Fatal Drug Overdoses on the Rise in Mississauga

The sight is something no one ever wants to see. It’s something no one expects to see, either.

The usual quiet of a cool summer morning in the Port Credit neighbourhood broken up by the screams of an onlooker as someone falls to the pavement, convulsing. Reports on popular social media pages about a possible uptick in drug use that may or may not (the evidence is anecdotal) be related to what one Mississauga resident called “a rash of break-ins” in the Port Credit and Lakeview areas.

Over the past year, Mississauga residents—especially those who live in the city’s southern neighbourhoods—have been gathering on social media to ask a troubling question: is serious drug use on the rise in Mississauga and its Lakeview and Port Credit neighbourhoods in particular?

At this point, no one has an answer—but experts do know that overdoses (especially fatal ones) are indeed on the rise in Mississauga and Peel in general.

I think those neighbourhoods have always been areas with more noticeable amounts of substance use,” says Adam Chalcraft, a harm reduction coordinator with the Peel HIV/AIDS network, who added that Peel doesn’t have much data on drug use habits per neighbourhood. “That’s hard to track because of the stigma and criminalization of substance use. But people are using drugs all over the region, but perhaps where it’s less obvious.”

One thing Chalcraft does know, however, is that overdoses (many of which involve fentanyl) are most certainly on the rise.

In the last year, there’s been a dramatic increase in fatal and non-fatal overdoses.”

The data backs Chalcraft’s disturbing observation.

Back in January, Peel Regional Police reported that 37 people had died from fentanyl use in Peel over the last three years. In 2014, there were eight deaths where fentanyl was either the primary or a contributing factor. In 2015 there were 12 deaths. In 2016, there were 17.

If you’ve been hearing a lot about fentanyl lately, that’s because all levels of government are working frantically to combat the concerning rise in fentanyl-related deaths.

According to Peel police, the drug is dangerous and has caused a number of fatalities in both western Canadian cities and the Peel Region. In terms of use, fentanyl is commonly prescribed to people dealing with chronic pain. Although there has been talk about the skin permeable substance also being a risk to first responders, it does appear that fear of the risk may be overblown.

In the event of an overdose, a person might experience difficulty breathing and eventual respiratory and cardiac arrest.

Most concerningly, it’s triggering overdoses in people who might not be aware that the drugs they’re using are cut or tainted with it.

I’ve personally seen 15-16 fatalities in clients I work with since January. About 10 or 12 were overdoses, three were murders and one was illness. Regionally, the numbers are higher,” he says. “In 2015, 65 fatal overdoses were recorded, but others might not have been recorded. In 2016, we’ve seen more powdered fentanyl and it’s being cut into substances people are using.”

Chalcraft, who works with clients who are homeless or at risk of homelessness and provides harm reduction counselling to people at risk, says fentanyl is increasing deaths.

I’m hearing that it’s turning up in heroin, crack, cocaine and crystal meth. There are people knowingly taking it and they’re at risk too,” he says. “One of the big things that’s increased is people not looking for fentanyl getting it in heroin and overdosing while doing their usual amount. If someone has no tolerance at all, a small amount can cause an overdose. We weren’t seeing this before. We weren’t seeing opiate overdoses in non-opiate users.”

The Region of Peel is also carefully watching the uptick in opioid-related overdoses.

We know from the data that there has been an increase in overdoses over the past decade or more,” says Dr. Kate Bingham, associate medical officer of health with the region. “Rates of opioid-related overdoses are lower than in Ontario as a whole, but we’ve seen an increase in the last 10 and particularly over the last three years.”

And while people who use illegal drugs are at risk of fentanyl and opioid overdoses, so, too, are people who access the drugs legally for pain relief.

It’s a complicated problem with opioids,” says Bingham. “One [issue] has been long-standing over-prescription of opioids for chronic pain treatment and that’s been over a number of decades. Physicians desire to treat chronic pain, but there’s a growing understanding that the risk of addiction is greater than what was originally understood to be the case.”

Some people who use prescriptions go onto develop addictions,” she adds. “A subset of the population abuses drugs like heroin and there’s contamination with opioids in the illicit drug scene. Most fatal or serious overdoses are related to drugs tainted or cut with fentanyl. It’s stronger than what people are expecting and what they’ve taken before.”

While the use of illegal substances is common enough, there’s always been a pervasive myth that drug use is restricted to urban centres. For many Mississauga residents, the sight of police and other emergency personnel surrounding an apartment building while dealing with an active overdose is remarkably disturbing because the suburbs are thought to be insulated from the more difficult trappings of urban existence.

