Many people are aware that Canada is facing a national opioid crisis. In April 2016, the government of Canada declared a public health emergency for “the growing number of overdoses and deaths caused by opioids, including fentanyl.” B.C. has the highest rate of deaths in Canada, with 20 out of every 100,000 people dying from using illicit drugs including, but not limited to, opioids, with a steadily climbing rate every year. In other words, four people die every day in B.C. alone from overdoses. At this rate, it’s likely that you or someone you know has been deeply affected by the use of opioids. It’s time we educate ourselves on what is making this a crisis, and what we can do as a community to prevent further loss of life.
What is an opioid?
Opioids are pain killers, commonly prescribed after surgery to manage pain. They can be naturally derived from the seed pod of the opium poppy, which is used to create morphine or codeine. Some are semi-synthetic, such as hydromorphone, which is derived from morphine, and some are fully synthetic, such as fentanyl. Opioids are not meant to cure an ailment, but to reduce the suffering felt from pain caused by ailments. Some commonly used opiates are Tylenol with codeine (T3s and T4s), oxycodone (sold under many names such as Percocet and OxyContin), Dilaudid, and fentanyl. These drugs can be either prescribed by a doctor as pain killers or, more dangerously, can be purchased on the street in stronger doses. A street drug that has popped up recently is carfentanil, which is a form of fentanyl, except 100 times stronger. Its original use was to sedate large animals, such as elephants, and was never intended for human consumption.
What makes opioids so addictive?
When opioids are consumed, either swallowed, snorted, smoked, or injected, they travel through the bloodstream and attach to the opioid receptors in your brain cells, which in turn release endorphins, suppress feelings of pain, and heighten feelings of pleasure. These feelings of pleasure are what facilitate addiction to these substances. When opioids are taken over long periods of time, your body responds by slowing its production of endorphins.
Of course, many other factors contribute to addiction, such as poverty, unemployment, family history of substance abuse, stressful situations, history of depression and anxiety, and regular contact with high-risk people and/or environments.
Who uses opiates?
One of the main reasons people start using and continue to use opiates, is to manage chronic pain. The B.C. Coroners Service released a report in 2018 investigating over 870 overdose deaths between 2016 and 2017. This report stated that 45 per cent had visited a doctor for pain-related issues and 52 per cent had reported receiving a mental health diagnosis.
Fatalities amongst the homeless population, which includes those living on the streets, in shelters, temporary rentals, and rehabilitation facilities, more than doubled between 2015 and 2016. Half of those deaths were due to drug overdose or alcohol poisoning, with many cases linked to the use of fentanyl.
However, there is no typical population that is more prone to taking opioids, and the reasons why people start taking them vary greatly. Everyone has a unique story. A fellow editor and I talked to some of the street-entrenched population in downtown Abbotsford to get their stories and opinions.
For Linda, her use of opiates stems from the need to manage chronic pain after being hit by a car and breaking both her legs four years ago.
“When I got out of the hospital, the doctor gave me a prescription for T3s to help with the pain, and that is not even going to touch it,” said Linda. “I’m still recuperating … It has nothing to do with getting high; it’s the only thing that will allow me to get up and move around.”
Opioid use could also result from traumatic life experiences and childhoods, when individuals turn to drugs as a way of masking or coping with emotional anguish. Harry, a man we talked to outside of his tent, theorizes that the opiate crisis has become so rampant amongst the younger generation because of rapidly advancing technology and our inability to keep up with the pace.
“Society is moving at such a fast clip right now … Technology is moving ahead at a pace where our emotions are not keeping up. I think this computer communication age is the age of miscommunication. I think what we have is an inability of society to cope with the new world order. People’s inner self, their emotions, their being, their soul, it is not learned, it is not moving at the rate of what technology is.”
Chief Constable Mike Serr of the Abbotsford Police Department started his career in 1990, working in Vancouver’s Downtown Eastside. It was there that he got a real perspective on some of the issues with drug addiction. I sat down with Serr at his office in City Hall, where he gave me his insights on the opioid crisis.
“What we’ve learned if nothing else, through the opiate crisis, is that everyone has been impacted… There isn’t one thing that can make people become addicted,” said Serr. “I think everyone has a unique reason for going down that pathway. Unfortunately now with fentanyl and carfentanil and some of these incredibly dangerous drugs that are on our streets, we’re just seeing the impact of how dangerous those choices are now.”
What are the dangers of prescription opioids vs. street drugs?
According to the Canadian Pharmacists Association, in 2015 53 opioid prescriptions were written for every 100 people in Canada, prescribed to treat acute or chronic pain. The association recognizes the need for increased monitoring and management of opioid prescriptions, as it is increasingly common for community pharmacists to receive prescriptions for inappropriate dosages. Fentanyl is typically prescribed by doctors to patients who suffer from long-term severe pain in the form of slow-release patches.
