When prescription opioids run out, users look for the supply on the streets
Number of addictive painkillers reported missing to Health Canada from pharmacies and hospitals increased
For Dana MacInnis, the pain started three decades ago, when he shredded a ligament in his leg playing soccer.
There was surgery, there was infection. And then there was Demerol. It took the pain away and made him feel invincible — until it didn't anymore.
Over the years, MacInnis found the dosage prescribed by his doctor was no longer enough. But he was uncomfortable repeatedly going back to doctors asking for stronger doses. He decided he needed to manage the pain on his own.
This is how he came to be standing on a street in Vancouver's Downtown Eastside one day in 2004, watching people exchange money for what looked like little pieces of paper.
"You tell yourself a small white lie... like, 'I know it's not the right thing to do, but I'll do it once.' And then it's so easy to do — there's so much of it here," MacInnis said. "And in a very short time, you'll find that you've made a very bad mistake — or mistakes."
Across Canada, the number of opioids reported missing to Health Canada from pharmacies and hospitals increased significantly between 2012 and late 2017, a CBC investigation found.
At least half, and likely more, of those drugs found their way onto the streets, where they are in high demand from people like MacInnis.
Doctors, pharmacists and other officials have sought to plug the holes that allow these drugs to find their way onto the streets.
In British Columbia, they have met with some success. The amount of opioids prescribed by doctors, which account for by far the most pharmaceutical-grade narcotics on the street, declined substantially in the province in recent years.
This was largely due to new prescription guidelines introduced in 2015, according to the Canadian Institute for Health Information.
The CBC analysis found reported thefts from B.C. pharmacies and hospitals also dropped significantly, from more than 100,000 pills, patches or packages stolen in 2015 to a little more than 5,000 last year.
The B.C. College of Pharmacists says a 2015 requirement for pharmacies to store such drugs in time-delay safes, which discourage robberies by not opening right away, is largely responsible for the drop.
The flip side of this success, however, is that even when the supply of pharmaceutical-grade narcotics is restricted, the demand remains. And dangerous synthetic substitutes, often laced with fentanyl or carfentanil, rush in to fill the void.
'You're never quite sure what you're getting'
The increased drug losses from pharmacies uncovered by the CBC investigation are not a cause but a by-product of the opioid crisis, said Mina Tadrous, a researcher with the Ontario Drug Policy Research Network in Toronto.
"What I mean by that is, perhaps some of these spikes that are increasing are because every time you tighten up regulations ... the demand for these drugs doesn't disappear," said Tadrous. "I think you worry if you tighten it up too much, that what happens is people go and see other sources and that's what we're seeing now, where other sources are tainted with fentanyl and carfentanil coming in from other places."
"And that's very dangerous," he said.
This is what has happened in B.C. Last year, nearly 1,500 people in the province died as a result of illicit opioid overdoses, according to the B.C. Coroners Service, the vast majority associated with fentanyl or carfentanil.
Another 500 died in the first four months of 2018. That's up from 183 opioid-related deaths a decade earlier.
When MacInnis went looking for Demerol on Vancouver's Downtown Eastside back in 2004, he was told it would be expensive and hard to find.
What he did find was "down," which is a street name for a substance that could be any number of opioids mixed with benzodiazepines, which have a tranquilizing effect.
"You're never quite sure what you're getting, which is one of the dangerous things about the drug crisis," MacInnis said. "There's no clean pharmaceutical-grade narcotics that are out on the street."
In the video below, MacInnis describes how he first went about looking for painkillers on Vancouver's Downtown Eastside.
Making sure 'things stay safe'
MacInnis struggled with his addiction for years.
"There were times I was clean for a couple of years. I had a life in the theatre. I was acting. I had a full-time job. I was a carpenter. Yeah, I had an apartment, a car ... But it could change very quickly," he said.
When fentanyl made its first appearance on the streets about two years ago, MacInnis overdosed three times at Insite, Vancouver's federally approved supervised injection site. Since then, he's been taking more precautions.
"You go to the same person day after day … and you usually know, once you've established a relationship with a dealer, they don't want to see you get hurt or go away, because there's a financial bond, even a friendship bond," he explained. "That's one system we use to make sure things stay safe."
Another is using supervised injection sites. MacInnis volunteers at three of them, including the Overdose Prevention Society, located in the heart of Vancouver's Downtown Eastside.
MacInnis was inside the facility talking to a reporter recently when a woman opened the front door and shouted, "Overdose!"
MacInnis grabbed an oxygen tank and a Narcan kit and ran outside, pushing his way through the crowd of people outside the door to a man who was lying unconscious on the sidewalk.
Two other people, including the facility's founder, Sarah Blyth, rushed outside to help, administering oxygen, Narcan and monitoring the man's vital signs. MacInnis made a call and five minutes later, the fire department and paramedics were on scene.
The man survived.
'I helped save somebody'
More rehabilitation beds, located outside the Downtown Eastside, would help people in his situation, MacInnis said.
Alternative, non-opioid methods of pain control, combined with psychological support when needed, also help those who have become reliant on high doses of opioids over the years, said Dr. Perry Kendall, B.C.'s former chief medical health officer, who spent years at the forefront of the province's opioid crisis.
"For people who are seriously addicted and chronic users, we have greatly increased in B.C. access to opioid replacement therapy for suboxone or methadone," he added.
MacInnis plans to start methadone therapy, under the supervision of a doctor, in the near future. Another thing that has helped MacInnis is volunteering at supervised injection sites, which he says is akin to a full-time job.
"I helped save somebody today. They could've passed away because there was nobody here to help them. [Helping] feels great. That helps you ... stay away from the cravings, I'd say — having that sense of purpose."
With files from Vik Adhopia