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Addicted in the city

A look at opiate addictions and what is being done to target it

One of the drugs most commonly seen by Celia Triemstra, the harm reduction coordinator at the AIDS Committee of Durham, as being used among the group's clients is hydromorphone, a pain medication derived from morphine and is typically used for moderate to severe pain, seen here in pill form. This drug can be taken in numerous different ways, including via injection.

One of the drugs most commonly seen by Celia Triemstra, the harm reduction coordinator at the AIDS Committee of Durham, as being used among the group’s clients is hydromorphone, a pain medication derived from morphine and is typically used for moderate to severe pain, seen here in pill form. This drug can be taken in numerous different ways, including via injection. (Photos by Graeme McNaughton/The Oshawa Express)

By Graeme McNaughton/The Oshawa Express

When Ashley Johnston, a student in Durham College’s addictions and mental health program, started her placement in the AIDS Committee of Durham Region’s harm reduction program, she thought she was going to see people addicted to drugs like heroin and crack. Instead, many were hooked on pain medication.

“I expected to see those hard drugs, but the people that come in are asking for supplies for opiate use, and it’s just things for pains and to kind of numb away what they’re going through. I would expect to see a lot of harder things, but you actually don’t see those things you’d expect to see, like the crack and the heroin,” she says.

“A lot of clients are misusing these drugs because it helps with the pain. It’s anything to get the pain away.”

Johnston is working on the front line of the committee’s needle exchange program, which is run in partnership with the John Howard Society and the Region of Durham. For the program, drug users can drop off used needles and pick up clean ones. Users can also pick up the wire mesh and glass stems needed for smoking crack cocaine.

The goal of the program is to not only keep these drug users safe, but to help keep the community safer and cleaner as well.

“What I tell people is that regardless of whether we have this program or not, people are going to use. If there was a way to get people to stop using substances all together, then that would be wonderful and it would’ve been done by now, but people are going to keep using,” says Celia Triemstra, the committees harm reduction coordinator.

“Not only are we trying to prevent the prevalence of HIV transmission through the injection drug use community, but we’re also trying to keep the streets a little cleaner. By providing the ability to return needles and providing them with new supplies, we’re preventing that transmission of blood-borne illnesses and also providing a way to return needles they were previously throwing in the garbage or throwing down sewer drains or leaving in the park.”

And while some needles don’t find their way back to the AIDS Committee – a recent post on the committee’s Facebook page indicating several were left under a bridge on John Street late last month – a vast majority find their way back.

“One of the things we strive for is to get as many returns as we give out. Overall for the exchange, it’s 92 per cent. We do take needles back and our return rate is pretty high, we’re trying to keep them out of the streets and out of the sewers.”

According to a 2014 study by the Public Health Agency of Canada, approximately one in five new HIV/AIDS cases in Canada each year come as a result of intravenous drug use. That number can go significantly higher depending on which province is being looked at, with the rate as high as 74 per cent in Saskatchewan and as low as 10 per cent in Ontario.

As for what it is that people are putting in their veins, Triemstra says the answer is pretty clear: opiates.

“Opiates are a huge one. A lot of Dilaudid, heroin has been making a bit of a comeback, and then there’s the occasional oxys and percs and hydromorphs,” she says, referring to the brand name for hydromorphine, a pain medication derived from morphine.

Johnston says that, based on the people she sees coming to exchange needles day in and day out, many are dealing with physical pain that they feel only the drugs can address.

“I have people that are in severe pain come in here on a daily basis and these means of harms reduction is actually what helps them cope with the pain they’re going through on a day-to-day basis,” she says.

“Some of these people aren’t necessarily addicted to the drug, but they’re addicted to the pain relief and they’re addicted to the needle. They’re addicted to the behaviour and the routine of preparing it all. But the biggest thing I’ve seen that’s kind of surprising is how many people rely on these things to help them on a day-to-day basis and function without pain.”

