Earlier this month a $32 million investment into Ontario’s opioid crisis was announced. Camille Quenneville, CEO of the Canadian Mental Health Association (CMHA), Ontario Division announced “that 2020 was the worst year on record for opioid-related deaths. More than 2,400 died last year, a 60% increase from 2019”.

With this investment CMHA is encouraging the government to further support people and communities struggling with substance use issues. This article will explore Ontario’s Opioid Crisis and what is being done about it.

WHAT ARE OPIOIDS

Opioids are a broad collective of medications that relieve pain. These drugs interact with opioid receptors in your brain, spine, and other areas throughout the body. In essence, opioids tell your brain not to feel pain. These drugs are only available through prescription from your doctor and require management to ensure you are not taking too much, too often. Opioids include (but are not limited to:

  • Codeine
  • Fentanyl (Abstral, Actiq, Durgaesic, Fentora)
  • Hydrocodone (Zohydro, Hyingla, Lorcet, Lortab, Norco, Vicodin)
  • Hydromorphone (Dilaudid, Exalgo)
  • Methadone (Dolophine, Methadose)
  • Morphine (MS Contin, Morphabond)
  • Oxycodone (OxyContin, Oxaydo, Percocet)
  • Naloxone

SIDE EFFECTS OF OPIOIDS

Doctors need open communication with patients while they are being prescribed opioids. Side effects they are monitoring include:

  • Nausea and vomiting
  • Drowsiness
  • Constipation

Your doctor will also need to confirm all other medicines and supplements you are taking as some prescriptions such as sleeping pills, antibiotics, and antidepressants can cause serious, even fatal complications.

OPIOID TOLERANCE VS ADDICTION

After relying on opioid medications to relieve pain, many people’s tolerance levels increase. This means the patient requires more of the drug to feel relief. It is important to note that tolerance is not an addiction; however, it can lead to addiction.

When your body becomes use to opioid medication, the receptors in your brain and spine are dependent on its effects. This can lead to a patient experiencing withdrawal symptoms such as:

  • Anxiety
  • Diarrhea
  • Muscle pain
  • Nausea and vomiting

When a patient becomes addicted to opioid medications, they begin to compulsively seek out more. Many experience a change in behaviour which creates negative consequences in their professional and personal lives.

WHAT HAPPENS WHEN AN OPIOID ADDICTION GOES UNTREATED?

Unsupervised and chronic use of an opioid medication has several consequences. The drugs will change the patient's brain chemistry and have physical effects on the body as well. When patients are no longer prescribed the medication they face risks from withdrawal symptoms, injection and overdose. Specifically, the following is usually a result of an untreated opioid addiction.

CHANGES TO THE BRAIN INCLUDE:

  • Increased tolerance as your brain chemistry adapts.
  • Uncontrollable cravings.
  • Irritability and anxiety.

PHYSICAL SYMPTOMS INCLUDE

  • Muscle aches.
  • Fever and sweating.
  • Vomiting and Diarrhea.

RISKS FROM INJECTION INCLUDE:

  • Possibility of contracting hepatitis, HIV or other infectious diseases.
  • Scarred and collapsed veins.
  • Bacterial infections of the heart and bloodstream.
  • Unknowingly injecting other drugs such as heroin.

OTHER MEDICAL COMPLICATIONS INCLUDE:

  • Lungs and breathing slows/stops (this is considered an overdose).
  • The sexual health of a patient declines; men may experience erectile dysfunction and women develop irregular periods.
  • Cardiovascular events such as abnormal heart rate and heart attack.

WHY IS FENTANYL SUCH A BIG PROBLEM?

Fentanyl is usually dispensed by a physician through intravenous form. However, for chronic pain, it can be administered as a patch, worn on the body for the day.

Fentynal accounts for 87% of the 2,426 opioid-related deaths in Ontario, in 2020. This is because many people who are taking “street drugs” do not realize they are consuming fentanyl. Heroin is often laced with fentanyl, this increases profit for those selling heroin, however most people using it are unaware. The combination of heroin and fentanyl is incredibly dangerous, making it difficult for anyone to survive.

