oxycontin, then turned to almost anything she could get her hands on, including hydromorphone and even Tylenol 3.

The relief that the highs brought her was louder than any of the overdose scares.

"Then you're looking for your next fix and you're aching for it and you're anxious for it. You need it. It's as if you have a very dry mouth and you're craving water. You need water so you'll do what you can do to get water."

While she left her addiction in Ontario to start a new life in New Brunswick, the deadly wave of opioid addiction and the dangerous fentanyl threat are marching east.

A report released this week by the federal government says opioids are killing an average of eight Canadians every day and the impact, as forewarned, is moving east towards Atlantic Canada.

But despite what's been learned from the British Columbia experience, where the province declared a public health emergency almost a year-and-a-half ago, New Brunswick is one of the only provinces that doesn't offer free naloxone kits, the potentially lifesaving overdose antidote, in pharmacies.

And even the chief medical officer of health there admits things could get worse before they get better.

'It's not a crisis here in New Brunswick'

In the Maritimes, the number of publicly funded prescriptions for opioids increased by 26 per cent between 2010 and 2015, according to data compiled by the Canadian Institute for Health Information. Their numbers show publicly funded opioid prescriptions increased by 28 per cent in New Brunswick between 2010 and 2015.

'At the end of the day, I think it's probably going to get worse before it gets better.'  - Dr. Jennifer Russel

New Brunswick doesn't have the same prescription monitoring problem that Nova Scotia has, and some frontline workers worry once prescription pills aren't as readily available, fentanyl will dig its deadly claws in even more.

Dr. Jennifer Russell, acting chief medical officer of health for New Brunswick, acknowledges the issue has to be taken seriously.

Dr. Jennifer Russell

Dr. Jennifer Russell said New Brunswick isn't immune to the fentanyl crises, but it's not a crisis yet. (CBC)

"We're not immune to this. That act that we're aware of what's happening. It's not a crisis here in New Brunswick at this point in time," she said.

Russell says the province's response plan will only be made public in the coming weeks and the provincial government is planning to hold a summit on the issue in November.

"At the end of the day, I think it's probably going to get worse before it gets better. I think ramping up all of the things that we need to do deal with the situation as it evolves, is really important," said Russell.

Premier Brian Gallant and the new New Brunswick Health Minister BenoĆ®t Bourque weren't made available for an interview.

Churches fundraising for naloxone 

For Julie Dingwell, executive director of AIDS Saint John, it's a lethargic response

"We've been seeing fentanyl come in through our needle exchange program in patches. So when people are returning needles, we've seen fentanyl patches for a few years. So we've known that people have been using fentanyl for quite a while," she said.

Julie Dingwell

New Brunswick isn't prepared to handle a fentanyl crisis, according to Julie Dingwell, the executive director of AIDS Saint John. (CBC)

"We've even had people using crack say, 'I used crack and then I slept for a day,' which you would never normally sleep on crack... I think we're in the middle of the mess, but I don't see an end in sight at the rate we're going."

What would help, says Dingwell, is having naloxone kits readily available, but those kits are not easy to come by in the province.

"So our government has initiated a fentanyl overdose committee as a response to the things, but a committee is not getting naloxone in the hands of the people who need naloxone. So, we need to be way more proactive," she said.

"Naloxone kits cost about $40 a kit. So we raised the money through whichever community groups we were asking for money. We asked some churches who supported us for money. And we've raised enough for about 45 kits."

AIDS Saint John estimates that of the 328 overdose deaths between 2005-2015, more than 60 per cent involved opioids.

Deaths that could have prevented with naloxone.

"Oh we would need hundreds. We would need hundreds," said Dingwell.

The Nova Scotia case

The Canadian Institute of  Heath's report shows that New Brunswick already has a higher rate of opioid poisoning hospitalizations than its neighbour Nova Scotia.

NS Opioid Deaths 20161028

Dr. Robert Strang, Nova Scotia's chief medical officer of health, holds a press conference to discuss the province's developing response to opioid drug misuse and overdose in Halifax on Friday, October 28, 2016. (Darren Calabrese/Canadian Press)

And that province is already implementing a plan.

Anyone wanting a kit of injectable naloxone can get one at no cost at their local pharmacy

Dr. Robert Strang, that province's chief medical officer, says the province is considering what to do next for a situation that could already be getting worse.

"I think the ultimate issue is that as long as we have individuals who are trying to feed their addiction, if you will, by accessing illegal street drugs, that street drug supply now in Canada, especially in Western Canada, is highly toxic. Initiatives like naloxone and supervised injection sites are necessary, but they really are a band-aid," he said.

"Unless we're comfortable with letting large numbers of people, who are often marginalized, impoverished or in addiction for a whole bunch of reasons, unless we're prepared to essentially write those people off we need to have this conversation."

Health minister visits Shepherds of Good Hope

Health Minister Ginette Petitpas Taylor, left, listens to Deirdre Freiheit, president and CEO of Shepherds of Good Hope, speak about the agency's frontline work helping opioid users. Petitpas Taylor visited the agency as new statistics on the opioid crisis were released.

In an interview with CBC Radio's The House the new federal Health Minister Ginette Petitpas Taylor quickly shut down that possibility.

"The issue of decriminalizing drugs is not something that we're looking at. What my priorities are as health minister is right now, first and foremost, is reducing barriers to treatment for many people that are using substances that are harmful to them," she said.

Petitpas Taylor said her department is looking into making substitution therapies, like methadone, more easily available.

"For doctors to prescribe methadone they have to have special licence. Well there are things we can do to make sure that can be done easier."