Updated June, 2021.
We recently interviewed Rose Ceci (a certified psychiatric mental health nurse with the Canadian Mental Health Association), to get her take on today's most pressing mental health issues.
In addition to other major hurdles, she was quick to pinpoint the problem with opioids.
"We are facing many daunting challenges in this field: lack of funding, lack of services, long wait lists—especially for youth. And then there's the problem with opioids.
There's no doubt that we are facing an opioid crisis, and are in dire need of awareness and services for those who are suffering."
You might not immediately recognize the connection between opioids and community mental health. But if you consider the very strong relationship between addiction and mental illness, the link becomes much clearer.
Does your work put you in close contact with people who struggle with poor mental health, and may be impacted by opioid abuse?
What should you know about the crisis? These 8 facts and key stats are an excellent place to begin.
1. What exactly are opioids?
Opioids are medications that help relieve pain. They're a class of drug naturally found in the opium poppy plant. Some opioids are made from the plant directly, while others are synthesized in labs.
Common examples of opioids include:
- hydrocodone (Vicodin®)
- oxycodone (OxyContin®, Percocet®)
- oxymorphone (Opana®)
- morphine (Kadian®, Avinza®)
People abuse opioids in various ways. They swallow the pill in its normal form. Or, open the pill/capsule, dissolve the contents in water, and inject it into a vein. Some snort the powder.
2. How are people getting opioids?
Some opioids are prescribed by doctors. For example, if you've just had surgery or are recovering from a serious injury, your doctor may give you morphine or codeine to ease the pain.
However, opioids have become increasingly available through the illegal drug trade. Fentanyl, for example, is often mixed with other street drugs (like heroin) and packaged into fake pills.
Many drug users are exposed to fentanyl without even realizing it. This opioid often turns up in other drugs, which have been produced on surfaces or using equipment that carry traces of fentanyl.
Fast facts to know:
- bootleg fentanyl is about 40 times more potent than heroin and 100 times more potent than morphine (source)
- fentanyl is a cheap way for drug dealers to make street drugs more powerful
- Canada's illegal drug supply is heavily contaminated with fentanyl
- you can't see, taste, or smell fentanyl
- consuming just a few grains of fentanyl can kill you
- 94% of opioid overdose deaths in Canada happen by accident (source)
3. What effect do opioids have on the body?
Opioids relieve pain. The medication travels through your blood and attaches to opioid receptors in your brain cells. The cells release signals that dull your perception of pain, and boost your sensation of pleasure.
In lower doses, opioids make you sleepy. But, higher doses can slow your breathing and heart rate, reducing oxygen supply to the brain. This can lead to coma, brain damage, and death.
Meanwhile, the pleasurable feelings opioids induce are highly addictive, and can easily lead to dependency, abuse, and overdose.
4. How many Canadians are impacted by the opioid crisis?
Between January 2016 and June 2018 more than 9,000 Canadians lost their lives due to apparent opioid overdoses.
In 2017, approximately 11 lives were lost each day because of opioid overdoses.
Of all the opioid-related deaths reported in the first half of 2018, 94% involved accidental overdoses. And 72% of those involved fentanyl.
It's important to note than in addition to deaths, thousands of Canadians have experienced opioid-related health problems.
Fast facts to know:
- Over the past 5 years, we've seen a 27% increase in hospitalizations from opioid poisonings (Canadian Institute for Health Information)
- Hospitalizations are more common in smaller communities
- Life expectancy rates in Canada have stopped increasing for the first time in decades, largely due to the opioid overdose crisis (Statistics Canada)
- Young adults are hardest hit by the trend, and most likely to experience opioid-related poisonings
5. Who is most vulnerable to opioid abuse?
The opioid crisis has seriously impacted individuals, families, and communities all across Canada. However, it is young Canadians, aged 15-24 who are most frequently hospitalized for opioid overdoses.