CAN OPIOIDS BE TAKEN SAFELY?

Opioids remain a safe medication as long as the patient and doctor are communicating; openly and honestly. The patient needs to relay their pain levels, and side effects to the doctor, so he/she can continue to treat their condition with care. Patients will significantly reduce their risk of side effects and addiction if they take the medication as prescribed.

There are some medical conditions that increase the risks of opioids including:

  • Anxiety or depression
  • Fibromyalgia
  • Obesity
  • Sleep apnea

Your doctor will also need to know about the patient's history of tobacco, alcohol, and other substances. A family history of substance use should be given to the doctor as well.

STEPS YOU CAN TAKE TO BETTER MANAGE YOUR MEDICATIONS

It may be comforting to know there are steps you can take to reduce your risk of complications or addiction.

  • Ensure all your doctors and health practitioners (including dentist, naturopath, etc) are aware of all the medications and supplements you are taking. This includes updating them as your medications change.
  • If possible, get all your medications from the same pharmacy. Pharmacies have a system in place that will warn pharmacists of potentially dangerous interactions.
  • Read the literature that comes with the medication. These are instructions for taking the medication, as well as information about side effects and actions to take in case of accidental ingestion or overdose. Keep in mind that instructions and side effects will change over time as we continue to learn about medications. That means it is important to reread the literature once-in-a-while.
  • Ensure the medication has not expired. Most medications lose their effectiveness after some time, making its effects unpredictable.
  • Report side effects right away. If you experience any of the above side effects (such as nausea, mood changes, confusion, constipation, etc) your doctor will need to know.

HOW TO HELP A LOVED ONE OVERCOME ADDICTION

If you start recognizing signs of addiction in a friend or family member you can offer support. Some common signs that your loved one has a problem include:

  • Neglecting responsibility at home, work or school.
  • Binging or consuming more of the medication than intended.
  • Lying about consumption.
  • Not remembering what they said or did while under its influence.
  • Continuing to over-consume, even after loved ones have expressed concern.

Initiating a conversation about addiction is not easy. It helps to prepare yourself for a number of possible reactions including anger and denial. Sometimes it is tempting to use their reaction as a reason to avoid the discussion, however, their use of substances is not likely to get better on its own.

Be honest when expressing your concerns. Be honest with yourself too by going into the conversation with a firm understanding that you cannot force someone to quit their addiction. As difficult as it is to watch, in the end, the choice to stop consuming is up to them.

It is understandable to feel sensitive during this. Attempting to appeal to the emotions of your loved one though, is often fleeting. You wouldn’t be the first to fall into the trap of thinking: “if I yell enough / cry enough / threaten enough, then they’ll stop. “What did I do wrong” is a question many supporting family members eventually ask themselves. These thoughts and exclamations do not end the addiction though, instead, your loved one will usually make false promises to satisfy your needs. This has, for many, become an endless cycle of hope, disappointment, and frustration.

Please do not be hard on yourself during this time. When a loved one develops substance use issues, communication is important but difficult. Being a source of emotional support and comfort should be your goal.

WHAT IS BEING DONE ABOUT THE OPIOID CRISIS?

The CMHA is calling for more harm reduction services. This includes a safer opioid supply. As Camillle Quenneville, CEO of the Ontario Division of the CMHA says “Harm reduction is an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with substance use”. Harm reduction includes low-barrier access to naloxone, as well as safe consumption sites, outpatient counselling and support.

Naloxone is a medication that helps to reverse an opioid overdose. Many pharmacies provide free nasal spray and injectable naloxone kits (no prescription is required). The CMHA has also developed an opioid overdose kit that provides information about opioids and how to access naloxone.

The $32 million investment will also hopefully allow the provincial government to increase the number of consumption and treatment services in the province. There are currently 21. These sites have been proven to prevent overdoses and death, while also offering connections to other support services.