Ashley Johnston, left, a student in Durham College's addictions and mental health program, and Celia Triemstra, the AIDS Committee of Durham Region's harm reduction coordinator, are among those working in a region-wide needle exchange program. A 2014 study by the Public Health Agency of Canada found that as many as one in five new HIV/AIDS cases every year in Canada stems from intravenous drug use. (Photo by Graeme McNaughton/The Oshawa Express)

Ashley Johnston, left, a student in Durham College’s addictions and mental health program, and Celia Triemstra, the AIDS Committee of Durham Region’s harm reduction coordinator, are among those working in a region-wide needle exchange program. A 2014 study by the Public Health Agency of Canada found that as many as one in five new HIV/AIDS cases every year in Canada stems from intravenous drug use.

Needle exchanges, drug use on the rise

The AIDS Committee, along with its partners in the needle exchange program, has seen an explosion in the amount of drugs being exchanged since it was first created.

According to a report from the regional health department, the needle exchange program has seen explosive growth since it was started in 1997, when it gave out 6,017 clean needles and took in 6,254. In 2015, the program saw 538,984 clean needles given out and 473,654 needles taken in, marking a 90-time increase in the past 23 years.

Triemstra says this massive increase for exchanged needles can be attributed to a mix of higher usage, but also due to more people becoming aware of the program.

“It’s a combination,” she says.

“There might be more use in the region, but also the awareness of it is becoming more known in the community. And people are becoming more comfortable accessing these services through either John Howard or Pinewood or here.”

The regional health department report does indicate that Durham has seen a growing number of patients in one of Ontario’s public drug programs being prescribed opiates, with a 36 per cent increase for those aged 15 through 64 from the 2006-2010 period and 2011-2013 period. These programs are available through the province and cover most of the cost of prescription drugs for those who qualify, including those receiving Ontario Works payments or disability support, and for those aged 65 and up.

And with those growing levels of drug prescriptions have come a growing number of related hospital visits and deaths. According to that same report, there were 228 visits to emergency rooms in Durham Region as a result of drug misuse. By 2015, that number was 440. Between 2005 and 2014, there was an average of 28 deaths per year as a result of drug toxicity.

As for why these numbers are going up, Dr. Aaron Orkin, an emergency physician at Sinai Health Systems in Toronto and a Canadian Institutes of Health Research-sponsored researcher with the Schwartz/Reisman Emergency Medicine Institute, part of this can be attributed to the fact that there are simply more opiates available for doctors to prescribe, and it affects everyone.

“Opioids have moved from a drug that was harder to access and was usually misused in the form of heroin that was only available through illicit formulations, to a whole range of formulations available in pills, available from pharmaceuticals, available from the misuse of prescription,” he says.

“This opioid misuse, we see it recreationally, we see it among students, we see it on campuses, we see it in the young and the old, we see it in the rich and the poor, we see it in men and women. They use different drugs across those demographics, but they can all result in death.”

And to keep up with their addictions, some drug users have turned to more dangerous drugs. For example, when the popular Oxycontin was taken off the market and replaced with OxyNeo, which was much more difficult to process into an injectable substance, many turned to heroin and other prescription drugs. Orkin says removing one drug from the market in order to curb addictive use did little, as opiates are, at the end of the day, generally the same.

“If you were to say we were going to get rid of one brand of cigarette, nobody would be surprised, and everyone would switch to another brand. It’s really just brands of the same thing. Yeah, they work in slightly different ways and a little bit differently in the body, but molecularly, they act in the same way,” he says.

“So it should surprise nobody when look at one and go, ‘Oh, people are misusing that one and we’re going to take it off the market,’ that people will go ‘I have an addiction and I need to find another one that behaves in the same way.’”

According to a 2014 study by the National Institute on Drug Abuse, the number of heroin users went up by more than 75 per cent in a seven-year span, from approximately 380,000 users in the U.S. in 2005 to more than 670,000 by 2012.

The study notes the risk of overdose for heroin is much greater than prescription drugs due to the user’s unawareness of purity and the possible addition of substances such as fentanyl.

