But what about the indirect role of overprescribing opioids? You know, the stories we’ve all heard about: a doctor prescribes opioids to a patient who becomes addicted, then cuts the patient off, forcing the patient to seek out dangerous street drugs. That’s where I heard some different views.
“I’m sure you could find testimonials in a lot of newspapers of a person who had a leg injury and then their doctor gave them drugs and they liked the drugs and now they continue with drugs and now they’re living in the Downtown Eastside,” said Dr. Mark Tyndall. “I mean there are potential stories about that, but it’s highly unusual, and [with] most of those people, there’s probably other factors involved in why they ended up that way.”
But other medical experts I talked to in BC weren’t quite as categorical.
“We hear a lot in the media about people becoming prescription opioid addicted initially—and there’s a case in the Victoria Times Colonist newspaper this weekend of a young person, a high school student I think was 16 years old, who had multiple surgeries in the last year and then became prescription opioid addicted,” said Dr. Evan Wood. “Then, as they’re not able to get prescription opioids, turning to other drug use. So there’s that pathway for sure. I think that’s very common in the United States, where the overprescription of opioids was a huge issue. Canada is number two in the world, second only after the States in terms of prescription opiate prescribing. So there’s certainly that pattern of use.”
The news story that Dr. Wood was talking about concerned 16-year-old Elliot Eurchuk, who’d been injured playing sports and underwent four surgeries for sports-related injuries. Against his parents’ wishes, Elliot was prescribed opioids for the pain. They were reportedly told that he was old enough to make his own treatment decisions. Elliot was subsequently expelled from high school for using drugs. On the morning of April 20, 2018, his parents found him in his bedroom; tragically, he had died from a drug overdose. The BC Coroners Service is investigating his death.
“Then there’s the pattern of use where people become addicted to street opioids, whether that be counterfeit pills, heroin, fentanyl, or other opioids that people are becoming addicted to on the streets,” said Dr. Wood. “I think it’s multifactorial, but they’re certainly the two big pathways I think are getting people addicted.”
Preliminary data from a study by the BC Centre for Disease Control found that people who overdosed were more likely to have been on long-term prescribed opioids for pain than the average person, but that at the time of their illicit drug overdose most did not have an active prescription. Indeed, people who use drugs and activists are adamant that some doctors are contributing to the opioid crisis by cutting off people who’ve become addicted to prescribed opioids and who then end up turning to street drugs.
“We’ve been sitting with people who, a year ago, had a home. They got cut off their prescriptions and went to the illicit market and have now faced I can’t even remember how many overdoses just in a matter of months,” said a representative of Pivot Legal Society, a legal advocacy organization that’s litigated cases all the way to the Supreme Court of Canada. “And they’re now in the criminal justice system—someone who is struggling with cancer, was cut off his pain medication, and is now using on the illicit market. These are extremely real things.”
“The drug manufacturers—some of their practices in pushing this stuff to people were exploitative and very aggressive,” said Westfall, who himself used illicit opioids for several years and now represents thousands of people who use drugs across Canada.
There’s been a big push for doctors to tighten up their prescribing practices around opioids. Studies have also come out recently that question whether less addictive alternatives could do an equal job of providing pain relief. That may make sense for people who aren’t yet addicted to opioids, prescribed or otherwise. But what about those who are already using prescribed opioids and have become addicted? A blunt crackdown on them could backfire, running the obvious risk that those patients may resort to toxic street drugs instead.
“Pharmaceutical drugs are sort of drying up,” said Westfall. “More people are just turning to fentanyl or street heroin.” As surprising as his claim was to me, I would soon learn that the opioid crisis was affecting people from all walks of life—including those whom you’d least expect to use illicit drugs.
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WHY DO PEOPLE START USING? WHY CAN’T THEY STOP?
Buddhist teacher, yoga instructor, father, opioid user.
To the outside world, Michael Stone was the last person you’d think would become a casualty in the opioid crisis. The renowned Zen Buddhist teacher and charismatic yoga instructor led retreats and workshops across Canada and internationally. He spoke at TEDx Toronto and authored books like Yoga for a World Out of Balance and Freeing the Body, Freeing the Mind. He even created a guided meditation app.
“The majority of people who study with me don’t consider themselves to be spiritual,” wrote Michael. “I help them decrease stress and anxiety, decrease reactivity, quiet the mind, increase contentment, foster embodiment, live healthily, and to enjoy well-being.”
The forty-two-year-old lived with his wife, Carina, and their two children on idyllic Pender Island in British Columbia’s picturesque Southern Gulf Islands. He had a child from another relationship as well. Michael also lived with bipolar disorder. Although he’d experimented with psychedelic drugs in his teens and early twenties, he instead came to rely on his practice and self-care for relief: meditation, exercise, early to bed, special diets. He was getting help from naturopaths, herbalists, personal trainers, and therapists. However, as things became increasingly difficult for him to manage, he sought help from a psychiatrist and eventually went on medication. When that didn’t seem enough to stabilize him, the prescribed dosage was increased.
