Under the Covid-19 pandemic, the opioid crisis in Canada has itself become an epidemic.
Last year, 1,128 Albertans died from opioid overdose, more than double the number recorded in 2016. While Edmonton and Calgary account for most of the overdose deaths, per capita the southern Alberta zone has the highest rate of 32.8 deaths per 100,000 people — again, more than double the recorded rate in 2016.
Reported data on the provincial government’s website indicates over 75 per cent of overdose deaths are male. Deaths also occurred in age groups from 0 to 84 years old, with peak numbers falling between the ages of 25 and 49.
While informative, it’s easy to forget that such data represents real human beings who had goals and dreams and who have now left behind loving family members and friends. The numbers also don’t indicate the social implications overdose deaths are having in local communities.
For Myrna Red Young Man, however, such heartache is impossible to overlook. Bringing information and hope to her community is a personal mission for Myrna to help others avoid her own experience: her grandson died of an overdose last summer.
“I really want to see a change to stop the drug abuse and alcohol abuse. It’s taking the lives of our people,” she says.
Her grandson’s overdose, Myrna continues, was driven by trauma after he was sexually assaulted. “He did report it, and all he was looking for was comfort and help. Someone just to hold him. And what did he do? He turned around, he used drugs and alcohol to help him comfort his feelings.”
Though Myrna made arrangements for her grandson to see a counsellor, he wanted to speak with a therapist outside of the community for a sense of anonymity. With the Covid-19 pandemic causing backlogs in scheduling, Myrna’s grandson never got in for an appointment.
About a month after the assault, he overdosed and passed away.
While at the funeral home arranging her grandson’s service, Myrna got word that his mother had also just fatally overdosed.
“I just sank to the floor,” recounts Myrna. “When I knew all that happened, I thought, I got to do something. I got to try and protect my family — I have to. Not only my family but my community too.”
Myrna’s story is one of hundreds experienced by families across Alberta. To help prevent more tragedy, the provincial government announced March 24 it would start testing a digital tool in the fight against opioid overdose this summer.
The Digital Overdose Response System (DORS) is a mobile app that can summon emergency responders in the event of an overdose. People planning to use opioids or other substances can input their address into the app, along with information on where they are in the house or how to enter the premises.
The app initiates a timer that, if left unchecked, will trigger a call from the Shock Trauma Air Rescue Service (STARS) emergency centre, which will then dispatch emergency responders to the location. The app also contains information on recovery supports and local services that can help people along the road to addiction recovery.
An overwhelming amount of overdose deaths occurred last year when individuals used alone, with 70 per cent taking place in private residences.
The most effective way to prevent overdose deaths is to administer the medicine naloxone. The key, however, is someone else has to revive the victim, meaning that users who take drugs alone substantially increase their chances of dying if they accidentally overdose. The DORS app, therefore, can provide timely assistance when an individual’s life literally hangs in the balance.
As a class of drugs, opioids are medications originally designed to relieve pain. The most common are codeine, oxycodone, methadone, hydromorphone and fentanyl. Opioids work by binding to specific opioid receptors on nerve endings.
“The body naturally makes opioids for pain management,” explains David Leung, a Pharmasave pharmacist in Pincher Creek. “Synthetic opioids or narcotic medications mimic these natural opioids, but have slightly different molecule shapes and so have different characteristics.”
A general characteristic, he adds, is the potential to cause a sense of euphoria and an overall depression of the body’s systems. Opioids are dangerous because, when taken in high doses, the euphoric high increases but breathing may slow to the extent that an individual can fall unconscious, stop breathing and even have their heart stop.
Though their effects are powerful, Dr. Leung emphasizes that opioids can be taken safely.
“Leaving pain untreated is not a solution,” he says. “If you leave your pain untreated, it can get worse. It can cause you a lot of other issues.”
He adds that people should not mistake a dependency on drugs — needing medication to function physically, for example — with addiction, which is altered behaviour from biochemical changes occurring in the brain resulting from continued substance abuse.
Such changes cause the individual to act irrationally when they don’t have the addictive substance in their body, making using the main priority.
Safely using opioids is a matter of understanding the risks associated with the medication and working collaboratively with health-care providers to ensure the prescription is managed responsibly.
“Speak to your prescriber — the nurse practitioner or doctors who wrote your prescription — and voice your concerns,” Dr. Leung advises. “This will also guide them in your pain-management options and alternatives to opioid therapy.”