“I started using with Dilaudids, which is just a pain medication like OxyContin,” said James, an opiate user living in Abbotsford. “A friend of mine at work offered them to me and I didn’t really know what I was doing at the time, and after I took them I felt pretty good, and I started doing them recreationally.
“You start with the pills, and then you upgrade yourself, I guess you could say, to heroin, which is cheaper. Then all the sudden it becomes a habit just as expensive as the pills, so I tried fentanyl and figured maybe I could save money doing this. Nobody wants to move up the scale. I guess my last step would be to start shooting it up, and that is a threshold I haven’t crossed and don’t want to cross.
“The high is good for a little bit, but not very long… Unfortunately, everyone thinks they can control it, but that’s not the case. It becomes a disease because you need it. You wake up, feel sick, and you don’t want to do anything to get your day started, to be a functional member of society, until you get your dope fix, and once you get your dope fix you’re worried about your next one.”
Prescription drugs are what get people hooked on opioids, but the street drugs are what kill them. There are some dealers that are sloppy and the drugs become mixed as a consequence of this, but some dealers are purposely mixing fentanyl into other drugs because they know how addictive opioids are, and it’s a way to get people even more addicted.
“We’ve seen fentanyl, carfentanil, in almost all drugs, except for marjauana,” said Serr. “We’ve seen it mixed with meth, cocaine — almost all drugs. For anyone buying illicit street drugs, including MDMA, there is a potential that it will be contaminated with fentanyl or carfentanil.
“Sadly, people know that the drugs on the street are incredibly dangerous and have the potential every single time that they take it to kill them, yet the drug addiction, or the urge for that drug, is more powerful than the rational thought that I shouldn’t do it because I could die. And the drug dealers are continuously making these drugs more potent, even though they know they’re killing their clientele.”
What can be done to treat opioid addiction?
Treatment looks different for every person. Some people are ready to make the step to enter a detox clinic or rehab centre, and others just need someone with lived experience to walk alongside them and support them until they are ready to make that step.
Other people may be ready for opioid-assisted treatment. For many, the drug hydromorphone is administered, which is a synthetic opioid. Serr is an advocate for this type of treatment, which just recently became legalized in Canada in May 2019. Methadone is another medication used to treat chronic pain and opioid use disorder. As of May 2019, medical practitioners are able to prescribe, administer, sell, or provide methadone to their patients freely without requiring an exemption from Health Canada.
There is also the easier to access medication buprenorphine, which goes by the trade name of Suboxone, a prescription drug that helps people achieve long-term sobriety. The positive effects, such as reducing drug cravings and preventing withdrawal symptoms, are felt in a matter of days, and the side-effects are less pronounced than methadone.
“It’s a safe supply, and it’s proven itself over and over again,” said Serr. “So instead of a drug dealer giving someone a very poisonous, dangerous dose of fentanyl, what we do is through a doctor we give synthetic heroin, and the bonus of that is that a drug dealer is typically going to try to get people to take more drugs, where I am hoping that doctors will try to moderate a person’s use, so a person can maybe go on with their life.
“With opioid addiction, everyone thinks you can go into treatment, you can do your 60 days and you’ll be fine — that’s just not the case. Most people are unsuccessful eight, nine, or 10 times before they are successful, so we need to find a way to support people, and part of that will be through a clean supply of drugs”
Charles, an ex-opiate user who is currently in the treatment centre Joshua House, credits his sobriety to Christianity and spirituality.
“You have to replace your will and the drug of your choice with something greater than yourself and with a positive environment that will influence you to look into the future, to get over your bad habits, and get out of your own will and start living in God’s will,” said Charles, currently four months sober. “That’s easier said than done; it’s going to take work. But you are worth so much more than dying on the street with a needle in your arm. There is just so much more to live for than dying under a bridge in Hastings.”
What has the government done to respond to this crisis?
In May 2019, in response to the severity of the crisis, Canada became the first country to legalize injectable hydromorphone (i.e. prescription heroin), used to treat patients with severe opioid addiction. However, this drug is only to be administered under the supervision of an experienced physician who is trained in injectable opioid treatments. Before the change is legislation, the only clinic offering it nation-wide had been Crosstown Clinic in Vancouver.
There are currently two overdose prevention sites established in Abbotsford, including Riverside Shelter, just down the street from the UFV Abbotsford campus, and Positive Living Fraser Valley. Here, opioid users can consume substances in a safe and clean environment, under the supervision of trained medical staff. As well, the government has passed the Good Samaritan Drug Overdose Act which provides “legal protection for people who experience or witness an overdose,” protecting overdosing users from charges of possession of illegal substances.
What is Abbotsford doing to combat opioid overdoses?
