Both of Rhonda’s adult children had substance addictions. One, her daughter, still does. The other, her son, died of opioid poisoning in April. He went into a drug-induced coma three days before he was scheduled to start rehab.
Rhonda lives a modest life. She’s a health-care worker, a caring mother. She was a main pillar of support for her son when he relapsed on his addiction and began using again during the pandemic when all his regular supports were no longer available to him.
“(Safe consumption sites) need to be everywhere with a safe drug supply, if they can’t make it to recovery,” said Rhonda.
Rhonda’s two children are the perfect example of the dichotomy of drug addiction. Her daughter has no fixed address but mainly lives in Edmonton’s downtown core. She’s a heavy user, and while she has tried to get help in the past for her addiction, has not yet succeeded in getting the support she needs.
Her son, on the other hand, was not what most people would have considered a typical drug user — he lived outside the big city in Fort Saskatchewan with his young child and partner, held a good job in the trades, and had experienced a long stretch of sobriety.
“If they die before then — then I guess there’s no point in having recovery.”
Pandemic aftershock
Alberta saw its highest-ever opioid-poisoning death rates in the winter of 2021, specifically November and December 2021. The pandemic brought with it an increase in homelessness, which has become a dominant city issue over the past few years. The pandemic also brought with it more drug use, and with tight border control from COVID-19 restrictions, the drug supply changed. Fentanyl became the dominant street drug, and this past winter saw an increase in benzodiazepines — benzos — mixed in with the supply.
Between January and August, 370 people died from opioid poisoning in Edmonton, and 978 in Alberta. In Edmonton, 93 per cent of those deaths involved fentanyl poisoning, data from the province shows. In second place for toxicity poisoning is carfentanil — which is about 100 times stronger than fentanyl — with 54 per cent, and in third, methamphetamine with 49 per cent.
In 2019, Jason Kenney under the UCP was elected premier, and the province shifted its support to an abstinence-and-recovery-based approach to addiction. Under this model, the province, which is responsible for funding addictions services, provided funding for more treatment centre beds, which are needed, and more recovery-based services.
The UCP government, now under the leadership of new premier Danielle Smith, will continue its recovery-based model of prevention.
“Over the next two years, we’re investing an additional $124 million to dramatically increase access to recovery-oriented services in Calgary and Edmonton,” Colin Aitchison, press secretary for the minister of mental health and addictions, said in a statement to Global News.
But the government’s approach offers only a few pieces to the complex puzzle.
“Harm reduction” is the concept that keeps coming up in talking with advocates, families and doctors. According to the Alberta Health Services website, “a harm reduction approach aims to reduce the negative consequences of using psychoactive substances, without necessarily reducing substance use itself.”
“Through policies, programs, and practices, a harm reduction approach accepts that abstinence may not be a realistic or desirable goal for a person, (and) emphasizes that stopping substance use is not required to access health or social services.”
And the data shows that it’s not just people in the downtown core who are suffering from this drug supply. People, like Rhonda’s son, who fit the profile of your neighbour on your suburban street, who holds a good job and cares for their family, are also struggling.
And, according to experts, the majority of people – 50 to 70 per cent — are using in their homes.
That’s where virtual programs come in, like the Digital Overdose Response System app, which supports drug users who live outside the support centre hub of downtown. The DORS app, created by Dr. Monty Ghosh in partnership with Alberta Health, allows people to set a timer for when they are using, and if they become unresponsive in a certain time, first responders will automatically be sent out to help them.
These virtual options are part of a multi-pronged approach that Ghosh, an internal medicine doctor and addictions advocate, said we need to take to battle the opioid epidemic. Prevention needs to be “key and foremost,” said Ghosh, an associate professor at the University of Calgary and the University of Alberta.
Ghosh said this includes having naloxone kits widely available to reduce drug poisonings, ensuring harm reduction services are in place, and including safe consumption sites, virtual options and access to opioid agonist treatments.
“We really want to meet people where they’re at in terms of the recovery,” Ghosh said. “Some people always keep using (the app) or some support that they can get — the best housing, wraparound services. But it will support them where they’re at.”
