Audio series on opioids: In Plain Sight

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day, approximately 12 people die from opioid overdoses in Canada. We see this on the news. We know that it's happening. We know that it's real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love; that it couldn't happen to us. The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone.

The following content may contain sensitive themes that are not suitable for all audiences.

Episodes

Episode 1: Charlotte

Robbed of her childhood, Charlotte began using drugs at a young age to cope with a traumatic upbringing. Listen to Charlotte’s story and how her journey to recovery now inspires her to help other people who use drugs.

Transcript: Episode 1

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

Every day, approximately 11 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

This is where Charlotte’s story begins… 

Charlotte:

Hi my name is Charlotte Smith. I guess my problems really started when I was about uh – I was almost 13 and my biological mother came to England, because she is British but she had moved to Canada and had gotten married, and uh, she but had never been in my life. I was adopted out when I was six months old.

When I was about 13 she wanted to find me and re-adopt me and take me back into her custody so she did. And she paid for my immigration to Canada. Sponsored me in. And, it was a pretty devastating transition for me. I was very homesick. I was ok for almost year and we were in our honeymoon phase, but after that, everything went downhill.

I started cutting my arm and avoiding my biological mother. I stayed out a lot with friends. I didn’t want to go home. I didn’t feel like I was wanted there.

I had found some recordings that my mother had done of her self-therapy and she was just sobbing into the recording saying how I wasn’t really like her daughter, and how I didn’t speak like her and I didn’t have the same values as her and she was clearly devastated by that.

As my mental health declined, her behaviour towards me also declined. She became very emotionally abusive.

Eventually, she dropped me off outside of a foster home where I had babysat. This was a few weeks before Christmas, when I was 15. I cried for about three days straight. After about a week of being in this foster home, where I wasn’t a ward of CAS (The Children's Aid Society), but my mother was paying rent to the parents to keep me there, which had been cleared by CAS.

I was so scared of being alone, you know. I didn’t have any family in Canada besides my biological mother and I thought if things don’t work out at this foster home, I’m just going to be completely alone in a country where I really don’t feel I belong.

So their marriage dissolved. The foster home was completely destroyed by that. I ended up living on my own on and off with that man and in and out of horse farms that I had also volunteered at when I was 13 and 14, since coming to Canada.

So horses, and that experience, really provided great opportunity for me for housing – because I had the experience mucking stalls – when I came back to these places I was a 16-year-old homeless girl. They would take me in and let me work there for a room. But I also started using a lot of ecstasy. I had never done any drugs before being kicked out of my house.

But after that, everything just seemed even more hopeless than it was before. It was just a way to cope. It was a way to cope with being homesick from England, and then it was a way to cope with the loss of my newly found biological mother.

Narrator:

So at just 18 years old, Charlotte left Canada and returned to England – with no life skills or experience living on her own.

But the ties she had to Canada began to tighten and she soon found herself leaving England to return to the only life she really knew.

Charlotte:

Then things went further downhill because I had failed at going back to my home. I had come back to Canada and now the farms were out of reach for me.

So I just started doing more drugs. I met some people who were prescribed OxyContin and I started to take that. And, at first I thought this was great, because it allowed me greater strength capacity. I got a job in construction, and I was able to keep up with the men. I was able to lift the drywall sheets – everything – and keep that energy going all day because of these pills. I didn’t realize that I was addicted to them.

They also gave me a lot confidence and I moved in with a woman who was addicted to OxyContin, and her son. And I taught her how to crush them up and snort them because that’s what I had always done with ecstasy. I didn’t realize that that would make her addiction – which I still, I didn’t realize that even she was addicted, but it took her addiction to prescription pills to the next level because she started going through them so fast because the high is more intense but it’s shorter. And of course you build up resistance too. So, then we started having to go through all of her pills and finding ways to buy more. And when I didn’t have them, I would be very sick and the whole world would be gray. Like, apart from the physical sickness.

And the woman I was living with ended up going to detox because of that. And I felt very responsible. She ended up losing her child as well, for a period. But when she came out of detox, she came out with a boyfriend who used crack cocaine and I then fell into smoking crack with her and her boyfriend. And it was fairly easy because it wasn’t my first time seeing crack.

I used to use online dating sites to secure drives places to pick up these ecstasy pills. So I would tell guys that I was going to sleep with them if they would give me a drive so that I could go get my pills. And one time, the gentleman who was driving me around had offered me crack and I spent, I think 4 or 5 days in his apartment, just high out of my mind. Just not fun, paranoid, scared but lighting that pipe and taking the next hit, and the next hit and the next hit. Even though I was shaking and sweating and sketched out.

And I got out of that apartment and I thought, “wow.” And it took me a few days to recover. I thought, “I’m never going to ever do that again and I hope I never see it again,” and I didn’t think I would. But by the time when I saw crack again, when I was 19 now, things had gone so far downhill I really felt like that I had left nothing to lose. I had no family. I had no real future prospects. I had dropped out of high school. There was no hope of returning to my family in England.

I felt like I was a complete failure. So I smoked the crack for the next three years every day. The only times when I didn’t was if I was in jail or when I was working to try to get more drugs – which was through shoplifting or sex work. And of course during this time I also kept doing OxyContin but I also started injecting OxyContin and morphine and cocaine as well, which was a very terrifying experience actually.

Even though I did it, it’s not that it didn’t scare me. I would go into these houses where I would see people searching for veins for hours – just poking needles into their arms, just trying to find that hit. And having abscesses, and having seizures, and just using dirty needles, sharing needles, and as shocking as that was, I honestly just felt as if I was finished – that my life was never gonna be what it could been if perhaps, I hadn’t come to Canada or if my mother hadn’t kicked me out.

So I followed suit, and I and I used dirty needles, and I shared them and I did all of those things. And, uh, really the only reason that I got out of drug use was through pure luck. And that’s what’s so frustrating about the system as it is right now, is that there is no standardized state-sponsored help for people to get out of addiction or homelessness. There is no reliable solution.

Everybody, sort of, is left to find their own way, which I was lucky enough to do. Because one of the last times that I went to jail, I knew that if I got out of jail and I went back, picked up the pipe or the needle, that I was going to end up with AIDS or HIV. A lot of my friends at the time had one of those diseases or the other.

So I called a friend, and he agreed that when I got out of jail, that I could move in with him. So, I went out there and I didn’t come back into the city at all for probably almost a year. And in that time, somebody helped me get a job at a horse farm. And every day that I walked into that farm, I saw the horses and I knew that if I were to pick up a pipe, if I were to go in to Ottawa and to go downtown, I would lose everything. All the trust that I built up with these people and all the privileges I was given to take care of these animals. So I was able to stay clean.

Then I did a year of college. Which now I’m starting my masters in September. I’ve got – had many opportunities to conduct research on populations that I used to be part of – like sex workers, drug addicts and homeless youth.

So, finally I can sort of see a future for myself. And it’s a future where I believe that I’ll, hopefully, be able to help some of those people that I’ve left behind. Cause I definitely do have survivors guilt, PTSD from, uh, the experiences of being homeless and being addicted to hard drugs. So that’s something that I still struggle with. I have a lot of nightmares, where somebody will be overdosing and I can’t save them. And those happen all the time, and that’s something I have to continue to try to put behind me.

I also still struggle with active addiction. So, I’ve been sort of some what on the straight and narrow for 5 years. Addiction is very powerful and I seem to not be able to escape it – and I wish that something could take it from my mind. But so far I haven’t found a way to do that. And there are so many memories that I have of using in Ottawa – that wherever I go, it’s just constantly in my face.

And I know that addiction and drug use is invisible to a lot of people that have not experienced it. But when you have experienced it, it’s unavoidable. And wherever you go there’s reminders of it and there are triggers that cause you to have urges to use and they can be very hard to deal with and there’s not necessarily a lot of help for that beyond, you know, weekly meetings with councillors or group sessions with other former users like, NA (Narcotics Anonymous).

But really it’s something that’s always there inside you. And even I’ve watched my friends die and people are dying every day in Ottawa from opioid use. And as painful as that is for me to see those people dying, it’s still not enough of a deterrent for me to not use when… when that urge strikes me. And that makes me feel disgusted at myself. And I don’t know what the solution is.

Narrator:

Fifteen minutes. That’s all it took for Charlotte to take us on a life journey.

She then shared reflections on her life, how the world came to treat and perceive her – how she began to see herself differently too.

Charlotte:

One thing I noticed when I was using crack and heroin and OxyContin and morphine on the streets, was that you are no longer treated like a young girl. You become seen as responsible for yourself, as an adult who is making – conscious of their decisions – and just simply choosing the wrong path. Which I very much felt like I was not an adult and that I still had the mentality of when I was 15.

So to be treated like an adult was difficult, because when you go, say to your social worker for a welfare cheque and they are very unsympathetic that you’ve been using or that you can’t find a place to live it’s very damaging. And… it’s awful because you so badly want people to see that you are a 19-year-old or 20-year-old girl, and that you need help.

But they tend to view you like just the way they see any other street user and that it’s your fault for the position that you’re in. And it’s very uncomfortable to ask for help because you don’t feel like you deserve it, because you start to think that, “I am the cause of my own demise here and I did do this to myself.” Which is to a point true, but there were also a lot of other complicated issues that played into me taking that choice to use drugs.

And I think that that barrier that comes up between you as a young drug user and the rest of society – it causes you to look for belonging in other ways outside of the mainstream. So you become very close to the older people on the street the older addicts who are around you and you forge some sort of community with them. But it’s certainly not a healthy community and that’s not because of the individuals themselves. They may be very nice people and they’ve also come from so many different backgrounds, but the lifestyle associated with drug use on the street is very toxic.

So I met people who were actively engaged in sex work and who were not honest about that when I first came on the scene. So they would set me up on dates with men who I honestly, naively, stupidly thought were, maybe wanted to date me. And they were not. They were paying the people I knew to have sex with me and I had just had no idea, and that’s what I mean by that I was a child even though people were treating me like I was an adult.

I was very naïve and people wouldn’t believe me when I said I didn’t know they were pimping me out. They would just think that oh you’re a slut. But no, I really didn’t know and I when I did realize, I tried to kill myself.

The girl that I was staying with, who was an IV drug user, she ended up being all I had. I felt safe with her and then when I realized that she was selling me to men and that she really didn’t care or that she did care about me, but her need for drugs was so powerful that she was willing to risk my life or my safety to get those drugs, I was devastated and I stabbed my arm multiple times with a carving knife and she had to call an ambulance. And because of that, she wouldn’t let me go back to her place. Because I was a heat bag then.

Because of me she had to call 9-1-1. Which is a serious offense in this subculture of drug use and homelessness and sex work because police are pretty awful to drug users, in my experience. And it’s very hard, even if you’re watching your friend overdose, you do not want to call 9-1-1, because you don’t want to get in trouble. You also don’t want to call 9-1-1 because you know that the person laying on the ground does not want to wake up and see the police in their face and be taken to jail because of their addiction. And that is a call I have had to make. And I tell you that I did leave my friend on the floor until her lips were blue before I called 9-1-1 because I was scared of the police.

And the time that I tried to kill myself when I was first realizing that I’m in this subculture, where people can only care up until they get their next hit.

When I was released from the hospital in Quebec, I was covered in blood. This is another example of how you’re not treated like a young girl – when they took me in, they were basically laughing at me. They weren’t taking it seriously that I had tried to kill myself and they told me that I just, you know, I was just in drugged-induced psychosis, basically and that I was jonesing and that I just needed another hit, and that’s why I was acting out.

They didn’t give me even any bus fare. They let me – they released me to a place where, you know, outside of the hospital where I had no idea where I was and I had to find my own way back to this girl’s house… not knowing that she would also reject me from there. But just the lack of compassion… I know to them, I was wasting their time because they had real people with, what is considered real health issues – that aren’t addiction – to deal with. But I really did need their help. And if an adult, I feel like would have treated me like I was a young girl who needed help, things could have been different. But they didn’t even try. And that all contributed to me just giving up more and more.

I was worthless. I, uh, walked all through the streets of Ottawa in those bloody clothes and nobody offered me any help. Except a bus driver let me on for free eventually. And the only places that I could go were crack houses… and I call them crack houses but these are houses where there is a lot of prescription drug use its not all crack. It’s all kind of drugs, a lot of opioid use, a lot of needles… and those are the people that ended up taking care of me and letting me sleep on their couches with their bed bugs until I was healed enough to get my stitches out and carry on about my business.

And by then there was no other options outside of sex work because – I was too awful looking to get away with shoplifting. So, when you go into shops when you’re looking clean and tidy, they don’t notice you and you can get away with a lot more than when you walk in in dirty clothes and scabs all over your face and arms. You get noticed very quickly. So sex work becomes one of the only options because men, and not all men, but a lot of men don’t seem to mind if you are dirty and if you have scabs and if you are sick.

Every other part of your identity beyond drugs and prostitute and homeless are erased and that’s what people see. They see an addict and they can justify many actions against you by that. They can justify throwing you in jail, or kicking you out or having sex with you when you clearly are in no shape to be doing that because you’re just an addict – and you’re no longer a young woman who was scared, who needs help, who was a new comer to Canada. You’re just seen as disposable.

I don’t think that people treat young girls who are not homeless addicts the way that they treat homeless young addicted girls and I wish that is something that could be changed. I know a lot of men that have done terrible things to me, have daughters at home that they would kill somebody for doing the same thing to. But because I made the choice to put a needle in my arm I lost all the privileges that many humans in Canada do get. The rights over their own body – to not be touched while they are sleeping.

And just because I made the choice to sell my body or because I made that choice – because it was the only choice that was left to me…doesn’t mean that I can’t be raped. Because I did get raped and there are a lot of other girls who are out there getting raped too. There’s just no respect for addicts.

Narrator:

As far as she has progressed in life, sobriety is still a source of shame for Charlotte and she is always aware what the world expects and what is realistically possible.

Charlotte:

People do tend to think that when you stop being an addict, you’re supposed to at least stop doing all drugs and I think that’s taught in a lot of these recovery practices. But for me, that’s not the case and I think it is a dangerous misconception.

