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The Quest to Quell the Opioid Crisis

by: Shawn Stickney
Digital Journalism Student

Hard eyes stare out from the hooded face of a man pushing his bicycle less than a block from the Downtown Mission in Windsor. A small group huddles in the parking lot facing the building’s rear.

Just across Pelissier Street from the mission, a middle-aged man wearing sunglasses, despite a sunless sky, anxiously crosses over to join the gathering. Nearby, tiny-plastic water dispensers used in preparing opioids for injection lie discarded on the ground.

Between the mission on Victoria Street and Goyeau are a twisted maze of crumbling asphalt, empty lots, and red-brick apartments.

Windsor-Essex County Health Unit released a report early this year on opioid misuse in the area. The report contains density maps showing where the bulk of patients in opioid-related visits are living from postal codes given at the hospital.

The map for Windsor, which looks like the thermal-warning-system that a power-plant operator might monitor, lights up over an area stretching from roughly Wyandotte and Ouellette in the north to Pine and Ouellette in the south and bounded by Goyeau and Victoria on the east and west respectively.

The WECHU report cited a rate of opioid users in WEC which is 18.9 percent greater than the provincial rate. The 382 opioid-related emergency department visits in 2015 mean the number has more than tripled in the county since 2003.

In Statistics Canada’s 2011 National Household Survey Windsor scored the highest out of 13 cities with low-income people living in very poor neighbourhoods.

Statistics Canada went on to say, “Of the 54,500 low-income people in Windsor, 18,200 of them resided in the 10 very low-income neighbourhoods….” That’s about 33 percent of the low-income population living in ghettos.

A map included with the 2011 household survey shows areas of Windsor-Essex County ranging in colour from peach to dark burgundy based on a percentage of how much of the low-income population is living in very low-income neighbourhoods: burgundy marking the areas with the highest concentration. The proportion of burgundy to peach was significant.

The low-income neighbourhood map and the density map of opioid-related emergency department visits in WEC show some striking similarities.

An online report released this year by Health Quality Ontario says, “Prescription opioids, along with the illicit use of opioids, have thrust Ontario (and the rest of Canada) into a full-blown public health crisis.”

The medical community is in general agreement that opioid use is a crisis in the province, however, gaps in opioid-related data have made agreeing on the scope of the problem more difficult.

The number of opioid linked deaths in Windsor-Essex County was reported as 43 deaths back in early March when it was in fact 24, 19 of which were from Windsor. The Windsor-Essex County Health Unit’s report was republished with the corrections, however, the data in the report still does not contain any statistics for this year or last.

The lack of data regarding substance abuse and the efficacy of treatment methods is not an issue isolated to Windsor-Essex County.

Bankole A. Johnson, in a 2010 online article for the Washington Post, said, “It’s understandable, if unfortunate, that treatment centres that have a financial stake in recruiting patients might be reluctant to aggressively track — much less publicize — data on their patients’ success down the road.”

Doris Stillman, program director at the House of Sophrosyne ̶ a local addiction recovery centre ̶ commenting on post-treatment tracking said, “There are lots of people out there being very successful it’s just that we don’t necessarily always hear about that because they don’t report into us.”

The issue of collecting evidence and statistics has been one source of conflict in a dispute of ideologies that divides the world of addictions treatment.

A recent report by Behavioral Health of the Palm Beaches, Inc. says treatment facilities and programs generally fall into two philosophical camps. The first is the abstinence/faith-based approach embodied in programs like Narcotics Anonymous and A.A. The principal idea is that substance abusers entering abstinence programs cut off all substance use and remain free of alcohol and drugs. Abstinence is an important part of any substance abuse treatment, but argument arises over whether it should be the only way of treating patients.

The second is a harm reduction approach. Harm reduction based treatments do not always require that the substance user come off drugs or alcohol entirely and allow opiate substitutes such as methadone and naltrexone to be used. The harm reduction approach acknowledges that users may not favour the faith aspect of twelve-step programs or the prospect of getting completely sober.

“To portray any single treatment method as being the only acceptable or effective treatment as being all that is effective as a treatment mode is a cruel deception,” local addictions expert Dr. Tony Hammer said, “People are dying as result of their well-intended but mistaken philosophy.”

The Windsor-Essex Community Opioid Strategy-Leadership Committee, chaired by Dr. Wajid Ahmed from the WECHU, held its first meeting in December 2016 and has since released an ‘Opioid Strategy Consultation Document’ for the county.

The document outlines the four pillars of the committee’s strategy. The second pillar being ‘harm reduction’, the other three being prevention and education; treatment and recovery; and enforcement and justice.

As part of the harm reduction pillar, the report says, “promising practices from Canadian cities like Vancouver and Toronto, have led the Windsor-Essex County Health Unit to begin investigating the feasibility of Safe Injection Sites in Windsor and Essex County.”

Dr. Wajid Ahmed could not be reached to comment on the feasibility of safe injection sites in Windsor-Essex.

“I’m all for it,” said Byron Klingbyle, harm reduction coordinator at the AIDS Committee of Windsor, pointing at data which has come out of the injection sites in British Columbia.

The numbers provided in a recent update on Vancouver Coastal Health’s website are promising. Since opening their doors in 2003, the injection sites have been used by over 3.6 million individuals to inject illicit drugs under medical supervision; Medical staff have treated 6440 overdoses and administered close to 50000 ‘clinical treatment visits’ with no deaths.

“That’s a statement right there. That proves that they work,” said Klingbyle.

Substance abuse has had a long history. Some of the earliest writings on it appear in the Bible, which condemned drunkenness, according to a 1993 report by Dr.  Jerome Jaff in Alcohol Health and Research World.

Since Biblical times there have been different stances on substance use and abuse that run the gamut from outright prohibition to seeking a higher power.

Klingbyle, reflecting on the various policies and stigmas surrounding drug use, said, “Let’s take a look at this tremendous war on drugs.”

According to a Stanford University report, President Richard Nixon started the war on drugs in 1971 when he said, “America’s public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive.”

The war on drugs, like the war in Vietnam carried out under the leadership of five successive presidents, has had a massive body count.

In Canada, the politics and the culture are different, however drug policy has long been inspired by the rhetoric south of the border. Things are slow in catching on here, but policy decisions often mirror what is happening in the United States.

For example, The U.S. banned a crushable version of the drug OxyContin and replaced it with OxyNeo in 2010, which promised to be far harder for drug users to inject or snort. Canada was slow to follow but eventually introduced OxyNeo in the spring of 2012.

There has been a great deal of progress made in the province and Windsor-Essex. Allisson Jones, writing for the Canadian Press in Toronto on June 12, said the province was putting $15 million in to adding healthcare workers and distributing naloxone kits, an effective overdose-reversing drug that has saved lives; And a separate Canadian Press update from Toronto on Aug. 30 said the province added $222 million to reduce opioid deaths in Ontario.

Dave Waddell, in the Windsor Star Nov. 2, said that of the $222 million announced by the province, $475000 is for the Windsor area. Along with the funding in Windsor-Essex County, new policies and practices have made naloxone more accessible to those who need it.

Craig Pearson, in a May 5 Windsor Star article, said: “A new federal law that will provide immunity from drug possession charges for anybody who calls 911 when someone is overdosing is being hailed locally as a way to save lives.”

The Windsor-Essex may have been hit harder than other communities in Ontario by the opioid crisis, but nobody has been sitting idle.

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