Locating safe consumption sites
Safe consumption sites, another harm reduction approach, come into play, particularly for those in the marginalized community who do not have access to a phone, let alone internet or data to access an overdose prevention app. They are using in the streets, or when they can, in supervised places like safe consumption sites where they can fix with new, clean gear and are surrounded by medical professionals in case they overdose. There has never been a reported overdose death at a safe consumption site.
Before the pandemic, Edmonton had nine safe consumption sites. Today, it has only three — all within the downtown core.
There is an alternative to the brick-and-mortar consumption sites. Mobile overdose prevention sites are smaller and can move from place to place, depending on the need of certain communities. And it’s important for outreach workers like Ghosh to know where these overdoses are happening throughout the city so that they know where to focus their care.
“You can test the waters to see if it actually fits with the community,” Ghosh said. “If it doesn’t, move the site to another location.”
Another thing that needs to be considered is the diversity of the population, he said.
Ghosh said services need to be tailored for clients who are Indigenous, gender diverse, experiencing homelessness or even from upscale neighbourhoods.
“It’s not really a onesize-fits-all model. It’s something we really have to tailor and have a multi-pronged approach towards.”
Inhalation sites
One limitation to safe consumption sites is that they are only for IV users, according to Angie Staines, founder of on-the-ground harm reduction organization 4B Harm Reduction Society.
“Every stupid decision, Twitter announcement, is just another nail in my child’s coffin,” said Staines, whose son Brandon is a heavy drug user living in Edmonton’s downtown. He’s the reason she started her on-foot organization, which hands out harm reduction tools, like clean needles and naloxone kits.
“It’s maddening. It’s heartbreaking to watch.”
So why not create a safe inhalation site, she asks, since meth — which is commonly smoked through a pipe – is one of the top three drugs used in Edmonton.
In 2020, the provincial government stopped publicly publishing opioid death heat maps, which showed where overdose deaths were occurring throughout the city. Through a Freedom of Information Act request, Global News was able to gain access to the 2022 death-by-neighbourhood records, which show that, between Jan. 1 and Sept. 1, opioid-related deaths occurred all over the city — not just in specific neighbourhoods.
One of the only safe inhalation sites in Canada for a time was Prairie Harm Reduction in Saskatchewan. It opened in 2020 alongside a safe injection site so that no one had to be turned away based on the drugs they were taking or how they chose to consume them, explained Kayla DeMong, the organization’s executive director.
Not only is Prairie Harm Reduction the first of its kind in Canada, it’s also completely privately funded — meaning it receives no government funding. The organization operates under federal Sanction 56, which exempts consumption sites from the Controlled Drugs and Substances Act.
Crystal meth has been the number one drug used in Saskatoon for years, DeMong said, but fentanyl is becoming more common.
“We have more people who are knowingly using fentanyl who are smoking it,” DeMong said.
The safe inhalation site provides users with the opportunity and support to smoke their drug of choice without judgment and with peace of mind.
Gaps in the system
An increased amount of fentanyl-laced supply during the pandemic was one of the largest contributors to the increase in drug toxicity in Edmonton, experts said.
Benzos, unlike fentanyl, don’t react to naloxone, which is most commonly used to reverse the effects of opioid poisoning. With all these drugs mixed together, users have been basically playing drug roulette every time they purchase street drugs. Poisonings reached an all-time high.
There is a massive public health crisis when it comes to opioid use and poisoning.
“The treatment doesn’t match the toxicity of the drug supply out there,” Staines said.
With such high toxicity levels in the drugs, the withdrawal process is much more intense and can take longer, she said. And the current models for detox and treatment are not set up to support that kind of addictions healing.
Jade regularly talks about going into detox and stands in line at the George Spady Centre with everyone else looking for a detox bed. But because she has access to supports like a psychiatrist and has a temporary place to stay at her father’s house, she is not considered at high enough risk in the triage system to qualify for a bed.
Even if she did qualify, it feels close to impossible to get a detox bed anyway. Every day there is a long line of people outside the George Spady Centre at 105 Avenue and 101 Street. All are hoping they will be chosen through the triage system for detox. Triage intake is open for only an hour every morning. If you don’t get in there, you can go to another detox centre, but the only other one (funded by AHS) is at the Royal Alexandra Hospital’s Complex Medical Detox Unit. There are only six beds for patients needing in-hospital treatment.
The lack of access to detox beds makes it so easy for these people who are already on the margins of society to walk back into the streets and use, Staines said.