Because if you tell me that I can’t smoke pot or drink alcohol for the rest of my life, I’m going to be very anxious and panicky just the thought of that to not have that kind of safety net of more socially acceptable drugs.

When I first got off the streets, marijuana really helped me stay away from going back to the hard stuff. It also helped me sleep at night. I find that I have less nightmares. I find that I have less reoccurring traumatic thoughts about my past when I’m smoking marijuana. And I’m ashamed of that pot use to a certain extent because… while it is legalized and there is a lot less social stigma around it, I think or I feel like in professional worlds, that it might delegitimize me in the field of research because I use it so often. I feel like people may think that I am not a serious professional or they might worry that I’m conducting research stoned. I don’t use it for the day to day activities. I use it as a crutch at night.

What I hope to do is transform the research process into one that can be actually part of prevention and intervention for youth homelessness and addiction. So by helping to facilitate positive, meaningful youth engagement with youth who are at risk of homelessness and addiction, or who are experiencing those things. And trying to send the message that when we’re in places of privilege, like I am now, like, each interaction that I have with a youth who is experiencing hard times, can be a positive one.

It can be more than just a simple interview where I’m siphoning knowledge from them about their experience, to publish towards my own career. I can try to offer them resources, I can try to offer them hope, and at the very least, I can ensure that I’m giving them cash dollars for their participation in my studies, rather than gift cards, which are not a form of harm reduction, the way that I see cash is.

Because if I’m giving cash to my participants, then and they need drugs, then it’s my line of thinking that they’ll have to do one less awful thing to get those drugs because they have that $20. And I think that there is a perception, that when you’re giving addicts money, you’re enabling them. I think you need to respect people’s wishes too. If somebody is asking you for money, it’s because they need money. And it’s not up to you what they do with that money. And I think that you can provide some semblance of safety by giving them that money, rather than a gift card – which will not help them get the drugs they need... in which will mean that they will still have to go walking down the streets trying to catch the eyes of drivers who will stop and ask them if they want a date.

I hope that in all the research that I do I can engage meaningfully with youth, I can get them excited about the possibility of returning to school or following dreams outside of school that are off of the streets and away from drugs.

And I think from the youth that I have worked with so far, they do appreciate that I come from a background similar to their own and they do seem to be more willing to talk to me about more intimate details of their experience because of that. And they’ve told me that. And they seem also to be excited that I’m doing so well, and I think it gives them a sense of hope that, well maybe, you know, the future doesn’t have to look homeless and addicted.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 2: Darryl

Meet Darryl, a doctor, who began using opioids to treat his back pain. His opioid use became problematic when he started taking them for reasons other than pain. Even with his medical knowledge of opioids, he felt like he could not escape using them. Listen to his story and how he is working to help raise awareness of the opioid crisis.

Transcript: Episode 2

Darryl:

The question is, how does a doctor and somebody who’s so well educated get addicted to fentanyl? This is how it happens.

I’m already addicted to Percocet, I’m going through withdrawal, and I wanna just simply feel better.

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

Every day, approximately 11 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

This is where Darryl’s story begins… 

Darryl:

My name is Darryl Gebien, from Toronto. Born here, raised. Did, uh, 17 years of education and I eventually landed a job back in my home province, Ontario, in the emergency room. And that’s when things were going well. Getting my new career started. It had a very trying residency, but it was excellent and was very good training.

Then came a day when I woke up. I’ve always had back pain, but this was substantially worse. I had had it since I was 18, off and on. I always knew something was wrong with my back but to this point it was completely. Except one day, things changed.

So my mother had saw what I was going through with the pain, and she gave me one of her one her Dilaudids. She had back pain. And this is definitely a hereditary component. So that was my first introduction to an opioid, and, uh, I liked it immediately. I mean, it helped the pain, but I also liked the mood it gave me. Everything kinda felt good. So, immediately I was drawn to it because this one pill took away the pain, and psychologically, as well, I felt good. And, my mum recognized right away that something was up, cause I think I had asked for another one two hours later and I remember her laughing, kind of. A nervous laughter. “Oh, I can see what’s going on here. No, no, no. You’re not gonna get any more of those.”

That was the beginning for me. If Advil wouldn’t cut it, then an opioid would. The pain got a little bit better. It would come and go. I’d go many months without any problems. But then, progressively, that got worse. And, I started relying more and more on Percocet.

So, I had prescriptions at this point from my family doctor. And I was taking Percocet periodically. The first prescription lasted a very long time. I remember that I had that pill bottle in my medicine cabinet for about a year. But, I found that the worrisome thing is that there was nothing really serious going on in my life. Life was going well.

But I do remember, at one point, that part of me that I guess is somewhat risk taking and trying new activities or pop a pill when his friends are over playing PlayStation Golf, um, because we’re having a few beers. And I’m like, “uh, I wouldn’t mind trying to see how the Percocet feels, like, when I’m having a couple of beers”.

That was a decision that was just a horrible one in the end, because I opened a Pandora’s Box. But, that’s in my nature. Why’d I do that? But I did. And I didn’t realize the consequences would lead to a horrible spiral that almost led to my death from a fentanyl addiction, years later.

So, that was the beginning of my downfall. It wasn’t like I was doing it every weekend. But just here and there, I would be going out with friends and I’d pop a pill. So I wasn’t taking it so much for back pain anymore. It was there. I would use it for the back pain but sometimes I’d take it just, socially.

Does this mean I’m a bad person? Does this mean I have no morals? This is how it starts for a lot of people. I’m not alone. And I do carry a lot of shame, and, uh, embarrassment over that. But then, it’s something I’ve learned to recognize and control now. You know, I’ve learned the hard way to be careful with my decision-making. But going back, anyway, to that time, it was a slow and steady spiral that started and, it just progressively became a little more frequent and a little more than one pill, a little more often that I’d be drinking.

Just to add fuel to this fire, things had changed in my life as well. I met a girl. She ended up moving from New Brunswick to Toronto, and this happened kinda quickly. She had a daughter. And my life changed very rapidly. Because things started not going so well. And then we had another child – we had my first child… her second child. And so, bought the house. And, um, and it changed now, from single life – living in a condo – to buying a home, working late, a job in the emergency department and the marriage was precipitous, the pregnancy was precipitous. This acceleration, I think, also undermined what was going on in my life, cause the marriage wasn’t going well, there was also lack of communication between my wife and myself, which is. — we’re both to blame.

Also, there was a lot of discord between her and my mother. And it was a very, very difficult situation. And I eventually cut off my parents. Um... my wife and my mother got into some major, major email arguments, and I had to make a decision at one point, of what… what I was gonna to do here. So I chose my wife. And that also led to more problems, cause now I’m cut off from my support network.

We’re a very tight family. And, so the relationship’s getting worse, my back pain is getting worse, and isolation from my friends and family is starting. I’m internalizing my feelings. I’m not expressing myself to my wife or anybody else. And maybe it comes from my profession, but you know, as a tradition, you don’t share information about yourself, to remain professional. And I took it out on myself with the drugs. I felt that they helped take it away, the... it helps treat my anxiety. And the back paid.

So the back pain’s getting worse. It’s progressively affecting me, not just the pain-wise, but neurologically if affected my leg, I had weakness in my leg. It affected my bladder. I had problems with urination. And then, my wife and I decided to move from Toronto, because she’s unhappy in Toronto. I’m mobile with my job. I want to put some distance between my family and I, to be honest. Another bad decision. But we moved up to Barrie. And this was the icing on the cake here, because then within two years, my addiction just completely, uh, spiraled out of control.

Narrator:

Cut off from his family, separated from his friends, Darryl found himself both physically and emotionally isolated from what supports had previously buoyed him from completely going under.

Increasingly he found no pleasure in the activities he once loved – except one – which grew to fill the emptiness inside of him – exacerbated by what he felt was a toxic work environment.

Darryl:

It just extinguished any sort of life within me. Everything going wrong here.

The work. Be stressed and come home from work and be stressed at home with a constantly revolving argument with my wife. And now looking back, I mean, it’s obvious there were some serious issues. I’d forgotten about this until later on, but I remember I would come home from the night shift, or any shift, and I would sleep in the driveway, in my car. And that is an obvious sign that something is definitely very wrong. I just... I didn’t want to go into the house, and face an argument and stresses of my relationship with my wife.

One thing I just need to describe here, just rewind a little bit, is the Percocet addiction grew and grew and grew. And, I just need to let you know that, how insidious the addiction is. Anybody who’s been prescribed Percocet, if they’re using regularly over a week, and they suddenly stop it, they will feel the effects of withdrawal. It is so strong and potent and it’s insidious on how the addiction grows on you.

So that person stops. The next day they’re going through withdrawal and they don’t even know it. Because they’ve never felt it before. But they fell very irritable. Discontented. Anxious. Nervous. Sweaty. Chills. Aches. Pains. And they don’t know what... You know, I was going through that one day. I didn’t know... I had no idea what it was.

It wasn’t after a week for me. This… we’re talking after several months. So a couple of years now actually. It was a day, I wanted to stop. And, the next day, within 24 hours, I was in a horrible shape with this withdrawal. And I didn’t know what it was at first. I didn’t recognize it. I just... people compare it to a flu, but it, it’s so much worse than a flu. Because flus don’t affect your psychology. Um, maybe you feel down. But, I mean, going through withdrawal... physical stuff’s like the flu. But what’s much worse, is the psychological. What’s going on in your head. You feel like you’re going to die. You feel like the world is going to collapse around you. And THAT, is incredibly powerful. Because, no one wants to feel sick. And how do you avoid from feeling sick? You take more. And, I don’t think I realized at the time, but I took another Percocet later on – and, low and behold, aha – I feel, felt back to normal.

So that was a pivotal moment in my addiction, because now I’m totally hooked on it. Dependant. I’ll feel sick, and psychologically, in very rough shape, if I don’t take it. And so now, I’m a slave to the drug. And that was a big step – realizing that I’m going through withdrawal.

Within six months, my use of Percocet – I’ve already given you the background – just completely escalated, and took off. And there was a day when I had no more Percocet, but I had a fentanyl patch at home. It had been there for a year. I did wear them occasionally, because, when I had exacerbations of the back pain. But this day was different. When I was going through opioid withdrawal, and I became desperate, and I wanted to simply feel better. And, this is a very common thing for addiction in general, is people go to extreme lengths to feel better. And, they will rob. They will steal from their family. They will burn bridges. They will rob banks. They will steal from pharmacies. Sell their bodies. And doctors will abuse their right to prescribe opioids. I totally took advantage of my ability to write prescriptions.

I’m going through the Percocet withdrawal, and… I had the fentanyl patch, and this is where that recklessness in me, with that whatever it is in my personality, but I Googled on how to smoke it. I’d heard people were smoking fentanyl patches. I didn’t want to wear it, because it wasn’t strong enough. I was already deeply addicted. My tolerance to the opioids had grown. So wearing the patch didn’t have that effect of medicating my pain and my soreness. So I Googled how to smoke it, and, um, I was alone in the house. And I cut it up into little squares, and, I had a puff. And, it was incredibly strong. And I would have died, right there and then. I would have overdosed, had I not had the tolerance I had built up with the Percocet.

It was an incredibly strong high. Powerful high. And I loved it. Immediately. And so it was like the first time I had the Perc... or the Dilaudid, many years previously. It’s a very similar thing. I’d just been introduced to something new, and it just hard-wired my brain at that point. I like this, I want more.

The down side of this is now this drug is potent. This drug is, you know, a hundred times more powerful than Percocet, if not more. And not only is it more potent but you go into withdrawal even faster because it’s such a rapid acting drug, fentanyl. So it gets you higher. And it gets you higher faster, but you also come down faster. So within 15 minutes, I was already craving it and taking more. It was that fast. The addiction just spiraled, accelerated now. That spiral just sped up a thousand fold. And so now, the next day, I couldn’t stop. It was six months of hell. It only took me six months to spiral to the point where I almost died.

Something had to give. Either I was going to die because – not from an overdose – but just from, just from extreme use. I’d lost so much weight. And I’m hiding it. And trying to keep it all together. And I’m still able to work. I was not getting high at work. I would get around that. I would get around going through withdrawal, by wearing a fentanyl patch. And, I was dying. And, my mother knew it. My friends knew it. And I wouldn’t get help for myself.

And then a couple of times, I tried to quit. I’d come home to my parents’ place. And live – I’d stay on the couch for five days and just was in horrible, horrible shape. And try to wean myself off. And I thought, you know, a week would be enough. I’d get time off work and try to wean myself off within a week. And that was not even close. In the end, it took me six months to get off the stuff. Six months, not a week.

So, eventually I gave myself up. The pharmacy figured it out. The police got involved. I got arrested. My work was notified. Taken off the schedule. And I went to rehab for five, six weeks. And, um, went through absolute hell, uh, when I was there. I was incredibly sick.

They don’t do this anymore, but I was put on Suboxone, and put on a rapid wean. Most people don’t tolerate it well. They start using again. But I guess for doctors who have, like me, who are very stubborn, I need to learn things the hard way. And I’m glad that they did it, buy, my gosh, I went through withdrawal, not once, but three times while I was there. And it was the biggest nightmare, worst nightmare of my life, by far.

And I was incredibly, uh, weak at that point, but it took about 36 hours of the worst of the symptoms to get over, and then it was another six months to get through the physical stuff. And then it took another two years to get over the psychological effects. Couldn’t make up my mind on things. Very difficulty with concentration. Obviously I wasn’t working but it just took me a very, very long time to get through it all.

I did have a couple of relapses. The police were investigating me. The last relapse, was soon after rehab when I should not have been discharged. To be honest, I wasn’t ready, I was still very sick. But, I had a court date and I was released and I wanted to leave rehab. So I relapsed.

That’s when I, uh, what I’d call it a dry shower incident. So I relapsed on the fentanyl – smoking it in a shower stall in the basement. I smoked down there, because the smell wouldn’t trickle into the house. But I didn’t realize that I had overdone it and my wife saved my life. She came downstairs because I disappeared. And to this day, I still think it was night time, but she tells me it was morning. And she came down to find me green-faced, barely breathing. And that’s one shade away from blue. Which is cyanosis – which means “sayonara.” So she found me, just teetering on death’s doorstep. And I remember the look in her face when she, yelled my name and I guess I opened my eyes and the look of fear in her eyes, I will never forget.

