One in nine Ontarians get a prescription for an opioid each year and three people die from an opioid-related death in Ontario every day.
Given this reality, I am lucky. No one close to me is dependent on opioids to manage their chronic pain or is addicted to opioids. No one close to me has died from opioid use.
As a doctor, I have cared for people dependent on opioids. Mostly they have been brief encounters on the medical wards to treat infections from drug use that often ended with the patients discharging themselves against medical advice. Because of the pressures of a busy medical ward to discharge patients as quickly as possible, and partly because of my inadequacies as a physician, I have rarely engaged in meaningful conversations about what led to their drug use or discussed ways of ending it.
On my way to and from work at St. Michael’s Hospital in Toronto, I often cycle by people shooting up in the streets, lying on the sidewalk or apparently high on drugs. I almost never stop.
Like most Canadians, I know that opioids are effective at treating pain. I also constantly hear the statistics and news stories about the ravages of opioids—those prescribed by doctors and those obtained on the street. I interact with people on opioids, but I almost never take the time to hear their stories or try to understand their lives.
Luckily, I was recently given that opportunity. Tara Gomes, the leader of the Ontario Drug Policy and Research Network, was keen to give a voice to users of opioids and health care providers to supplement the research reports that she and her group have produced about opioid use and opioid-related deaths.
Together with Tara and her team, Healthy Debate identified 11 people who have had experiences with opioids, and we have woven their stories, photos and videos into a multimedia product called The Opioid Chapters.
Their experiences and perspectives are varied and extraordinary.
Dan and Michael both developed chronic pain after a back injury. They have tried almost every treatment available, and an opioid is the only treatment that takes the edge off their pain; this allows them to function. They are terrified that the current concern about addiction will make physicians avoid prescribing opioids to people like them.
Greg’s wife died at home from an inadvertent fentanyl overdose.
Benjamin, Fran, Henry, Jackie and Sean all were addicted to opioids. Their routes to addiction were different—opioids prescribed to treat mouth pain when dental work was unaffordable, illicit drug use starting at a very young age because of family situations that are unimaginable to me, and exposure to Percocet that was prescribed to others who then sold the drug to make a profit.
I was impressed by how eloquent they were. There must be something about looking death in the eye on a regular basis and struggling to survive on the streets that gives you a wisdom I don’t have.
Their roads to recovery were long and arduous, often taking many years, with starts and stops along the way. They talked about people treating them with respect and being there for them as an important part of their recovery. The importance of non-judgmental support is also articulated by Lisa, an addictions counsellor.
Rupa, a family doctor who inherited a practice in which many patients were prescribed large doses of opioids and became addicted, describes the long and at times emotionally draining process of weaning people off opioids. I admire her very much—this is hard work that takes time and doesn’t maximize billings.
Angela, a pain specialist, eloquently describes the psychological factors that often contribute to chronic pain and how difficult they can be to treat. She describes the role of opioids in her practice while at the same time pointing to the devastation that their indiscriminate use can cause.
I hope that the Opioid Chapters illustrates the complexities underlying Canada’s opioid crisis. And the humanity.
There are no easy solutions. We need to be clear-headed and compassionate. We need to focus on the individuals affected but also on the social issues that often lead to addiction.
We also need to remember that there are many people who we couldn’t interview because they are dead.