Serr saw that the strategies used to treat drug addiction had created a revolving door, where first responders would inject naloxone into someone who had overdosed, revive them, only to see them in the same situation the next day, never really fixing the problem.
He has played a crucial role in chairing the Abbotsford Opioid Working Group, which started in 2015, and received a grant from the provincial government of $100,000 to fund Project Angel. This initiative, staffed by a Peer Support Worker who has lived experience using drugs, is all about connecting drug users with resources. When the police, fire, ambulance, or anyone in the community sees someone who is in need of help, dealing with problematic substance use, they are connected with an angel and led to different pathways of assistance and care.
“When someone is struggling, they can contact the program and we can help them find the resources, and start the dialogue so they’re not alone. What a lot of people experience is that they find they have nowhere to turn,” said Serr. “If you can’t get someone quickly into a bed, then at the very least we can build that relationship so that when they are ready we can help them and support them.”
Serr highlighted the fact that this crisis is not simply a policing issue, but requires a joint effort on behalf of the entire community. That’s why the Abbotsford Opioid Working Group has included a seat at the table for everyone who can bring solutions: the police, community, and social services — such as SARA for women and Positive Living, Fraser Health, the city, UFV, and Indigenous communities.
“For police officers, we will never stop aggressively going after people that distribute, import, and produce drugs; that is 100 per cent what we need to do. But people who are misusing drugs, we need to help and use other approaches,” said Serr.
What has the University of the Fraser Valley done to respond to this crisis?
Any student is able to obtain a naloxone kit free of charge from Student Life, after passing a short online orientation on how to use the kit. Naloxone can be injected if you encounter someone you think has overdosed from opioids. It will temporarily reverse the effect of the opioid and buy enough time to get them to the hospital.
An important step for people with drug addiction is to seek counselling, to see where the trauma and triggers are coming from that may cause opioid use. UFV offers bi-weekly counselling services free of charge for its students, with counsellors trained in drug addiction counselling. Although there is a longer wait time to see a female counsellor, you can usually get in to see someone within two weeks. However, if you or a friend are experiencing a personal crisis, you can get in to see a counsellor right away on the Abbotsford or Chilliwack campus. To book an appointment to see a counsellor, visit the Counselling Services office in B214 or call 604-854-4528.
If you have a personal crisis outside of UFV counselling office hours (weekdays, 9 a.m. – 4:30 p.m.), you can call the Fraser Health Crisis Line at 604-951-8855. If you are a member of the student health care plan, you can call the Empower Me hotline, which provides counselling services over the phone 24/7, at 1-844-741-6389.
How to safely use drugs if you require opiates:
If you are going to use drugs, please do so in the company of someone who is staying sober and can administer a naloxone shot and call 911 in case of an overdose. Avoid any drug use if you have been drinking alcohol. If you choose to inject drugs, use needles only once, never use someone else’s needle or allow them to use yours, and safely dispose of your needle in a safe sharps disposal.
Take advantage of the services that offer BTNX Fentanyl Test Strips, which allow you to check your drugs for contaminants like fentanyl. These strips are available at Public Health Units in Langley, Mission, Abbotsford, and Chilliwack, as well as Abbotsford Community Hub Centre.
Consider alternatives for managing your chronic pain, such as less-addictive pain medications and nonpharmacological therapies.
What you can do if someone you know is using these substances:
Before having a potentially life-saving conversation with someone you are concerned about, make sure they are fed and rested. Let them take a nap, while cooking them a healthy meal, or ordering some food. Make sure to have the conversation in a safe environment, while you are both relaxed, and not overcome by strong emotions, such as anger. It might even be helpful to have this conversation while driving, or walking, as it is less confrontational than being face to face. Start the conversation by letting them know that you deeply care about them and their well-being, and you are concerned and want to understand their reasons behind their drug use — and most importantly, listen with an open mind, without any judgement, shame, or guilt.
Most of the time, people struggling with opiate addictions want to get help, but need assistance taking that first step of calling clinics and making appointments. If you are able to help them book an appointment, and drive them to it, that could be the best thing you can do for them. Call the B.C. Alcohol and Drug Information Referral Service at 1-800-663-1441 for access to treatment centres and clinics.
A note for those who use opiates or care about someone who does:
Substance use disorder is a legitimate health issue, NOT a failure of character. This is not your fault. Drug use does not make you any less worthy of love or compassion. There are resources out there for you — take advantage of them. Recovery is possible, but it will take perseverance and extreme amounts of patience to see that happen.
The names of opioid users interviewed for this article have been changed for their protection and safety.
Illustrations: Renee Campbell/The Cascade
Andrea Sadowski is working towards her BA in Global Development Studies, with a minor in anthropology and Mennonite studies. When she's not sitting in front of her computer, Andrea enjoys climbing mountains, sleeping outside, cooking delicious plant-based food, talking to animals, and dismantling the patriarchy.