I put her through hell.

Narrator:

Darryl’s life was saved that day… But what next? Would this moment lead him down the road to recovery?

Darryl:

I will never forget the look on her face, but I can see… what I’d done to her and what I’d done to myself. And uh, you’d think that a person would be done then. Guess what? No. I kept going. I kept using.

She took away the paraphernalia that was strewn around me in the shower stall. And I went right back to using again. And I didn’t care. I didn’t care about anything at that point.

The bottom that finally got me was being arrested. Two weeks later, the police were investigating me and that last prescription for fentanyl triggered a response by the police saying “we gotta arrest this guy now. He’s a danger to himself and the public.” So they arrested me.

Police came, seven o’clock in the morning, and raided my house. I was handcuffed and taken away. That day I was arrested. Put in the Penetanguishene jail, stayed there for about 18 days. And here I am, in an orange, prison jumpsuit, and three months previously, I was working as a successful physician in an emergency department. So that was very much a rude awakening. By this point, believe it or not, that was the beginning of my healing. Being arrested and taken away from my wife and children, that was finally the bottom. The rock bottom, at that point.

So, I got better after that. I healed, when I was in jail for those 18 days. It was very sobering, scary experience, but I did okay in the end. Parents were there all the time visiting. When I finally made bail, I had to split from my wife. And so, she lived in the house with the kids. And I moved down to my parents’ place in Toronto. And, after that, went to a couple more rehabs, and finally got it right.

In total, I did six months of rehab, and finally got better. Clear-headed and healed.

With relapse, generally there’s a sequence of events that goes on of decisions. And I realized, if I do good, I feel good about what’s going on in my life and good things tend to happen. If I do bad, if I relapse nothing but sheer negativity is going to happen. And it took a couple of relapses to realize that.

If I just think about my decision making before I become impulsive. And that’s another feature of my personality, is impulsivity. To recognize it, and control it. And I carry that with me to this day. I’ve made a series of good decisions now. And I’ve built up a massive amount of recovery – of good, healthy recovery – because I’m taking better care of myself.

I’ve learned to voice. To not internalize. To externalize. Share my issues with people. I’ve went to hundreds and hundreds of 12-step meetings. I went to after-care groups. I went to an addictionist and a caduceus group, which is people in recovery who are health care professionals. So that’s called “Caduceus.” And built up a strong support network.

And, I had to live the next two years though, uncertainty about my future. I mean, the Crown attorney was talking to me about a 12-year sentence. Twelve years. Living like this, every day, not knowing. And then having the back pain, of course. It’s still there. It’s still going on. Major stressors. But I learned to talk about it. I learned all these things about how – I became a master of coping with my stress without medicating myself. That’s – that was the difference of what happened as the new Darryl versus the old Darryl.

And that, surprisingly helped in many, many ways. I learned that the same things that helped in recovery, are the same things that lead to happiness. That’s a big one right there, as well. Things like being connected with other people. That’s huge. Being honest. Not being… not internalizing – like I say I keep using that word, but being able to express what’s going on. And so, something came to life in me, and my mother called it. She was... she was impatient, wondering when it’s gonna happen but it did happen. And then it grew, and grew and grew. And I remember, speaking to a guy in recovery and saying, “I’m finally back to the guy I was five years ago.” And he goes, “no, no Darryl... you’re better than who you were five years ago.” Wow. That’s true. And I’ve grown stronger and stronger since. It just took one hell of a lesson to get there.

So, I’m living my life like this two years, not knowing what my future’s gonna bring. Eventually, I did plead guilty. Just for the record, it was trafficking fentanyl. But not trafficking just to make money kind of trafficking. Not dealing. Lot of people – and I thought this once too – that trafficking equates to dealing. No. Trafficking equates sometimes to dealing but the movement of drugs, giving of drugs, if you share a joint with somebody at a party, that’s trafficking. By me writing prescriptions for fentanyl, and, uh, having somebody involved when they gave it back to me, forcing a pharmacist to give a bogus prescription to me, that’s trafficking.

So, I pleaded guilty, and I was sentenced to two years, plus a day. So that put me into the federal system. I was scared silly, of course, to be – to sit there and have my future in the hands of a judge. But fortunately, I got a very favourable sentence and it did come with a sense of total relief. At least now I know what’s going on in my future. Cause living like that with two years of uncertainty, is definitely a horrible way to live.

So, I was cuffed and taken away. Not a good time. To see what I did to my family and friends and being in the courtroom and to see the tears and, but I was okay. So I went into the federal system and I served eight months and good behaviour. I was at Joyceville, Joyceville Medium. Which is an assessment, now called assessment unit, for two months and then for six months I was minimum security at Joyceveille as well. And, I did okay.

It was a little difficulty when I first got out in December of 2017, just to readjust to normal life. To this day, loud noises and any sort of violence really bothers me. So it’s kind of – it’s a couple of scars left over I guess. But um, that’s the weird thing, I didn’t really witness much violence when I was in jail, prison, but I cannot watch a single thing on televisions – anything that has to do with violence.

But I did okay in the end. I did a lot of writing when I was in there. I became a math tutor. I was a librarian assistant. I became physically active. And got healthier again. So, here I am, six months later and I’ve never been stronger in my life.

What I want to do now, what I am doing, is speaking out about the opioid crisis. Speaking out about opioid addiction, substance abuse in general. And I’m willing to talk about my story in any sort of public forum, public speaking, education seminars, students, police.

It’s important to me to tell – get out there and public speaking, any forum whatsoever, to explain this stuff to people. Like, why is it people will break into pharmacies and prostitute? Well I want to give the answers to try to humanize it, explain why people are doing this. And, I now see the patterns, which I never would have seen before when I was a physician and passing judgment on addicts. Giving them second-class treatment, which is endemic as well across emergency rooms in North America.

That needs to change as well. There’s no room for judgment in the workplace, especially in healthcare. No room for judgment. We need to start looking at people, uh, people who are identifying as substance users, whether they’re on chronic opioids or full-fledged addiction, we need to look at them as somebody who – look past the manipulation, to realize, why are they trying to manipulate – because this is a sick person. And I want to let the doctors and nurses understand and try to treat people with compassion, and to be humane as opposed to judgmental.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who drugs from receiving help.  To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 3: Mélissa (audio available in French only)

Mélissa had it all; a good job, a condo, a nice car, a loving family and good friends. A dependence on opioids took it all away. Hear her story and how she is embarking on a road to recovery.

Transcript: Episode 3

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

Every day, approximately 11 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love, that it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

This is where Mélissa's story begins… 

Mélissa:

I had a good job as a client care attendant for people, uh ... who had terminal bone cancer. I had a great condo, a nice new car, a sports car, Tiburon, manual. My family didn’t think I’d get it, but I got it. It was a point of pride for me. I had lots of good friends, and I used coke occasionally. And my family relationships were going really well.

When I was 14, in high school, I hung out with some guys from Ottawa, and we did speed. When I was 18 I met a guy, a serious relationship that lasted 7 years. We broke up because of cheating, and then I started to work as an escort because it paid well. I started putting ads in the newspaper. I did some porn, and that led me to organized crime. I felt safe with them: if ever anything happened to me, I just had to call them and they’d take care of it.

That’s when one of them moved in with me. I wanted to help him out—little did I know what that would involve. After he OD’d, I saved his life. And by way of thanking me, he paid my rent and introduced me to heroin, which he bought for me. I was 24 years old at that time.

I realized things weren’t right when I was 28. I was doing heroin, crack, speed, oxys and fentanyl. It all fell apart when I lost everything: my boyfriend, my apartment, my friends, my furniture, my clothes and my personal hygiene. I was ashamed of myself. It got to the point where I was squatting in abandoned houses with no heat and no running water. I owed money to the drug dealers and the government.

I defrauded the banks by putting empty envelopes in the ATMs. I had about 20 different credit cards, with limits from $100 to $5,000. I lost my driver’s licence. I now have a criminal record, and as everyone knows, when you have a criminal record you’re stuck with minimum wage jobs for the rest of your life. My car was repossessed by the company because I couldn’t make the payments anymore. I was 28 years old, I went bankrupt, and I was on probation for the next three years.

So here I was at 28, on the street, no housing, tons of debt, no car, tons of family problems. I didn’t know what to do. My instinct went into survival mode. Rule number 1 was using. Every hour, every minute, and every second of the day, I had to get my fix. I’d stay with one person, then another for a few days at a time. Sometimes I had no place to sleep, so I’d sleep on a park bench, in any old park.

I had no hygiene, and I weighed 80 pounds. I’m 5’ 6”, so technically I should weigh 125 pounds. I was literally skin and bones. When I had no money for drugs, I turned to prostitution, or easier yet, I slept with the dealers in exchange for drugs.

Using is truly a demon that thinks for you, acts for you, and controls you in an incredibly cruel way. It literally tears you apart. I used with several people. And people will steal from you, they’ll manipulate you to get your stash. When you live on the street, your life is in constant danger. I got into even more trouble with the law—another probation, for one thing—and had even more family problems.

I lived on the street for three years. After three years, I was literally exhausted, both physically and mentally. In January 2018, I started therapy for the first time in my life at the CRDO [Centre de réadaptation en dépendance de l’Outaouais]. I stayed for two weeks, because I thought I’d be cured when I finished therapy. Therapy is really hard when you’re using. You’re scared, you don’t know what to expect. It’s change, and sometimes you’re not ready to change.

I had relapse after relapse—you always return to your old patterns of consumption. In May 2018, I went back into therapy and successfully completed a 38-day program. You’re safe in therapy. I succeeded and I’m proud of it. You learn a lot of things in therapy, but the most important thing when you come out is how people react when they see you: you’re healthy, you’ve gained weight, you don’t have dark circles under your eyes, it’s all wonderful. I’m fine now, but I relapsed on the 75th day. Why? Because I fell back into my old patterns of consumption.

What I’ve learned about myself is that I’m beautiful, that I can be happy without drugs. I have to think of myself before others. It’s important to talk to someone when things start to go wrong. I got my independence back. Now, at 32, I have my own apartment, I cook for myself, I’m important, and it’s true that sleeping on something often brings a solution. I weigh 115 pounds. I haven’t used in 2 months and 2 days. It’s hard work, but it’s worth it. Being happy and not using is the best gift I could have given myself.

Another thing I learned is that when I was using, I had lots of friends, and now my old friends think I’m boring—and that’s normal, I’m not using anymore. I’ve built a new circle of friends, I have confidence in myself and that’s the important thing. To society, since I have a criminal record, I’m labelled a criminal. People are too quick to judge: when you’re using, people call you all kinds of names—slut, cow, junkie, bitch, etc. Now that I’m sober, people see me as a good person who knows what she’s doing, and also, importantly, a responsible citizen. I also belong to L’Addict, an association for current and former drug users.

I’m leaving on December 30, 2018, for a three-month therapy program in Ottawa, and I’m proud of it. This will be my challenge for 2019. I’d like to say that yes, it’s hard, and no, it’s not easy, but take the time, it’s worth it. I’m doing really well and I want things to get even better. After my three months are up, I’d like to get my driving licence back, finish paying off my debts, and be very happy and especially smiling. Don’t be afraid to ask for help—it’s worth it. Good luck, everyone. My name is Mélissa C.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who drugs from receiving help.  To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 4: Amy

Amy's brother Josh had a great sense of humour and loved playing sports. He went to a party one night and experimented with the drug hydromorphone. The next day, Amy received news she never dreamt she'd hear. Listen to their story.

Transcript: Episode 4

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day approximately 12 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

Josh had a great sense of humour and loved playing sports. He went to a party one night and everything changed. His sister, Amy, shares his story...

Amy:

We grew up in a small town in Nova Scotia. I’m one of four siblings. I’m the oldest. Josh is, the middle child. We had a very good childhood – very typical, middle class. We all were involved in different sports and had our own interests. I was in gymnastics and volleyball, Joshua loved hockey, skateboarding and snowboarding, played sports throughout school. We were all very close.

Josh always was a risk-taker. And he had a fabulous sense of humour. He was always the class clown and the person that could make people laugh. He also enjoyed volunteering at my grandmother’s daycare. He would spend summers there helping her out, and taking part in activities, with the other kids. He really enjoyed, connecting with younger people, too, as he got older. And kids loved him because he did have such a great sense of humour and was very playful and even into his twenties was always the kid at heart.

When he left school, he went out to Alberta. He was working out west as an arbourist. He loved doing that. That was something that, he felt a sense of accomplishment in… getting the training and getting promoted. And that’s kind of when our lives changed, forever.

At first it was great news. We had heard Josh had got a promotion in Nova Scotia to move back, home where all our family is and we were all thrilled. And he was pretty proud of himself, too, because he had the ability to hire some of his friends when he came back to Nova Scotia from Alberta. And he thought that was pretty cool. He was 21 and just a zest for life, starting out on this new adventure. Purchased a new car coming home, I can remember he was so proud of it, always shining it up. Looking for a new apartment. Just a lot of things to look forward to.

And on March 19th he’d been home maybe two months, maybe not even that long. I’m not quite sure, but it was still relatively new. He was staying with someone and getting all these things in place, like apartments, buying furniture, things like this.

It was a Friday night. He had finished work that day. He was supposed to, meet me at a cottage, a family cottage, which was about an hour away from where we lived. And he called and said, “I’m just so tired, Amy, I’m sorry. Work was really long today. I need to pick out this furniture to be sent to the new apartment and I’m just too wiped to drive out there. There’s always next time.” And those were actually the last words I ever heard from my brother, is “there’s always next time” which is so ironic, because unfortunately there wasn’t.

We had just a regular night at the cottage. I had no sense that anything was not the norm. I woke up that morning, packed up our stuff, headed back to our hometown. I took my daughter swimming. We were in the pool, having fun. Again, no sense that anything’s wrong. When I arrived home, I was getting her changed out of her bathing suit and my phone just was ringing incessantly. And I could start hearing notifications go off. And I was actually getting quite irritated — I’m trying to get a wet bathing suit off a toddler and I’m thinking, “what is so important?” like, you know, who is this?

