While they are both pleased with the soon-to-be opening of the temporary safe consumption site after years of running the Sudbury Temporary Overdose Prevention Society (STOPS), Karla Ghartey and Marie Pollock told Sudbury.com the site is “merely a drop in the bucket,” of a necessary drug strategy.
Ghartey is a nurse, community advocate and co-founder of STOPS; Pollock is a peer harm reduction advocate and a person with lived experience, though she refers to it as “living experience.”
They both feel there needs to be what’s known as “safe supply” when it comes to substance use.
It’s a similar tactic used to ensure those who wish to use substances like alcohol, cannabis and cigarettes are receiving a product that is high-quality, but also contains ingredients that can be listed, as well as the amount of each ingredient contained in the product.
Much like there is quality control for harmful substances like alcohol, cannabis and cigarettes to keep people safer, Ghartey and Pollock both said contamination of the opioid supply is a major driver of overdoses and deaths. There is no quality control for illegal drugs.
Ghartey said, in her opinion, dose can’t always be a factor.
“You don't even know what the doses should be, because you don’t know what's in it and don't know the concentration.”
Public Health Ontario recently released statistics in 2021 of what is being referred to as an endemic inside a pandemic, stating that a “progressively toxic drug supply is having an impact on the increased number of opioid-related deaths across the country.”
During the pandemic, more than 25 per cent of these opioid-related deaths were linked to a non-prescription benzodiazepine (tranquilizer), compared to approximately five per cent pre-pandemic.
Many of these are not approved for use in Canada, which suggests that they are contaminating the unregulated opioid supply, stated Public Health Ontario. Polysubstance use (consumption of more than one drug at once) also increased during the pandemic.
Public Health Ontario also stated there was a significant increase in stimulants contributing to opioid-related deaths, with their involvement rising from 50 per cent to 58 per cent during the pandemic.
In fact, while both Ghartey and Pollock say the issue has been around longer than the pandemic, data suggests that the pandemic has had a part to play in how toxic the supply has become. Supply volatility increased dramatically once pandemic lockdowns were declared in March 2020, according to the Canadian Centre on Substance Use and Addiction (CCSA), and this has been linked to supply chain issues and border closing.
Pollock said that adding ingredients — also called ‘cutting’ or ‘stepping on’ — that can be found in other medications, and even other chemicals, creates more product without increased cost or risk to the manufacturer.
Introduced in 1996, prescription opioid OxyContin is often seen as the catalyst of the opioid crisis. As more people began using the drug, initially being told that it was non-addictive, more people started misusing it. Dealers turned huge profits as the painkiller became a popular street drug.
There were attempts by law enforcement and the opioid manufacturers to make the drug more difficult to access, but with a lack of support for those already in the grips of addiction, many people turned to the streets and to other opioids, including heroin.
As the demand for opioids increased, the powerful synthetic opioid, fentanyl, was added to the supply of heroin.
In 2016, a study by Public Health Canada found that fentanyl was fuelling a rise in opioid-related deaths. The study said fentanyl, which was becoming more prevalent, was also increasingly mixed in with other substances, upping the risk of an overdose.
However, Pollock said the focus on fentanyl could be due to insufficient testing of the drugs being used, especially those that cause overdose.
“They see fentanyl present, and put it down as a fentanyl death, when no one has any idea what caused the overdose,” she said.
Pollock added there could be toxic substances, like excess caffeine or animal tranquilizers, in the supply and that would not be registered if the substance is not tested.
“And I know my people,” she said of those she knows who use substances regularly. “Fentanyl has been around for a while, and they have a very high tolerance.”
In 2020, 69 per cent of opioids seized by law enforcement agencies across Canada consisted of fentanyl or fentanyl analogues, according to Health Canada's Drug Analysis Service (DAS).
But while fentanyl is still detected in an overwhelming majority of illicit drug deaths in Canada, the unknown quantities of other substances mixed in with the fentanyl is what Pollock said is a real problem.
Benzodiazepine, which is typically prescribed as a sedative, is dangerous when paired with fentanyl because the sedation increases the risk of an overdose, according to Health Canada. Worse, Naloxone, a fast-acting antidote that reverses the effects of an opioid overdose, doesn't act on benzodiazepines or on most other synthetic substances found mixed in with opioids.
As well, the toxic drug supply is complicating medical care for substance users.
“A lot of healthcare procedures and approaches are still based on the old school information of drug supply, which is not applicable nowadays,” said Ghartey, “because we are dealing with synthetic poisonings.”
“We're seeing a lot of benzos (benzodiazepine), which are as addictive, if not more addictive than opioids,” said Ghartey. “And they are more challenging to deal with in terms of an overdose, because Naloxone doesn’t do anything.”
Pollock said she believes more than 50 per cent of the people using substances in Sudbury are more addicted to tranquilizers and benzodiazepine than they are to fentanyl.
“Some of the substances that I've sent out to be tested have a very low quantity of fentanyl,” she said. “You get a higher quantity of benzodiazepine and tranquilizers and other unidentified agents than you do fentanyl.”
Pollock said that not only can someone become addicted to benzodiazepine without even knowing it was in their supply, but that the substance can be harder to get off of if one desires. “From experience with benzodiazepines, it's a lot harder mentally and physically, it's a longer process,” said Pollock. “And it also depends what kind of health care you're able to get, that it plays a part in that as well.”
And while the supervised consumption site – still a temporary one, notes Pollock – is a good first step, there is a need for increased support and a safe supply. Think of it as alcohol: safe supply is available at the LCBO, and a bar could be considered a safe consumption site.
“What we're also still seeing is that just because someone has the desire to cut down on their use, or stop their use, or whatever is in their journey for them, that doesn’t mean the resources will be available,” said Ghartey. “We've seen a number of people access the Addictions Medicine Unit (AMU) at Health Sciences North, and then as soon as they're discharged, they're right back to where they started because there's no transition component. There are no support systems, or there are no long-term strategies. It's almost like people don't have a choice, because they have nowhere to go.”
Ghartey said safe supply is meant for those who don't respond to first- or second-line treatments like methadone or suboxone, for any number of complex reasons.
“The fact of the matter is, every time someone uses a substance, essentially, they could die right then and there.”
Safe supply will also protect those who are not ready to stop.
“Not everyone can fully abstain from substances, nor do they wish to,” said Pollock. “And that needs to be respected.”
Ghartey and Pollock both feel that while the consumption site is desperately needed, it is only one piece of the puzzle. They feel there needs to be support for those who wish to use substances, something that keeps them healthy and safe, while also respecting their needs, desires and rights.
“When you look at the root causes, you're looking at it from a perspective of society, you're looking at it from the perspective of policies and procedures, classism and racism and intergenerational trauma,”said Ghartey. “We need to look at those bigger things, in addition to the other little things that happen within families, within people. That's why this supervised consumption site is a drop in the bucket. Yeah, we need it, but we needed it long ago and we need so much more.”
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.