First Nations communities are also particularly vulnerable to opioid abuse. The CBC reports a 21% increase in British Columbia First Nations overdoses last year, compared to the year before.
In Alberta, indigenous communities are also disproportionately impacted by the opioid crisis. In 2016, First Nations people died of opioid overdoses at a rate three times that of the rest of the provincial population.
In general, over-prescribing of opioids, histories of trauma and violence, and lack of health care services are driving up opioid abuse and deaths among aboriginals.
6. What are signs of an opioid overdose & first aid treatments?
According to the Canadian Union of Public Employees (CUPE), opioid abuse is so widespread, we need training on how to identify and respond to an overdose in the work place:
"As the prevalence of opioid overdose increases, it is becoming more likely that our members may encounter clients, patients and members of the general public who are experiencing suspected opioid overdose reactions."
These are the typical signs and symptoms to watch for in cases of opioid overdose:
- slow or irregular breathing (or no breathing)
- slow or no heart beat
- pale and clammy skin
- extreme drowsiness
- very small pupils
- very low blood pressure
- dizziness and confusion
And what needs to be done first, when someone has overdosed? The number one treatment is a drug called Naloxone (aka Narcan).
Naloxone works by attaching to the same brain receptors as opioids, thereby blocking their effect. It's available as a nasal spray, injection, and hand-held auto injector. The faster it's administered, the better.
According to CUPE, many organizations have decided to include Naloxone in their standard First Aid kits and procedures. Others provide it as a take-home drug for people who are likely to experience or witness an opioid overdose.
They recommend employers provide training in administering Naloxone, and complementary First Aid protocols, such as CPR.
It's also important to note that because Naloxone rapidly reverses the effects of opioids, the patient may experience sudden withdrawal symptoms, and become distressed, aggressive, or even violent.
Basic training in addiction and withdrawal behaviors is very helpful in preparing people to handle this kind of situation.
7. Government response to the opioid crisis
The Canadian government has launched a number of initiatives to combat the opioid crisis. Here's a quick overview of the strategy:
- increased access to treatment, particularly in First Nations and Inuit communities
- more tools/sites for checking drugs for opioid contamination
- easier access to Naloxone
- the Good Samaritan Drug Overdose Act (legal protection for people who experience or report an opioid overdose)
- more supervised consumption sites (see a list of approved sites here)
- public awareness and anti-stigma marketing campaigns
- opioid warnings and handouts for patients
- better prescribing guidelines, and national treatment guidelines for opioid disorders
- measures to reduce illegal opioid supply
- more national data collection and research on opioid-related deaths and harms
- identifying better ways to manage chronic pain (Canadian Pain Task Force)
8. Poor community mental health and opioid addiction
Opioids don't just mask physical pain. They help dull suffering from past traumas and feelings of anxiety and depression.
Opioids release dopamine, a "happy" chemical, that induces a high or feeling of euphoria.
They offer an temporary—but very powerful— escape for people dealing with mental health challenges and unbearable living conditions.
It's no surprise that people who are already suffering from drug addiction (consuming illegal street drugs) are especially vulnerable to opioid poisoning. Or that remote communities, where health services are lacking, see higher rates of opioid abuse.
Or that First Nations communities, where people are suffering from high levels of trauma, addiction, and marginalization are also highly impacted by the opioid epidemic.
It's also crucial to remember that opioid addiction is highly stigmatized (like so many other addiction and mental health issues).
This is a complex problem that stretches across class and socioeconomic boundaries.
Plenty of people become addicted to opioids because the drugs were prescribed by their doctor to deal with a legitimate medical issue. And yet, they are reluctant to seek treatment because of the stigma associated with addiction—and strong feelings of shame.
This is where community mental health training, services, and awareness are so important.
Beating the opioid crisis will take a combined effort on all fronts—from law makers and members of the medical community, to local community mental health services, and people working on the front lines.
Community mental health and addiction training
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