So, I root through my swim bag, get out my phone, answer the call and it’s my younger sister. And just the tone in her voice, I knew something was… was terribly wrong. She asked me if I was alone. I said, well, I have Chloe with me, my daughter. And she said, “is anyone else there with you?” and I’m like, thinking why, why does that matter? And she said something happened. I said, “Just tell me, just tell me, Mallory.” And that’s when I found out.

She said, “Josh went to sleep last night, and he never woke up.” And just a wave of shock and… I can’t even explain. I’ve never had those emotions before in my life until that day. And not knowing what could cause something like this to happen. My brother was an extremely healthy, happy, 21-year-old man. I just couldn’t understand. How does he go to sleep and not wake up?

He had had spleen issues the year prior, so we immediately thought, well maybe his spleen ruptured in his sleep and nobody, you know, nobody was with him. We waited for the medical examiner a few days later to give us a call and that’s when we realized that Josh was perfectly healthy. His cause of death had nothing to do with anything physical. And that’s when she asked us if substances might have been involved.

We were kind of taken aback by this. We were expecting answers that day, not more questions and then she said we’d have to wait for a toxicology report. So that’s when my family started to call people who he was with that night, friends, trying to find out what what he was up to, and if drugs could have been involved.

And then quickly we found out that he had attended a party with a group of friends. It was a birthday celebration. And the prescription painkiller hydromorphone was being experimented with and offered to people and he, he tried it and that ended up being the cause of death, we found out later in the toxicology. We had to wait a long time for those answers, but we found through friends and we pretty much knew, after speaking to people that that was very likely the cause. And it was absolutely shocking.

I had no idea that experimenting with a prescription painkiller, which is prescribed by a doctor could have such permanent, irreversible damage. I always thought that people who were harmed by substance use developed addictions, and there was this long period of time where they would struggle, and family could reach out and help them and get them into treatment.

I never dreamed that one night I’d be talking to my brother, everything’s happy, all is great in the world, and the next morning I wake up and he’s gone. Because of one, one pill. It definitely evoked feelings of helplessness because, looking back, I don’t really know what we could have done except, now — this happened in 2011 — so in 2011 there was no naloxone available without prescription. There was very little awareness about opioids. There was no Good Samaritan Law. So these are the types of things that I think could have impacted that situation that weren’t accessible to people and people weren’t aware of seven years ago.

Narrator:

Devastated by her brother’s tragic and unexpected death, Amy found herself stepping into an advocacy role in the hopes of broadening awareness of how the opioid crisis could affect any one of us.

Amy:

It was nine days after Joshua passed when I started my advocacy. I didn’t really plan on starting advocacy, I just knew that if this could happen to my family and my brother and I had no anticipation that this was even a possibility, that there was a lot of other people in the world in the same position and they needed to be made aware. And we needed to act on this issue. Because my family was not aware until my brother passed away and all I want to do is prevent other people from learning about the crisis in that way — through prevention, education. There’s lots of things we can be doing to prevent these tragedies, because they are preventable deaths.

There is no magic bullet, but first of all we need to reduce demand. We need to save the lives of those who are currently at risk and using, through safe consumption sites, accessible naloxone, accessible medication-assisted treatment. We need to treat the people that are currently using and save their lives, and while doing that we can be preventing unnecessary exposure to opioids through more cautious prescribing, education, awareness. We need to be working on both sides of the crisis to make a meaningful impact and save as many lives as possible.

Because, I don’t know how many times I’ve heard the narrative of as well – I know illicit fentanyl is ravaging our country right now. But I don’t know how many stories I’ve heard where people were first exposed to opioids through prescription, thinking they’re safer, they’re cleaner — which they are, in a sense, they’re definitely safer than illicit fentanyl — but, a lot of people are initially exposed in that way and then once they develop tolerance or a substance use disorder, it can often then lead to seeking stronger alternatives, cheaper alternatives, if prescription pharmaceuticals aren’t readily available or, or not strong enough.

So, we need to be working on both sides. We can’t arrest our way out of this issue, too. I think decriminalization of personal use would be very helpful. It would help people engage in treatment. Because when you criminalize people who use drugs, then they do it… they hide it. They do it in silence.

Because lots of people, even like my brother, maybe if he lived that night and continued using opioids and developed a substance use disorder and needed to seek help, when you criminalize drug use, you know with his job, with his everything else, that you have so much to lose because you’re admitting to breaking the law by saying that you use drugs. So, I think it would be very helpful for people, if they could seek out help without the fear of being criminalized. Those are some things I think that would be very useful.

The criminalization too is so related to stigma. I never experienced stigma in my life until my brother passed away from a drug-related death. I never knew what that felt like, but I quickly learned.

When I began my advocacy and started to speak out publicly, I had to learn very quickly not to read the comment section because the hatred towards people who use drugs, in society, and the misunderstanding that these people are “less-than” is very hurtful and it’s very prevalent. I think that’s one of our biggest barriers to implementing some of these interventions, is the idea that substance use is a moral issue, not a health issue. And until we can change society’s thinking in that regard it’s going to be very hard to implement some of these interventions or get support, get political will, get public support for these interventions. And I think that that’s also what’s allowed this crisis to perpetuate.

Seven years ago, when my brother passed away –most, opioid-related deaths were prescription-related. And those numbers were still very high, like hundreds of people in Alberta dying per year. Numbers have stayed constant in Nova Scotia. Even in Ontario, hundreds of people a year dying from opioid-related deaths as far back as seven years ago. And, but nobody knew it was really going on and nobody really seemed to care. And I think that had a lot to do with stigma. These are people that, you know, are doing it to themselves. This is not really an issue that helps people in politics or, you know, people that have special interests to pursue. But now that we created such a large opioid-dependent population, organized crime has entered and they’re willing to feed that with illicit fentanyl which is just devastating.

It really didn’t need to get to this point, but the stigma around the issue allowed it to kind of, grow in silence and it perpetuated it without people being even aware that this was happening until it got to such, large, devastating proportions.

I think it’s helpful for people to share their stories and bring a face to the issue. And sadly, I always say this is a club you don’t want to join, but so many people have, unfortunately. And, I see much more awareness now of people sharing their stories than seven years ago when my brother passed. And I do think that that is very helpful to actually see the faces of the people, hear from the families that are being affected, the family voice and, even the people that are currently using, people who use drugs, they have a voice. And their voices matter. So, people with lived experience have an important part, to play in this issue and they need a seat at the table. In hearing our voices, in seeing our faces, will hopefully reduce stigma.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed and language used by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 5: Elsa (audio available in French only)

Elsa is a social worker at a harm reduction organization. Everyday she offers support and empathy to people with substance use disorders. Listen to her story.

Transcript: Episode 5

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day, approximately 12 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn’t happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

Elsa is a social worker at a harm reduction organization. Every day she offers support and compassion to people with substance use disorders. Let’s listen to her story…

Elsa:

My name is Elsa. I’m a social worker. Basically, what I do is work directly with people according to their needs, but always in terms of their substance use. We can offer to set up a meeting with a social worker to help them achieve their goals, no matter what those are – reducing their substance use, quitting, asking questions, getting information, or asking questions about a family member who’s using. We also provide all the sterile equipment such as crack pipe kits, injection kits, naloxone kits, and always with information and education. But we also go out into the community of substance users. We meet them in their environment, always with the aim of improving their living conditions and meeting their needs in terms of the distribution and equipment they need. The person is truly at the heart of our interventions and our mission; our priority is always the well-being of the person being helped.

My biggest challenge is to get people who want to get involved, but who have all too often been excluded and judged, to see their experience really as something positive, something they can pass on to someone else. So that it becomes an experience that helps them and others as well. Basically, my work allows me to encourage those same people to deliver their message, claim their rights, name the injustices they have suffered. It’s always a matter of giving those people back their power over their lives, their rights, their voices, and that’s a challenge in itself, because when people feel socially excluded, it’s not easy to get them to consider their experience as a form of expertise that can help others. To come to that awareness is one thing; and then there’s connecting with other people who are using, not necessarily the same substance, not necessarily the same experience, not the same age – that’s another challenge. You know, there are clashes in the kinds of drug use, the kinds of substances, even the way they’re administered. Someone who injects, someone who smokes, it's very different, even though there are a lot of similarities, but for the people who are living that life, it’s hard, you know, to create a bond of trust with someone who isn’t like them or isn’t using the same drugs or isn’t the same age.

I think that through my role, really, I encourage them to consider their experience as meaningful, you know. And that allows them to see another side of the story, because for some people, it’s the first time in their lives they’ve been told it’s something positive, you know, a kind of expertise. Whereas they’ve always thought of it as the most difficult period of their lives, a time that taught them nothing. You know, they’ve often experienced a lot of judgment and rejection from their own family, you know, from their job. They’re homeless, they’re in a really tough situation, and then they realize for the first time that they have rights. There are a lot of users, you know, there are a lot of people who want to claim these same rights. So that makes community solidarity a challenge, but it’s not impossible. I see now – and it took me awhile – that it’s something that builds up gradually, but now there’s a good solidarity and a respect for the experience of others, no matter where they come from, and when someone even more marginalized than they are joins the group, they get an unconditional welcome. So it’s even more beautiful, you know. It’s a worthy challenge, I think, that it’s a long-term thing, something to be achieved in the long run, it takes patience. You know, solidarity within a group doesn’t happen in a single meeting. They come because they know it’s an opportunity to get together with other people with lived experience, but they don’t necessarily know where it’s headed.

In order to help people who use drugs, you have to adapt a range of services for a range of people. The same goes for access to substitution therapy, now called opioid antagonist therapy: people aren’t offered many choices, if they’ve tried methadone and it didn’t work, if they’ve tried Suboxone and that didn’t work either, what can we offer? What can we offer a person who’s decided to take a safer approach to their substance use, who’s seeking treatment as a positive alternative for their survival and their health, and who voluntarily puts aside the risks of using a contaminated substance, but who finds themselves with no other choice than to repeat a treatment that doesn’t meet their needs? Treatment restrictions can have far more dangerous consequences, especially with respect to the unsafe supply of substances. Although doctors can prescribe medical heroin, which could be considered access to a safe supply, very few do. Because, let’s face it, these days, when you get your drugs in the traditional way you’re not talking about a safe supply. You’re at high risk of using a contaminated substance. Not to mention the conditions, not forgetting the conditions related to substitution therapy, the whole model of reward and punishment, it really doesn’t meet the needs of the person who is using. In fact, the person has to go to the pharmacy every day for safety and supervision purposes. The pharmacist will make sure that the person actually takes their medication properly, so there’s really a mouth check. The person has to take urine tests. At any point, have we taken the time simply to ask the person what they need? If the person’s urine test comes back positive, ultimately they can be cut off from treatment and lose the so-called privilege of getting a prescription for two or three days’ worth of medication so they don’t have to go to the pharmacy every day. We talk about patient safety. I see the opposite, because when you deprive someone of the treatment that person wants—and you have to understand that when they go for treatment, they may already be having withdrawal symptoms. So they’ll wait until morning to go for treatment, but what about a person who’s experiencing withdrawal symptoms and who’s been cut off from treatment—well, where are they going to go to get supplies? In terms of safety, there’s nothing less safe than that. It pretty much guarantees that they’ll go get a fix in their familiar environment instead of seeking treatment. There are people who use while they’re in treatment – it’s a fact. I think we have to start from there. Because if we don’t focus on what the person needs, well, we’re jeopardizing their safety.

People undergoing treatment often face judgment even when they go to the pharmacy. Some pharmacies require people on methadone or Suboxone therapy to go through to the back. That’s quite something for them, being made to feel different. And I ask myself, how do we explain that people who have a prescription for morphine are free to buy their pills in considerable quantities and take them home without ever having to take a urine test, and without necessarily having complete information about what is prescribed? There’s a real split between the two, and don’t think the people going for treatment don’t see that. You know, they feel like they’re being monitored, and it’s hard for them, feeling the judgment of the pharmacist every time they show up to pick it up. And asking someone to pick up a prescription every day, that doesn’t take the person’s experience into account. When you’re living in chaos, it’s not easy to stick to a routine. You know, it takes a long time to get there in the morning, and then you have to wait. Getting there in the morning doesn’t necessarily mean you’ll be the first one seen, and it happens, you know... people have told me they wait much longer than others for their treatment. For me, that’s really a big gap, because I think we should offer the person diversity, choice, and support when it comes to treatment, there are people who get put on the treatment without necessarily knowing what it really is, without being warned that they’ll experience withdrawal symptoms every time their dose is reduced. There’s a real need for support and information for people who want treatment. There is also the fact that, well, we can prescribe medical heroin, but very few doctors do it. So that’s not an option either. I know there are studies on injectable treatments, but we’re not there yet. You know, it’s harder, but when you consider that people are using unsafe substances and dying as a result, it’s important to think seriously about changing that, because we’re talking about people who are motivated to seek treatment. These are people who have already come to that point. We’re not talking about people who aren’t interested in treatment. They are at that point, they want it, but they don’t have the information, they don’t know how it works. They feel unsupported, they feel judged at the pharmacy. As far as I’m concerned, this is a big problem.

The stigma attached to substance use, and by extension to substance users, is probably the biggest barrier in our work. Yet we all know that substance use is everywhere, you have to forget the image of the person injecting themselves in an alley between two dumpsters. Stigmatization, people who use face it every day, and even those who quietly leave that environment still experience it. It’s very discouraging, you know, to make some progress, to stop using, and still feel you’re being judged by people—family or even, you know, the police, the hospitals. There’s a sort of loss of hope in the person... It’s difficult when you make the journey, and you end up, you know, recognizing that “I did it,” yet you feel that people still look at you the same way, that you’re still perceived as someone who uses drugs and who is problematic. That’s just about enough to make a person want to give up. Fortunately, I’ve seen many who didn’t go down that road, but decided instead to defend their rights, but you have to realize that  a person who’s stopped using and is on the road to recovery is not necessarily the strongest person in the world. It’s still a fragile time for the person, and the way people look at them carries a lot of weight. Stigmatization, you know, we’ve seen it, is being stopped and searched as you cross the street, while other people cross the street and don’t get stopped. It’s also going to the hospital with an injection-related abscess and being treated by the staff as if you were contagious, and dangerous. It’s going to the pharmacy and having to go through to the back; it’s being told “you just have to stop, it’s a matter of willpower;” it’s being labeled a troublemaker. Sure, using when you’re homeless is a lot more visible, but do we really try to put ourselves in that person’s shoes when we find it personally upsetting?

