Prescription painkiller abuse exploding in Hamilton

Hamilton has a prescription drug problem, and its getting dramaticallyworse.

Where crack once reigned as the most dangerous drug in the city, painkiller opiates like oxycodone, fentanyl, percocet and morphine have moved in,creatinga crippling and pervasive addiction problem for drug users.

• READ MORE: Prescription painkillers fuelling crime in Hamilton

This rapid rise in illegal opioid use has driven doctors, police, pharmacists, the coroners office and addictions counsellors to forma special task force to find ways to better work together to combat the growing problem.

All of them are saying the same thing: In the last five years, more and more people are using and abusing prescription painkillers in Hamilton.

It just takes you over. Its a big wave of bliss. You dont feel any pain, you dont think about anything thats hurting you.- Rebecca, former opioid user

According to statistics obtained by CBC Hamilton from the Drug and Alcohol Treatment Information System, admission rates for local opioid withdrawal programs are now the second highest in the province, behind only northern Ontario.

In 2002, one in ten people who entered a withdrawal management program at St. Josephs Healthcare were opioid patients. In 2012, its one in four. The number of female opioid withdrawal patients at St. Joes is now more than double the provincial average.

As well, opiate deaths now make up over half of all acute drug related deaths in the city, according to the coroners office. Years ago, heroin was the most common opioid doctors saw.

Now, its prescription pills.

'I would've sold the clothes off my back to get it'

Rebecca stands on a busy street corner in downtown Hamilton. Within seconds, she has picked out three people she could approach to buy drugs.

Him, and him, and her, she says, vaguely gesturing to people passing by. I can just tell. I can tell by the way they slouch.

I know I slouch that way too, she says, taking a long drag on her cigarette. You just have to look at them the way they walk, and the look in their eyes.

The 23-year-old has been clean for over ten months, now. But before that, she spent years with a needle in her arm, every day, shooting up opiates usually morphine or hydromorphone. She has asked that her last name not be used.

Id steal. Id manipulate. Anything. I wouldve sold the clothes off my back to get it, she said. It just takes you over. Its a big wave of bliss. You dont feel any pain, you dont think about anything thats hurting you.

And if you want to get high, then Hamilton was the place for her, she says. She lived ina depressing, toxic environment, where prescription opioid abuse wasrampant because of opportunity.

Its just so easy, she said. Most of the people shed buy from had prescriptions for the drugs and were selling their excess supply or they were able to get prescriptionsbut never actually needed the drugs.

You can get it anywhere, she said. Not just downtown, the NorthEnd, or Barton Street. Its in Westdale and on the Mountain nowhere is off limits.

Jim has seen the problem sprawl out over Hamilton from an early age. The 23-year-old asked that CBC Hamilton not use his real name.

I ended up going to a house on the Mountain, and it was really really sad, because the house was strictly used for drugs, he said. And youve got a 60-year-old mom shooting up her 15-year-old kid. Youve got a girl contemplating robbing her boyfriend at gunpoint. Its just stuff thats so surreal.

Jim was addicted to oxycodone and heroin for two years, and cocaine and crack for seven years before that, after first trying coke at 13 years old. Hes been off drugs for years.

Its different. Its survival. You need this, or youre going to be on the floor, dying. Your blood is going to feel like fire.

OxyContin is so powerful that on a daily basis, I could either shoot up a point of heroin or an OxyContin in fact, I would prefer the OxyContin over the heroin. And most addicts would.

A rising risk

Hundreds of people are rushed to Hamiltons hospitals every year for opioid related emergencies. According to the Ministry of Health and Long Term Care, there were 515 LHIN opioid emergency visits in Hamilton in 2012, up from 439 in 2009. Emergency room visits peaked in 2011 at 545.

People are dying, too. There were 22 opioid-related deaths in Hamilton in 2012 more than half of all drug related deaths in the city, according to the Office of the Chief Coroner.

Every single day of my life, I would pray to get cancer. I would pray to die. I would pray for a way to kill myself.- Jim, former opioid user

And more people are seeking help for addiction. Just 10 per cent of St. Josephs Healthcares withdrawal management program for men consisted of opioid patients in 2002. That number has grown every year to 24 per cent in 2012.

The numbers are virtually the same for women. Opioid patients made up eight percent of St. Joes Womankind Addiction Service in 2002. A decade later, that number had more than tripled to 26 per cent.

We have patients and populations who are at risk, said Norm Buckley, the Director of Hamilton Health Sciences pain clinics. We know we have the pain problem, we know we have the drug problems.

But what none of those involved in combating illegalopioiduse and addiction can answer is why Hamilton's rate is worse than other cities. Buckley and others point out its not a problem thats exclusive to Hamilton. Opioid abuse and addiction is rising on a national scale.

