In the grips of Penticton’s overdose epidemic, the community gathered together Wednesday night at Okanagan College to search for solutions.
Emergency responders, service providers and the public took part in the town hall meeting which also served as an education forum for all involved, including a former drug addict.
The current problem really hits home for Dustin Johnson.
“I think that everybody has a good grasp on what needs to be done. Being an addict myself and having clean time, there’s different routes that people need to take. There’s not one set thing that needs to be done or that works or doesn’t work. It’s a cumulative thing that has to happen and the community needs to get behind it for sure,” Johnson said.
It was as much an educational session as it was a discussion on the crisis.
“I think it’s really informative because probably 90 per cent of the people, if not more, of the people in that room have never used drugs in their life. They have no idea what happens to somebody when they use drugs. They think it’s just this terrible thing that takes over. Good people get sucked into drug addiction,” Johnson said. “These people that are overdosing aren’t terrible people. It’s just somebody who has taken a wrong turn and it has effected their life in a really negative way.”
Born and raised in Penticton, Johnson was addicted to crystal meth for around seven years when living in Alberta. He moved back two years ago and attended outpatient care at Pathways Addiction Resource Centre. He still attends Narcotics Anonymous meetings to this day.
“There’s a lot of avenues where people can go to get help. It’s important to let people know that they’re not the only person struggling with an addiction. You’d be surprised at the normal people that struggle with day-to-day things.”
He said he has also suffered from mental health issues, which go hand in hand with drug abuse. While Johnson wasn’t surprised to hear what was discussed by the panel, he noted it was good to see people coming together with a common goal.
“I still feel there is some beating around the bush when it comes to Interior Health and their outlooks on things. But everybody wants the same goal. They want people to quit using, first and foremost, but right now it’s more or less stopping the overdoses. The harm reduction is good, but at the same time I feel harm reduction, in a sense, does feed into addiction one way or another,” Johnson said.
Around 80 people showed up to discuss the overdose epidemic in Penticton at a town hall meeting held with a panel of front line workers, doctors, emergency workers and more at Okanagan College Dec. 7.
Residents asked questions of the panel consisting of Larry Watkinson, Penticton Fire Chief, Anne Benn, emergency health services manager of patient care delivery for the South Okanagan; Don Cocar, independent community pharmacist and owner of Knights Pharmacy in Penticton; Dr. Silvina Mema, medical health officer for Interior Health; Leslie Lappalainen family physician who works at the Martin Street Outreach Centre and the medical lead for addiction medicine for mental health and substance use for Interior Health; Dr. David Stoll, who works in the Penticton Regional Hospital emergency department and part time at the Martin Street Outreach Clinic providing opioid addiction treatment since 2006; Kate Fish, regional harm reduction coordinator for Interior Health; Mike Mai, who is responsible for intake coordination at the Martin Street Outreach Centre.
What is fentanyl?
Fentanyl is a synthetic opiate, manufactured with chemical components, as opposed to heroin and morphine, which are created from opium poppies.
“It’s actually a lot cheaper to mass produce a quantity of synthetic opiate than it is to grow poppies, transport it and process that. That’s why it has taken over,” Stoll said.
Why are people dying?
An opioid overdose slows down the breathing process to the point when the user stops breathing on their own. The obvious lack of regulation for illegal drug producers also presents a challenge, with what was dubbed the “chocolate cookie effect” creating inconsistent concentration in doses leading to overdoses even for experienced users.
“It’s really unpredictable. The other thing, it’s being mixed in amphetamines or cocaine. Those are people who don’t have tolerance for opiates and they are using what they think is a stimulant, but it has a very powerful opiate in it. So they have no tolerance and that’s why we’re seeing some deaths,” Lappalainen said.
Read more: Interior Health overdose prevention
What is happening in Penticton?
Interior Health has been gathering more surveillance data from overdose patients in emergency departments and community organizations.
“What that data shows is the drug consumed the most was heroin. Was there fentanyl or not? We don’t know. We don’t test the drugs, we don’t test the patients. The RCMP has the capacity to test drugs. If they find drugs at the scene they are able to get it tested for its contents,” Mema said.
