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Opioid Overload: Identifying the problem (part 1 of 4)

Waterloo Region is not immune to the nationwide problem of fentanyl in the community
File photo. The CTS site for Kitchener at 150 Duke Street West. Ben Eppel/KitchenerToday

The solution to any problem is first realizing that there is a problem to begin with.

That is no exception when it comes to the opioid crisis that has plagued all of Canada.

Waterloo Region is not and has not been immune to the side effects of the issue of trafficked fentanyl and carfentanyl.

Some of those side effects include overdoses and some of those overdoses include death.

In 2017, 801 overdose calls, 853 in 2018 and in 2019 we're on pace to exceed those numbers.

A solution to help combat overdose deaths is the Consumption and Treatment Services (CTS) Sites.

At one point though, they were called a Safe Consumption Site or a Safe Injection Site as it is in other provinces across Canada.

CTS sites were first introduced in BC after the opioid issue got out of hand, before it spread to other parts of the country.

To date there are several across Ontario, Alberta, BC and all across North America, but there are none in Waterloo Region.

Kitchener will have a site up and running in the near future and Cambridge is still looking for a site to put their site, should they follow through with the plan to erect one.

Though, what exactly is a CTS site?

Grace Birmingham is the Manager of Harm Reduction for Waterloo Region. 

She describes some of the services it might provide in addition to what her role is for the region.

"We're responsible for all things harm reduction. We're responsible for limiting the impacts of substance abuse across our region. We also run a needle syringe program to help people out as we've been running for 20 years."

A CTS also provides clinical services where people can get access to clean equipment. 

In addition, they can get access to STI testing, immunization and that type of thing where people from that population may not go to a hospital or doctors clinic to obtain due to various reasons.

This includes getting access to naloxone, a type of drug that helps reverse the overdose effects of opioids.

The site would become a gateway to the healthcare system and other services for those who are active drug users.

According to Birmingham, most harm reduction services are built on a foundation of successful relationships and trust.

"And for clients who aren't willing to access traditional health services, that trust will ensure and help build a willingness for other services that they may need. 

The CTS would provide access for treatment for any particular infections. 

Birmingham explains that not only does it provide health services, but let's just say someone who is in need, needs an ID. 

They might not be able to access the similar routes to get said ID as you normally would. 

Like a passport for example or any sort of identification card. 

A CTS site would also be a gateway for those who would need those types of excess services.

Though, 2019 is not the first time we've heard about the issue of overdoses throughout communities. 

It's been an issue for years, first identified by Michael Parkinson with the Waterloo Region Crime Prevention Council back in 2006.

He says there was a revolving door between the criminal justice systems and the health system back then.

"We identified prescription opioids as a leading cause of death back in 2008. We produced the first scale and typology of the problem. We did research on naloxone and make it be made available along with real time overdose monitoring. That recommendation was made because of the concern of the bootleg fentanyls would land here one day and would manifest themselves as clusters of overdoses in the community."

According to Parkinson, opioids were being prescribed in Ontario and were becoming a part of the issue, which began what he equates to alcohol prohibition when it comes to this crisis.

He got together with colleagues in Vancouver and Guelph back in 2012, created and presented a mixed community forum on the risks of opioids in a community and what it could mean for both the region and possibly the country. 

They shared their initial report they put together from the appropriate stakeholders. 

The report itself said opioid overdoses will increase and the drugs will become more dangerous in addition to other factors. 

"Watch out for doctors who just shift and prescribe a different opioid. The report made the same recommendations, many of which were unfulfilled today. There was naloxone expansion at the time and rapid access to addiction treatment. Combating stigma was also a part of it and outright discrimination. So what the community told us in 2012 has absolutely come to pass."

At the end of the report, he called opioids, and more specifically the fentanyls, a threat to public health and public safety.

By 2016, Parkinson along with colleagues issued a second advisory after their first report in 2012.

At the time there was no overdose data and nothing to point to the fentanyls. 

Now bootleg fentanyls are seemingly responsible for the continuous increase in overdose related deaths.

"It was less about hydromorphone and other prescription opioids and mostly about the bootleg fentanyls. Most of those overdoses were accidental and most of those overdose are occurring among people who don't have the protective factors that most of us enjoy. For example, income and employment. We have watched this crisis unfold and it has taken its toll. Not just on families and friends who are left behind, but people who are in direct service as well. For years now, they struggle with daily grief, trauma and burnout, yet they're our best assets in this journey to combat what is most likely the most significant health crisis since the Spanish Flu." 

Shortly after these reports, the design and schematics of what a CTS would bring would come to fruition, largely lead by those in Lower Mainland British Columbia, one of the hardest hitting communities of the opioid crisis.

Parkinson said they've consulted with those who would use or want these sites.

They consulted with youth as young as 13 to see why they use to begin with. 

Some common themes is that drugs were accessible and were used to cope. 

Mainly to cope for those who feel oppressed or used by adults in their lives.

To put it into a conclusion, Parkinson says there has been solutions in the past, but the solutions have been temporary as the funding has dried up.

He calls it a failure of the system.

That governments seem to be the last to know about anything. 

It wasn't up until 2017 Health Canada wasn't counting the dead from drug related overdoses and there was only one supervised injected site in Canada.

"After SARS hit in Canada, there were a number of expensive reports and committees that were established along with recommendations that were made. Of those recommendations was to remove the politics out of health. Though we haven't seen a proportional response to deal with the opioid overdose crisis as we saw with SARS or even a basic contamination issue with food, or influenza. People are pointing to structural discrimination and stigmatization."

It seems like communities are playing catch-up now with constant improvements in treatment services and harm reduction services, including the implementation of a CTS site, which has already been erected in many communities across Canada.

Listen for the four part series - "Opioid Overload" - all this week on 570 NEWS.

You can also listen below:


Brandon Graziano

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