More fentanyl deaths in Ontario, but where are the detox programs?
A few years ago, Tara Finnessy’s life revolved around drugs.
“Every day was a struggle because without that drug, you’re so sick. You’re debilitated,” the Ottawa woman said about her addiction to fentanyl. “After you’ve been using for a long time and you’re physically addicted to the drug, you can’t feel right unless you’ve have it. It no longer becomes about being numb. It now becomes a struggle of just feeling well: well enough to function.”
At the height of her addiction, Finnessy was consumed by fentanyl, and getting the hundreds of dollars needed to buy it.
“You do things to obtain your drugs. Things you normally wouldn’t do like sell your TV, maybe take some groceries back that you bought. Silly things like that. But the desperation is so real that that’s all I could do just to keep my addiction and keep myself feeling normal.”
Eventually, she realized that she was hurting herself and her son. “My family, I was disengaged from them, my community. I really felt like I wasted so much time and I decided that I was going to give methadone another go.”
Finnessy was able to start a methadone treatment program that same day. She went to Recovery Ottawa, a local methadone clinic, and immediately got a prescription. Now, she hasn’t used fentanyl in two years, she said.
Getting methadone is easy in Ottawa, but getting further treatment often isn’t. And while experts may disagree on what kinds of programs will best serve drug users, they all agree that there needs to be more of them.
Methadone is a common treatment for opioid addiction. It works by replacing a fast-acting drug, like heroin or fentanyl, with a similar slow-acting drug: methadone. Methadone users don’t experience the same high as they do on other substances, but it helps to prevent the painful withdrawal symptoms associated with opioid use.
Methadone helped Finnessy start to get her life back together, she said, by freeing her from the need to find money for her next fix. “Your body is OK and you’re feeling OK. And every day that passes that you no longer have to engage in certain behaviours is another day that you start to feel better about yourself,” she said.
Some people stay on methadone for years, and some, like Finnessy, slowly taper off their dosage with the ultimate goal of eventually getting off opioids altogether.
“For some people, (methadone) will be enough. For most people that will be enough. For some people, they will need more, they will need more support,” said Rob Boyd, director of OASIS, a harm reduction and needle exchange program in downtown Ottawa.
Mark Ujjainwalla runs the Recovery Ottawa methadone clinic that Finnessy attended.
“At this clinic, people are a mess,” he said. “Their health is bad. They have hypertension, diabetes uncontrolled. Open sores and swelling and stuff. So physically they’re a wreck. Emotionally they’re a wreck. They’re all anxious, depressed, PTSD, grieving for this or that. Financially they have nothing. No jobs, no hope. They live in shelters or on the street. So there’s really nowhere for them to go.”
He believes that lots of these patients would benefit from a long stay in a residential treatment facility.
There, they would get to detox under medical supervision, get access to counselling and psychological help, and care for their other medical problems.
“I’ve run a medical detox. You come in looking like that, immediately I put an intravenous in. Immediately I’m starting you on nutrition stuff. I have a dietitian and all that. Immediately I’m looking at your cardiovascular, your whole health,” he said.
Even just regular meals and a safe place to sleep would help many people, Ujjainwalla says. Some of his patients actually look better after a stint in prison, he said, just because they’re eating better and are less likely to be using behind bars.
But finding residential drug treatment in Ottawa isn’t easy. Global News sat with Ujjainwalla for approximately two hours as he made calls, looking for a bed for a 23-year-old woman who was a fentanyl and crack user and hepatitis C-positive, and who had lost her provincial health card. After phone calls to seven different agencies and lots of time on hold, he found nothing that was immediately available. In some cases, staff estimated the wait could be over a month.
Most organizations and mental health or drug addiction hotlines referred him to one of two locations: the Ottawa Withdrawal Management Centre or the local emergency room.
The Ottawa Withdrawal Management Centre has 26 beds (20 for men and six for women). According to Nick Paquette, a staff member there, patients can typically get in within about two days if they keep calling to check if a bed is empty. Since people typically stay for five to seven days, there is a lot of turnover.
There are no doctors on staff there to assist with detox – if a person has severe symptoms, they’re brought to the emergency room.
“You’d have to go there and sit there and see how that’s going to go. Thirteen to 20 hours, and they’ll do s**t for her,” Ujjainwalla said.
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The Royal, a mental health hospital in Ottawa, has 12 beds for medical withdrawal treatment under doctor supervision. There are only 34 medical withdrawal treatment beds in all of Ontario, according to Kim Corace, a doctor in the Royal’s substance use and concurrent disorders department.
Ottawa has a population of nearly 900,000. Ontario has about 13.6 million.
This just isn’t sufficient, said Ujjainwalla. “We’re not doing enough for them and I’m feeling sad for them because there’s no door in here that I can open to put you into a detox centre that’s medical. There’s no door to put you into a treatment facility. There’s no career door, there’s no employment door. It’s just get your methadone in the bathroom and go.”
He would like to see more long-term residential treatment facilities available in Ontario.
“The thing I try to explain to somebody who would listen to me is: she has a treatable illness. It’s treatable. I can show you that people get better. If you gave me the money, I could put her in a treatment centre in the U.S. and leave her there for six months and when I bring this woman out here, you won’t even recognize her.”
Boyd is less convinced of the efficacy of a residential treatment program, particularly if it doesn’t include methadone – as he says many do not. In fact, an abstinence-based program can be dangerous, he said. Abstaining from a drug means that their tolerance drops. And unfortunately, many people do end up using again even after attending drug treatment. That’s a problem if they suddenly don’t have the tolerance they’re used to.
“It’s potentially lethal for people to go into a residential treatment program without methadone or suboxone.”
But, he does agree that the “basket of services” offered to people looking to treat drug addiction should be improved. “Someone who is homeless with a mental illness has significant barriers to recovery. Part of the role of treatment ought to be to provide equitable access to treatment which means that you have to deal with the mental health issue, you have to support them with the housing issue.” And while some such services exist in Ottawa, they can be tough to access or are just too small.
“If you ask patients and families, they will probably tell you that there is a great need for services for opioid problems and related mental health issues. And there’s just not enough. That’s probably what they’d tell you.”
Some patients benefit from in-patient treatment, and others from psychological counselling or outpatient services, she said. Improved outpatient services can reduce pressure on the limited in-patient beds.
“When you’re looking at opioids, when you’re looking at any addiction treatment, we need the full spectrum. Not every patient requires an in-patient bed,” she said.
Whatever the treatment, Finnessy believes that it needs to be immediate. The day you get treated, she said, “that’s the day that you can start making changes in your life. Because you’re no longer sick and you’re no longer needing to go and seek out those drugs.”
Any wait can have serious consequences for a drug user, she said.
“For some people, that waiting becomes their death sentence. Because you’re still sick you’re still using, you still have those behaviours.”
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