In a tiny office in a small building hidden behind a St. John's long-term care facility, Tree Walsh is trying to figure out how to fight a growing problem.
A report released this week by a national health organization shows that Newfoundland and Labrador is close to the top when it comes to the per capita prescribing of opioids.
It's a reality that strikes home as Walsh and a staff member restock shelves with boxes upon boxes of clean needles and other supplies to be given out when needed by users.
"The [opioid] numbers are more staggering than anybody could imagine," Walsh said.
"I'm not surprised because a significant number of those people are people who use our services."
Walsh is harm reduction manager for the Safe Works Access Program (SWAP), a needle distribution service offered by the AIDS Committee of Newfoundland and Labrador.
The results of a recent Canadian Institute for Health Information (CIHI) study aren't a shock to her.
The document, published earlier this week, shows that opioid prescriptions are on the rise in Canada over the last five years. The CIHI's research shows that 21.5 million prescriptions for the potent painkillers were dispensed in 2016 — up from 20.2 million in 2012.
CIHI found that opioid prescribing practices varied across the country, with Alberta (7,955) and Newfoundland and Labrador (7,878) reporting the highest number of daily doses.
Quebec and British Columbia reporting the lowest number of daily doses per 1,000 residents (3,601 and 5,496, respectively).
Hard to swallow
Health Minister John Haggie the numbers are easy to understand, but hard to swallow.
"Effectively, every man, woman and child in this province each year gets eight days of opioid prescriptions," he told CBC's On The Go.
It's a number Haggie wants to see lowered but there a lot of factors at play. The aging population is part of the problem, as is doctor training and physicians trying to deal with the high number of chronic pain sufferers.
"Our approach at the moment is to try and provide education to our prescribers and dispensers and this piece of information helps frame it," Haggie said.
Earlier in November, Haggie introduced a new program that hopes to put a stop to "questionable prescribing" of opioids — one that will flag someone who is trying to get multiple prescriptions from multiple doctors.
It's a step in the right direction, but Haggie acknowledged that less supply means the demand goes up.
"That's what happened in other jurisdictions, such as British Columbia," he said.
'Prepare for more death and heartache'
The CIHI report noted that while British Columbia can boast one of the lowest defined daily doses in the country, this year alone more than 1,100 people have died from drug overdoses — with more than 83 per cent of those deaths blamed on fentanyl.
"Our [province's] problem is the lack of treatment facilities and appropriate treatment for opioid addiction," said Walsh, who fears this province is heading in the same direction.
"What we know is that the overdose rate will increase," she said.
"What happened out west will happen here. We can see the wave coming. We need to prepare for more death and heartache."
While Haggie is more optimistic, his department is trying to get ahead of the problem. The health minister cited a recently launched naloxone kits program.
Haggie said change is coming. He knows there is room to improve on the programs offered in this province but attitudes need to change as well.
He told CBC that behavioural therapy, lifestyle changes and physiotherapy are far more effective and safer than opioids.
His government rolled out a safe-prescribing course to be taught to all new doctors in January. He hopes to work with groups like the Association of Registered Nurses of Newfoundland and Labrador as well as the provincial College of Physicians and Surgeons.
Both Haggie and Walsh know that this province needs to get in front of the opioid crisis before it has a chance to get worse.