When people think of addiction and drug use in Canada, their minds might turn to cities like Vancouver, Toronto, or even Halifax.
But small towns in Nova Scotia have their own struggles when it comes to addressing addiction and overdoses.
In 2020, 96 people in Nova Scotia died due to drug toxicity — 10 more than in 2019 — according to monthly reports from the Nova Scotia Health Authority that have not been made available to the public.
While the central health zone, which covers Halifax and the surrounding areas, had the highest rates of opioid mortality since December 2019 — 3.9 per 100,000 people — the other health zones weren't far behind.
The western zone had a rate of 3.5, and the northern and eastern zones had rates of 3.3 and 3, respectively. The report doesn't break down the number of drug deaths not related to opiods by health zone.
Since July, at least two people in the northern health zone have died because of drugs.
One of the deaths was due to an overdose. Another was as a result of sores related to levamisole, a livestock dewormer that has been reportedly combined with cocaine in the Pictou County area.
Albert McNutt, founder of the Northern Healthy Connections Society, said his biggest concern isn't the numbers, but the people behind them.
"When we're looking at stats, we're looking at a bigger picture, but we're forgetting the small picture, which is that individual, that one person that is making headway in their life and moving forward even though they're living with an addiction," he said.
"They're forgetting that individual who took their own life because they no longer had a purpose to go to, a program."
The society, based in Truro, N.S., started in 1996 as a program for people with HIV and AIDS. It later expanded to work in drug harm reduction and is one of three organizations in the province that runs a free needle exchange program.
It also runs mobile outreach services around the province's northern health zone and distributes "emergency bags" containing syringes, tourniquets and other safe use items to pharmacies in small communities for people who may have missed their outreach services in Truro.
When the society began to focus on people who use drugs, McNutt said it had difficulty bringing people in. While drug use is pretty much stigmatized everywhere, it can be especially amplified in small communities.
"We started out with very few people accessing services because a lot of stigma's attached to it, discrimination's attached to it, fear of being known in a small rural community," he said.
"That's one of the biggest things that we deal with in the northern zone because it's primarily rural and everybody knows everybody, and so you keep it very much secret."
Addiction 'not easy to hide' in rural N.S.
Many factors play into why people may use drugs, such as socioeconomic situations, lack of affordable housing, and access to mental health and addictions programs.
"It's not like these folks woke up one morning and said, 'Hey, I want to be addicted to drugs,'" said McNutt.
"They turn to drugs to feel good. They turn to drugs to deaden the pain they're feeling ... and it's so easy to hide that in a big city, but it's not easy to hide that in a small community."
McNutt said his program has seen people "from all walks of life," and making assumptions about who uses drugs can be harmful.
"They could be someone who has been an honour student in school. They could be somebody who didn't go very far in school. They can be business people who get hooked on the medication," he said.
"It is something that people just don't realize. There's so much of it going on."
The Nova Scotia drug report identified Pictou and Antigonish as having among the highest rates of rates of pharmacy distribution for naloxone, the drug that can be used to reverse an opioid overdose.
McNutt said that's actually a good thing.
"They know that the drugs are being tainted with other substances, and so by arming themselves with naloxone kits and getting the training, I think that that's really showing a positive response and a proactive response," he said.
"I think once somebody loses someone to an overdose death due to drugs, they want to be prepared to prevent the next one. And naloxone is a pretty effective way to do that."
In recent weeks, there have been multiple reports of contaminated drugs in Nova Scotia.
The northern zone and the eastern zone, where Antigonish is located, also have the highest rates of substance-related emergency calls.
More programs needed
While the Ally Centre in Cape Breton — another organization that runs a free needle exchange program — is run out of Sydney, N.S., it offers services throughout the eastern health zone, including Antigonish.
In an email, Ally Centre executive director Christine Porter said there are four pharmacies in the small town that take part in its brown bag program, each taking approximately 20 bags each month. The centre also provides safe supplies to the opioid recovery program.
"I don't believe our Naloxone trainer traveled to Antigonish to train and give kits, so most likely, that distribution is coming from the pharmacies and [the opioid recovery program]," she said.
Aside from the three needle exchange programs — run by the NHCS in the northern zone, the Ally Centre in the eastern zone and Mainline in the central and western health zones — there are a number of smaller groups around the province dedicated to doing outreach and educating people about harm reduction.
But they don't exist everywhere.
"There's not enough harm reduction programs," said Kimm Kent, the founder of the Peer Outreach Support Services and Education Project, or POSSE, in an email.
POSSE works out of Windsor, Sipekne'katik and Lower Sackville and trains people between the ages of 15 and 30 to be peer support outreach workers. They then work with members of their communities to teach harm-reduction strategies for safe drug use.
"POSSE has had requests to expand to many places … but first we require sustainable funding for what we have," Kent wrote. "So many needs for so many people. I sure wish there was more equity in the world."
McNutt agreed. He said the province needs not only harm-reduction programs, but more programs in general where people who use drugs can learn skills, connect with others and find purpose and compassion.
He said the Northern Healthy Connections Society used to have a program where women would make reusable cloth bags. After that program was cut due to funding, he said one of the group's members died from an overdose.
'A little bit of funding would go a long way'
That was "very, very hard on us," he said.
"It seemed like while the program was running, she had a place to go, she had a purpose. She felt like she was actually going to work again," he said.
"People feel lost sometimes when they don't have something to go to or be involved with."
McNutt said he submitted an application to Truro town council asking for funding to recreate the program.
"I am hoping that they will really consider the fact that engaging the population and talking about in a positive way, in a proactive way, is far more important than turning your back on them," he said.
"A little bit of funding would go a long way to change someone's life."
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