“Now and then he would mention a wish for a safe, non-addictive prescribed natural form of opium,” explained Carina. “He thought it might calm his overactive mind. Unbeknownst to everybody, he was growing more desperate.”
Carina was pregnant with their third child on July 13, 2017, when Michael left for a quick, routine trip to Victoria on nearby Vancouver Island. He never returned home. Using his cell phone call log, Michael’s family has tried to piece together what happened on his last day.
“On the way into town he called a substance abuse and addictions pharmacy, likely to ask for a safe, controlled drug to self-medicate. He was not a candidate. He got a haircut, exercised, ran household errands, and finally acquired a street drug.”
When Michael didn’t return home that night, Carina called the RCMP to file a missing person report. Around midnight, the police found Michael unconscious in his vehicle. Paramedics administered multiple doses of naloxone and intubated him. He was pronounced dead at 1:30 a.m. The coroner’s investigation found that he’d died of acute fentanyl toxicity caused by an unintentional illicit substance overdose. He was kept on life support for two more days, with Carina at his bedside, so that his organs could be donated.
Out of this tragedy, his children were left without a dad and Carina was widowed, but three other people got a new lease on life because of Michael’s organ donation. A week after his death, a GoFundMe page was launched to support Carina and her children, raising over $130,000.
“It may be hard to put one’s mind into his, to imagine how he could take such a risk with a young family, baby on the way, with such a full life and such fortune. Rather than feel the shame and tragedy of it, can we find questions? What was he feeling? How was he coping?
“What can we do for ourselves and others who have impulses or behaviours we cannot understand? Impulses that scare us and silence us? How can we take care of each other?” asked Carina.
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Michael Stone is one of thousands of people who have died from illicit drug overdoses. Each of them has left friends, fa
mily, and loved ones behind. Who exactly is using illicit opioids, and why?
“It’s across the board,” said Leslie McBain, co-founder of Moms Stop the Harm. “[From] families in poverty and traumatized and their kids end up on the Downtown Eastside to every single socioeconomic strata there is. There’s the families of professionals, the lawyers, the doctors. People that are living in communities all across Canada. It can be anyone’s child. It’s in every corner.”
In BC, the vast majority of illicit drug overdose deaths are men (82%), and 90% of victims were between 19 and 59 years old (with 30- to 49-year-olds disproportionately affected). Of those who have recently died from an illicit drug overdose, 80% had a pattern of daily or regular illicit drug use; 9% used illicit drugs occasionally (on weekends or once a month); and 1% had no evidence of illicit drug use in the last year. In the remainder of cases it wasn’t possible to determine the frequency of drug use.
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Where are these overdose deaths happening?
“People are dying primarily because they’ve been using substances indoors, using alone, often unable to summon help because if they’re using alone they don’t have somebody there to administer naloxone or call 911 if they get a bad batch,” said Andy Watson with the BC Coroners Service. “Really, this is driving home the fact that we have a toxic drug supply.”
Data from the Coroners Service defies the popular myth that the overdose crisis is exclusively about homeless street-drug users overdosing in places like Vancouver’s Downtown Eastside: only 9% of illicit drug overdose deaths were officially homeless people. Still, many other overdose deaths also occurred in such precarious housing locations as shelters and single room occupancy (SRO) facilities. As a result, much of the response to the opioid crisis has been targeted to these impoverished areas, leading to significant improvements in rates of surviving an overdose. According to Vancouver Fire Chief Darrell Reid, if someone overdoses from illicit drugs in a private residence outside of Vancouver’s Downtown Eastside, their chances of dying are three times greater than if they overdosed within that area.
In BC in 2017, 59% of illicit drug overdose deaths occurred in private residences, 25% in other residences (e.g., hotels, motels, rooming houses, shelters), 12% outdoors (e.g., streets, vehicles, sidewalks, parking lots, public parks, wooded areas), and the remainder of cases in other locations, such as inside public buildings and businesses. More than half (52%) of illicit drug overdose deaths involved people using alone, and that number is rising.
“I think many people didn’t realize the extent to which broad segments of the population were using illicit opioids, but now we know about it, because we see them dying and it’s really challenging to get control of it,” said Chris Buchner with Fraser Health.
Buchner was an HIV/AIDS activist in the 1980s and 1990s. He earned his social work degree and then a master’s degree in health administration. He’s been at the forefront of efforts in BC to stop the spread of communicable diseases and reduce the health risks faced by people who use drugs. And although Buchner helps lead the health authority’s response to the opioid crisis from within the system, his urgency and tone showed me that he hasn’t lost the voice of a passionate advocate. That’s just what is needed most right now.
“There are a large number of people who are employed, have stable lives, relatively stable housing situations, [but] who are dependent on illegal opioids,” explained Buchner. “That didn’t become noticeable because, you know, [with] opioids, if they’re not poisoned and people can predict and understand what’s there, the worst thing that can often typically happen to someone is that they get constipated or they get drowsy.”