Another source of statistics for Interior Health are provincial coroner reports.
“They test the people who have died from an overdose. They are finding that 60 per cent of the deaths, more than half of the deaths, there is fentanyl implicated in that death. More than 90 per cent of the people are found to have more than one drug,” Mema said.
The second drug found most commonly is cocaine.
“Sixty per cent fentanyl is pretty high, when in 2012 that was five per cent. So in four years we have increased dramatically the number of fentanyl, and that correlates with the number of deaths that are increasing, so I think it’s fair to assume that fentanyl is playing a large role,” Mema said.
Benn said emergency responders in Penticton last year had attended to 125 overdoses, but by the end of October of this year emergency services had already responded to 125.
“We are significantly higher than we were last year,” Benn said.
Fire Chief Larry Watkinson said first responders are seeing a different kind of overdose when they arrive on scene.
“The severity of the patient that we’re seeing has changed,” Watkinson added. “(From) an overdose where the patient is still conscious and speaking to responders, to the point where we are seeing more frequently now they are non-responsive, not reactive to any stimulus. That is a big trigger for us that there is a different type of drug that we’re facing versus methamphetamine or any other synthetic drug that is not laced with fentanyl.”
In the Penticton area, the types of drugs leading to overdoses are particularly associated with what users believe to be heroin, crystal meth and cocaine.
What is Naloxone?
The panel demonstrated the correct way to use a Naloxone kit, which can buy time for someone suffering from an opioid overdose, though they noted Naloxone kits are not a definitive treatment, and the first step is to call 911.
“One of the challenges we’ll see is a patient will feel significantly better, they’ll wake up, and unfortunately a lot of the time they’ll want to then leave the hospital facility,” Stoll said.
The panel was unable to say how many Naloxone kits have been used in Penticton, however thousands have been distributed provincially.
Can you test for Fentanyl?
There is currently no reliable way to test drugs for fentanyl. Urine can be tested for fentanyl, and Lappalainen said that at least 50 per cent of the patients she tests are positive for fentanyl if they are using opiates.
“There is some work being done at Insite, which is a supervised injection site in Vancouver, testing drugs specifically for fentanyl. However, they were using the test strips that were made for urine, to test the drugs. So they haven’t been approved for that purpose and whether that’s a good measure is hard to say. So some people may get some false reassurance in testing it using a urine tester,” Lappalainen said.
Where is the drug coming from?
The panel said a lot of fentanyl is coming from China, which Mema agreed was the current theory, noting a lot of the components used to create fentanyl are unregulated in China. She added there are currently diplomatic discussions to start regulating the substances abroad.
Watkinson added that currently first responders are unable to 100 per cent identify a fentanyl production site. He said it was a larger problem in the Lower Mainland.
“We’re quite concerned with fentanyl becoming a user lab-type production. We’re seeing it at a high scale coming from Asia. We’re certainly becoming more cautious about how and what fentanyl labs will look like,” Watkinson said. “We’re still not clear exactly how to recognize a fentanyl lab.”
What are some misconceptions?
Mema noted using drugs recreationally is no safer, and harm reduction methods do not encourage drug use.
“Using drugs is not safe. We don’t want to say that ‘oh if you use like this you’re fine, if you use a Naloxone kit you’re fine.’ No, using drugs is not safe. That’s first and foremost, but we know that ’say no to drugs,’ is not going to cut it for many people,” Mema said.
Stoll noted the association with overdoses and needle drugs is incorrect, with snorting, inhaling and other methods of ingesting drugs all able to cause an overdose.
“Don’t just think, oh there’s no needles here so the person couldn’t overdose, that’s not the case,” Stoll said.
What can be done?
Mema noted that community efforts are needed on when provincial resources aren’t enough.
“People are dying as we sit here right now,” Mai said.
Breaking down barriers between service providers and working more in concert is something that is happening now with many of the panel members meeting to discuss how to best tackle the issue.
“I think the message is getting out there. I think it’s just the matter of getting more action,” Mai said.