Saskatchewan needs to change its strategy after another year of record overdose deaths
Cover by Gregory Beatty
Statistics on overdoses and overdose deaths in Saskatchewan are not easy to find. For some reason, Saskatchewan Health Authority doesn’t release numbers regularly. Most data comes from the Coroner’s Office and, in Regina, city police.
On Jan. 12, the Coroner’s Office announced that Saskatchewan’s confirmed and presumed overdose death toll for 2020 was 379.
The previous high was 177 in 2019.
Of the 172 confirmed deaths, 82 were in Regina and 33 were in Saskatoon. Regina’s death toll is surely higher than that, because in mid-December city police put it at 106 (with 1,060 overdoses overall). Unlike Regina, Saskatoon city police don’t track overdose calls. But based on the confirmed death toll, Saskatoon’s numbers will be considerably lower.
Saskatoon is a larger city than Regina, so all things being equal, overdose deaths should be higher there. But things aren’t equal. Saskatoon has something Regina doesn’t — a safe injection site.[mfn referencenumber=Note]The Nēwo Yōtina Friendship Centre recently applied to the province for an exemption to open a safe injection site in Regina.[/mfn]
The site is run by Prairie Harm Reduction. Looking back on 2020, director Jason Mercredi says it’s been a tough year.
“Staff are doing what they can, but it’s hard for them, because we’ve known some of these folks for years,” he says. “Staff burnout is starting to happen, and we’re definitely seeing burnout in the community.
“People don’t know where to go and who to turn to, and I think they feel abandoned when it comes to the addiction crisis.”
Stresses caused by the pandemic, such as disrupted supply chains and increased isolation in the user community, didn’t help. But Covid-19 is no excuse for why 2020 was horrible, says Mercredi.
“You can’t tell me the provincial government and the local community didn’t know the crisis was going to happen because we’ve been talking about it for years,” he says. “We knew the tainted drug supply would be introduced to Saskatchewan. Now, it’s here — and it’s here to stay. As a result, we have the situation we have, with a record amount of people dying.”
Pushing back against critics who say it’s not doing enough to fix the crisis, the Saskatchewan Party government points to recent investments in mental health and detox treatment.
Barbara Fornssler, a University of Saskatchewan public health researcher, says much more needs to be done.
“Good on them for putting more money into treatment,” she says. “That’s a good thing. But will it deliver the most impact? Probably not, and there are other tangential issues.”
Fornssler is in stage two of a study looking at opioid use in Saskatchewan. Stage I ran from 2017–2019 and surveyed care providers such as paramedics, emergency room doctors and addiction counsellors. Stage II will focus on the user community. [see sidebar]
Fornssler says a continuum of care is needed to address the addiction crisis.
“We have this idea that someone can be without housing, employment and other life resources, and we can pluck them off the street and put them in a treatment centre. Then somehow the centre is going to solve all the chaos and trauma in their life in a 28-day cycle, and spit them out as a perfectly reformed human being who will go back to the same environment and somehow acquire all the supports they need to continue not using substances,” she says.
Supports can take many forms. One that operates on the front end of addiction is greater investment in pain management clinics, says Fornssler.
“That’s something we heard from medical service providers,” she says. “People were saying ‘Hey, we’ve got individuals, particularly in rural and remote communities, who are getting injured at work, and they have limited access to physiotherapy and other rehabilitation programs.’
“Without those resources, the doctor is left saying, ‘Do I leave this person in pain, or do I give them a prescription?’” she says. “Obviously, they don’t want them to be in pain, or perhaps self-medicating through other means.”
For a time, OxyContin was the prescription opioid of choice. But it proved to be far more addictive than Purdue Pharma had represented, and that led to a huge surge in problem use. More recently, potent synthetic opioids like fentanyl and carfentanil have entered the market.
For people in the throes of addiction, safe injection sites are another vital support. But so far, the Sask. Party government has balked at funding them — to the point of denying a $1.3 million request from Prairie Harm Reduction in last June’s budget.
PHR previously operated as AIDS Saskatoon, but changed its name this summer when it decided to open a safe injection site. While the government decision was a setback, PHR persevered, and through several fundraising projects managed to open the site on Oct. 1 with a paramedic on staff.
“When we were looking at cost effective models, we went with the paramedic because that was the cheapest medical professional we could afford,” says Mercredi. “And their skill-set is very well suited to preventing people from dying, because that’s literally their job.”
The paramedic only works limited hours, though. And if they have to go on Covid precautions or get sick or take vacation time, PHR can’t provide that service.
In addition to supervision, safe injection sites also supply clean needles. That helps lower the incidence of HIV and Hepatitis B among users. Per capita, Saskatchewan has long led Canada in HIV infection, so harm reduction isn’t just limited to overdose prevention.
PHR has naloxone on site. Naloxone can reverse the effects of an overdose, and PHR also does neighbourhood patrols to look for users in medical distress and pick up used needles.
PHR provides other outreach services too, such as a drop-in centre and family support program.
Judging by the disparity in overdose deaths in Saskatoon versus Regina, PHR is having a profound effect. Not only is it saving lives, it’s almost certainly saving the provincial (and municipal) government money.