People who are using face discrimination on a daily basis because of their social status, and from different sides, like the justice system, the health care system, the welfare system, their family, their friends ... and it can even be at the grocery store, it’s literally everywhere.

When you’re in the business of advocacy, you know you’re not always going to be in public favour. We’re dealing with several issues. We’re talking about solutions, and they’re not necessarily the solutions that the average person would come up with. That’s the most difficult part, I would say. The current system is prohibitionist, and by criminalizing drug use it has created a judgmental atmosphere that infantilizes and stigmatizes people who use drugs, because they are perceived as a burden or a threat. I think we really need to change our perspective, both individually and collectively, and educate ourselves not only about drugs per se, but also about the harm reduction approach, which we don’t often see but which has shown the most significant results in terms of health promotion and implementation of safer practices for overdose prevention. Right now we’re in the middle of a public health crisis; people are dying, it’s literally a matter of life and death. Behind the overdose statistics that we see... it’s not just numbers, you know, it’s people, and, especially, it's mothers, fathers, aunts, grandfathers, friends, colleagues, people who may have been closer to you than you think. The most important message, I think, is that no one is safe. We all have someone close to us who’s using, whether we know it or not, but it’s not necessarily problematic for everyone. I think that regardless of whether or not you’re using, you really need to be informed, because it can happen to you too...

I never thought this job would be easy, but let me tell you, when I get home safe and sound I sometimes think about the people who can’t even count on the word “safety.” Those people are in survival mode. I understand the survival instinct, and that allows me to better understand their reality. When you have nothing, what do you do? When we try to put ourselves in their position, the social workers, even we sometimes say to ourselves that we couldn’t do it, but seeing the positive impact we can have on their lives, even when they have absolutely nothing, as far as I’m concerned, that’s my paycheque.

When it affects you personally, especially in a job like this, it’s hard to,you know, you have a unique relationship with the person. You’re not their mother, you’re not their friend, you’re not a co-worker; you’re the person who helped them with their substance abuse. When this person dies because of their substance abuse, you wonder what you could have done to change that, you know. But the reality is that there was nothing to be done. All we can really do is be there. But sometimes those deep wounds can’t be healed. I’m not a doctor, I’m not a psychologist, and sometimes, despite all the professional help they may have access to, a person’s unhappiness can be really deep and difficult to reach and heal.

I think that as a social worker, you have to be constantly aware of the emotional work you’re doing. When we’re working with people, we always put up a barrier; we don’t take on their emotions, you know, we’re there to put ourselves in the other person’s place, to understand and support them. Because if we take on their emotions, we’re not helping them. If the person is crying and I start crying, that won’t do any good. But the emotional work, sometimes you’re not aware of the magnitude of it until you get home and realize that you experienced, you know, something that ... People come to see us every day and tell us about the darkest moments of their lives. We never let them go, there’s always something going on. So it’s really important to consciously get some distance when you get home. I think, you know, there are some social workers who’ve lost the ability to keep that separate. I haven't been doing this for 20 years. So I’m still working on that, but it’s really important, because emotional fatigue can set in. You see it a lot among community workers. It happens pretty regularly: the social workers take some time off, then they come back to work. It’s important to look after our mental health. And I think it’s also important to be well supported by your organization. In my organization we don’t talk about sick leave, we talk about wellness leave. It’s a simple distinction, but it changes the way we look at things. We’re encouraged to take time off when we don’t feel right, not just when we have a sore arm or a headache. Because in our line of work it’s important to really be present and ready to listen to the person, regardless of how you yourself are doing and how you might be feeling on any particular day. It’s important. And I think the priority is to ask yourself, “Am I ready to go to work today and to listen to people? Or am I upset about something, or do I feel like I didn’t get a wink of sleep all night and might not be the best advocate for the person?” It’s a job in itself to consider and recognize those limits. It’s something I’ll probably be working on all my life. But that’s part of the job. That said, I do it mostly because I'm intrinsically motivated. For me, it’s a passion. So for sure there are emotions involved. So I have to try to figure out what the emotion is and what to do with it, you know. I find that doing advocacy work is a great way to deal with emotions: to focus on the solution, not the problem ... to keep moving forward. It’s fun for me, you know, to keep moving forward and finding solutions, but it’s also nice for people who are beset by problems to believe that yes, there is a solution. And there are rights to be defended, claims to be made. You know, you have the right to be defended because you are a person like any other. That’s what really helps me to channel my emotions, to kind of transform them into motivation, which helps me to advocate on behalf of people who are using.

Narrator:

Tragically, the number of opioid-related deaths in Canada continues to increase each year. This crisis is affecting the health and lives of people from all walks of life, all age groups and all social and economic backgrounds. Elsa shares her thoughts on what could be done to help reduce the number of opioid-related overdoses and save lives.

Elsa:

I believe we have to hope for change at both the structural and the legislative level, as well as a change in our level of investment in the repressive and prohibitive model, which has shown that none of the measures implemented so far seem to reduce mortality rates consistently. At the moment, the legislative framework for substance use doesn’t allow us to save lives, and more important, it criminalizes a whole community of people. Remember, people who use illegal drugs are still considered criminals in Canada. But are they really criminals? If we label them criminals and put them in jail, are we really promoting their health, are we really helping them? They are people just like you, and if one day you find yourself in a precarious situation and you start using, whether or not that becomes problematic, I’m convinced that you wouldn’t want to be seen as a criminal. I believe we have to act, and not lose sight of the source of the problem. Beyond criminalization, there’s a real problem with the supply of substances.

Currently, the supply of contaminated drugs, which aren’t subject to any form of quality control, is a determining factor in overdose deaths, and it’s also what allows users to keep using. Why is drug contamination dangerous? Because we think the risk has to do with street drugs, street users, but we know that people who use drugs don’t all come from that background, and if they don’t, they may not be aware of the resources. Basically they could end up, for instance, in a situation where one weekend they decide to use cocaine recreationally (which happens, we all know it), without even considering that it might be contaminated, without knowing that there are organizations distributing test kits to detect the presence of fentanyl. So they’re at risk of overdose, and they may not have the information they need to avoid this kind of situation. If I ask you this: If you use twice a year, have you thought about having your naloxone kit with you? The supply of contaminated drugs and the criminalization of this drug use put you at risk of overdose and label you as a criminal. We need change, and fast, because the number deaths is now in the thousands.

I had the immense privilege of working with someone whose journey amazes me to this day. I watched them grow and recognize their strengths, through all the opportunities for involvement they had. The truth is that this person taught me a lot about myself. Considering the sheer weight of their experience, the tears they shed when they shared their story with me, it’s impressive to see how adaptable human beings can be in survival mode, and how, too, they can recover. Today, this person draws on their experience, their expertise, to advocate for people who have travelled a similar path. I think the important thing here is that there’s hope in every story... you just have to find the positive in the details, because if we don’t believe it ourselves, we can’t help the person achieve self-worth and self-trust. It was probably through that person that I learned the most.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed and language used by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 6: Kirk

Kirk suffered a serious injury to his hand and was prescribed opioids to help manage his pain. After eight years, he made the decision to stop using opioids and went through months of work to reduce his medication use. By sharing his story he hopes to encourage people to work with their doctors to find solutions that work best for them. Listen to his story.

Transcript: Episode 6

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day, approximately 12 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

On vacation down south for his 40th birthday, Kirk ventured off resort with a hotel staffer for a drink to celebrate the occasion. The night took a dark turn when the car pulled into the parking lot of an abandoned restaurant where a threatening group was waiting. Fearing for his life, Kirk fled and climbed a fence across the street, slicing open his hand. He made his way to a local hospital where his hand was treated and sewn up, but when he returned to Canada doctors discovered that his injury was severely infected. They rushed to save his hand. Kirk underwent four surgeries and a year of physical therapy to regain the use of his hand. He was also prescribed opioids to help manage his pain. Let’s listen to Kirk’s story...

Kirk:

When I was in the hospital, I was seen by a, a pain team on a regular basis. They manage a person’s pain levels, and after each surgery, I was given a morphine pump for a short time. And then, treated with perhaps morphine injections, and also other pills such as opioids such as OxyContin, and medication like that to control the pain. Which I thought was a good thing because it was giving me more mobility, it was giving me the strength and pain tolerance to do this stretching and grasping with my hand in physiotherapy that went on for about a year.

So, once I was out of the hospital, I continued to see my family doctor, and, and she took over the pain medication that was, in my mind, really, I thought that was the only option to get through all this pain I was experiencing. So, I was started on, a regular dose. I first started off with a fentanyl patch, and that changed to the OxyContin, Percocets, and many other different forms of medication. And again, the goal was to control this pain, get me back to work and I had young children at the time, so really trying to work through the pain, and so on. As time went on, and yes, I did make it back to work, and did continue on with, with  looking after my young family along with my wife. At the time my children were three and five years old, young boys, active boys. So, I kept thinking that this medication was helping, it was giving me the mobility, it was helping me control the pain.

I always felt that the medication would get me closer to, my goal was always to get to zero pain. As time went on, I realized that that wasn’t a very realistic goal. And, if I would have understood that taking medication, especially opioid pain medication, as prescribed, that early on my body was becoming habituated to this medication. I was becoming addicted to the medication. I didn’t realize that and I also didn’t realize that getting to zero pain was maybe not a realistic goal, even though that’s what I was always striving for.

So, several, I don’t remember the exact timing but, as time went on, I understood that this pain was ongoing. I made it into a pain clinic as St. Joe’s which was fantastic. I also realized that there was other residual effects from this experience. And, one of the main ones that I understood was, PTSD — Post-Traumatic Stress Disorder — was something that I was suffering from, and that I was treated with – by my psychologist, which was great to get that understood and in control, which was great once we came to that solution.

So, I continued to take the medication. I was at the pain clinic and we tried all sorts of different things such as ketamine infusions, a whole host of other medications. And what I realized after about eight and a half years of treatment was that I totaled the medication and was up over 600 scripts of, of various medication in a eight-and-a-half-year period, which was astounding to me.

It came to me one night as we were sitting in our home, I said to my wife Anna, I said, “Anna,” I said, “I’m done with this medication. Finished.” And she said, “Well, what do you mean?” And I said, “Well I’m getting so many side effects from these opioids,” I said, “There’s got to be a better solution.” And she said, “Well, what’s your solution?” I said, “My solution is stopping the medication.”

I felt that a certain point with the opioids, that it was making my pain worse. And in fact, after eight and half years of use, it was making my pain worse. So, I came up with this plan, my initial plan was to just stop the medication, cold turkey if you will. And I, I presented this to both my pain specialist, my family doctor, and they both agreed that this wasn’t a good idea to just stop the medication. I’d be putting my body through too much trauma. Your body gets addicted to opioid medication after a very short amount of time, so it wasn’t a good option to just quit cold turkey.

So, I thought of what else could I do? And then I started reading about tapering. What tapering is taking your medication that your body is accustomed to, and gradually reducing the medication at a very slow rate. It’s called a long taper. And so, I did do that, and I did come in with a plan to my doctors and presented it to my family doc. And she agreed, she agreed with the plan and the timing.

So, initially I was taking my medication down 10 milligrams every three weeks. And each time I would take it down, I would get nauseous, I would get sick, sweating, really feeling just awful for many days. And there wasn’t much I could do about it. I, I just had to fight through this. And I kept anchoring my end goal to things like, my children, to things like –– you’re going to get back your normal life, is what I kept telling myself. So, I really was, was fighting against this medication and, and really made the medication, in my mind the enemy. So, the medication was the enemy, and I was anchoring this taper to, to my children and getting to zero was my goal, and I kept thinking that I gotta get there.

So, every three weeks I’d get sick as I reduced the medication, and I would become a little bit better as time went on. I didn’t miss any work, I kept going to work. And so as time went on, this whole process took about seven months to get to zero. But, probably about midway through it, I thought, well this is just taking too long, I need to increase the duration. And what I mean by that is, instead of tapering every three weeks, I wanted to taper every two weeks, because I felt that this process was taking just too long.

So, I did it to two weeks, and I eventually, you know, I eventually got to my goal after seven months. In 2016, thankfully I made it to zero. When I got to zero I was expecting that I was going to, you know, this veil of opioids, as I often call it, this cloudiness that opioids caused, all these side effects and so on, affected my memory and, and many other parts of my life. I thought it was all going to disappear when I got to zero, when in fact it didn’t. It took me about nine months from the point of zero, nine months beyond that, to really feel normal again —  to feel like I was before the medication, before my injury.

So that was very, very surprising to me. I wasn’t expecting that. And as I was going through this process, often I’d ask my doctor, doctors, well hey what about this, what about that? And it wasn’t like they didn’t have the answer, but it was more of a textbook answer, and they had never gone through a taper and I definitely didn’t expect them to go through a taper. What I was looking for was, I was looking for a person that has done a narcotic taper successfully. I was looking to call them up or something like that to have access to a person who has done this because I felt like that was the missing link. I was motivating myself to do this, but it was long, it was painful. At times I was questioning whether I was going to make it to zero.

Thankfully I did make it to zero, but the only missing part, if, if I could do it over again, was I was looking for access to a person, or people, that had done this successfully, and I could not find that. So, I did do it on my own, and my doctors were absolutely amazing, but I do feel like the missing portion of this was that a lot of my doctors didn’t seem like they had experience in, in opioids. They were, yes, supportive, but a little bit, I wasn’t sure if they thought I could do it sometimes. I’ll use the example of when I initially suggested to my doctors that a taper was the direction that I was going in. One doctor suggested that suboxone was the right direction for me. And suboxone is an opioid medication that a lot of folks try when they’re tapering. So there was the suboxone solution from one doctor. And the other doctor disagreed with this direction and he suggested that I don’t take suboxone, that a long taper would be the right solution.

