Understanding substance abuse

BY TAYLOR PACE

A father walks through the door of the safe injection site in Toronto pushing a stroller with a toddler inside. He is here to use. This sight initially shocks Darryl Gebien, who is there as an observer.

But the shock quickly disappears when he realizes the alternative: a father dosing alone, potentially nodding off and overdosing; potentially leaving a child unattended.

“What would be the alternative for this guy? He’s going to use, and he’s smart enough and had the guts to go into the SIS (safe injection site) with a young child where it’s safe. If he does nod off and pass out, his toddler has somebody to keep an eye out for his dad. The alternative is just horrifying,” he said.

The opioid epidemic has been dominating news headlines across Canada for the last year, and Waterloo Region is no exception.

The region has been weighing the pros and cons of implementing safe injection sites by visiting active sites in the province and considering public opinion.

On April 10, the region voted unanimously to begin evaluating potential locations for the safe injection sites. A report is expected in May.

Studies show these sites do not increase crime rates or drug-related litter, and in 2015 the neighbourhood surrounding Vancouver’s safe injection site saw a 25 per cent decline in overdose deaths.

This is a significant number, considering paramedics in Waterloo Region responded to over 700 suspected opioid overdose calls last year alone.

While statistics show many members of the community support the implementation, there is still significant pushback from community members, primarily because of concerns for public safety.

But Gebien, a non-practising health-care professional in long term recovery for a near fatal fentanyl addiction, believes the public safety concern surrounding safe injection sites is unmerited.

“It’s not like people congregate there,” he said. “These are not people who are going to engage in organized crime. They just want to be alone with their drugs, they don’t want to hurt people. They just simply want to be safe and have a place where they can be undisturbed.”

Gebien started using drugs in 2008 when he was prescribed Percocet for back pain.

“I woke up one day, I slept on the couch funny and I woke up with excruciating back pain.” He said he was using it properly at first, but a year later he took some out of curiosity when he wasn’t experiencing pain, while having beers with his friends. “I look back and go, ‘that was an awful decision.’ I should have known better.

“I started relying more and more on the Percocets to numb both the back pain and emotional pain. I didn’t realize I was addicted to it until years later when I didn’t take it for about 24 hours, and I felt withdrawal; I felt very ill and irritable, and it went away the second I took another Percocet.”

He is not alone. A local lawyer, who will be called Joan Smith to protect her identity, started using opiates recreationally when she was 22. She said addiction can sneak up on you.

“I was in denial about the problems my use was causing for the first several months. It wasn’t until I experienced withdrawal for the first time that I realized the trouble I was in. My life hasn’t been the same ever since. There’s a saying that when you can quit, you don’t want to and when you want to quit, you can’t,” she said.

Growing up, Smith’s upper-class family lived in one of the richest cities in Ontario. She had what she said was an ideal childhood. “I got straight As and graduated high school at the age of 15, then went on to university and graduated on the honour roll. I was naive and used to think that people like me didn’t get addicted.

“I don’t live on the street or steal to pay for drugs. I have my own apartment and a good job. If you passed me on the street you would never guess I was an injection drug user,” she said.

She suffers from mental illnesses and turned to drugs to cope with the pain. “Addiction isn’t about getting high – it’s about reducing suffering.”

She also noted the argument for rehabilitation services instead of safe injection sites is unrealistic. The rehab system is a broken record with its 12-step sobriety program, and needs to be improved upon. A start, she said, would be by employing actual therapists and doctors, rather than just former addicts.

“Relapse rates are high and addicts are at their most vulnerable when leaving detox or rehab because their lowered tolerance increases their risk of overdose.

“Improving the current system will take a lot more time and money, neither of which we have right now. We need to do something immediately to stop people from dying. The first step to treatment is keeping people alive,” she said.
Gebien agrees, and said that he almost died from resuming his previous dosing after abstaining.

But, he said, “(Safe injection sites) are not powerful enough on their own. The problem is right now people have reached their bottom and finally want help, and have to wait for a bed. With any other medical condition, a person gets prompt treatment. With addiction, people have to wait three to six months, and during that time they’re at high risk to overdose.”

Gebien believes harm reduction should be multifaceted with both opioid replacement therapy and safe injection sites, adding he thinks opioid replacement therapy is the most effective form of harm reduction.

“For every one person who’s using a safe injection site, there are 100 more that are snorting crushed up Percocets or they’re burning fentanyl patches. So there’s a lot more users who are functional in society, and you could help a lot more people by providing opioid replacement therapy (such as methadone or suboxone).”

Methadone is the method local resident John Lavergne, a recovering substance abuser, has been using, although he is a strong advocate for safe injection sites.

