By WENCY LEUNG
Monday, September 10, 2018
The statistics provide a grim portrait of the opioid crisis in Canada.
Nearly 4,000 apparent opioidrelated deaths occurred in 2017, according to government data. In the same year, an average of 17 Canadians were hospitalized each day because of opioid poisoning.
Meanwhile, in Ontario alone, nearly 1.6 million people - about one in nine - receive a prescription opioid to treat pain every year, Ontario Drug Policy Research Network (ODPRN) data show.
But the numbers only tell part of the story. A new multimedia project, titled the Opioid Chapters, delves beyond the data to share the personal experiences of those affected by the crisis. The project, created by ODPRN and the independent website Healthy Debate, launched on Sept. 6, as experts from across Canada gathered in Toronto for the final day of a two-day Opioid Symposium attended by Health Minister Ginette Petitpas Taylor and Canada's chief public-health officer, Dr.
Theresa Tam. It uses video, audio, photographs and text to tell the stories of 11 individuals, including those relying on prescription opioids to manage pain, those struggling with opioid addiction and health-care workers grappling with the crisis.
"They could be your next-door neighbour. They could be your family or friends," said Tara Gomes, an epidemiologist and principal investigator at ODPRN, who conceived the project. "By putting all these different experiences together in this project, we thought it would provide everybody with an opportunity to really understand and experience all those different pathways that people have had in using opioids and maybe help people have a broader appreciation of how complex this issue is."
A solution to the opioid crisis will require improving the health of individuals with chronic pain, while also not putting people at risk of developing addictions or creating an environment that could be dangerous for those who have an opioid-use disorder, she says. Among the individuals profiled on the project, published on the site theopioidchapters.com, is a woman from a small town in Ontario, who was initially offered a neighbour's prescription Percocets and went on to buy pills from others who were prescribed them. There is a man who lost his wife after she took a lethal dose of prescription fentanyl, and a man who found that only opioids provided pain relief from his back injury.
The project also features a community outreach and addictions counsellor who sees the many shortcomings of the healthcare system, a family doctor who is trying to help patients taper off opioids and a director of a pain clinic who has seen the pendulum shift from physicians prescribing too many opioids to them now refusing to give even small doses to patients who could benefit from more.
Gomes says she approached Healthy Debate to collaborate on the project after she and her research group conducted numerous interviews last year while gathering information to develop a research program related to opioids. In the course of their interviews with Ontarians who had experience using opioids for nonmedical purposes, as well as for treating chronic pain, Gomes says she realized there was a demand for a platform where individuals could share their stories.
Dr. Seema Marwaha, a physician and journalist on the editorial board of Healthy Debate, says the Opioid Chapters project provided a chance for the health website to experiment with a new multimedia format that builds on its familiar Faces of Health Care photojournalism series, which documents people's personal health-care experiences in text and photographs.
"It's not enough sometimes to read about what someone has gone through because you put your own spin and bias on that," said Marwaha, who developed multimedia for the project. "But when you're able to properly visually represent someone's experience and hear their own words, I think it's different and I think there's more depth there."
The following are excerpts of participants' stories from the Opioid Chapters.
Michael Strange injured his back while working as a cameraman.
He has found solely opioids provide some pain relief.
I've tried so many different things for my pain. People say, "Have you tried acupuncture?" Yeah. I've had two different kinds of laser therapy. I had doctors and friends say I had to try marijuana. I got the vaporizer and it did nothing for my pain. The only thing I never tried is hypnosis.
My doctor sent me to a pain specialist. He said, "I am going to remain your GP, but for this particular aspect of your health care, I want you to go see this doctor."
He is a terrific doctor. I love the guy. And I understand why he wanted to give me up to somebody who could write prescriptions freer than what he could.
About four years ago, doctors started to be under a lot of pressure from the government about opioids. I think doctors in Canada right now are running scared.
I am now seeing a terrific pain specialist and she has done marvelous things with me. She runs you through a battery of tests - the clinic has a psychologist, physiotherapists and mindfulness classes. I feel so much better.
But it's primarily to do with the opioids. I have tried virtually everything there is out there, and opioids work for me.
She has been instrumental in putting me back together again.
Every two months, at a minimum, I see her for a drug renewal. She gives me a 30-day prescription and one repeat. She will ask me, "Michael, how are you? Are you OK with the drugs? Do you need more? Do you need less?" I find that is so different from the GP, where he is saying to himself, "I think I've got to pull my overall prescription writing back."
Dr. Rupa Patel is a family doctor helping patients taper off opioids.
I took over a high-opioid-prescriber practice about seven years ago, after the prescriber suddenly left. Some of the patients were on very high doses - the highest was 1,200 mg of morphine a day - and I knew I couldn't continue those prescriptions. Luckily, I had some experience working up North, where there was [someone who prescribed high doses of opioids], and I had already done a lot of opioid tapering and de-prescribing. So my clinic began that process. We tapered probably 40 to 50 patients. We established a "no oxycodone" policy in our clinic, because that drug was known to be sold and used on the street. This was welcomed by many in our community, as my clinic was located in a vulnerable neighbourhood. Through routine urine testing, we found people who were diverting their prescriptions - their urine tests were repeatedly negative for opioids.
We did slow opioid tapering, and I tried to figure out how people got on those meds. I would hear about really difficult, horrible childhoods or years of spousal abuse. Years of violence. Middleaged women would talk about their pain, which was fibromyalgia, which they had never heard of. I was able to label that for them and talk about it.
Tapering was not easy because when someone is dependent on opioids, their brain is demanding it. They would yell, scream, threaten all kinds of stuff. The important thing was to get those people down to a reasonable dose of the drug or actually get them off of it. And most of them have stuck with me. I am still their family doctor and I have learned a lot from them.
Michael Strange, who is featured in the multimedia project Opioid Chapters, sustained a back injury while working as a cameraman, and has found opioids to be the only treatment that provides relief.
DR. SEEMA MARWAHA