So, at this point, I became a little researcher. And everything, every medication, every direction that doctors were suggesting, I became, myself and my wife became an advocate for ourselves, our solution, as to what is the best solution for us, and we came up with that suboxone was not the right direction and that the long taper was the right direction. So, maybe at the time, the doctors, you know, there wasn’t a lot of patients coming up and there wasn’t a lot of tapering really being discussed.

And, you know, really, overall, I think my experience was very positive. Thankfully my doctors saved my hand. What I wish is, I wish they came to the conclusion that getting to zero opioids was the right solution for me quicker, became very disruptive in my family life, in my work life, and it took me a very long time to realize that being on no medication is the right solution.

When I speak publicly, a lot of times doctors, or other folks in the audience will ask, “Well, compared to when you were on medication, versus now how does your pain differ?” And they’re surprised to hear that my standing pain, the pain that I have right now sitting, talking today, is very similar to the standing pain that I had while I was on medication. So it fascinates me that the medication really wasn’t helping me as much as I thought it was. And you know, like a lot of pain patients, the medication becomes a crutch, and it just becomes a habit of doing it for eight and a half years. You think that it’s helping. Where the medication did help was especially when I did physical activity, the pain spike that I experience now is likely worse than it was before. But I don’t have all these side effects that I experienced, or the moods swings, and was affecting my ability to think and remember things.

Narrator:

Tapering off his medication worked for Kirk, but it is important to remember that recovery and chronic pain are complex. They can affect individuals very differently. Chronic pain can have adverse and life-changing effects on a person’s ability to function and on their mental health. When taken as directed by their health care professional, prescription opioids can help patients experiencing pain manage their conditions and allow them to lead full and productive lives. However, as with all medications, opioids can come with risks and potentially dangerous side effects and it is important to discuss how best to manage your pain with your health care provider. Kirk hopes his story will encourage people to work with their doctors to find a solution that works best for them.

Kirk:

I’m not advocating that everyone needs to get to zero opioids. That’s not what I’m saying. What I’m saying is that through education, through experience, I came to the realization of my solution. And so when I speak about pain and tapering and opioids, it’s all about trying to open up that avenue for someone that may be experiencing this, and you know, maybe this is part of their solution. Maybe listening to me makes them move on to whatever solution is best for them. Maybe it’s walking their dog, getting a little more exercise. Keep searching for that, that solution because  I think it’s out there for everyone. It’s just a matter of whether the person is ready to start listening to some solutions, or maybe implementing some solutions out there.

Because, for whatever ails you, and there are a lot of things that creep into people lives as we get a little bit older, whether it’s pain or other challenges in your life, I believe that, just keep searching, reading, talking with family members. I mean, it really helps  if a person has a very supportive family. In my case, that was a great help, But even if a person doesn’t have extended family, or close family they can tap into I think there are other resources such as a doctor or a therapist.

My psychologist, I think, was probably the biggest key to this puzzle. And there was never a time when she said, well, “You know what, you really need to get to zero. You really need to get off this medication.” Because I think when anyone says that to a person, you think about maybe a relative who would smoke. When people keep telling him, “Hey, you need to quit, you really need to stop,” what they really need to do is come to that own conclusion, with their own experiences, rather than other folks telling them what they need to do.  When you can slowly come to this conclusion of whatever you need to do, on your own, with education, with listening to other family members, other experts, it makes the solution much easier.

Since I’ve gone to zero my life is changed in a very big way. Probably within, less than a year — I can’t remember exactly how months I got to zero — I lost my job. I worked for the provincial government for many, many years. And I did lose my job and I can’t say if its related to opioids or not, because at the same time the government agency I was working for was privatizing. So, we knew that folks in our department were going to lose their jobs, and so I was one of them. And at the time I was very angry. It took me a long time to realize that this was a good thing. This was a good opportunity for me. And my opportunity was to speak about what I’ve learned, and you know, what has happened to me. So, I took my severance package, and I’m in the process of writing a book. And I speak to policy makers within Ontario that will listen, and I speak to other agencies that are interested in this because I want to try and help, with a little bit of the solution for this opioid crisis.

Pain is a very complicated thing, and a very personal thing. But what I continue to read about within our province and within our world, is that people continue to die from opioids. So I’m trying to move the needle, just a little bit, with my story and, and my solutions, that maybe these positive experiences from patients should be magnified and talked about a little bit more to motivate and to educate both doctors and patients.

When I was on the CBC show White Coat, Black Art in November 2017, I kept getting random emails from people across our country, stating that “Hey what was your solution? What did you do? What was your secret?” And so, I was surprised about that. I was surprised these strangers I didn’t know — and it wasn’t just one person, it was quite a few people that were reaching out to me — and, and they were saying stuff like, “You motivated me to continue to taper, or to consider tapering as an opportunity.”

So, both surprised, but also understanding that I think a lot of folks out there are looking for solutions if they’re ready, and it’s really coming up to that point of, when are you ready? When are you ready to potentially take down your medication a little bit or whatever your solution needs to be to make your overall life better? Because what I could say, I was quite a high dose of opioids and it was interfering with many, many different parts of my life. And it happened so quickly, that you, you don’t even know you’re there until you’re off the medication for quite a long period of time where your personality is back. Your motivation is back. You can get a good night sleep and you’re not a walking zombie. Because as much as I could function on the medication, looking back on it, it, it’s very, very impairing. You’re impaired. But as I say, said earlier rather, it happens so gradually that you barely know it’s happening, so... I’m really looking forward to continuing to spread this word, that helping people with these types of challenges, with pain, it is possible.

It’s amazing how many people out there want to help. And, you know, maybe want to switch up what they’re doing. But it’s really an overall realization of, hey, maybe there’s a better solution.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed and language used by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 7: Donna

Donna reflects on her relationship with her daughter who struggled with problematic substance use. She shares her experiences and her advocacy work to put a spotlight on the opioid crisis. Listen to her story.

Transcript: Episode 7

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day, approximately 12 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

Donna reflects on her relationship with her daughter who struggled with problematic substance use. Let’s listen to Donna’s story…

Donna:

She suffered from, from symptoms of anxiety and mental illness for years before she was finally diagnosed. She self-medicated with OxyContin that she was prescribed. And she was very honest about it, she was, “This works, this works with my social anxiety.” And in my naivety I said that’s great, you know, let’s have you stay on that, and you’re functioning! You’re functioning well, you’re perfect, you’re easy to get along with. And then the doctor cut her off of course when she said to him, you know, “this is what I’m using it for”, and he said, “well I won’t prescribe it for that”, and actually fired her from his practice. And then she turned to the street drugs and that was the downward spiral to the point where she lost everything. Her children, her home, her relationship, everything, and ended up living on the streets, and becoming your stereotypical substance user, you know, the one that you want to cross the street to avoid.

You know, and my experience with her was to just practice tough love, and that just pulled her down ever further. By the time I realized how dangerous what she was doing was, it was already too late, and I couldn’t get to her to try to turn anything around. And then like I said, it was a matter of, you know, getting the phone call from the hospital saying you better come, we don’t know if she’s going to get up off the operating table. We’re going to amputate her legs to stop the necrotizing fasciitis. And, and by the time I got there, they had finished the surgery itself and said, you know, there’s nothing that we can do to stop the infection. It had already gone into her internal organs, and she was going to lose her life from it. And then it was just a matter of her saying to me, you know, you really need to know what addiction is really all about. And, for the remainder of her days that’s what she did with me, is she talked to me about what her issues were, the underlying causes of her needing to take drugs.

And, it was an eye-opener. When she first died, I, you know, her wish was for me to go out and to be able to help other moms and dads to understand what their children are really using drugs for. And it’s not for pleasure and it’s not for fun, it’s not for, you know, just – keeping up with your peers. Once, once you get started on something it’s very difficult to turn away from it especially when it comes to opiates, and the differences that it makes in a person’s body. That’s been my biggest challenge, is to let parents know that it’s not just a willful behavior, and something that they can stop. We really need to work hard to understand what opiates do in a person’s body, and the dependency that’s created out of it.

You know, and parents just, they find it easier — and I personally found it easier — to practice tough love then to delve into a problem that nobody’s been able to solve over decades. And, that all was back when opiates were, I’m going to put it in the terms of “clean drugs” because they were prescribed drugs. And now, what is out there on the market, I mean, it’s not even, people don’t even have a chance to get addicted to the drugs. They die before they even use their second dose in a lot of the cases. So, it’s not the same crisis as what it was when I was dealing with my daughter I… Parents today don’t even have the chance to practice tough love, or even decide, to decide to use it, it’s just automatic death and you know, they, they get that phone call that their child is dead rather than their child is addicted. I mean, I had the chance. I blew it. But parents today don’t even have that chance.

In most cases, I don’t think it is possible to see it coming. You know, a kid goes out to a party and somebody says, “hey, try this”, and they do, and it could be anything from cocaine to, you know, a pill party, and fentanyl is laced into the drugs, and they take it, they’re opiate-naive and they’re gone, they’re dead.

If I had it all to do over again with the knowledge that I have today, and I do do this with my grandchildren, and with my nieces and nephews is, I’d just be completely open and honest. I inform them of the crisis, I let them know that the bad drugs are out there. You know, and to be very, very careful of what they’re doing and what they decide to do. I’m not naive enough to think they’re not going to try drugs. I don’t want to see another member of my family die from that, and it’s just warning them, letting them know how to use naloxone, to never use alone, to give all the precautions out there to them. Give them all the tools in the tool box, and let them know that, you know, I’m an open book. You can ask me anything, you can tell me anything, and I’m only here to help. I don’t criticize, I don’t stigmatize, I wouldn’t do any of the things that I did to my daughter. It’s just a matter of being there, having an open discussion, being available for someone to reach out to. You really cannot have high morals and put yourself above this crisis. It’s deadly.

Narrator:

Donna dealt with problematic use of prescribed medication herself. Even with that experience, she found it difficult to relate to what her daughter was going through.

Donna:

You know, I was on prescribed OxyContin, I was on Neurontin, I was on Effexor, Wellbutrin, all at the same time and I drank. And totally addicted, and I just stopped cold turkey. I was able to do it, and it wasn’t pleasant, it wasn’t pleasant for the people around me. But I was able to do it.

My daughter didn’t have that opportunity, instead of working with her through that I criticized her and stigmatized her and… I mean, I was responsible for taking her children away from her and putting her in jail. So, the policing aspect of it, or the criminality aspect of it is, really, what caused her to turn away from asking for help from any of us. And trying to fend for herself when she’s in crisis mode already. So, no, it’s not the answer, that’s not the way to go. I, I do believe that health and social and mental wellness is, is absolutely the medicines that are needed to combat this crisis.

I think it’s important for people to be able to freely speak about their own battles with addiction. And I think that that, taking it out of the closet is the only way that we’re going to be able to solve this crisis. With the way that we treat people who use substances, we force them to keep it hidden, and like I’ve said many times that’s what kills them. We can’t solve something that we can’t see. If we can bring it out in the open and discuss it from the perspective of the people who are using the substances and also the people who are trying to help them so that we are actually understanding what it is that we’re trying to help, rather than just doing what we think is needed to be done, that’s when we’re going to come to the proper solutions.

I mean, in my experience now, in running the underground overdose prevention sites, I was getting lawyers and judges, coming in just to be watched while they use their substance. So, creating that open atmosphere kept them safe. But still, I had to do it underground, so it wasn’t as open as what you might think. People are ready for help. People are ready to get off their substances, but we need to develop a system that will draw them in and make them feel comfortable, so that they aren’t using in their bedrooms.

We had, a young boy, as young as 13, come and ask us for help. And, it’s a matter of accepting the fact that they’re doing it anyway, that they need to be supervised so that they don’t overdose and die, and to provide all the other... arms of health care and social care and mental health care at the same time. This was a boy who was from a good family, had broken his, well, had shattered his leg, and had been on opiates for the pain, and just could not wean himself away from it, and couldn’t speak to his doctor, and couldn’t speak to his family, about the fact that he was going through painful withdrawal. He was told to just buck up and put up with it and get over it. But he went to the street and he started using street drugs. And he was stealing from the home and stealing from the family to get the money to buy these drugs. And, and just continued.

Instead of, instead of, you know, punishing the child for doing all these bad things to get something that he absolutely needs, it might have been a better situation if they had said, “Okay, why are you stealing? Why are you selling everything in the house? Why do you still need the drugs?” And then go to the doctors and say okay, we need to wean him down, cut or titrate him down, in a matter that, that is going to allow him to not be ill while it’s happening. And we have to pay attention to this and we have to monitor what’s going on. In hindsight I would go all the way back with my daughter and say, “Okay, you fell down the stairs and you’ve been given OxyContin and you’re addicted to it now. Let’s go to the doctor, let’s go to the addiction clinics, find one that works for you where we can… not have you go through the painful withdrawal and you know, and everything else and just bring you down on your dosages until we can actually get you off”.

I think the first thing that I would caution a parent to do, is to not make it what they expect to happen. It has to be the values that the person who’s using the substances wants to attain. And that might be using for the rest of their life but being able to manage in society at the same time. You cannot expect people to be what you want them to be. You have to allow them to be what they want to be. And… in my daughters’ case, after she learned that she was going to die, she said, “I just want to be peaceful. I don’t want the demons running around in my head anymore and I don’t want the pain from all of the injuries that I’ve caused myself. I just want to feel at peace.” And knowing that she was going to die regardless, I had to accept that, you know? I had to accept the fact that she was going to continue using substances until the day that she passed away. It’s her choice, it’s not ours, it’s not our life to live. Yes, I want to keep them safe. I want to keep everybody alive, but… it is a matter of it being their choice, and when they’re in a position of not being able to make the right choice, you have to support them in trying to find that right choice.

My go-to now is definitely going, sending people to the rapid-access addiction medicine clinic. They sit down and literally ask the person, “What is it you want? Do you want to use safely? Do you want to reduce your use? Do you want to go cold turkey? What is it that we can help you and support you in doing?” And they make a plan. They have a contract, and they work through it.