But drug use is common in Peel and while it might not be possible to pinpoint how many more people are using (if that is indeed the case), it’s apparent that more people are dying and that those at risk are harder for support groups to reach.

The situation is also compounded by the fact that organizations like the Peel HIV/AIDS Network are compact and tasked with dealing with very vast catchment areas.

I work with staff of 12 people and we work in Brampton, Mississauga and Caledon,” says Chalcraft. “In Toronto, for example, most agencies or centres have a catchment area that’s just a neighbourhood. That makes it easier to find people you’re looking to connect with. Trying to service an entire region is a challenge. A lot of the drug use isn’t happening out in the open. It’s hidden, like the homelessness.”

In some cases, drug use and homelessness are connected (although not always)—and hidden homelessness is on the rise in Mississauga.

Last year, United Way revealed that in 1980, two per cent of Peel households were considered low income. Now, 45 per cent are low income. In 2015, over 14,000 people — including close to 4,000 children and youth — used homeless shelters and transitional housing (of which the region has an extremely limited amount).

But while poverty and substance use can be connected, Chalcraft says that anyone could be at risk and that neighbourhoods in which drug use is more visible are not necessarily worse off in terms of overdose risk.

We’ve known that it can be more visible in downtown Brampton, Port Credit, Cooksville and some other neighbourhoods, but rich people are using drugs too, but they can use more discreetly and pay discreetly for treatment,” he says. “Substance use happens across the region. Neighbours are reporting seeing more people using outside, but this is something we’ve been seeing for a long time. We know these spots have people who use drugs.”

When it comes to tracking drug use, it can be difficult to obtain perfect data.

Drug use is a difficult thing to measure because it’s difficult to get data on people who use drugs,” says Bingham. “There’s a lot of stigma around it. You can ask people in a survey, but it’s hard to ensure you’re getting accurate answers. One data source we have in Ontario is a survey about high school students, but that’s a limited subset of the population. Getting data on adults is difficult.”

As far as data on high school students go, drug use does appear relatively common (highlighting the fact that not every user is someone one would conventionally consider “troubled”). According to the Ontario Student Drug Use and Health Survey (2013-2015), in Peel, 35 per cent of grade 9-12 students used at least one drug in the last 12 months.

That estimate includes illegal drugs (including marijuana) and prescription drugs used for non-medical purposes. The rate is similar to Ontario as a whole.

As expected, marijuana is the most commonly used drug, with 20 percent of grade 7-12 students in Peel having used it at least once over the last year.

Opioid use, however, is not unheard of in these age groups.

In 2015, 11 per cent of Peel students in grade 9-12 reported using opioid pain relief pills without a prescription for non-medical purposes over the past year. The most common source of these pills? Family members (52 per cent).

To be clear, rates of opioid overdose and opioid-related harms in Peel are generally lower than Ontario as a whole, but the growth in overdoses reflects a troubling trend. In both Ontario and Peel, there has been a more rapid rise in overdoses since 2013—particularly in men between the ages of 25 and 44.

In 2016, 46 opioid deaths were recorded in Peel (compared to 800+ in Ontario), representing just over three people per 100,000 in the region.

That same year, there were 253 emergency room visits among Peel residents due to opioid overdoses (for a rate of 17.3 emergency department visits per 100,000 population).

But while it’s easy enough to identify a problem, it’s much harder to come up with a workable and sustainable solution.

The criminalization of drugs and drug use is causing people to not want to call 911 if someone overdoses and even with the introduction of the Good Samaritan Act (which allows people some level of legal immunity when reporting an overdose), there’s a deterrent for people to call,” says Chalcraft. “Criminalized people use in unsafe situations and when people are forced to buy unregulated supply, that’s when you see these tainted substances happening. If heroin is in short supply, people take what’s left and cut it.”

Although the proposal is decidedly controversial, Chalcraft thinks it’s time to have a serious—and uncomfortable—discussion about how effective drug criminalization really is.

We need to do something around criminalization. Harm reduction is a bandaid solution, we need to make larger policy changes,” he says. The west coast has seen more increases, but the numbers are significant for Ontario. Over 6,000 people in Canada have died of accidental overdose over a two-year period. The other issue is governments being slow to react to this situation, we’ve been calling for more naloxone and we don’t have enough. The conversation about this in Peel hasn’t started yet.”