Triemstra says that while she has not heard directly of any people attending the AIDS Committee having switched over to heroin as a result of an addiction to prescription drugs, such a switch would not surprise her.

The AIDS Committee of Durham Region is one of several organizations taking part in a regional needle exchange program, which allows intravenous drug users to exchange used needles for clean ones, allowing the old ones to be properly disposed of. Triemstra says that this helps stop the rate of HIV/AIDS and other blood-borne diseases, which can be easily spread via dirty and shared needles. The number of clean needles given out by the program has gone up substantially since it was first started, going from 6,017 in 1997 to more than 530,000 last year. Triemstra says this could be the result of more people knowing about the program, as well as growing numbers of drug users. The program also allows crack cocaine users to exchange glass stems and wire mesh, helping stop the spread of contagious disease among drug users.

The AIDS Committee of Durham Region is one of several organizations taking part in a regional needle exchange program, which allows intravenous drug users to exchange used needles for clean ones, allowing the old ones to be properly disposed of. Triemstra says that this helps stop the rate of HIV/AIDS and other blood-borne diseases, which can be easily spread via dirty and shared needles. The number of clean needles given out by the program has gone up substantially since it was first started, going from 6,017 in 1997 to more than 530,000 last year. Triemstra says this could be the result of more people knowing about the program, as well as growing numbers of drug users. The program also allows crack cocaine users to exchange glass stems and wire mesh, helping stop the spread of contagious disease among drug users.

Where to go from here

While not the case for all users of opiates, Triemstra says that many of the people she sees through her work with the AIDS Committee are those facing many other issues in their day-to-day lives.

“The clients who stick around talk about housing issues, food issues, a lot of them are street involved, they talk about shelters and the lack of shelters in Durham Region. Some of them, they have no housing or food concerns,” she says, adding that more have come to the committee’s offices now that the colder weather has come to stay.

“They’re looking for sleeping bags, mitts, hats, socks, things to keep them warm, or they’re looking for that bed somewhere, whether it’s in a shelter or a withdrawal management centre or crisis centre. They’re looking for that warmth.”

While the partnerships the AIDS Committee has are strong, Triemstra says that there needs to be more resources available in Durham for those using drugs and looking to get clean.

“There’s only one men’s shelter in all of Durham I believe. I think there might be two youth shelters now and one or two women’s shelters, but there’s also shelters for women fleeing abuse. Really it’s shelters and addiction services that we need more of,” she says.

“I feel that if there are more options, it would have a positive impact on addiction issues within Durham Region. A lot of the time, what happens is a client will come in and they’ll be like, ‘Listen, I need to go to treatment now. I’m done now.’ They’ll go and there will be a three-week wait for the bed. And in that three weeks, they’ve either lost that motivation or they’ve run into a friend and are using again.”

Orkin adds there are a number of things that the medical community can do as well, such prescribing fewer opioids and in smaller doses.

He adds that people need to stop looking at addiction as an issue of morals and criminality, but as a health issue.

“We need to be careful as we talk about these things, to characterize this as a health problem that needs a health approach rather than a matter of morals, that a person has something wrong with them or isn’t thinking correctly, or a matter of stigma,” he says.

“It’s not a matter of people not being able to make good decisions, it’s a matter of people having an illness that needs attention.”

Orkin says that these are just a few of the changes that need to happen both locally and across the country in order to deal with the growing number of people addicted to opiates, and that there won’t be one simple solution.

“If you think about the solution to when we realized, as a society, that there were too many people dying in cars, we made cars safer, we made street design safer, we got rid of drunk driving. We saw it as a complicated problem, and fixed it in a multi-factorial way,” he says.

“This is a huge problem too, but rather than it being cars running off the road and people driving drunk, it’s being caused by a really complicated problem in the medical industry, with legal and illegal drugs, and we’re going to have to look at that complicated problem, and solve it in a complicated way. We’re going to need to use every strategy we can think of at the same time so that hopefully a few years down the line, we can look back at this the way we looked back at the history of dangerous driving.”