Fentanyl and Life-Saving Care: Its Not About Us, Its About All of Us

Sheila Jennings, MSTH Ontario Leader

On April 5, 2018 the British Columbia government issued a press release stating that it will allow nurse practitioners to prescribe hydromorphone, methadone and suboxone. This progressive public health measure was put forward to save lives in the present opioid drug crisis. This measure is progressive because many Canadians still view those who’ve overdosed or who are at risk of doing so, with a mixture of fear and contempt. For others however, these are our children and the fathers and mothers of our grandchildren. As such, to us they matter.

The backdrop to the BC health policy initiative is the shocking number overdoses, many of which involved exposure to the drug fentanyl. There were 982 deaths in BC in 2016, with 67 % involving fentanyl. Approximately 1,422 overdoses occurred in B.C. in 2017 and fentanyl was implicated in 80% of those deaths. In Alberta almost 1.9 people a day died from fentanyl poisoning in 2017. That number is growing. Several people overdosed in Saskatchewan last month. Fentanyl had arrived on the scene.

An Ontario MHLTC News Release reported that from July to September 2017, there were 2,449 ER visits for overdose, up from 1,896 in the previous three months. Deaths due to overdoses rose dramatically from 2016 to 2017. Those ambulances you see go whizzing by on their way to an emergency room, people’s children are dying inside them. My child was in one of those ambulances. The Canada Health Agency recently reported that there were over 4,000 overdoses in Canada last year ̶ 1,500 more than in 2016. Advocate Zoe Dodds has referred the crisis as ‘carnage’. Advocate, Vikki Reynolds, referred to it during a workshop I attended as a ‘horror show’. The collective noun for a group of crows is ‘a murder’. I’m going with ‘a massacre’ of overdoses. In 2015 my son’s heart stopped during an overdose. A not uncommon event in these kinds of overdoses. These numbers make it feel like a massacre to me. Fortunately for us, a woman nearby saw and had called 911. She remained with my child and she remains, whoever she is, in my mind.

Mothers want more progressive health care initiatives. In 2017 Ian Hanomansing published “If it hasn't happened ... it's coming': Mothers of addicts urge a radical approach to fentanyl crisis.” The article features women speaking about their children’s experiences with drug use. They told their stories in the setting of extreme stigma to illustrate the need for change in our orientation towards those who use drugs. Their message: stop criminalizing drug users and start protecting them instead. They warn people will not stop dying until Canada wakes up.

We must learn from those with lived experience, and in particular from youth who’ve survived. They are the experts. We can also learn however from mothers living the crisis. As well, professionals with various forms of real life experience with the crisis, like Leigh Chapman and Zoe Dodd in Toronto, and Vikki Reynolds in BC are working very hard, caring, educating and advocating for others about the opioid crisis that affects all of us. I’m fortunate that Chapman provided us with extremely helpful personal advice by phone. We must listen closely to what these experts say, because too many people are discovering a very hard way that there’s little margin for error. Death can come to your family in an innocuous looking pill. Don’t underestimate the power of peer pressure, if you do not want to learn that your child has died, or is fighting for their life in an ICU, learn from those who have.

You can also learn about the crushing effects of stigma. Jettison terms like drug addict and junkie from your vocabulary. Learn about opioid dependence and withdrawal. Find out about ‘harm reduction.’ According to a recent Angus Reid poll, 1 in 8 Canadians (12.5%) know someone who became opioid dependent in the last five years. Yet Statistics Canada’s January 2018 Opioid Awareness Survey found that only about one in fifteen Canadians (7%) know how to access Naloxone and use it to interrupt an overdose until help arrives. Get a Naloxone Kit and ask someone how to use it. Do this, because if you come across someone who has overdosed ̶ and some of you reading this will ̶ they will be relying on you for help.

Support safe injection sites. Or at least don’t oppose them. The opioid crisis is the menacing force to be reckoned with; drug users are not. One mother in the article I mention above comments of the overdose crisis, “If it hasn't happened in your family ... either you're in denial or it's coming.”

It’s a fact. Be prepared.

An open letter to the CBC Ombudsperson regarding the use of stigmatizing images

Ms. E. Enkin, Ombudsman, Canadian Broadcasting Corporation, P.O. Box 500, Station A, Toronto, Ontario

April 5th, 2018

Dear Ms. Enkin,

We are writing this letter to draw attention to a serious concern we have regarding the use of misleading imagery in CBC articles presenting issues around the epidemic of substance related overdose. The organization we represent is called “Moms Stop the Harm”. We are a national network of mothers from across Canada who have lost loved ones to substance misuse or whose loved one is hoping for recovery. Our organization’s primary objective is to save lives. Our efforts to do this are founded in the principles of harm reduction and opportunities that are served under that umbrella.