Jade did successfully get through detox recently, and had a place in a treatment centre in Calgary, but when she used, she was immediately kicked out.
Rhonda said it’s not easy for anyone to go to detox.
“You are the sickest you’ve ever been in your life,” she said. “It’s like the worst flu ever. And you know what you need in order to take those symptoms away. But everybody’s telling you you can’t have it.”
A few weeks ago, Jade went to the hospital because she was sick with something unrelated to her drug use. After her stay, it had been two days since she had used. She thought it was the perfect time for her to go to detox. But because of the timing, the only place she would be able to go was to the Addiction Recovery Centre in Alberta Hospital, just outside city limits. Jade doesn’t have money or a car and wasn’t lucid at the time, so she wasn’t able to ask for a ride. She ultimately didn’t have a way to get to the detox centre even though she wanted to go.
Instead, she left the hospital and walked back into her regular lifestyle.
Chris, Jade’s older brother and Rhonda’s first-born, got lucky in that he had a detox and treatment bed waiting for him. Chris was what most people would consider a “functional” user — he was a pipefitter in the oil and gas industry and he had a family and home. But drugs were still accessible to him. And as his mental health waned, he used.
Chris started using drugs recreationally when he was a teenager, mostly experimenting at parties. His usage became more frequent with time and eventually he was in a full addiction. After several years of using, he had some sort of epiphany, Rhonda recalled, and he got clean.
“He detoxed himself with my help, went to Narcotics Anonymous and it seemed to be working,” Rhonda said.
He had six years of sobriety under his belt by the time he started using again in February. It was alcohol that initially kicked things off after he was pressured to drink by his peers — it was also alcohol that got him going, Rhonda recalled. Within two weeks he was using hard drugs again.
It didn’t take long before he knew he needed help. He reached out to his mum and told his work what was going on. His bosses arranged for him to go to treatment and had a bed lined up for April 9. On April 6, he used one last time and overdosed. He was taken to the hospital and intubated. On April 11, Rhonda made the decision to take her son off life support. Chris officially died on April 12 from drug poisoning at the age of 34.
“He was literally three days away from going to treatment,” Rhonda said. “And remember, he reached out in February to get help. And so they weren’t able to give him help until April, which is ridiculous, because there was that giant stretch of time where intervention could have happened in order to save his life. But of course, it didn’t. So here we are.”
Chris did everything a person addicted to drugs is “supposed to do, according to more traditional thought process,” Rhonda said.
“Unfortunately, there’s nothing for them between reaching out for help and recovery. There’s that gap where there’s nothing. Like, what help was there for him at that point in time other than go to an N.A. meeting? And I’m so sick and tired of hearing that — ‘I’ll go to an N.A. meeting.’ Yeah, that’s going to solve everything.”
Meetings helped Chris a lot when he was in recovery the first time. His best friend also went to meetings, and he had a sponsor who supported him while Chris continued to use as he waited for a bed this past winter.
“There’s limited things that we can do,” Rhonda said. “First of all, we are not mental health or addictions professionals — we are family members. We are friends. We are loved ones to him. We don’t have the skills or the knowledge to be able to do a lot of the things that need to be done.
“I have mental health first aid so I can do the talk a little but not really — I am not a mental health or addictions professional, so what the heck do I know? We were there for him, I guess, on a personal and emotional level. But there isn’t much that we can do.”
There are these gaps in the system where drug users who are asking for help have to wait to receive that help but they’re also at the mercy of their addiction. Sometimes, as was the case for Chris, time is not on their side.
Even with the province’s increases in funding for detox and treatment bed space, there are still wait-lists, making it even more difficult for people to get clean. And oftentimes, there is a wait between detox and treatment, if they are not connected programs, meaning people have to stay clean in the interim while they wait for a treatment space.
A 2019 community-based report stated that there is high demand for the services at safe consumption sites. Almost 47,000 people used a safe consumption site in Edmonton (at the time there were three sites in the city) between January 2018 and March 2019. And those were pre-pandemic numbers, with one less site than is currently open.
The move away from harm reduction to a treatment-centric program has advocates and parents fuming over the provincial government’s decisions on how to treat the opioid epidemic over the past few years. In the end, what they want are more options to keep their sick children alive.
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