As the Aug. 31 International Overdose Awareness Day approaches, Kaela Pelland, director of peer engagement with Réseau ACCESS Network spoke with Sudbury.com about the challenges currently facing those who use substances, and those who are dying from drug poisoning.
Pelland said the issue is systemic, the result of “a drug policy that is directly linked to drug prohibition.”
On Aug 23, new data from Ontario's Office of the Chief Coroner revealed that Public Health Sudbury and Districts had an opioid death rate of 57.9 per 100,000 people in the first quarter of 2022.
In Ontario, it was second only to Thunder Bay, which had an opioid death rate of 82.1 per 100,000 people in the same period.
The coroner's data showed there were 2,790 opioid-related deaths in Ontario from April 2021 to March 2022, and 2,727 deaths during the first year of the pandemic.
Pelland told Sudbury.com that in addition to toxic street supply (that is illegal drugs cut with an adulterant that can make them more deadly), systems that have treatment and policy built around “moralism”; the practice of moralizing, especially showing a tendency to make judgments about others' morality, are largely unsuccessful.
“At some point in time in history,” Pelland said, “a group of people in power decided that we should criminalize and demonize entire groups of people by associating them with a substance, and it hasn't been successful. We associate a specific substance with being good or bad, when in reality, it's the relationship we have with substances that can be positive or negative.”
She notes that there are many people who are able to use substances, including opioids, in a healthy way and function well or even thrive in their day to day life.
“They may have support around them,” Pelland said, but also, they more than likely have access to a safe supply – a prescription in most cases – rather than be forced to purchase street supply.
That access to safe supply is paramount in many ways, she said.
“Someone now has to resort to buying an illicit supply, and now, that person may need to find a way to raise funds because street drugs may be more expensive than they are prescription,” Pelland said. “Then, someone has to put themselves in potentially dangerous situations to buy those substances, rather than just going to pharmacy, and then there are other temptations or behaviors that someone might expose themselves to, other behaviours and risks in order to get their substance.”
Even when someone decides to stop using substances that they feel are impacting their lives negatively, the road to recovery can be fraught with obstacles.
“If folks are coming out of treatment, and they have no home, no support, they will often revert back to previous behaviours,” Pelland said. “Someone who has been sober for weeks or months is right back in the same city, or living with folks who may be partaking in the substance they just went to treatment for. It’s not surprising that without a proper support plan in place, folks will revert back to old ways.”
Overdose and death can occur simply because of lowered tolerance without daily use. “Within 24 hours of someone not using, their tolerance goes down,” Pelland said. “For instance, when people are released from jail or the hospital, they weren't using at all, and they're now out in the community in deep, painful withdrawal. They're gonna revert back to their normal rituals, using their substance of choice, without realizing that they need to use significantly less.”
Even when there is support in place, Pelland said, prejudice from health care workers can change people’s desire to access treatment medications like Methadone and Suboxone, or to speak to their doctor about their substance use, in the same way they speak about their diet.
“If someone decides that getting on methadone is the best thing for them, they have to go to an office urinate in a cup every week, they get labeled ‘clean’ or ‘dirty’ depending on results,” words which Pelland said can add to the prejudice they feel.
Even getting their medication is done in a segregated manner, and while Pelland said she understands that was initially for privacy reasons, it can result in many feeling “othered,” like they are doing something wrong rather than just obtaining medication from a pharmacy.
“It's really challenging to work in such a broken system and challenging to live in such a broken system,” Pelland said. “You're making all of the efforts and you're doing everything possible to keep yourself and everyone around you safe, but the system is designed to fail. It's just a cycle at the end of the day.”
That cycle is leading to overdoses, and now, poisoned supply is increasing them.
“The reason why so much naloxone is needed in the community is because the drugs are poisoned,” Pelland said. “There's always going to be problems with substances because of how people's relationships form with those substances, which is unique to every single person. But when you regulate it and normalize it, and make it safe. A lot of the negative health outcomes dissipate.”
And fewer deaths will mean less grief and additional trauma amongst the tight-knit vulnerable communities. Pelland said she has lost so many people to drug poisoning and overdose that “it’s in the double digits now” and there is grief felt for that loss; but each new loss is also a reminder of every loss previous to it.
“Because the rest of society has completely ostracized them, they've developed this beautiful, supportive community,” Pelland said. “But now, over the years, they’ve had to see these friends die, family die, they live in a constant state of trauma because they’re constantly responding to overdoses, so we have a lot of folks who are just riddled with trauma from being in survivor mode all the time. That's really taking its toll on folks who have survived thus far.”
In addition to harm reduction and overdose education like that Réseau ACCESS Network will hold on Aug. 31, Pelland said real change needs to happen in drug policies and systems.
“We need to point the mirror back at the systems that created this problem in the first place,” Pelland said. “It's been decades and decades of blaming the person who uses drugs, blaming the marginalized community for being where they are, for being who they are, when in reality, this structure is built for that.”
She added that more than anything, there needs to be more listening to the vulnerable populations themselves.
“At the end of the day, who better to decide what the community needs than the community itself? It's not up to us to control them anymore. We need to follow their lead.”
You can find more information about International Overdose Awareness Day here.
Jenny Lamothe is a reporter with Sudbury.com. She covers the diverse communities of Sudbury, especially the vulnerable or marginalized, including the Black, Indigenous, newcomer and Francophone communities, as well as 2SLGBTQ+ and issues of the downtown core.