Yes, there is a lot of relapse, and there is going back and forth, but it’s an open dialogue where a person is just accountable to themselves: this is what I decided to do and this is what I want to do and these people are here to support me in getting that done. Rather than locking them up and throwing them in an addiction clinic and just closing the door and saying, you know, you’re going to suffer through this. Not only have they been punished for whatever troubles they had to be on opiates in the first place, but then they’re being punished to get them off of it. I just don’t think that we need to continue to punish people for something like this. I think that we need to be in a position of helping them. Getting to the root causes of why they’re using substances in the first place.

Narrator:

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed and language used  by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Episode 8: Stéphane (audio available in French only)

Stéphane underwent surgery to deal with recurring abscesses and was prescribed opioids to help manage his pain. After taking more medication than he was directed, his challenges with problematic substance use grew worse. Stéphane shares his experiences and his journey to recovery. Listen to his story.

Transcript: Episode 8

Narrator:

In Plain Sight is a Health Canada audio series that explores the personal stories of people affected by the opioid crisis.

The most recent data shows that every day, approximately 12 people die from opioid overdoses in Canada.

We see this on the news. We know that it’s happening. We know that it’s real. Yet, we tell ourselves that it couldn't happen to the people we know, the people we work with, the people we love. That it couldn’t happen to us.

The reality is, the opioid crisis is happening right before our eyes, in plain sight, and it can affect anyone. There are thousands of stories waiting to be heard.

Stéphane underwent surgery to deal with recurring abscesses and was prescribed opioids to help manage his pain. Let’s listen to his story...

Stéphane:

I was 25 years old at that time. I was a family man, a man of my word, I did some weekly activities with my little family, I played with my boy, I dined at the restaurant with my wife. We went to the movies, we had a lot of fun. We often had small intimate evenings while drinking a few glasses of wine...

And then, I was having family problems. I stopped talking to my parents for a number of reasons, which led to a drinking problem to reduce my anxiety. I am a very stressed person by nature… I am a hypersensitive person. I was diagnosed with a generalized anxiety disorder at a young age. However, I had largely settled before my little boy arrived. So I would have a few beers every evening and the problem with that is that it prevented me from driving my car and this became a hot topic between me and my wife because there were a lot of activities we couldn’t do in the evening, we couldn’t do many things together… so in general I have always enjoyed my life… I had a nice swimming pool, a nice house, I used the BBQ when I got home from work, I had a drink when I got home, I would talk with my wife about my day, but I always had a bit of emptiness inside… I had a lot of trouble finding it, it was through this experience that I realized a lot of things.

It had been a few months since I had surgery for recurrent abscesses, and one time it was really hurting me and I asked my doctor for pain medication, without having any ulterior motives or even being informed about opioids in the first place. The surgeon asked me what I wanted between Dilaudid or Percocet. Dilaudid is a hydromorphone… I know that now. Percocet consists of 5 mg of oxycodone mixed with 325 mg of Tylenol, so I chose Percocet, because I had already heard this word around me, but I did not know what it was exactly. I came home from the hospital and I was in a lot of pain. I took one tablet which contained 5 mg of oxycodone as I said… About 30 minutes later, I began to get really tired, I was hot, I was nauseous, I was in really bad shape, I wanted to throw up so I went to lie down in bed. The next day I wanted more, I thought it was too strong, but the third or fourth day after my operation I was still a little sore so I continued to take it until at some point… that’s when it started… A sensation of euphoria came over me. And when I say euphoria, I mean an incredible euphoria, a state of well-being that I had never felt before in my life. I looked at my wife sitting on the couch, and a ray of sunshine passed through the window, it lit up the whole living room. I looked at it, I said, “WOW! What's going on? I feel really good.” I had tears of joy in my eyes, I said to myself, “What’s happening?” I was speechless at the time. That’s when I discovered the wonderful world of opioids, not knowing all the baggage that comes with it. Then the good thing with that is that I started going out more often. I was doing a lot of activities with my wife, with my family. It was the happiest chapter of my life. But it was what’s called a pink cloud. A pink cloud is the first time a child goes into a candy store… or anywhere. It’s the feeling you have, a feeling you will find one time and that you will always try to chase, all your life, like the first time you got drunk with alcohol with your friends, you have a really good time, you always try to get that feeling again. Once your pink cloud has passed, it’s over after that.

What I had not been told is that when you take narcotics your body becomes physically addicted, and psychologically addicted too. So that withdrawal is about to begin. I didn’t know that at the time. Now my first prescription, I took it… It was my wife's birthday, we went to the movies together, then instead of having a glass of beer, I decided to take my Percocet, and then I was like “WOW! I am really going to stop drinking, then just take this now, I feel really good when I'm on it.” So after a couple of times, maybe a month, I had no more pills left. But it did not bother me, it wasn’t the end of the world. I said to myself, “If I have it, I have it, if I don’t have it I don’t have it.” I called my surgeon and said: “I still have a lot of pain around the abscess… would it be okay if you sent me another prescription?” She told me, “Listen”. That’s when she gave me this comment that has stayed with me over time: “You are going to have much bigger problems than your little stomach ache if you keep on taking these narcotics.” Then… that has followed me all my life… at least for as long as my addiction lasted. So then I was going to work, I went home and all I can remember is that I didn’t feel good anymore after taking more and more Percocet… I didn't feel good anymore, but I didn’t blame the Percocet, I really thought it was just me. I went to work, then I would have to leave around noon to go home. I took the bus, I was tired, I was nauseous, I would lie down and sometimes I slept for four or five hours. I would wake up at like 6 o’clock in the evening… I would think, “What’s happening?” But even then, I didn’t think it was that… I thought it was maybe a rough patch or seasonal allergies, or whatever.

Then, the good thing with that is that I managed to let go of alcohol, so I reduced my drinking quite a bit with the Percocet. So to me it was not a problem yet. I went out more with my family, my anxiety had completely disappeared from my life, it was gone. I did not feel any more pain with the Percocet. I told myself, “What’s the problem with taking Percocet instead of having a beer? I feel good taking it.” That’s when I contacted my doctor, another doctor… it was a doctor I had gone to all my life… so we knew each other pretty well, he knew I wouldn’t lie to him for anything… I took advantage of that. I asked him to prescribe Percocet for fibromyalgia. He believed that, it was very simple to get what I wanted… I mean, I also have a lot of friends who just explain something to their doctor and get magic prescriptions, just like that. I didn't have a lot of Percocet at the time. I was taking maybe 3 or 4 tablets a day, and then he prescribed me 90 Percocet per month. So then it felt like Christmas, I think it’s pretty obvious… I mean, when you have a jar of candy which will last you a long time… there you know… I was set… I was set up for every month, I’ll have my 90 Percocet… the best life in the world…

That’s when I began to go home early from my job more and more. I thought that I was always feeling like that, depressed, grumpy, anxious, cold… sweats, hot flashes, bad nausea when I had not taken my Percocet. I was thinking that this was normal life, because at this point I was taking it every day. I went through the 90 Percocet within maybe three weeks… I had a week where I was in withdrawal at the time. But I didn’t yet know what withdrawal was, because it was my brain trying more and more to convince me that this was what life was like without my Percocet.

At first I went from 4 tablets then maybe two months later I was taking 12 tablets a day and after that I was at 16 to 20 tablets. So I was taking between 4,000 and 6,000 mg of Tylenol a day. With only 3,000 mg of Tylenol, you can easily get sclerosis of the liver, have heart problems… your internal organs can just… shut down. It was in November-December of 2015 that things started to go wrong… I started having withdrawal symptoms… I did not yet know about this however… I started doing more research on the internet, looking at forums, chatting with people, seeing how they felt and that’s when I started to understand what withdrawal was, the symptoms and the whole thing.

So then my wife, she was really supportive, she tried her best to help me during my withdrawal. Then what she was doing, she hid a few pills from me without me knowing. So that when I reached my week of withdrawal, she would put some, put 4-5 on the stove. Then I would look at her and say, “How did you do that?” I was really happy. She told me, well, at least tonight we’re going to do something together, whatever, then try to manage the rest, you know, to not be in withdrawal. So for me it was a like a gift from heaven…

It was then that my wife announced that she was pregnant with our second child. Then at that time I changed my medication to Oxycontin. I went to the pharmacy… It doesn’t exist anymore! It was replaced by OxyNEO and it was very expensive. We’re talking about $150 a month. But I don’t have insurance, I am a contractor… I tried OxyNEO for the first time, but it didn’t work at all, really not at all. I tried a few tricks like scraping them, like with a peg egg. I tried melting them, grilling them in the oven… there was nothing to be done… I contacted my doctor again. I said, “Can you change me to Percocet?”

When I saw that it was starting to go wrong again… I started to have more and more withdrawal symptoms… at this point I was at two weeks of withdrawal. That’s when we moved, it was July 2016. I asked my doctor for a prescription of Oxy IR. That’s what I had found on the internet. There are several forms of oxycodone… There is controlled release, but IR is instant release, which means that the release happens instantly. The reason I did that was to remove the Tylenol, specifically. So he prescribed me the same quantity, but 10 mg, so 45 tablets of 10 mg. I didn’t go any further, I stayed at that same dosage. That was when I had my first really big withdrawal. It didn’t take long before I got one and then when I had my first withdrawal, I will always remember it, I was going to pieces, I couldn’t sleep, my legs were restless. So then I asked my pharmacist for an advance, and they said, “OK, no problem, we will advance it for you this time.” So then I came back to earth, I started asking myself questions like, “OK, I don’t think I’m going to be able to keep taking it every day…” But it's a pain that is easy to forget. Because when you’re on a high, you’re not worrying about the future, you’re not worrying about anything. You don't care how long you have to wait before you go to get your prescription. You don’t take the time to calculate your next withdrawal, whether you should pay attention or not, because you feel good about yourself, you tell yourself that you will always stay the same, but that’s where it becomes a problem. So that the next withdrawal I had, I went to the pharmacy, I explained the situation and then they did not want to advance my medication for me. I was really angry, really, like in a rage. I was depressed, anxious, crying, I explained to them, “I am in withdrawal…” And then they told me, “Go to the hospital if you are in withdrawal, there’s nothing we can do, it’s against the law, everything is tracked really well, we cannot do that.”

I turned around, I contacted my doctor, I told him, “I’m still in real pain, can you advance my prescription?” No problem! He did it. He called my pharmacy, he said, “You can let him have it, there’s no problem.” Just like that, as if nothing had happened. Then I was in withdrawal for a couple of days because he had not written it instantly, it happened a couple of days later. But one day there, it looks like nothing for most people, but one day when you are in withdrawal it's a terrible nightmare. That’s when I started to go through my Oxy IR too quickly. My doctor told me that I was addicted to my medication.

I decided to take my medicine every two weeks to avoid having withdrawal for too long because I had no control. So I thought to myself, “I’m the mature one in this, I’m going to try to keep better control…” then after 4-5 days, I already had enough medication. I began to have withdrawal all the time, then it started being unbearable, not just for me but for my family as well. Because when you are in withdrawal you don’t feel well, you don't feel like helping anyone. You just want to find a comfortable spot and stay there.

So after a good month, a good six months - of all this, I began doing research on the internet for another drug that is a little less intense but, you know, still does the same thing. And there were a lot of people talking about Dilaudid.

But me, stupid and naive as I was, I didn’t know that the more you take, the more you will need to take. Then I asked my doctor to change it, and he said, “Ok, come and get your prescription.” So now I'm trying these Dilaudid. I take them orally as it is written and I started to have a lot of nausea, then I didn’t feel good, it felt heavy. I’m always going to remember this feeling. It was not a good feeling. It was not like Percocet at all. I was mostly sad on this. But I told myself, “Oh, it’s probably withdrawal from oxycodone, because it’s not the same drug, blah-blah-blah, I’ll give it a chance.” So I waited about a month like this, then no… it was always the same thing… the Dilaudid didn’t work for me. So I contacted my doctor again and I asked him for Oxy IR, but instead of 45 I told him, “Give me 90 of 10 mg.” Then he says, “Ok, no problem, come and get your prescription.” So then I went to get it, then after a month I had gone through it, then it was then that I had my biggest withdrawal and I began to have symptoms that were quite unpleasant. I started to have diarrhea, I started to have stomach cramps, like I was in so much pain, then I just couldn't sleep anymore. I had to go downstairs, sleep on the couch down in the basement because I was just moving all the time. I was kicking a lot. They call it the restless leg syndrome. I was depressed... but a depression so severe that I had suicidal thoughts and that is just not me. I had persistent anxiety so that I didn’t even want to leave home. So, I did some research on the Internet to find a better way to take Dilaudid and it was when I did the research, that I came across a word, bioavailability. Bio, is the body, availability is how the drug will work… If you’re going to get it let's get its maximum dope potential, so that's when I read that, by snorting it you would get up to 70% of the drug, while orally, you're just going to get 10%. So that’s a big waste. Then by injecting it... well, it's not for nothing that hospitals inject people... because they do not want to lose money, I mean it's expensive to make narcotics, they use the method with maximum potential, so they inject people with morphine or Dilaudid which is just synthetic morphine.

I asked my doctor to change to Dilaudid, and then he told me I was being annoying. I went there, he gave it to me anyway, and then I started snorting it. Then I felt a little weird... it wasn't like me, but it felt kind of... I thought it was really, really good. I was hooked right away. But it did not have the same effect as oxycodone. We're not talking about the same high anymore. Now we're talking about the same high as heroin. I was starting to feel... there are a lot of people who call it the same... nod, n-o-d. You face gets heavy, you feel... it's like a warm blanket that wraps around you. You feel so good, but you just want to crash, you don't want to talk to anyone. You don't want to have sex, you have no libido, there's nothing, you just feel so good in the depths of your being, but you have no more desire to live, you have no more emotions. Nothing makes you feel anything anymore, while oxycodone gives you more of a high, you want to do things, you want to go out, talk with people. Your mouth, it doesn't stop, you just talk, talk, talk, and people are like "OK can we talk?" "No!" OK perfect. No one can even get a word in. So, when I had finished my Dilaudid, that's when I had the most excruciating withdrawal I've ever experienced, I thought I was dying. Then I even called infohealth 811.