“If somebody’s end game is to get clean, great. It gives them access to opioid replacement therapies or social workers or whatever to take the next step forward, while keeping them from dying in the street,” he said.

He said in addition to giving drug users access to counselling and opioid replacement therapy, the sites would give drug users access to health care, which can be difficult for users to access in the first place.

“Not a lot of people realize your doctor can fire you, so it’s really hard for people who use drugs to get GPs because if they’re honest with their doctors, very often their doctors will be like, ‘I don’t want to deal with this person, because it’s too complicated.’”
Gebien said before he started using, as a health-care professional he was guilty of stigmatizing users as well.

“When someone identified as a chronic drug user in the emergency room, they would get second class treatment. That needs to change, there’s no room for judgement,” he said.

Lavergne said the stigma can be crippling. He mentioned a friend, one of many, who died of an unintentional fentanyl overdose.

“His mom found him in the bathroom. He’d been using drugs for maybe three years. His parents had no idea. He held a (regular) job, he worked at the same place as his mom. He was by all counts a good, normal kid, who also maintained a drug habit quietly. There’s an awful lot of people like that.

“People can’t be open with their parents, with health-care professionals, because of that judgement. And these are the places where that really matters. You should be able to go to your family and say ‘I have a problem and I need help and support,’ or to your doctor, but instead because of the stigma and judgement, people end up dying alone in bathrooms.”

So for Lavergne, and many others, the safe injection sites are about keeping people alive.

“It’s not going to ruin downtown. People have stigma-based fears,” he said.

Wilfrid Laurier student Ana Mrazovac has been involved in a study that aims to find the root of these fears. Titled Public Knowledge of and Support for Safe Injection Sites in a Metropolitan, it started as part of an anthology for school, but is now something the students are conducting on their own time in hopes of understanding public opinion on safe injection sites.

“I think right now it is the only intervention that we see actually saving lives. Of course there has to be a better solution that would target the root problems and stop it from happening in general, but that’s not an attainable goal at the moment. But if you’re not going to try to get to the root of the cause (immediately), you still have to do something to help them,” she said.

The study was conducted in Kitchener and Waterloo by interviewing the public to understand how much they know about safe injection sites and to get their opinion on them.

“The problem is increasing in these smaller cities and it’s not getting any better, so I hope our study will help that,” Mrazovac said.

The study is so far inconclusive as to whether a lack of support for safe injection sites stems from stigma or lack of information, but a second study is being conducted, which will also include Cambridge, which she hopes will clarify the reason for push back.
The students interviewed over 300 citizens, with just over 75 per cent agreeing with the implementation of safe injection sites in Kitchener-Waterloo.

However, Mrazovac noted those against safe injection sites are likely not as vocal because it would be considered the unpopular opinion.

“Those people who are saying that we need more intervention and rehab facilities, as opposed to these sites where (substance users) can just go and use their needles, well, you still need to get them to come to these facilities and you can’t do it by force. A lot of them don’t want to get help because it soothes the pain; they’re in a lot of emotional, sometimes physical pain as well, it’s a pain alleviator, even though it’s not the most traditional way,” she said.

Safe injection sites are also cost-efficient despite what many think.

“With reductions and the number of people needing to be revived, there are health savings to the health sector. Not having to revive someone, keeping them alive, saves so much money. It keeps (hospitals) from having to have a hospital bed for them, which means they have a hospital bed for someone else. With all the recent evidence and continuing studies being done, it seems to have positives from economic sides and for the individuals and for society. I think the positives at the moment are outweighing all the negatives,” she said.

Mrazovac said adverse childhood experiences, or ACEs, often play a large role in addiction, meaning substance users are often exposed to traumatic experiences at a young age, such as abuse, neglect and troubled households, which leads them down the path of substance abuse.

“A lot of these people who have addictions have so many ACEs. If you’re empathetic to them in any way, you can see they didn’t choose the lifestyle they have a lot of the time. It’s wrong to continue to penalize them for something they didn’t really have a choice in in the beginning,” she said.

Smith said, “If we were losing this many people from the flu, car accidents or homicides, the community would be outraged and something would have been done ages ago, but people don’t seem to care about addiction until it affects someone they know.

“Addicts are human beings, just like everyone else. They are someone’s child, parent, sibling, friend, co-worker. We didn’t choose this lifestyle. We want to lead happy, healthy, normal lives but somewhere along the way we got lost and we need help to get ourselves out of this mess,” she said.

Lavergne said, “At this point in the opioid crisis, everybody knows somebody who is strung out, whether they know it or not. Everyone’s got a family member, someone they love, somebody in their world, who has a habit and they just don’t realize it yet.”