No agreement was reached this week on the best way to respond to the opioid crisis in Sudbury, but there was open and frank discussion that something dramatic must be done to save people’s lives.
There was even talk about changing the Mental Health Act to allow the province to detain people in treatment for six to eight weeks. It was not endorsed, but the fact such an extreme step was suggested demonstrates the profound impact the opioid crisis is having on communities across the country, but particularly here in Northern Ontario.
The event was an online town hall meeting held to discuss ways the opioid crisis might be addressed in Sudbury and across Northeastern Ontario. The town hall was hosted by Sudbury MPP Jamie West, who brought several speakers together Wednesday night to look at ways to ease the crisis through harm reduction, and to discuss the progress of finding a supervised consumption site, where people who take drugs can have a dedicated place to go.
After meeting and talking for more than 90 minutes, a lot of empathy was expressed, ideas were put on the table, but there were no new solutions agreed upon for the complex challenge of bringing the crisis to an end.
While some suggested more resources should be directed at treatment programs through established health services, other speakers challenged that option saying that many drug users want help, but don't want to be institutionalized.
Highest death rate in the province
As the opening speaker, West noted that based on the number of overdose deaths per 100,000 population, the Sudbury health unit jurisdiction had the highest rate in Ontario. The provincial statistics also showed that four of the top five death rates among health units in Ontario were all in Northeastern Ontario.
West said the past two years especially have been devastating for friends and families of drug addicts in the Sudbury District.
"It has been two years too many and we have lost too many loved ones," said West.
"The bottom line is that immediate action is needed to prevent opioid addiction and overdoses."
West said collaborative and compassionate solutions are needed. He said his role as MPP is to amplify the voices of concerned citizens and make sure the voices are heard in government. West said previous forums have told him that people in Sudbury don't just want to hear how bad the problem is, they want to help resolve the issue.
Big questions, no simple answers
Being able to resolve one's addiction is something that Darren Ransom was able to do. The Sudbury man, now in his 30s, spoke about his personal experience that began when he was a teenager.
He described himself as a youth who got good grades, was involved in sports, but then got involved with drugs at a young age after "hanging out with the wrong crowd". When he was 18, Ransom said a friend got him to try Oxycontin, the time-release prescription opioid many say led directly to the opioid crisis.
"I did it. I got hooked. I had no idea what I was getting into. It led me into a life of slavery and addiction. I couldn't break free of what I was stuck in. I tried for many years. It took 14 years before I got clean," said Ransom.
Another speaker at the online event was Maria Pollock, a member of STOPS (Sudbury Temporary Overdose Prevention Society) in Sudbury. She said the all-volunteer organization came together in the past two years in response to what she termed the toxicity and opioid poisonings that were taking lives in Sudbury.
"We also noticed how other cities and provinces were also dealing with the same issues as we are here," said Pollock. She said STOPS was a vital emergency service in Sudbury.
"We're out there to save lives and to prevent overdoses."
Also joining the conversation was Dr. Popuri Krishna of Sudbury, a psychiatrist at Health Sciences North. He said much of his work is with people who are "severely mentally ill." Krishnas said there is a situation where people who are addicted can develop mental illness, but it can also work the other way around.
"The thing that is happening is those people who may have substance use can develop mental illness. And those people who have mental illness can develop substance use," said Krishna.
"Which came first we cannot really say."
He said when he first began working in psychiatry, he dealt mainly with primary psychiatric disorders that are seen in every other community across the country.
"But things have changed," Krishna said.
He added that he is now trying to discover what is driving the level of addictions in Canadian communities.
"People are suffering. They're suffering more."
West responded by suggesting to Krisha that there isn't a simple solution. West asked what could the government do to help.
Krishna said it was a big question with no simple answer because there is no one single proven solution.
He said one of the "huge problems" that is faced by those who provide treatment is that no one can be forced to accept treatment.
"You can take a horse to the water, but you can't make it drink," said Krishna.
He added that a key concern in treatment is that many patients do not understand that they need to accept treatment. Many believe they do not need it, he said. He said there are useful treatment and rehabilitation programs being offered for people who become addicted.
"But we cannot really make them stay there if they do not want to stay there," said Krishna.
He said there have been several occasions where he kept a patient in the hospital in an acute care bed waiting to get them placed in a six-week or eight-week program, only to find that the addicted patients would check themselves out of the hospital. He added that families also cannot force their loved one to stay in treatment.
Forced addiction treatment?
He said the Mental Health Act could be a solution. Krishna used the example of a person with a severe schizophrenia disorder. He said if it could be demonstrated that the patient could be a harm to himself or others, there is an option to have the patient detained. This doesn’t exist with drug addiction.
Krishna said if he believes the patients needs treatment, he has to bring the case before a review board in order to get permission to have the patient detained.
He said the issue could be resolved by changing the law, but he said it is not something that should be decided by doctors alone. Krishna said it would require "a safe and compassionate" approach that would require civilian oversight.
"We could call it a compassionate drug-free care facility," said Krisha.
This suggestion did not sit well with everyone.
Pollock, referencing her experiences as an outreach worker, said she agreed there is no one solution or answer.
"Not everybody is comfortable going for medical attention at a hospital," said Pollock. She said she knows many people who will refuse hospital treatment for many different reasons.
She added that not everyone is comfortable in a 12-step program, a reference to the 12-step Narcotics Anonymous program, similar to the program Darren Ransom used in his recovery.
She said there is a stigma attached to formal treatment and people will shy away from it. She did suggest that grassroots organizations such as STOPS do need to continue discussions with the medical community to try to find solutions.
Significant discussion was also held about the progress of supervised consumption sites, an idea endorsed by the Community Drug Strategy in Sudbury, which authored a comprehensive study that was released in June 2020. Based on that study, Public Health Sudbury and Districts (PHSD) has been spearheading a drive to find a suitable site in the downtown area.
PHSD public health nurse Josée Joliat said there are criteria that must be met for a suitable site. This includes things like accessibility, proximity to social services, be at least 200 metres away from a park, a school or a daycare, be 1,500 to 2,000 square feet in size, have rooms for a nurse, a consumption room, a post-consumption room and appropriate municipal zoning.
Joliat said so far none of the potential sites has met the criteria. This means the initiative is halted for the time being.
"We've also encountered with certain owners and neighbouring businesses a lack of interest of not wanting to have these services around," she added.
Joliat said the effort is continuing with discussions with certain property owners. She added that PHSD has enlisted help from the City of Greater Sudbury and she is feeling confident a solution will be found.
Joliat added that on another front, PHSD is working with STOPS (Sudbury Temporary Overdose Prevention Society) to find a temporary site.
"We're looking into finding a place where we can put together a sanctioned temporary site which is a different application that we can put in with Health Canada," said Joliat.
This would allow for the creation of a supervised consumption site on a temporary basis until PHSD can create a permanent site in Sudbury.
She added that supervised consumption sites are not new. They have been created in other Canadian cities, giving addicts a relatively safe and secure place where they can consume drugs and get immediate help in the event of an overdose.
Len Gillis is a Local Journalism Initiative reporter at Sudbury.com. He covers health care in Northern Ontario.