Circumstances would vary case to case but many overdose situations in Saskatoon would likely see police and/or paramedics called, perhaps an ambulance trip to emergency and a hospital stay, and in the case of death, a coroner’s investigation.
“Those are all the most expensive options you can list,” says Mercredi. “Consumption services are one of the cheapest options when it comes to intervention. If we were operational 24/7, we could deal with a lot more people than those organizations.”
Like Fornssler, Mercredi appreciates the investments the government has made. “We’re happy that we have new addiction beds and more addictions counseling, but people are still dying in record numbers.
“We would love to work with government to develop some pragmatic solutions, so we’re hopeful for the upcoming budget cycle that we will get funded,” Mercredi says. “But clearly the need for safe consumption sites is high — not just here, but in Regina and probably Prince Albert. Because as Vancouver has shown, there’s no such thing as waiting out the addictions crisis.”
Probably the most controversial harm reduction initiative is safe supply. So far, only Vancouver and Toronto have taken tentative steps to implement programs.
Fornssler says the idea has merit.
“If there was a regulated supply, we’d see a huge reduction in harm as people wouldn’t be poisoned with substances like fentanyl suddenly showing up in their supply.”
The benefits don’t end there, she says. “If you spend eight hours a day seeking the substance you need to not feel dope sick, when are you going to do any of the other things people do to improve their quality of life?
“If someone could walk into a doctor’s office and get their prescription for the week, then all of a sudden they have those eight hours back to connect with family, build friendships, address their underlying traumas through counselling, and do other things to restore stability to their life,” she says. “But when you’re living in chaos, it’s almost impossible to do.”
Police chiefs in Regina and Saskatoon have both said greater investment in harm reduction is needed and that we won’t “arrest our way” out of the crisis.
Fornssler hopes governments in Saskatchewan heed that advice.
“We’ve seen huge changes in the conversation around mental health and suicide, and that needs to be broadened to include substance use and mental health,” she says. “I feel like we’re on the cusp of change that could benefit a lot of people, if we reframe the conversation and focus on health instead of [criminalizing people].”
Stigma and Stereotypes
It’s been standard practice in public health research for some time to consult people who have first-hand experience with the disease or condition that’s being studied. This is true with everyone from cancer patients to people suffering chronic pain.
This is a much newer practice when it comes to substance use, says University of Saskatchewan researcher Barbara Fornssler.
Fornssler is about to embark on stage II of a study into opioid use in Saskatchewan, where she intends to engage with the user community. She attributes the previous failure to consult with them to stigma. “The War on Drugs has been extremely successful in stigmatizing people who use drugs,” she says.
The stigma, she adds, can be self-imposed when people constantly hear negative messages about how bad they are. Then there’s the broader social and systemic stigmas, where we allocate fewer healthcare resources to the problem and, with certain substances, even criminalize their use.
The qualifier “certain” is needed because substance use in our society takes many forms, from sanctioned (such as coffee, alcohol, tobacco, prescription drugs and (since 2018 in Canada, anyway) cannabis), to the non-sanctioned such as cocaine, crystal meth, LSD and opioids.
“For many people, substance use isn’t necessarily problematic,” says Fornssler. “It doesn’t cause a huge amount of harm or lead to crime or other social issues. But for some folks with background issues such as childhood trauma that prevented them from developing the coping skills we would maybe expect them to have, substance use basically becomes their coping mechanism.”
That comes with a caveat, though. Because with opioids, not all users fit that profile, says Fornssler.
“There’s an assumption that the only people experiencing problematic use are those who are marginalized, unemployed or struggling in other ways. What we’re seeing with opioids are a lot of problem users are full-time employees — usually male — working in the oil patch, the trades, or other physically demanding industries.”
During her study, which you can learn about at p5projectyxe.ca, Fornssler hopes to survey that group. She’s also interested in engaging with lawyers, doctors, teachers and other professionals who may be problem users.
Dispensing with the stigma and stereotypes around opioid use should improve the quality of the research and lead to better outcomes, she says.
“I think it’s a good idea to ensure the services being provided are actually meeting the needs of the people.”
Opioids and Overdoses
Opioids can be made naturally from the poppy plant (morphine and codeine are two examples), and synthetically in labs (such as methadone and heroin, along with fentanyl and its analogues).
Likewise, there are prescription and street opioids. They work by binding with receptors in the brain to reduce pain impulses and provide a sense of pleasure.
At low doses, opioids can induce drowsiness, while at higher doses they can slow the person’s heart rate and breathing. In addition to weak or no breathing and extreme drowsiness, other signs of overdose include difficulty walking/talking, blue lips or nails, pinpoint pupils, cold and clammy skin, dizziness, confusion and choking, gurgling or snoring sounds.
In 2017, Canada passed the Good Samaritan Drug Overdose Act. It provides legal protection from drug possession charges to anyone experiencing or witnessing an overdose who calls 911.
When administered in time, naloxone can reverse overdose effects. Saskatchewan has a take-home naloxone program where people can get free training on how to recognize and respond to an overdose and administer naloxone. To learn more about the program, which includes a naloxone kit, call 811 or visit saskatchewan.ca/opioids.
Naloxone kits can also be purchased at select pharmacies, and some community organizations distribute free kits.