Karen Rivera remembers lying over top of her son, Gorge, as he was sprawled out on the floor of her garage in southwest Calgary, barely conscious and breathing, having just overdosed on fentanyl.
She remembers the moment as clear as if it were yesterday.
It was near noon on Saturday, Feb. 3, 2018.
"All I could tell myself is that 'you cannot cry because you have to remember every single moment of this day just in case it's the last time,'" said Rivera.
Rivera's son, then 21, survived his overdose — and a second one about a month later. But she says that as a result of these two incidents, doctors have told her Gorge suffered a brain injury that impairs his memory, his emotional regulation, some physical movements and his ability to process information and control his impulses.
She says the family has had to get to know him again, and his needs are taking a toll on everyone.
She says they haven't had anyone to turn to for help — to address the brain injury, the addiction, or both.
"We've been fighting for him, fighting to keep our son alive, even though it's hard.
"And we want to quit — and we don't because there's nothing for him, there's no one there that's going to help him."
She says Gorge, now 23, fails to comprehend or remember any of the addiction treatment programs he's tried.
And brain injury programs need him to be clean before they can help him.
But those who work in both fields say she's not alone. They say there are others who are falling through the cracks because of this emerging dual disorder: people with addiction and overdose-induced brain injuries.
Hooked early on
Rivera says Gorge, who was always active and outgoing as a child, was surrounded by a good group of friends in his home in the southwest community of Strathcona.
She says he started experimenting with drugs at 13, when an adult befriended him, offered him drugs and encouraged him and some of his friends to start dealing.
She says Gorge's friends later stepped away from that lifestyle, but Gorge, for whatever reason, didn't.
She says he spent his teens in and out of addiction treatment centres and spent time in a youth detention centre.
Rivera says he never felt he had an addiction problem and says she could only watch as his addiction spiraled out of control.
She recalls the day she found him slumped in the driver's seat of his vehicle in the family garage. She dragged him out onto the floor and called 911. She says the car wasn't running at the time, but later, doctors said he had suffered carbon monoxide poisoning, along with opioid poisoning.
She believes her son must have accidentally hit the car starter button and, because it's on a timer, it shut off after about 10 minutes, before she found him.
"He was so out of it, he pressed the button on his car starter and suffered a double whammy and almost died."
She says she was by his side daily as he recovered in hospital.
But it wasn't until about a month after the overdose that she noticed a change in his personality, his behaviour and his ability to process information.
She says his memory has been impaired to the point where he'll forget he's put food in the oven and go to bed. She says she's woken up to find smoke coming from the oven. She fears the house could burn down.
She says he also struggles with depression, has bouts of anger and has become very impulsive.
"We are his eyes, we are his memory and we try to coax him from making wrong decisions."
She says despite his brain injury, he is still able to use the income supports he receives to hop on a bus and find illicit fentanyl.
Falling through the cracks
Rivera says that because of Gorge's complex issues, she's been unable to find the proper supports.
She says the addiction treatment centres say they can't help him because he can't comprehend their programs — and the brain rehabilitation programs say they can't help him while he's still using — so she's at a loss for where to turn for help.
"We are left with a young man with no help and it's very difficult" said Rivera.
Dr. Ronald Lim runs the opioid dependency program at the Sheldon Chumir Health Centre.
Lim says lately he's been seeing more people like Gorge who suffer from the effects of having overdose reversals — either through the use of naloxone, or by reviving on their own.
"We all know that when you suffer an opiate poisoning, the brain gets starved of oxygen, and if you reverse them, the body can recover. But often times there is some anoxic, or lack of oxygen, brain damage that occurs," said Lim, medical lead of the Calgary opioid dependency program.
Lim acknowledges there is a gap in services in Calgary right now for those dealing with both issues.
"They are falling through the cracks," he said.
"They come in, you know, day after day, and they don't remember what was told to them the day before. So these individuals need contained environments where they are kept safe," said Lim.
Lim says his heart goes out to the families who are left to manage this dual disorder. He says his team is looking at ways to assist, such as arranging transportation or facilitating guardianship orders.
"So far there isn't a dedicated facility that will consistently deal with individuals that have these two conditions."
The Southern Alberta Brain Injury Society, an advocacy and referral group, says it's seeing a similar trend.
"It's becoming worse because of the drugs, they're more easily accessible," said Natasha Brzoza, executive director the Southern Alberta Brain Injury Society.
The agency runs support groups and helps people who have usually had some type of brain rehabilitation access housing, financial services, transportation, food bank and sometimes legal issues.
Brzoza says the agency has clients who have overdose-induced brain injuries but they are drug free.
It turns people away who are still using drugs.
"We have to make sure that our support groups are safe for people, and if somebody is using, it just doesn't create a safe space for them, so we would refer them to a treatment facility."
But Brzoza says not everyone understands how to work with people who have a brain injury. So they are either rejected at the treatment facilities or don't remember what they learned. They end up back at her door no further ahead.
"It's a boomerang effect, and unfortunately these people are suffering because there is no support for them."
Hope for Gorge
Karen Rivera says she knows that boomerang effect well.
"We need someone to help us look after our son, a program would be lovely where he can go and actually do things and be guided, supervised, to address the brain injury and also help them through the addiction," said Rivera.
But she says she's thankful to have recently found some reprieve and support through Dr. Lim's clinic.
Gorge is receiving supplemental opioid therapy to try to control and reduce the amount he uses. They are exposing him to a psychiatrist, monitoring his health, and arranging Calgary Transit Access transportation.
"My hope for Gorge, for all of us, is to see him happy and functional and have self-worth for himself. That is our hope for him — and to not have to depend on drugs anymore."