Buckley offers thatHamilton has a vast, under-serviced pain population. Couple that with an economy that has struggled for years after the downfall of the steel industry, and it creates an environment where addictions grow.

Debbie Bang, the manager of St. JosephsHealthcareWomankind addiction service says trauma is the root cause of addiction. And until we can change that piece, there is going to be a demand. And as long as there is going to be a demand, there is doing to be a supplier. She also touts Hamilton's withdrawal programs as some of the best, attracting people from outside the city to use them.

What those fighting the problem do know is that as legal prescriptiondrugs, opiates create a new abuse landscape that will require new solutions.

Coming together to search for answers

That is what has led Buckley and a host of other key stakeholders to form a working group out of McMaster University to overhaul the way prescription opioids move through Hamilton. The group brings together those who see the benefits of prescription painkillers when used properly and the people who deal with the consequences when they are not. They're trying to work through the needs of both: availability for the beneficialuses, as well as control and management to prevent abuse.

The groups scope is far reaching, and includes police, the coroner, pharmacists, the College of Physicians and Surgeons, the Canadian Centre for Substance Abuse and pain physicians like Buckley who is also the chair of the Department of Anaesthesia at McMaster.

By next year the group hopes to have established a new set ofguidelines on prescribing policy for opiates to find a best practice for chronic pain.

But theyre also trying to fix an even more fundamentalproblem: most of the big players in drug prescribing and enforcement hardly ever talk to each other. That leads to people slipping through the cracks, and a more rampant abuse of the system.

People have to get to know each other, Buckley said. The police have to get to know the docs, who have to get to know the coroner. You have to figure out how to communicate.

Right now, that communication is severely lacking. Under the guise of privacy concerns to protect patients and the law enforcement process, many organizations are reluctant to release any information about a person involved in a drug case or abuse situation, he says.

In fact, the current system hardly advocates any sharing of information at all. Right now, if a person was convicted of trafficking prescription medication and Buckleys name was on the bottles, he wouldnt be called unless he himself was part of the investigation.

One of our patients in the pain clinic brought in the front page from the Niagara Falls paper that had a photograph of the take at a drug seizure and there was one of our physicians names prominently displayed on the prescription bottle, Buckley said. No one called his office. He had to find out from the media.

Hospital hopping

Not surprisingly, when police arrest people for trafficking and they have ten bottles of drugs with Buckleys name on it, he would appreciate a heads up from law enforcement.

And even though its public information, how often do I read the court registry to find out that my patient was just convicted of selling pharmaceuticals that I prescribed to him? Almost never happens. Were not in that loop.

Ontario does have a prescription monitoring program, but physicians dont have access to that information unless a pharmacy phones them to say your patient is receiving similar prescriptions from three other physicians, he says which again, almost never happens.

Hamilton Police vice and drugs Det. Sgt. Paul Downey is part of the opioid working group, and says he welcomes the increased communication. We have havent been doing it and thats something that were looking at doing now, he said. Thats what Ive instructed my people to do.

Downey says a change has to come, because he is seeing the rise of opioids, just like everyone else. Its been predominant at least within the last five years, he said. Weve got a real problem here.

Youre never going to get rid of it. Its always going to exist but we have to do what we can to minimize it, because its getting into the hands of kids.

Curbing the deaths

Regional coroner Jack Stanborough calls this group a needed response to a systemic problem, but doesnt see things exactly as Buckley does. He told CBC Hamilton that he doesnt think communication between the coroner and police is lacking.

Certainly, the police and coroners office have a close, symbiotic relationship, we work as a team together, he said. But more feedback streamed to prescribing doctors is needed, he added because once someone ends up on a slab in front of him, its too late.

Youre missing the boat when youre talking about how did somebody die, he said. Death represents the most problematic scenario in a much bigger problem, and we just see the worst cases.

We dont see [the people] whose lives are in shambles.

Not every player in the opioid working group sees answers for curbing addiction exactly the same, he says.

Weve got some people who are very adamant that we cant be too hard on controlling narcotics because of the tremendous need for them, he said. Then you have other people who are saying this is causing so many problems, we really have to clamp down.

The right answer is probably somewhere in between.

Bang, ofSt. JosephsWomankind addiction service, agrees that more communication will be valuable in fighting addiction, but larger conversations about societal issues also have to take place.

Every person who has struggled with addiction that CBC Hamilton spoke to for this story says trauma or mental health issues have been a catalyst for his or her problems. Both Rebecca and Jim managed to get help, and are leading much happier lives sober.

When you reach a point that you cant go any lower, its all uphill from there, Rebecca said. And now I look forward to every day instead of dreading it.

Jim says he now appreciates life in a way he never would have when he was hooked on opioids.

Every single day of my life, I would pray to get cancer. I would pray to die. I would pray for a way to kill myself, he said.

Now, Im happy.