We can alleviate some of the harm addiction brings

Managed opioid regimes work, writes Graydon Simmons

“I’d rather die than go into withdrawal,” he said, staring into my eyes. I didn’t know how extreme addiction could get until I heard those words. I had never thought the body could become so dependent on a drug it would be more important to a person than avoiding death.

That was my first time face-to-face with the opioid crisis on my own as a doctor. It was last summer at The Ottawa Hospital on an overnight shift as the senior medical resident.

The emergency department had consulted me to admit this patient, who had been diagnosed with endocarditis, a life-threatening heart infection. Severe infections are common complications of intravenous drug use due to the unsterile nature of street drugs and the settings in which they are injected. To prevent him from dying, this patient would have had to stay in hospital to start intravenous antibiotics.

Unfortunately, he was not the average injection drug user. He was living with a severe opioid use disorder, the worst I had ever seen, injecting heroin at least eight times per day. I ran through the options for treating his opioid addiction.

A detoxification program? Too unsafe with his addiction and heart infection. An opioid replacement drug ? He had been fired by two doctors for failing to follow opioid replacement treatment.

“They don’t get you the same high. You know that,” he noted. “I need an opioid and if I can’t get it here, then I will leave.”

I had a decision to make. Admit him to hospital with an opioid prescription to replace his need for heroin or leave his infection untreated and read “intensive care unit” beside his name next week (or even worse, “deceased”). What was the better choice for him? For our healthcare system?

If you have never met someone with a severe opioid use disorder, it’s easy to think patients like this are bluffing. That they just want you to prescribe them opioids so they don’t have to stop. That it’s a choice. They wouldn’t risk another overdose or having a heart infection go untreated with street opioids, would they?

Sadly, in my little over two years as a doctor I have learned the answer is yes, they would. Time and time again, we see the same faces with severe opioid use disorders that cannot be managed with standard treatments return to hospital with another life-threatening complication. Until recently, I began to grow disillusioned with the treatments for these patients. Then I worked with Ottawa Inner City Health.

Last fall, Ottawa Inner City Health began a managed opioid program.

In this program, people living with severe opioid use disorders are prescribed a regimen of safe, medical-grade opioids to stabilize their injection drug use and prevent their need for street drugs. It’s a radical approach, and after seeing it firsthand in January, I am happy to write that it works.

This program is not for any injection drug user. The patients enrolled are similar to those I typically meet in hospital.

They are suffering from extreme cases of addiction, on the brink of death from complications of injection drug use, but due to the severity of the disease cannot stop their use of dangerous street opioids.

Thankfully, innovative approaches like that used at Ottawa Inner City Health are breaking this cycle. When you meet patients in this program, you begin to see how life-changing it is. Once stabilized on a regimen of medical opioids, they are able to engage with health-care providers like never before. Instead of having to dedicate every waking moment to getting their next hit, they can stop and think.

With time, their dependence on street opioids ends and their risk of the next overdose or complication becomes minimal.

Rather than becoming another admission to hospital and, ultimately, another death statistic, these patients begin to work at the life they would like to have after their opioid addiction.

And while there is still a long road ahead for them and their addiction, at least some of the harm has stopped.

Until recently, I began to grow disillusioned with the treatments for these patients.