“Like gasoline on an open fire,” is how the team at the Archway Opioid Agonist Treatment (OAT) Centre describes the effects of COVID on the opiate crisis.
“We have become much busier since COVID began. Our referrals, self-referrals, and intakes have increased in both the OAT Centre and in the Abbotsford Addictions Centre,’ said Lesley, the supervisor of both Archway programs.
“People are more depressed; have fewer funds and they can’t see their families and friends. They’re craving connection and there are so many things that they cannot do. They’re stressed over the uncertainty and lack of control or information.”
“Everyone has different ways of coping; some people turned to comfort foods, some spend hours endlessly scrolling on social media, some drank more or in some cases turned or returned to substances – legal and otherwise.”
While COVID dominates the news headlines, 1,716 people in British Columbians died from illicit drug overdoses compared to 954 deaths from COVID in 2020.
“Both are tragic situations requiring different approaches and resources,” said Lesley. “Overdose deaths, because of the shame attached, are often underreported and not acknowledged as tragic. They are sometimes viewed as ‘deserved’ or a ‘likely outcome of a poor lifestyle choice’. As well, the stigma around substance use often leaves families and loved ones who have lost someone to overdose, embarrassed and unwilling to seek out the support they need,” said Lesley.
Since the opioid overdose-related deaths were first declared a public health emergency in April 2016, over 7,000 individuals in BC have lost their lives, including over 2,300 in Fraser Health alone. The OAT Centre in Abbotsford was set up in November 2017 to provide a local option for treatment.
Additionally, during this time, public health agencies distributed naloxone kits, offered drug checking, and worked to integrate harm reduction and overdose prevention into medical services and supportive housing models.
“With our collective efforts and enhanced substance use and harm reduction services, we were starting to see a significant reduction in the number of people dying from overdoses. Now, in the midst of the global pandemic, we know it has become more difficult for those who use drugs to stay safe due to increasing social isolation and a more toxic and unpredictable drug supply,” shared the Fraser Health President and CEO, Victoria Lee.
“The pandemic has reduced access to some health care services, trusted social relationships, and the daily routines that keep us healthy and safe. Last year, we recorded the highest number of overdose deaths in any year since the emergency was declared, and a corresponding decrease in the use of supervised consumption services, drug checking services, and other modes of support.”
As people were more isolated, they were used alone rather than with a friend or group. If they experienced an overdose, there was no one to call for help or administer Naloxone. In the first five months of 2021, 56% of illicit drug toxicity deaths in BC occurred within private residences.
Another contributing factor to the increase in deaths was the border closures which restricted some drug trafficking leading to an increase in toxic or tainted drugs.
“Someone who thinks they’re using heroin could actually be given fentanyl mixed with benzos. This can lead to them going to sleep and never waking up,” said Lesley. “Or they are being given carfentanil, which is a thousand times stronger than regular fentanyl.”
Fentanyl itself is over 50 times more potent than morphine and the BC Coroner’s service report showed that it was detected in over 80% of the illicit drug toxicity deaths in 2020.
The problem of tainted drugs is so common that the OAT Centre runs a urine drug screen analysis to determine which drugs people are consuming before helping them detox.
“Removing the stigma attached to substance use is critical because so many people would rather risk their lives than seek help,”
The OAT Centre helps stabilize people who use substances and significantly reduces the harm associated with opioid use. Physicians may provide prescriptions for Methadone, Suboxone, or Kadian depending on the needs of the patient. A mental health support worker also works with clients and provides referrals to other services as needed, including counseling through the Abbotsford Addictions Centre.
Methadone is a prescribed medication that can help people avoid withdrawals and can be used as a substitute for other opiates, which include heroin, fentanyl, or oxycodone. Methadone itself can be addictive however it allows users a safe and legal alternative, an important facet of the harm reduction model.
The goal is to gradually wean off methadone under medical supervision, but users can continue methadone use long term if needed.
“This place is way better than any other clinic I’ve been to for methadone maintenance. You can tell the staff cares about my well-being. All services are done very professionally and fast!” OAT Centre Patient
A newer treatment method, Suboxone blocks opiate receptors in the brain which can reduce withdrawal symptoms and cravings. Patients must go through withdrawal before they can safely take Suboxone which can be physically and mentally painful.
“Once the withdrawal begins, the doctor will give them a little bit of Suboxone and observe how it’s working for the patient. Most patients eventually start to feel better and take two doses daily depending on how much they need, or how quickly they will go into withdrawal,” said Loretta, the OAT Medical Office Assistant.
“If someone uses while on Suboxone, it will kick the opioid out of that receptor, and you will go into severe withdrawals again. So, when some people go on Suboxone, you know they want to get off this stuff. It is not a cure-it-all, but it is effective.”
Clients used to start suboxone while in the office but now do it virtually. Clients can see the OAT physicians virtually which increased accessibility for some and computers at the OAT centre were available for those without access to technology.
Kadian is used if Methadone or Suboxone don’t work for patients. It is a slow-release morphine that helps counteract withdrawal symptoms and reduce cravings.
