THE PAIN BEHIND OPIOID CRISIS
Adverse childhood experiences linked to drug abuse, says Trina Larsen Soles.
The opioid epidemic is the biggest public health crisis to hit B.C. in decades. Upward of four people a day are dying of overdoses, usually due to fentanyl poisoning of the street drug supply.
To date, the B.C. government has committed $322 million to address the crisis, including opening more supervised consumption sites, providing naloxone kits, urging people not to use alone, and trying to stop tainted drugs from coming into B.C.
Another potential response could deepen our public understanding and shift our approach to a more compassionate and effective outcome: recognizing and addressing the underlying role of adverse childhood experiences — ACEs — and how they make individuals more vulnerable to substance use.
The connection of ACEs to future chronic health conditions, social and behavioural problems, mental illness, addictions and early death has been known since the late 1990s. Called one of the greatest public health findings of all time, ACEs research studies now number in the hundreds worldwide.
In general, ACEs are identified with questions about exposure to physical, sexual or emotional abuse, parental addiction, divorce, domestic violence, and other forms of trauma or neglect. One tool generates a score on a 10-point scale.
The higher the number of ACEs, the greater the potential relationship to future social, behavioural and health problems, such as alcoholism and substance misuse, suicide and chronic disease.
Researchers are investigating the neurobiological mechanisms that are involved, such as the effect of toxic stress on the developing brain. Still others have been studying what can be done to mitigate the effects.
Despite two decades of research, however, the concepts have been slow to translate into public understanding as well as into policy and practice.
Too often, those with drug addiction are subjected to public condemnation, humiliation, further neglect and ostracism, and further traumatization — often by the very people who are meant to help them.
There is a better way.
Last November more than 600 people from B.C., Alberta, Saskatchewan, Ontario and the U.S. gathered in Vancouver to explore and share approaches to acknowledging, mitigating and preventing ACEs. The ACEs Summit: B.C. and Beyond, was a two-day conference that brought together physicians, mental health experts, educators, academic researchers, First Nations organizations, criminal justice representatives, community agencies, health authorities, provincial government policymakers and politicians, as well as people affected by ACEs.
We heard from Judy Darcy, the provincial minister for mental health and addictions, who stressed that addiction is not a moral failure, but a health issue. She emphasized the importance of treating those with mental health and substance-use issues with the same dignity and compassion that we treat those with physical health issues.
The summit was funded and organized by the shared care committee, a partnership of Doctors of B.C. and the Ministry of Health, and featured multiple presentations and panels to discuss how to embed ACEs awareness and response into schools, communities, family doctors’ offices, maternity care, mental health and addictions treatment and the criminal justice system.
A five-member panel on ACEs and the opioid crisis brought into stark light how our current approach contributes to higher death rates by isolating individuals who hide their addiction out of shame and use alone.
Calgary police Chief Roger Chaffin stated that we can’t arrest our way out of the problem, and that the focus has to be on people before they become addicted.
Linda Lupini of B.C. Emergency Services reiterated what many of us may not realize: that individuals who are dealing with emotional and physical pain through opioid addiction were doing all this under the radar, and the reason we are talking about it now is because their supply is poisoned. She stated that this has told us there are many more people than we ever realized who are struggling.
Although the opioid crisis is a difficult one, the ACEs Summit focused on a message of hope. By focusing on understanding ACEs and how they contribute to addiction and other serious health conditions, we can enable more compassionate treatment and more effective prevention. Together we can help heal those with ACEs already in their life story, and limit the creation of new ACEs in future generations.