People also shouldn’t be afraid to speak to their pharmacist about their prescriptions, as the Alberta College of Pharmacy requires pharmacists to assess a patient’s opioid use with every prescription filled or refilled.
While managing pain with an opioid prescription, it is critical that the medication be used as prescribed and instructed on the label.
“If instructions state ‘as needed,’ do so as sparingly as possible,” Dr. Leung says, noting that it’s important to use the prescription for as short a duration as possible.
“It is a known risk that the longer you use opioids, the more risk there is associated. When opioids are not needed, they should be avoided.”
Under no circumstances should prescribed opioids be mixed with other pain medications or alcohol. Patients should also take their unused opioid prescriptions to a pharmacy to be properly disposed of.
The illicit problem
While overdosing on prescribed opioids does occur, deaths from pharmaceuticals make up less than seven per cent of the total number of deaths recorded in 2020. Nearly all overdose deaths resulted from using illegally sourced narcotics, or drugs made for illicit, non-medical use.
Narcotics like heroin or stimulants such as methamphetamine can often be mixed with fentanyl to create a more intense high, though often with fatal results.
Ordinarily, fentanyl is prescribed to manage severe pain; three or four grains are enough to kill the average adult. Since it is odourless and tasteless, illicit drug users have no way of determining how much fentanyl is present in their supply.
Even more alarming is the increasing amount of carfentanil appearing in illicit narcotics. Carfentanil is meant to sedate large animals like elephants and is not licensed for humans. A hundred times more potent than fentanyl, one grain is enough to kill an adult.
Contaminated illicit drugs, says Dr. Leung, are a main contributor to rising overdose rates.
“With the borders shut down [as a result of Covid-19], people don’t have the same access so are mixing things,” he says. “If people are trying to access medication or access an opioid and unfortunately they access one that’s contaminated — the thing is, you don’t know.”
If an individual overdoses, someone who injects them with naloxone in a syringe — or uses a Narcan nasal spray that contains naloxone — floods their body with medication that temporarily boots the opioid molecule off the nerve receptor, reversing the system depression and reviving the victim.
For this reason, supervised drug-consumption sites are a growing resource in preventing overdose deaths.
The DORS app can also act as a lifeline to people who are unable to access a safe-consumption site.
Stigma often follows those who are trying to help prevent overdose deaths, as people possessing Narcan or naloxone kits are suspected of abusing opioids themselves. Given that the whole issue with overdose victims is they can’t help themselves, the assumption is more than a little unfounded.
In fact, the Alberta government has provided funding for take-home naloxone kits, free of charge to anyone who asks for them.
“Most pharmacies have these available and will offer them directly to patients or provide them if requested,” says Dr. Leung. “They are an effective, almost first-aid tool for reversing opioid overdose until medical help arrives.”
Often, individuals who abuse opioids are victims of trauma or suffer significant mental health problems without any support. For this reason, says Lori Vrebosch, punishing drug users is an ineffective way of addressing the problem.
“Statistics show that jailing people who struggle with substance abuse leads to a much higher increase in drug use after they are released,” she says.
“My own son was released from a nine-month stay in the Lethbridge correctional facility, and he got out and two months later he overdosed and passed away in Calgary.”
Lori was among the organizers for an overdose awareness rally and a photo shoot with Moms Stop the Harm, both held in Brocket last summer. The photo shoot helped highlight the local opioid crisis and connect grieving families with support. She adds that the general stigma is the biggest thing preventing necessary social change that would help those who struggle.
“People don’t realize you’re a broken ankle away from being given a prescription to opioid, which can set you up for addiction. Drug users also often fight years of unresolved grief and trauma,” she says.
“What if it was your child? What would you want to see?”
Instead of dealing out punishment and isolation, Myrna believes compassion is the only antidote that will help solve the crisis.
“You have to approach these people that are living an addictive life, you have to love them. You can’t just throw a bombshell on them and crash their life even more. That’s not going to help them,” she says.
Though government programs and funding play an important role in addressing overdoses, the social support that helps heal people from addiction comes from the grassroots level by the efforts of ordinary people — in particular, the unique matriarchal dedication that only a grandmother’s love can create.
“I’m not going to stop. I’m going to continue, to work diligently with the people,” promises Myrna.
“We need to continue to do awareness programs, in any kind of way, any form of way, that will help this community.”
Sean Oliver, Local Journalism Initiative Reporter, Shootin' the Breeze