Jan. 31 is Bell Let's Talk Day, where Canadians from coast to coast raise awareness about mental illnesses. Addiction and substance use too are central to this important conversation. Addiction can be broadly defined as a condition that leads to a compulsive engagement with a stimulus despite negative consequences. This can lead to physical and/or psychological dependence. Addictions can be either substance related (such as the problematic use of alcohol or cocaine) or process-related, also known as behavioural addictions (such as gambling or internet addiction).
A simple way of understanding and describing addiction is to use the 4 Cs of addiction approach:
- Craving
- Loss of control of amount or frequency of use
- Compulsion to use
- Continued use despite consequences
It is estimated that approximately 21 per cent of Canadians (about 6 million people) will meet the criteria for addiction in their lifetime. In recent years there have been growing concerns about the harms related to opioids in Canada. Opioids are a class of psychoactive drugs that are often used for pain management. These can include: fentanyl, morphine, heroin and oxycodone. While opioids are effective for pain relief, and many individuals can use them for short periods of time without concern, this class of drugs has led to harms across the country.
While fentanyl is a highly regulated synthetic opioid, illegally manufactured fentanyl is being unevenly distributed in substances sold on the illicit market. Such illicit substances can be lethal in small amounts, contributing to an increase in deaths related to overdose. Fentanyl, carfentanil and other fentanyl analogues have been found in illicit substances, like heroin, sold on the street. There have also been reports of high-strength opioids found in other substances, such as cocaine.
According to recently reported data, there were 2,861 apparent opioid-related deaths in Canada in 2016. From January to June 2017, there were at least 1,460 apparent opioid-related deaths, and it is expected that this count will rise as additional data become available. Overall, most apparent opioid-related deaths occurred among males (74 per cent) and among individuals between the ages of 30 and 39 (28 per cent). From January to June 2017, 74 per cent of apparent opioid-related deaths involved fentanyl or fentanyl analogues, compared to 53 per cent in 2016.
Who is at risk of an opioid overdose?
An overdose is a toxic amount of one or more substances that stop the body from working properly. People at risk of an opioid overdose may be defined as meeting the following criteria:
- Known or suspected prescription opioid dependence
- Polysubstance use, specifically if an individual is using other depressants such as benzodiazepines or alcohol
- Using alone or in an unfamiliar environment
- Using substances from an unknown source or dealer
- History of emergency care for opioid use
- Opioid use with known or suspected use of alcohol or benzodiazepines
- Release from a correctional facility with a history of opioid dependence
- Discharge from a treatment program for opioid dependence
- Using high doses of prescription opioids
Naloxone is a medication that acts as an opioid antagonist that temporarily reverses an opioid overdose. Naloxone is delivered intramuscularly (through muscle), or intranasally (through the nose) under the brand name Narcan. The medication can reverse the effects of the opioid by blocking the opioid receptors in the brain, but will only last for a short period of time. It will not have any effect on non-opioids that might be in the body. As with all health services, each province across Canada has unique regulations and frameworks in place for accessing naloxone.
Administering naloxone can assist the person experiencing an overdose in breathing more normally and potentially regaining consciousness. This provides time to seek emergency medical attention to treat the overdose in order to prevent further health concerns. As such, it is important that all first responders, including paramedics, fire fighters and police officers, carry naloxone, and that this life-saving medication be available in public places, like malls, stadiums and bars. Much like the way that defibrillators have become available in public spaces to assist a person experiencing a heart attack, naloxone too must be made available to assist anyone experiencing an opioid-related emergency.
Recently, the Canadian Mental Health Association Ontario developed a resource for supporting individuals, organizations and communities to become better educated on the impact of opioids and how best to recognize and respond to opioid overdoses, as well as information about naloxone.
With an average of eight opioid-related deaths per day, our country is in crisis. We must not overlook this important conversation.
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