The toll of death on mental health
Losing clients to overdoses or other health conditions is an unfortunate reality in the centre’s work. Too often, their list of upcoming patient appointments shows a name in red, their code to mark that the client has passed away.
“It just hurts because these are people we talk to on a weekly basis, if not more, and it really has a big impact,” said Loretta, the OAT Medical Office Assistant.
One of the hardest cases for Loretta was Jimmy*, a 68-year-old whom she labeled as sweet and gentle. He was a long-term methadone user for pain management. Over COVID she helped him set up an email and referred him to other services so that he would stay connected.
“He called me all the time and told me everything that he was doing. Then he called me one day and said he was going in for surgery. After that I did not hear from him for a while, only to find out that he had passed away,” Loretta recounted.
As they work through the impact of overdoses and relapses, staff rely on each other to talk through their experiences.
“If I had one wish for our programs, it would be to have better support and more access to counseling for the counselors and the employees around what they have to deal with,” Lesley stated.
Causes of Substance Use
The causes of substance use and addiction are complex and interconnected. Lesley referenced author and physician Gabor Maté who teaches that we should not ask “why the addiction?” but rather ask “why the pain?” It is becoming increasingly understood that substance use often exists as self-medication for pain – physical, emotional, mental, or spiritual.
Some people with a substance use disorder have an undiagnosed mental health condition. Once their mental health condition is being addressed, they may no longer need to use substances.
Mental health and substance use often go hand-in-hand. Previously it was assumed that the substance use altered brain chemistry but now studies are showing that people prone to addiction already have disruptions in areas of their brain. Genetic, developmental, behavioral, social, and environmental factors can all contribute to making someone more prone to using substances and becoming addicted to them.
“Addiction happens. There are several reasons why someone may end up addicted but at the end of the day, it happens. And it crosses all barriers – age, race, socio-economic situation, profession, upbringing,” said Lesley.
“I have a few clients that were on oxys (oxycodone) because of surgeries or back injuries through work. When their prescription ended, the pain was still there. Suddenly someone says to them, ‘well, I can get you oxys.’ And you can guess how this story goes,’ said Lesley.
“Not all people that get hooked on oxys and opioids are people that are looking to get high. It is often because they are in pain. So, you can’t judge.”
Overcoming Substance Use
Why an individual ends up seeking help also depends on the person. Some of these reasons include being tired of their life and wanting a different way or aging which brings about fragility and health problems. And sometimes people find something worth living for like a child, relationship or new-found purpose.
“People are often in a low of their life. They’ve either had a couple of friends pass away because of an overdose, or they have obviously had something traumatic that has brought them into our centre to ask for help. Something has jarred them into seeking help,” shared Loretta.
“Once someone starts treatment, we can go from seeing them barely being able stay awake to being alert and starting to look like themselves within three days,” shared Margaret.
Treating the physical dependency with a safe alternative is only the first step and staff encourage clients to seek support in understanding what purpose the substance use serves in their life and how they can find safer ways to cope. The stability that prescribed medication can bring can allow clients the space to process the trauma in their past.
It is not uncommon for stress, a return to an old environment, or fresh trauma to lead to relapses or setbacks in treatment.
“You know, sometimes you’ll have people go through 15 treatment centres, and then suddenly, they are able to stay clean,” Lesley said.
“When you asked them about what was different this time, they’ll say, ‘I just made a decision.’ It’s all up in here,” she continued, gesturing to her head. “This is why we have to keep trying to help as there is always hope.”
“This place is amazing. So helpful. I’m doing better than I imagined and I owe it all to them.” OAT Centre Patient
Did you Know?
From April 2020 to March 31st, 2021, the OAT Centre saw 133 patients of who were treated with Suboxone, Kidian, or Methadone.
A Welcoming Face
Knowing just how much their patients may have lost due to their substance use – family, jobs, housing – the OAT team strives to create a welcoming culture and treating patients graciously.
“There is still such a stigma attached to substance use, but we treat it like any other health condition,” said Lesley. “Removing the stigma attached to substance use is critical because so many people would rather risk their lives than seek help.”
“They put up with me and accommodate to me and I appreciate it so much!”
OAT Centre Client
Even something as simple as locking the front door during COVID and asking clients to ring a doorbell can be a barrier. “Because if we miss the buzzer it reaffirms to them that nobody is paying attention to them. And we stand to lose them,’ Lesley elaborated.
“The shame that people feel around substance use can prevent them from seeking help and we know that just getting through our front door can be a huge step.”
As the opiate crisis shows no signs of stopping, the centre is advocating for increased funding to hire more doctors, counselors, and medical office assistants. Currently, three part-time physicians provide medical appointments four days a week leading to a waitlist for services.
“We have the tools to help people choose a different path but need more qualified professionals to deliver services,” said Lesley.
While the scale of the opiate and overdose crisis can be overwhelming, the OAT team focuses on serving each person who walks through their door.
“If I can make a difference for just one person and their family, it’s worth it,” said Margaret.