From one end of this country to the other we are seeing our membership grow every day. More notably, it is apparent that the demographic assigned to overdose has changed and with that it is paramount we change our paradigms, especially those that serve to stigmatize the picture of substance abuse. The demographic we are referencing here are younger people who are using and dying alone. They are dying at home in upscale communities, dying on the sofas at teenage house parties, or even safely parked in the driveway in the family car.

The CBC has taken to repeatedly using the image of a green pill, a discarded needle and/or pictures of homeless people. They certainly have shock value and with that will capture the viewers’ attention. However, these photos could quite easily mislead the community into thinking that the deaths are confined to a specific user group.

Your organization has a vast following and coast to coast influence. It would be fair to suggest that your reporters are aware of the truth behind that which they report. With that awareness must come an understanding that the demographic of people dying by overdose statistically is vast and not limited to drug users who injects their substance(s). Many more are dying by alternative methods of consumption. Tainted illicit drugs like cocaine and methamphetamine are taking the lives of far too many. Research has shown that 80% of all street drugs are contaminated with deadly fentanyl.

Journalists have a responsibility to share the truth and educate the public. When they fail to show the broader representation, as is the case with the current imagery, it can feed the stereotypical story that too many believe. The story that tells us that only street involved people are dying during the overdose crisis. The public are in fact almost assured by virtue of a single method of consumption represented, that they are safe. Most don’t want to believe that their loved one could die by overdose let alone use illicit drugs that put them at risk. The truth is they can die, statistically they are dying and green pills and needles represent only a portion of users.

The statement below was taken from your own Journalistic Standards and Practices. It outlines a clear commitment to fairly representing the vulnerable in your media efforts.

We are aware of our influence on how minorities or vulnerable groups are perceived… We avoid generalizations, stereotypes, and any degrading or offensive words or images that could feed prejudice or expose people to hatred or contempt… When a minority group is referred to, the vocabulary is chosen with care and with consideration for changes in the language.

Deadly drugs are evolving and with them, so too should the imaging that serves to represent the substance user. We would like to add some suggestions of images that are more aligned with the actual deaths or using habits of our members loved ones.

  • cocaine on a neatly organized office desk
  • a young man on a sofa at a house party, head bowed seemingly sleeping
  • a small bag of powder next to a teenager’s text book

In addition, pictures that tell stories of effort:

  • images of people with lived or living experience from all a variety of backgrounds (including those who have died)
  • photos of professionals providing treatment or harm reduction supports
  • treatment or harm reduction supplies

We need greater communication about the opioid crisis across this country if we want to save lives. As a national news agency, you not only have an opportunity but more importantly a responsibility to the public. Generalizations such as images of people using and dying while out in public only feed the judgements placed on the marginalized and such images fail to represent the truth.

Sincerely,

Marie Agioritis, leadership Saskatchewan – on behalf of our Canadian team.

Moms Stop the Harm

MSTH Letter to the Prime Minister and Minister of Health demanding urgent action - response form MoH

Below is the text of a letter MSTH sent to Prime Minister Justin Trudeau and to Ginette Petitpas Taylor, as well as the response from the Minister of Health.

February 13, 2018

The Right Honourable Justin Trudeau, Prime Minister of Canada,                                                                Office of the Prime Minister, 80 Wellington Street , Ottawa, Ontario, K1A0A2

Dear Prime Minister Trudeau,

We are writing on behalf of the 350 members of Moms Stop The Harm (www.momstoptheharm.com) whose loved ones have died drug-related deaths, many of which have occurred during the opioid overdose crisis. Members of our advocacy group recently attended Town Hall meetings in Edmonton and Nanaimo. Thank you for hearing our questions and comments about the need for drug policy reform at those two town-hall events, and thank you for offering your condolences on our losses.

Did you know that since November 13th, 2017, over 400 letters were sent to the office of the Prime Minister by members of MSTH and their allies, and to date no one has received a personal reply? The letters were sent as part of a campaign called “Do Something Prime Minister.” Information about the campaign and photos can be found here: http://www.momsstoptheharm.com/personal-blog/

Those who sent letters are all relatives (mothers, fathers, brothers, sisters, uncles, wives, husbands, daughters, sons, cousins) and friends of those who died of drug-related causes. Almost all of the letters that were sent contained cherished photos of our loved ones who have died.

Given the personal nature of the letters and photos that were sent, it is very hurtful to the families that they have not received a response. As MSTH member Patricia Clark states: “This was a very heartfelt campaign and I am very disappointed that my family has not received any response from the Prime Minister.” Another MSTH member stated: “It was hard to do (to send the letter and photo), and my family will echo this, and to be ignored is brutal.” Members of MSTH feel stigmatized because the federal government has failed to contact us after we sent in photos and letters relating to our losses. Now that you know about this letter writing campaign, we are sure you will respond with a letter that we can share with the people who participated in the campaign. We hope your response begins with offering your condolences.

