The changing medical battle against fentanyl
The signs of opioid addiction crisis in Niagara can be seen everywhere if you know where to look.
At the Niagara Health System emergency department, the impact of drugs such as fentanyl can be found in the hospital’s balance sheets.
As the number of overdose cases grow, the need for the anti-overdose drug naloxone rises.
“It hasn’t reached a point where it is impacting our day-to-day in a negative way, but it has meant we had to take steps to prepare for these cases,” says Dr. Rafi Setrak. “We make sure we have a supply on naloxone on hand.”
Setrak said managing a naloxone supply can be challenging in the shifting nature of emergency medicine.
“I had a patient recently who presented with the symptoms of an opioid overdose. You start by using one dose of naloxone, and this case that wasn’t enough (to revive the patient),” he said. “So I had to keep using naloxone. This particular case ended up using all of the naloxone we had.”
Setrak says NHS has other supplies of the drug and, if necessary, can turn to the hospital pharmacy for help.
The increased use of naloxone is not just a symptom of more overdose cases, but a sign of the kinds of opioids being used.
Emergency doctors typically don’t get toxicology reports on their patients; needing multiple doses of naloxone to stop an overdose is a telltale sign of fentanyl or its more potent chemical cousin, carfentanil, Setrak says.
At the same emergency room doctors are arming themselves to better deal with overdose cases caused by fentanyl, people trying to help addicts recover are changing their methods as well.
Dr. Fraser MacKay, a partner at the Segue Clinic in St. Catharines, which treats addicts with methadone and suboxone — drugs that manage a patient’s withdrawal systems without providing an opioid high — sees about 2,000 patients a year. In the past few years, nearly half of his new patients tested positive for fentanyl use.
To provide more patients more tools, MacKay is bringing a new recovery program to Niagara.
It’s called Smart Recovery — a program founded in the United States in 1994 — and is expected to be up and running next month at Community Addictions Services in Niagara Falls and Quest Community Health Centre in St. Catharines.
Methodone or suboxone therapy is just the start of recovery, MacKay says. It stabilizes a patient, giving them the chance to address the underlying causes of their drug use. MacKay directs his patients to other community programs that will aid in their recovery.
MacKay said Smart Recovery is a reaction to discontent felt by some addicts with such programs as Alcoholics Annoymous or Narcotics Anonymous.
Those group-therapy programs, with their religious emphasis, don’t work for some people, who wanted a secular recovery program.
“That isn’t to say AA doesn’t work. It does for about five per cent of people,” says MacKay. “For the other 95 per cent, there is a need for other options, and there are people who are just turned off by the spiritual components of programs like AA.”
MacKay said the Smart Recovery program is an evidence-based recovery initiative, using behavioural therapy methodologies to help patients change their habits and understand how and why they used drugs.
Recently, several addiction workers from the Hamilton and Niagara areas were trained by Smart Recovery’s Rod Allwood in the program’s methodology.
Still, even if Smart Recovery is successful in Niagara, MacKay said it isn’t a magic bullet to solve opioid addiction. It’s just another option to help people.
“Programs like AA or NA (Narcotics Anonymous) or Smart Recovery are peer supported programs and that works for some people. But if you are someone who is really in trouble what do we do?” MacKay says.
“For someone who is really in trouble, I recommend they get connected to a formal rehab program. Rehab isn’t going to cure you, but it is a more intensive period of treatment that helps you get yourself on the right course.”