Hamilton has a prescription drug problem, and it's getting dramatically worse.
Where crack once reigned as the most dangerous drug in the city, painkiller opiates like oxycodone, fentanyl, percocet and morphine have moved in, creating a crippling and pervasive addiction problem for drug users.
This rapid rise in illegal opioid use has driven doctors, police, pharmacists, the coroner's office and addictions counsellors to form a 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. It's a big wave of bliss. You don't feel any pain, you don't think about anything that's 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. Joseph's Healthcare were opioid patients. In 2012, it's one in four. The number of female opioid withdrawal patients at St. Joe's 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 coroner's office. Years ago, heroin was the most common opioid doctors saw.
Now, it's prescription pills.
'I would've sold the clothes off my back to get it'
What are opioids?
Opioids are prescription medications that relieve pain. To get high, people can simply take more than prescribed, or break them down to snort, smoke or inject them.
Here are some of the opioids being used in Hamilton now:
- OxyContin: OxyContin is a time-released pain medication developed in 1995 for people who need around-the-clock pain relief. It was taken off the shelves in Ontario, but still exists on the street because of large stockpiles.
- OxyNeo: OxyNeo is a generic form of OxyContin that was brought in partially to curb abuse of the original drug. It can still be broken down and used to get high fairly easily.
- Percocet: Percocet is similar to OxyContin, but only lasts for about five hours as opposed to 12 hours. It also contains acetaminophen (the drug in Tylenol), which makes people sick if they take a lot of it.
- Fentanyl: Fentanyl is available as a skin patch, lozenge, pills, shots and a film that dissolves in your mouth. It's used for extreme pain situations, and often for cancer. In Hamilton, the patches are often chopped up and put inside the mouth, or smoked and injected.
- Morphine: Morphine is a common medium to strong painkiller, often used after surgery. A version called Hydromorphone or Hydropmorphs is often used in Hamilton
- Methadone: Methadone works by binding to the same cell receptors as other opiates but more weakly, helping a person wean off the other drug. It can still be abused, and is often used as a last resort to get high in the city.
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.
"I'd steal. I'd manipulate. Anything. I would've sold the clothes off my back to get it," she said. "It just takes you over. It's a big wave of bliss. You don't feel any pain, you don't think about anything that's hurting you."
And if you want to get high, then Hamilton was the place for her, she says. She lived in a "depressing, toxic environment," where prescription opioid abuse was rampant because of opportunity.
"It's just so easy," she said. Most of the people she'd buy from had prescriptions for the drugs and were selling their excess supply — or they were able to get prescriptions but never actually needed the drugs.
"You can get it anywhere," she said. Not just downtown, the North End, or Barton Street. It's 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 you've got a 60-year-old mom shooting up her 15-year-old kid. You've got a girl contemplating robbing her boyfriend at gunpoint. It's just stuff that's 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. He's been off drugs for years.
"It's different. It's survival. You need this, or you're 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 Hamilton's 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. Joseph's Healthcare's 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. Joe's Womankind Addiction Service in 2002. A decade later, that number had more than doubled to 26 per cent.
"We have patients and populations who are at risk," said Norm Buckley, the Director of Hamilton Health Science's pain clinics. "We know we have the pain problem, we know we have the drug problems."
But what none of those involved in combating illegal opioid use and addiction can answer is why Hamilton's rate is worse than other cities. Buckley and others point out it's not a problem that's exclusive to Hamilton. Opioid abuse and addiction is rising on a national scale.
Buckley offers that Hamilton 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. Joseph's Healthcare Womankind 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 prescription drugs, 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 beneficial uses, as well as control and management to prevent abuse.
The group's 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 of guidelines on prescribing policy for opiates to find a "best practice" for chronic pain.
But they're also trying to fix an even more fundamental problem: 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.
Killing Pain: Prescription drug abuse now Hamilton's biggest drug problem
CBC Hamilton examines the city's growing opiates addiction problem in a three-part series.
- Today: How prescription opiate abuse is taking over the city's drug scene and what medical and addiction specialists are doing about it.
- Wednesday: The growing connection between crime and prescription drug abuse.
- Thursday: Stories of Addiction and struggle. Three former addicts share their stories.
Live chat
Join CBC Hamilton Thursday at noon for a live chat with Dr. Norm Buckley, professor and chair in the Department of Anesthesia at McMaster's Michael G DeGroote School of Medicine. Buckley will be speaking about Hamilton's prescription painkiller problem, and just how this stakeholder group is trying to fix it.
"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 Buckley's name was on the bottles, he wouldn't 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 physician's 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 Buckley's name on it, he would appreciate a heads up from law enforcement.
"And even though it's 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. We're not in that loop."
Ontario does have a prescription monitoring program, but physicians don't 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 Staff Sgt. Paul Downey is part of the opioid working group, and says he welcomes the increased communication. "We have haven't been doing it — and that's something that we're looking at doing now," he said. "That's what I've instructed my people to do."
Downey says a change has to come, because he is seeing the rise of opioids, just like everyone else. "It's been predominant at least within the last five years," he said. "We've got a real problem here."
"You're never going to get rid of it. It's always going to exist — but we have to do what we can to minimize it, because it's getting into the hands of kids."
Curbing the deaths
Regional coroner Jack Stanborough calls this group a needed response to a systemic problem, but doesn't see things exactly as Buckley does. He told CBC Hamilton that he doesn't think communication between the coroner and police is lacking.
"Certainly, the police and coroner's 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, it's too late.
"You're missing the boat when you're 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 don't 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.
"We've got some people who are very adamant that we can't 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, of St. Joseph's Womankind 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 can't go any lower, it's 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, I'm happy."
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