However, with an inconsistently tainted street drug supply, people don’t know what they’re getting, or its potency. That results in a greater risk of an overdose, which can be fatal if the person is using alone or the people that they’re with don’t know what to do. So why are so many people using illicit drugs alone, where the risk of dying from an overdose is so much greater?
“The big challenge now is stigma,” said Dr. Bonnie Henry, BC’s chief medical officer, whose predecessor declared the opioid crisis a public health emergency. “People are using alone, and most of them, they have family, they have friends who often don’t even know what they’re using, and so it’s all about shame and about stigma and about how to have conversations.
“This is not ‘those addicts,’ ” she continued. “This is your brother, your uncle, your sister, your mother, and father. You think about why people use street drugs, and a lot of it has to do with pain, whether it’s psychological, emotional, or physical pain that gets people into it.” (Two other reasons focus groups have found for why illicit drug users are using alone are their belief that they can “handle it” by themselves and an unwillingness to share their drugs.)
“It could be your neighbour,” said Dr. Ronald Joe, medical director for substance use services at Vancouver Coastal Health. “They’re occurring throughout Vancouver. The initial indicators are that this is a group that’s isolated, socially isolated, who don’t have or who have difficulty in accessing healthcare services. Many have concurrent mental health issues. So [these are] people who don’t feel they can reach out for help.”
“This is highly prevalent in different areas in society and now across socioeconomic boundaries, more than I think at least historical views and presumptions would lead us to believe,” said Dr. Evan Wood.
In terms of professions, some experts have identified young men working in the trades as a group that’s seen a sizable share of illicit opioid overdose deaths. “Stereotypically, if you’re a male between the ages of 20 and 35 and you work in the trades industry and you’ve suffered an injury and you’re no longer on prescription meds, you have a higher risk of using fentanyl,” said Dwayne McDonald, assistant commissioner and officer in charge of the RCMP Surrey detachment. “We’ve seen that.”
“We identified that the trades were disproportionately represented in terms of overdoses and overdose deaths,” said Buchner’s colleague Dr. Aamir Bharmal, who is the medical health officer and medical director of communicable diseases and harm reduction with Fraser Health. “I think it’s the fact that the trades are a large employer. We know that the trades employ a lot of men who are younger and potentially within this age demographic category. Then there’s also those pieces around the injury and potentially that pathway as well.”
Dr. Paul Hasselback, a medical health officer for central Vancouver Island, has another view: “We tend to see an overrepresentation of occupations that don’t require criminal record checks. They’re long-term, experienced users,” he told me. It seems the jury is still out on the reasons why the trades are coming up more often in overdose death statistics.
I was surprised to learn about another group of people who are turning to illicit drugs: professional first responders, including police officers and paramedics.
“Those first responders that have had an injury and they’ve been given medication, they become addicted without knowing,” said Carolyn Sinclair. “I would say 99% of them said, ‘Well, they just told me to take these pills. They’d make me better. I didn’t ask if I was going to get addicted to it.’ Then they want to go back to work or they’re told, ‘Okay. You’re all better now.’ Well, in that line of work, there’s certain medications you can’t take and be at work. So you stop cold turkey. Now you have no more medication.
“You still may have problems, but you want to get back to work and you’re struggling, because you’re dealing with the addiction that you may not even have identified as such yet,” Sinclair continued. “You can’t go back to the doctor and get the medicine. So, they buy it in the places they work. Now they’re getting other types of drugs. For some of them it’s a huge problem.”
What Sinclair was describing was shocking and tragic at the same time. Some of the very same professional
s who are responding to illicit drug overdose calls are themselves using those street drugs. This crisis really does have no boundaries.
Heartbreakingly, many people who die from an illicit drug overdose were using secretly and died while a family member, friend, or roommate was at home, perhaps as close as the next room. But because those people had no idea the person was using illicit drugs, or thought they’d stopped using, they didn’t know help was needed—until it was too late. Even people who experiment or are occasional drug users are at risk.
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There’s no better time to get married in the Okanagan than late September. After all, this region in the BC Interior, home to world-class wineries and organic orchards, is too scorching hot in the summer to wear a tuxedo. The crystal-clear waters of Lake Okanagan tempt you to jump in just to cool off.
On September 26, 2016, 27-year-old Edmond Paul Adkin was attending a wedding at a hotel in Kelowna—a city on Lake Okanagan just north of towns with such blissful names as Summerland and Peachland. Adkin was an active guy who played lacrosse and hockey as a kid and then rugby in high school, and had recently started playing golf. He’d worked in construction for several years and had just started working for an investment management firm. He had a girlfriend, Talyn.
At 11 o’clock the evening of the wedding reception, members of the wedding party and one of his family members found Adkin unresponsive in a hotel room. He wasn’t alone: four other people were in the same room in various states of unconsciousness. An off-duty nurse who happened to be at the wedding quickly came and started CPR on Adkin. Paramedics arrived a few minutes later; they gave naloxone to the five people in distress before taking them to Kelowna General Hospital.
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