During your recent town hall meeting in Nanaimo, you stated, “there is a lot more to do at the Federal Government. We’re always happy to do more….We are facing tragedies…you are facing terrible tragedies that have no business in a country like Canada…we should be able to keep our communities safe. We are aware of the opioid crisis and it is something we need to redouble our efforts on to honour those we have lost and make sure we don’t keep losing the best and brightest….”

We appreciate your willingness to do more and would like to make several suggestions based on our experience and representing at least 400 families who have lost a loved one to the overdose crisis. We specifically request that you instruct the federal government to:

  1. Deploy more federal financial investment in responding to the overdose crisis and fund the response at the scale that would be expected for any other public health emergency of this magnitude. However, while it is critical, more than just funding is required.
  2. Work with Provinces and Territories and provide leadership to address the lack of training for health care providers in evidence-based addiction treatment that has led to Canada not having a functioning addiction treatment system. Many of the deaths of our loved ones can be directly traced back to the failure of our non-existent addiction treatment system. Leadership at the federal level is needed to push the provinces and territories into establishing evidence-based health care provider education in addiction medicine. This includes the inclusion of addiction medicine in medical student and nursing student curricula, as well as, critically, funding for addiction medicine fellowships so that the expert workforce that does not presently exist will be created in the coming years.
  3. Correct the woefully inadequate resources Canada has directed towards action-oriented substance use and addiction research. We want to see the role of research in promoting social change in this controversial area acknowledged through the dramatic scale up of addiction research funding. This could support both responding to the opioid epidemic as well as funds to help address questions related to other drug policy reform needs, including cannabis legalization and the decriminalization of all currently illegal drugs. Here, we strongly recommend following the example of the US National Institutes of Health by creating a substance use-dedicated institute within the Canadian Institutes of Health Research. Many of the services offered for addiction care in Canada are not based on a foundation of research and evidence, and establishing stronger research and knowledge translation capacity will help with needed implementation. Decisions like this make sense from an economic, political and knowledge mobilization perspective and should be made urgently.
  4. Create better governance to help organize the response to the overdose crisis. This could be accomplished through the formulation of a federal ministerial council on the opioid crisis. The council could be like the Alberta Ministers Opioid Emergency Response Commission (MOERC) initiated in Alberta in May, 2017 https://www.alberta.ca/albertas-opioid-crisis-response.aspx and draw on the experience of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada. This new council, focused on the opioid crisis, needs to include people with lived experience and families (including indigenous representation), as well as scholars and practitioners and health officials, who have knowledge of and understand evidence based strategies to address the opioid crisis. The implementation of this Federal Ministerial Council should be announced along with considerable dedicated federal funding. Alberta invested $30 million annually, and we would expect that a federal investment would match this on a per population basis. Such a Council should advise on the allocation of this funding in prevention, treatment, and harm reduction.
  5. Provide dedicated resources and provide instruction to provinces and territories to establish family advocacy and support groups and peer-support groups. People directly affected by the opioid crisis, including people who use drugs and family members affected by substance use or addiction, are best positioned to identify and help implement solutions. These groups have not been well supported or acknowledged. The need for federal action in this area is urgent.
  6. Act now on drug policy reform. After years of inaction by the previous government regarding drug policy reform, we are encouraged by recent changes that your Liberal government has implemented including: passing the Good Samaritan Act, approving supervised consumption services across the country, supporting the piloting of drug checking initiatives, and initiating a national anti-stigma and education campaign. We are also encouraged that Liberal MPs are hoping to adopt a priority resolution at the Liberal Party of Canada’s policy convention that would direct the federal government to eliminate criminal penalties for simple possession and consumption of all illicit drugs. The decriminalization of the possession of small amounts of drugs for personal use is urgently needed. Substance use disorder is not a moral failing. It is a health issue that requires treatment and continued support, rather than a criminal justice approach, an approach taken by Portugal, Switzerland and soon Norway and the State of Oregon.

We look forward to hearing from you as soon as possible. The families who sent those 400 letters are waiting for a response that will acknowledge their losses and provide information to them about the next steps the Federal government is taking to address the opioid overdose crisis.

We also formally request the opportunity to meet with you and you team to hear directly how we can mobilize support for the implementation of the above initiatives. Thank you in advance for your consideration of this request.

Sincerely,

Leslie McBain, Petra Schulz, Lorna Thomas

Co-founders. Moms Stop The Harm.

Cc: Linda Duncan, MP; Elisabeth May, MP; Don Davis, MP; Ginette Ginette Petitpas Taylor, Minister of Health; Suzy McDonald, Deputy Minister of of Health, BCCSU.