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Of Substance

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“Of Substance” is a new set of articles that will deal on the growing Opioid Crisis in Canada. Canadian Paramedicine would like to thank Charlene Vacon for reaching out to us with this proposal and for agreeing to speerhead this important innitiative.

Ask any paramedic if Canada is in a drug crisis and they’ll tell you it’s at its worst now.

We see what’s happening behind the front doors of quaint cozy homes, closed to most people but calling to us, “Hurry in!”

We smell the stale stench down dark alleys where we go looking for the lost.  We hear the onset of the agony that is grief coming uninvited into what was, mere moments ago, a good life.

Ask us if we’ve seen mothers crying inconsolably, friends in shocked disbelief, lovers angry because they tried so, so hard to find help before this.

According to Health Canada, it’s paramedics who transport 82% of the people who are poisoned by substances and end up at the emergency room, so we have a lot of experience.(1)

We can describe too well the sights and sounds of calls where we’ve been summoned to treat someone’s loved one, gone too soon because of an overdose or poisoning.

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In 2020, we witnessed more people die from opioid overdose and poisoning than ever before in Canada. This year looks the same.

In BC, it’s the Lower East Side. By 2016, the Lower East Side had become Canadian shorthand for down-and-out on the streets using substances to cope.

But, while BC went headlong into a drug-related crisis of poisoning and overdose that’s left 6,939(2) people dead in that province between 2016 and March of 2021, neighbouring Alberta could not pinpoint their overdose and poisoning crisis to a “Downtown Eastside.” It was creeping through communities;  cities, towns, and reservations were losing loved ones.

Last year, the prairie provinces found that they, too, were losing more people to overdose and poisoning. The drugs were a little different than out West, but the outcomes were just as harsh. New people became frequent callers, faltering as methamphetamine infiltrated their lives.

Ontario and Quebec were spared the catastrophe of numbers – at first.

The lower rates of poisoning made it feel that the sun was still shining on Ontario and Quebec. In the public health and political language of populations, statistics, the staggering numbers weren’t there. 

That was until the clouds came on with the pandemic. 

With the COVID-19 pandemic, the suspected poisoning calls in Eastern Canada came in more frequently. The overdose and poisoning crisis had spread.

In 2020, Ontario suffered the largest number of lives lost among any Canadian jurisdiction that year – or any year before it, with 2,421 people killed by opioid poisoning or overdose alone.

The shadow slipped over the Atlantic Provinces, too. In New Brunswick and Nova Scotia, opioid toxicity is harming more people than before the pandemic.

The island status of Newfoundland and PEI did not shut out non-pharmaceutical opioids. They may be illegal, but these “street” opioids are too often found where people don’t expect them: in other illegal drugs like cocaine, meth, or benzos.

In fact, non-pharmaceutical opioids – the fancy way of saying illegally made and unregulated opioids that often show up unannounced in drugs sold as something else – were responsible for 90% of the deaths from opioids in the first 3 months of 2021 in Canada.(2)

Even the territories are not spared. The Yukon has the highest rate of opioid-related deaths in Canada at 48.4 deaths per 100,000 population.(2)

Yes, we have witnessed this sad succumbing.

Yet, paramedics are not people who passively accept the role of witness at a tragedy. Paramedics are advocates and problem solvers.

With naloxone in our kits, we’ve come into communities to train other responders, bystanders and caregivers, showing them the steps to revive someone who has too much opioid in their system.

We’re educating youth about substance use and how altered dopamine and serotonin affects their brains. We’re teaching their parents – our colleagues, friends, and neighbours – how stigma, bias, and moral judgment can undermine good clinical care and the trust our patients place in us.

Paramedics have joined forces with nurses and social workers to provide harm reduction services that are helping keep people alive. We’ve been scrutinizing our response data and sharing it with public health agencies so that we can all understand the magnitude of the problem.

This new column is for paramedics from across Canada to tell us all what they’ve learned about substance use as direct health care providers to those most affected by the overdose and poisoning crisis; to share the successes, stories, clinical approaches, and the human side of this crisis.

We’ll hear from people who use drugs, too. Paramedic care and advocacy directly affects their lives. So, it just makes sense that we should work to understand what we do from their perspectives.

Other experts – people who can help us understand the history, physiology and psychology, experts who can describe the policy and sociology of this crisis, people who can define terms and explain ideas for getting beyond this crisis – will share here, too.

Paramedics know that Canada is in an overdose and poisoning crisis. And, we’re very good at crisis; it’s what we do.

With Of Substance”, we’re shining our light into the ombre of the opioid toxicity crisis. It’s another way we are helping to put an end to losing loved ones to substance-related harms.

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References

1. Canada H. Opioid-related Harms in Canada: Integrating Emergency Medical Service, hospitalization, and death data – Canada.ca [Internet]. Canada.ca. 2021 [cited 1 November 2021]. Available from: https://www.canada.ca/en/health-canada/services/opioids/data-surveillance-research/integrating-emergency-medical-hospitalization-death-data.html

2. HEALTH CANADA. Opioid- and Stimulant-related Harms in Canada [Internet]. Health-infobase.canada.ca. 2021 [cited 1 November 2021]. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants

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ON2021 – Of Substance
Charlene Vacon

Charlene Vacon

Charlene Vacon, PhD, PCP, lives near Montreal and works for an Ontario base hospital. She started a voluntary advocacy organization, Paramedics Responding to the Opioid Poisoning Crisis, in 2020 after losing her oldest son, Archie, to an accidental fentanyl poisoning in 2019. Contact Charlene at LCVacon@gmail.com or on Twitter @charlene_vacon.

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