‘A PERFECT STORM’
Bad batch of drugs, the hit to services during pandemic driving up overdoses
Donna Sarrazin, project manager for Safer Supply Ottawa, and project partner Mark Barnes are two of the people on the front lines of the opioid crisis in the national capital. The Civic Holiday long weekend is seen as a ‘perfect storm’ for the crisis, aligning with arrival of end-of-month government support payments and the possible arrival from Toronto of a drug supply laced with fentanyl and etizolam. And all of this is occurring during a pandemic that is already driving up the rate of overdoses.
People at the front lines of Ottawa’s substance-use crisis are readying this weekend for what could be a “perfect storm.”
The long weekend aligns with the end-of-month “cheque time,” when recipients get their government support payments, and also with the possible arrival of a drug supply laced with fentanyl and etizolam, the latter a long-acting benzodiazepine analogue, the effects of which are not countered by Narcan, or naloxone, the medication commonly administered in opioid overdoses.
Moreover, all of this is occurring during a pandemic that authorities agree is worsening the situation and driving up overdoses.
“It’s a perfect storm,” says Mark Barnes, owner-pharmacist at RespectRx Pharmacy and a member of the Ottawa Overdose Prevention Task Force.
The latest figures released this week by Ottawa Public Health show that monthly emergency department visits for opioid overdoses tripled between January and April, from 20 to 60, with only slight decreases since (57 in May and 50 in June).
And while Ottawa Paramedic Service uses a different system of coding for their calls, their preliminary data show a similar trend. In April, the service had almost 40 opioid-related overdose calls and that number grew by about 10 in each subsequent month. Heading into the final day of July, they had already reached 68 for the month.
At the Sandy Hill Community Health Centre, meanwhile, Oasis program director Rob Boyd says the rate of overdoses in their supervised consumption site nearly doubled from March to June, from 1.48 to 2.84 per cent, while at the supervised consumption trailer operated by Ottawa Inner City Health, overdoses jumped from 39 in December to 130 in June, an increase of more than 230 per cent.
“We’re pretty much back to the first days, with five or six overdoses on some days,” says Louise Beaudoin, nurse co-ordinator with OICH. “And now there’s a bad batch coming from Toronto.”
Beaudoin was recently warned that cocaine laced with fentanyl and etizolam had made its way to Toronto from B.C. and was possibly related to 15 overdose deaths there in nine days this month, which Toronto Public Health described as “the worst cluster of suspected opioid overdose-related calls involving deaths” since it began its monitoring in 2017.
Beaudoin, like others among the vanguard dealing with the crisis, studies these trends and movements the way others follow weather maps, looking to see what may come here and when.
Barnes notes a recent resurgence of crystal meth in Manitoba, while Donna Sarrazin, owner of Recovery Care and project manager for the Safer Supply Ottawa program, says that use of the drug is also on the rise in Cornwall.
And all agree that the pandemic is making things worse.
“In late 2019, we were actually starting to make ground against the opiate crisis,” says Barnes. “We’d seen a slight decrease over 2018 in the number of overdose deaths in Canada. And now we’re expecting 2020 to be so much higher.
“We were in a crisis before, and now it’s gone through the roof.”
The pandemic has left its mark on the opioids crisis in numerous ways. According to Ottawa Inner City Health peer shift lead Chad Bouthillier, those changes first became noticeable near the beginning of the year, with alterations to the makeup of the illicit drug supply itself.
“The borders were closed and dealers did not have their regular supply,” he explains, “so they grab from anywhere they can. They don’t know what’s in it.
“And our clients get ahold of it. And their usage sometimes drops off because of the lack of fentanyl or the quality of it, and so when they do get the fentanyl, it hits them harder.”
Beyond that, adds Sarrazin, COVID -19 has halted much of the progress that had been made in encouraging people who consume drugs to do so more safely.
“We’ve been trying to say to this population, ‘Don’t use alone.’ And then COVID comes and we say, ‘Stay alone.’ We’ve been saying, ‘Come see your addiction counsellor, stay in touch with your physician, see your nurse case managers. Stay connected.’ And then we say, ‘Don’t come in.’”
Even some laudable measures put in place to deal with the fallout from COVID-19 have led to unintentional harms. Sarrazin points to the Canada Emergency Response Benefit (CERB) program that has helped so many people weather the financial maelstrom created by the coronavirus as one example, providing those with substance-use disorder a regular stream of cash, thus removing them from the daily hustle. Getting out of that grind is one of the goals of Safer Supply Ottawa, but without as many supports in place to direct those energies into such needs as health care, housing and employment, it often leads to a one-step-forward, twosteps-back situation.
Simply the COVID-19-imposed decrease in contact between health-care professionals and those consuming illicit opioids and other drugs, says Sandy Hill’s Boyd, puts up a barrier to treatment.
“It’s hard to get over that initial threshold of going into treatment, so it’s really helpful when you have that frequent contact with health-care professionals or social workers or drop-in or shelter staff where, at that moment when you want to make a change, somebody is there to help you continue your motivation towards that change.”
Additionally, Boyd notes, some services no longer benefit large parts of the population that use supervised consumption sites, such as Sandy Hill’s addiction and mental-health counselling, which is now done online, rather than in person.
“The social system really fell completely apart for them.”
The decrease in supports, Barnes further points out, comes at a time when COVID-19 is also heaping fear and anxiety onto an already vulnerable group whose response to the added stress, in many cases, is to turn to opioids more frequently.
“It’s worrisome.”
We’re pretty much back to the first days, with five or six overdoses on some days.