The availability of naloxone is crucial to preventing opioid-related deaths and, fortunately, the Ontario government is working to distribute more kits to cities across the province.

Back in April, the provincial government announced that it was expanding access to naloxone (a life-saving drug that can temporarily reverse an opioid overdose) by providing it free of charge to anyone in need in over 200 cities and towns across the province.

The province reports that as of the end of March 2017, more than 28,000 naloxone kits had been dispensed at over 1,000 pharmacies, and at 40 public health units and community-based organizations that run needle exchange and hepatitis C programs.

As far as Peel goes, naloxone is available at the Peel Works Needle Exchange Program.

That said, Chalcraft says more should be done.

We [should have] overdose prevention sites or supervised consumption services. We’ve been seeing lots of drugs being cut, so people need to have spaces and areas to use. It could mitigate harm. We could find a suitable location that’s convenient for users, as people won’t travel far to get there.”

He also says wider access to naloxone is crucial.

The Region is looking at expanding its needle exchange program. People can get supplies from them and some supplies are also available at Shoppers, but you need a health card and that’s something not all our clients have. We need wider access with fewer barriers.”

Another thing that could help?

Hiring more peers with drug use histories to reach out to and counsel at-risk users.

We need to expand peer harm reduction work,” he says. “They have to go where people are using to help them. If there’s an apartment where people are using, can we train them in harm reduction and naloxone use.”

Chalcraft also says that everyone—especially police—need to treat opioid overdoses as health issues rather than criminal ones.

It would be helpful if police weren’t the first ones showing up to overdose 911 calls,” he says. “And police and firefighters should carry naloxone. We’re the last region that doesn’t have a regional drug strategy. We need to bring stakeholders together to formulate policy recommendations and have plans in place. We shouldn’t treat substance use as a criminal issue, but a health one. Police should focus on treatment and CPR. Overdose should be seen as health emergency—not a reason to make an arrest.”

For many people, overdoses are left untreated until it’s too late because onlookers—especially those that having been using with the victim—are too afraid to call for help.

We encourage people to call 911 and intervene and respond to an overdose. We understand why they don’t,” he says. “People could get in trouble and lose their kids, housing or go to prison. People don’t want to get in trouble or get their friends in trouble. The stigma also carried over by healthcare workers, and many clients report poor treatment by doctors and medical workers. These people are pegged as criminals. Folks who have significant issues with substance use have past trauma, often childhood trauma.”

Ultimately, Chalcraft recommends a compassionate approach.

I always hear the most horrific stories of people’s lives. Their drug use helps them cope with things that would otherwise be unbearable. Being socially isolated and isolated from society, it’s a key component to addiction. The opposite of addiction is connection. Traumatized people have a hard time trusting others or engaging in a full social connection. The drug is a coping strategy, and overtime it can cause other issues in that person’s life. Being re-stigmatized doesn’t stop usage, it increases it.”

In the meantime, the Region is working to prevent further deaths and educate people on how to cope with this developing issue.

So far, we’ve prioritized a few key areas—expanding access to naloxone and better understanding misuse and use in Peel,” says Bingham. “We’ve developed a local surveillance system to watch the situation in Peel. We [keep track of people] coming into hospital with symptoms of overdoses and we get that data in real-time. We look at that with delayed data and paramedics’ data. We monitor that on a regular basis. We’ve made partnerships around this issue.”

Ultimately, Peel is troubled because its growth has, quite honestly—and not purposefully—left vulnerable people behind.

We don’t have proper mental health supports for people, proper housing support or economic support. These are stressors in people’s lives,” says Chalcraft. ”[Maybe we can] do what Portugal did (decriminalize drugs). If that money for prisons and courts was diverted to services and outreach and therapies and prescription heroin or cocaine, that would be helpful. In Portugal, they average 30 fatal overdoses a year. We’re going to hit 6,000. The proof is there. Their exact model might not work here, but it’s worth having that conversation. We need to be doing a lot more than we are.”

But while it’s hard to imagine an immediate future without drug overdoses, Bingham is optimistic that the Region is taking the right approach.

It’s complex, there’s not a quick fix,” she says. I feel encouraged by our work thus far, and there’s a lot of work ahead of us and solutions aren’t easy, but they’re important. I get the sense that everyone is engaged in finding effective ways to improve the overall situation but it will never feel soon enough. All of these deaths are preventable.”

If you or someone you know is at risk of an overdose, click here to find out more info about locally available naloxone kits.

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