That's when she explained to me that we're full of small doors. Every time you take narcotics, you open more and more small doors all over your body, in your intestines, in your brain, and those little doors, when they are opened, they break. So that then there are other doors that open... they break and there are other doors that open in the long run so that you take more and more. But the problem with that is that when you start using too many opioids, your body opens too many doors and then when you have more, all those doors are all open. These doors that are open are looking for the drug to camouflage, otherwise your body’s temperature control will not work anymore because it becomes lazy, it doesn't do it anymore, it's not your body, it's not your brain, the drug has become the thing that takes care of everything that happens in your head. Your dopamine doesn’t work anymore, your serotonin doesn't work anymore, your norepinephrine doesn’t work anymore, nothing works anymore... not only that, it doesn't work anymore, but you've left a lot of doors open in your body. This is where you have withdrawal effects... So that’s what she explained to me.

So then I spent about a week in agony. I was deathly worried, and I was like, “I can't go on like this... ” But yet, I did, I did it for two months, all the time in withdrawal, and it had a big impact on my family. It had gone really far... I mean... I would come home from work... I was going to work on top of that! Which is already… I don't even know how I did it... Going to work in withdrawal, I don't even know how I did it, but I did. I would leave early, though, but I did it. When I came home, the first thing I did... I would have a shower and go to bed. I couldn't help my wife and we had a newborn baby as well. Fact is it tore my heart, but when you can't, you can't, I mean... The good thing was that at least I was going to work, I was bringing home the bacon. That was my goal, to at least try.

Narrator:

Always searching for a better high and constantly dealing with painful withdrawal symptoms affected every aspect of Stéphane’s life… his family, his friends, his work, his mental health. He recounts one of his lowest points.

Stéphane:

When I realized I was starting to snort at 6 a.m. before going to work. And I started snorting, then snorting some more, then every two or three hours, I had a congested nose. I was bleeding from my nose. It was so against my values, it's so not me. I'm so not a person like that, and yet here I was... I had no choice but to do it like this, because otherwise... my withdrawal was so intense. Once you start doing that, you can't go back. So another thing was to see my wife leave every weekend, in the mornings with the children while I rested... especially since I had a little baby at that time. A baby grows up quickly... I mean there are a lot of things that I missed, that I didn't get to see... You know... Yes, I would it with my eyes, but I was high all the time. There are many things you don't retain. You don't remember it because things don't touch you. I noticed that things stay with you when you're sensitive, when you're emotional, that's when it touches you and stays with you...

So then I no longer felt anything. Still today, I'm having trouble... I vaguely remember my baby, how that went, the whole thing. My wife did a lot of activities with the kids and I was dope sick as they call it. Then at some point - I will always remember it - my brother-in-law was at our place and we were playing on the computer and, I don't know what happened, I just took too much that day... It was like 11 o'clock at night, and then I started to really nod, but nodding to the point of like falling off my chair and then my brother-in-law looked at me like "are you ok, bro?". I didn't answer, and that's when – I know today – I was overdosing. I was overdosing... I was... my heart wasn't beating anymore... That's one thing I did all the time, I put my two fingers under my throat, where your pulse is to find out how strong it was beating, and my heart wasn't even beating anymore, I didn't feel it anymore, in any way. I went to bed. I could have never woken up again, that's for sure. At the time, I wasn't concerned about danger, and I thought, “It's not a big enough dose.” But... Oh yes! We're talking about 4 mg of Dilaudid, when you take, let's say 12 a day... yes, it's a big enough dose to kill you. When I came home from work, I went to bed. I was skipping everything. My wife was busy cleaning, washing dishes, making the little ones supper, giving baths, and all I did, I was going to bed. I tried as much as I could, I went to work, I came back, then I didn't even get a chance to enjoy my days, unless I was buzzed on weekends, that was different thing, and then what I did on the weekends, I was cleaning everything, I didn't stop until 4 a.m. I was so euphoric! I was making up for time I had lost. I was doing everything I could to satisfy my wife and try to pull my weight. Because she was really supportive. She's always been there, she's always tried to do everything to help and make the tasks so much easier... Still today, I still try today in 2019, I still try to do everything to lighten her load, to try to be the perfect man because it will never pay her back for all that she has endured... I spent my days sleeping. I was in the shower, I was crying, I was praying even though I didn't even believe in God.

As I said, with my wife, it was pretty difficult, it had a big impact, I will tell you the biggest one. It had an impact on my friends as well. We became estranged, as we say, because I didn't see them very much anymore. I moved right after... moving again... I moved once, and this is the second move. It was two years after the first time I had experienced the euphoria with the Percocet, because I thought the house was cursed... no joke... I really thought it was because of the house that I was unhappy. So then I started always arriving late to work. I was always getting called into the office, I was really on thin ice. I was not permanent at the time, I was a contractor. Then, I was going to lose my job at any time. I was trying as much as I could to get home early, do my day’s work and then just go home. I wasn't doing anything with my family, like... nothing. But it's ironic, because when I was on Percocet, I was living the good life... I always went out, I did a lot of things, but when I was on Dilaudid, it was another story... Now I wasn't doing any activities. Now I just wanted to crash. So after much reflection, I realized that the Dilaudid made me even worse than anything else. So I asked my doctor to change to 20 mg of controlled-release oxycodone. Because then I had done some research. I had become a little robot by then. Look, I needed to change my life, I needed to change things, and then the first thing they gave me was OxyNEO. I said, “No, look. I tried OxyNEO, it doesn’t work, it gives me nausea, I am allergic to it.” I used all the possible excuses not to have get that. Then I changed, I asked the pharmacist if he had generics. A good thing, you ask for generics and they aren't made like OxyNEO. So they gave me the PMS brand. Then I got home, and there were many ways, you could lick it, you dried it, then you could remove the coating on it and you swallowed it and it would give a better buzz, blah-blah-blah, and there on the internet they said, no, PMS is really crap, then blah-blah-blah try the Cobalt brand.

So, OK, perfect... I go to the pharmacy and I say, “Do you have the Cobalt brand? I am allergic to PMS.” I laugh now because it's crazy how are we ready to do anything, to lose face... it's clear that the pharmacists have heard this at least 25,000 times. So I thought to myself, “OK, I'll try the Cobalt.” I get home, I remove the coating, I try all kinds of things, and then I said to myself, “I'm going to try to snort them for fun". Because then I could see, it was a nice little powder. That's where I saw that WOW, OK, we’re talking about the same effect as the Dilaudid, but now, mixed with oxycodone on top, Watatow! It's the good life! My wife was beginning to notice that I was starting to sniff more and more frequently. That's when she said to herself, “OK. That's really... You've reached the limit. I can't accept this.” She was crying, and... for her it was the end of the world. But for me, I don't want any obstacles when it comes to my dope. And that was never me, it's against my values to think that way. But for the love I had for my family and I knew that I was so far gone... I decided, “I'm stopping all this.” That's when I contacted my doctor, and I confessed to him that I was addicted, like, really addicted. I was taking more than 350 mg of oxycodone a day.

So then, I talked with him about a treatment called Suboxone. He was not familiar with it, but yet he has a certificate. I told him that I really needed help, that I needed to get out of this... and then I went to his office and I confessed, I explained to him that the reason for my addiction was related to his prescriptions and that I had not been aware of all the problems that it was going to bring. I asked him to call all the pharmacies, to ban me, to put me on a list as a drug addict. I called all the dental centres, all the medical centres that I go to. I told them all that I was a drug addict, not to prescribe me with narcotics.

So then today, still to this day, I am still on a treatment of Suboxone, the dose has been reduced. I started Suboxone in 2018, I've been taking it for a year. I have had my ups and downs. After talking with my doctor, I finally got my Suboxone and then it was similar to Imodium cures. For those who do not know what an Imodium cure is, it's when you're in drug withdrawal, you're ready to do anything to numb the pain, whether it's with Advil, Tylenol, whatever, you just want to remove the pain you live with. I have a friend, and I have people on the internet who talked about it... the Imodium cure. Imodium is loperamide. So I tried it myself. I was really scared, it worked a little bit, but I thought, “It's too scary”, and I'm not going to have a bowel movement for a good 10 days... So I thought, “It's not for me, I'm not going to do this.”

But the effect was so heavy... I felt it in my face... it hurt almost, the effect it had was overwhelming. But when I started the Suboxone, that's what it did to me at the beginning. I was taking two 2 mg tablets a day, excuse me, 3 times a day. So I was 4 plus 4 plus 4, so if my calculation is right, 12 mg of Suboxone. Then that's when I realized it was too much for me. I wasn't well, there were times when my pupils were so small that you couldn't even see the black in my eyes. So I decided to call my doctor and I said, “Can you lower the dose,” etc., but he wasn't returning my call, it took a long time. I had waited before picking up my medication from the pharmacy because I wanted to talk to my doctor about it. I went to my pharmacy two-three days later... I asked them to prepare my medication. But the problem with that is that according to the College of Physicians, Suboxone, since it is a drug that is controlled, made for addictions, you have to take the tablets in front of the pharmacist and then they will give you the rest of the drugs in a small jar that you take you home, and then they can just give you one week's worth of drugs at a time. What I didn't know, however, is that you have three days to pick them up. After three days, they cancel your prescription and you have to contact your doctor again. That means if you're in withdrawal, you need to contact your doctor again to do all the paperwork over again, send it back to get your Suboxone back. So there, I was involuntarily in withdrawal, for a good week. I was not impressed. I mean, I complained, I tried everything, but it was the law. What is odd about that, however, is that Suboxone, as I say, is a drug that is a partial narcotic. It doesn't give you a high, but for oxycodone, etc., no problem... You go to the pharmacy, pick them up... a month later if you want, there's no problem. But Suboxone, no. That's where I think it doesn't make sense, and then especially to cancel someone’s prescription. I mean I consider myself a stubborn person, I don't take no for an answer on anything in life, I mean am patient, but for sure there are people who would not have tolerated it and would have gone back, gone back to heroin on the street or whatever. They're looking for a reason to give in, and you're cancelling their prescription just like that. Like, I think it's so ridiculous.

But that’s not all. It happened to me that there were weeks when things weren't going well and then I couldn't get to the pharmacy. I thought I'll go, let's say Thursday. I was supposed to go between Tuesday, Wednesday or Thursday, but I thought, “Oh! I’m going to go on Thursday.” Thursday comes and I don’t feel good at all, I really don’t feel good so that I can’t even take my car to go there. I call my pharmacy, I ask them. They tell me, “OK there's no problem, you can come tomorrow.” So, thinking that I can go on Friday, I arrive on Friday... your prescription has been automatically cancelled again. So I can't even tell you how many times it happened to me, at least 13 times, I'm not exaggerating, it happened 13 times that my prescription has been cancelled just like that. I have still kept going and still to this day I make sure not to miss it, but it can still happen to me. Then every time they cancel your prescription, you're in withdrawal. Withdrawal from Suboxone is just as bad as any other withdrawal.

Narrator:

Stéphane hopes his story will help broaden awareness of the possible side effects that opioid medications can have and how they can affect a person’s physical and mental health. When taken properly, prescription opioids can help patients experiencing pain manage their conditions, allowing them to lead full and productive lives. It is important to have an open conversation with your health care provider about your own pain management plan and to take medication as prescribed. Here is what Stéphane had to say about what helped him most in his recovery process and his own experiences.

Stéphane:

Hands down, the support of my wife. The mega-huge support of my wife, with the kids. Her understanding… I always told her what I was experiencing to the letter and she was really involved. She was really trying to help me as much as she could, without judging me, without pointing the finger. She was really trying to guide me and help me in my process to get out of this. She has been my light at the end of the tunnel.

It's okay to feel sadness, joy. It's okay to feel love, the wind on you, grief, having bad days, squabbling with your spouse. It's part of life. It is not important to try all the time to hide your pain by using substances. Even if you are a hypersensitive person, embrace, embrace the fact that you are a sensitive person. You're going to be better at being an artist. You're going to be more sociable than the others. You show your importance, you get out of your head. Let yourself be carried away, let yourself be guided by your emotions. Because I've noticed that when you take narcotics for a long time you lose that feeling. You have no more emotions, so you don't feel love anymore. Which makes sense because all narcotics just hide the pain you feel inside. So you don't feel emotion anymore, you don't feel anything. And I realized by stopping narcotics - I didn't quite let go of them, I'm still on a Suboxone treatment, but at least I still have myself. I have found myself. It's come to balance itself, and then it's important to let your neurotransmitters balance themselves by themselves, without taking drugs.

Today, I know the opioid system well, the neurotransmitters, the effects that they have, all that, but I had to be the guinea pig in all this. I had to learn everything by myself and then I told myself that this is the number one cause of the problem of addiction in our society. People are uninformed. People are not very well informed, opioids are not really explained to people. It is important to explain the effects of narcotics to patients. That's my biggest question in all of this: “Why would anyone provide 200 pills a month of oxycodone to a customer, without question, without anything." But when it's a prescription for a simple person trying to cope... It's a drug that doesn't make you high. I can just go back to the street and inject myself. What the hell is this system? How many times did I get angry because they cancelled my prescription? How many times did I almost start using heroin? It's too easy. I am naturally stubborn, but many of us are not. They would quickly return to another alternative so as to not be in withdrawal like the 13 damn times my prescription was cancelled.

Now you know my story. It's up to you to judge for yourself if you want to fall into that pattern.

Narrator:

The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recognizes the risks associated with using opioids for people who have or have had a substance use disorder. With funding from Health Canada, these guidelines were introduced, in part, to help prevent experiences like Stephane's.

Problematic opioid use is devastating Canadian lives. The numbers are tragic and staggering. These are the stories behind the numbers. This crisis has a face. It is the face of a friend; a co-worker; a family member. Meeting those eyes, and seeing our own reflection is the first step toward ending the stigma that often prevents people who use drugs from receiving help. To learn more about the opioid crisis, visit Canada.ca/Opioids.

This audio series is a production of Health Canada. The opinions expressed and language used by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

Is problematic substance use affecting you or someone you love?

This audio series is a production of Health Canada. The opinions expressed by individuals on this program are those of the individuals and not those of Health Canada. Health Canada has not validated the accuracy of any statements made by the individuals on this program. Reproduction of this material, in whole or in part, for non-commercial purposes is permitted under the standard Terms of Use for Government of Canada digital content.

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