By Nicolas Moyer
Lowertown residents have front row seats to the unfolding Opioid crisis. While some of its impacts are very visible – like the supervised injection site in Raphaël Brunet Park – others are much less so.
As front-line social workers and activists have taken measures in response to the growing crisis, many residents remain dismayed at changes taking place in their community and the lack of consultation with them on issues that affect their neighbourhood.
What is an “opiod”? The human “opioid system” is composed of opioid receptors in the brain and controls pain, reward and addictive behaviors. Opioid drugs exert their pharmacological actions through opioid receptors. Opioids are a class of drugs that include heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.
Opioid addiction is not new. There have been drugs like heroin and morphine around Ottawa, and Lowertown, for decades. It is the arrival of a super-charged opioid called Fentanyl which has changed the game. It is extremely powerful and addictive, between 50-100 times more toxic than morphine. Even a very small amount can trigger an overdose.
On the Front Lines
Caroline Cox at the Shepherds’ of Good Hope recalls how quickly Fentanyl arrived last February in Lowertown’s homeless community. Where in the past the Shepherds’ might have had 1-2 drug overdoses a year on their site at King-Edward and Murray, in February they had eight. It became 4-5 month until July when there was a big jump. That month there were 45 overdoses on their site, and then August, it became 75.
The stress on front line staff has been immense. Wendy Muckle, CEO of Ottawa Inner City Health, points out the massive efforts of the social services community to meet this crisis with prevention, naloxone treatment (naloxone can reverse an opioid overdose) and going out to meet people where they are using. For her organization and many others, the massive efforts dedicated to this crisis have come at the expense of other programs.
What is Fentanyl? A synthetic opiate narcotic, a prescription drug used primarily for cancer patients in severe pain. It is roughly 50 to 100 times more toxic than morphine. Heroin, cocaine, oxycodone, and other drugs can be cut with fentanyl, in powder, liquid or pill form.
What’s Needed Next
Despite the recent attention to harm reduction, experts agree this isn’t enough. To Ms. Muckle, more resources and support are needed to get past the urgent response phase and address broader solutions to opioid addiction. She identifies a range of services that are needed but aren’t getting the attention they need. For example, providing a range of treatment options because drug users don’t all respond to the same treatment and it usually takes years to get clear of their dependence.
What are the effects of an Overdose? A Fentanyl overdose can be triggered very quickly and by a very small portion of the drug. Early signs of an overdose include: severe sleepiness, slow heartbeat, slow, shallow breathing or snoring, trouble breathing, cold, clammy skin, trouble walking or talking.
Those closest to the crisis, like Ms. Cox and Ms. Muckle point out that drug addiction suffers from a severe stigma which limits investments in harm reduction, treatment options and research. Even with its high profile this year, the opioid crisis in Ottawa has only barely pushed the needle on harm-reduction services via temporary injection sites. And these only in the areas of greater concentration of need; in Lowertown. Needs exists in Carlington, Somerset West and elsewhere too. Some suggest the City should establish injection sites wherever they distribute clean needles.
What is Naloxone? Naloxone is a drug that can temporarily reverse an opioid overdose, when their breathing either slows or stops completely. If used right away, naloxone can help them breathe normally and regain consciousness. Naloxone can either be injected or given as a nasal spray.
Living at Ground Zero
To residents of Lowertown, one of the most visible elements of the opioid crisis has been the evening injection site installed in Raphaël Brunet Park. It has been a flashpoint for community members as the city and police have systematically refused to put an end to the site, even as organizers themselves recognized they were contravening multiple laws and bylaws.
Neighbours have many reasons to be upset, about the crisis and the takeover of a community park. Nearby residents have repeatedly shared accounts of increased drug use and unsafe behaviour that have accompanied the injection site. Many feel let down by the authorities and resent the lack of structured process and dialogue with the community.
While many expect that approaching winter will bring the end of the illegal injection site, the new injection sites at the Shepherd’s and the Ottawa Public Health clinic on Clarence can be expected to last much longer.
Until better treatment options are found, funded and spread across the city, it remains likely that the most vulnerable will congregate in Lowertown, where investments in emergency harm-reduction services are being made.
Despite their differences, social workers and residents all seem to agree on the need to invest in better, long-term solutions to assist people coping with drug addiction.