Hooked on hope: Former opioid user, new mom has ‘so much to live for’

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Nova Scotia freelance photographer and writer Peter Barss looks at the cost of opioid addiction on the East Coast and how some are finding a way out

Sydney Gordon could be dead. A statistic. A victim of the drug culture.

“I always had the potential for addiction. I was an angry and an unhappy teenager. In high school I was sexually abused by boys I knew and I hated it. I hated myself. Drugs were available and they let me escape. I could get away from myself and the trauma. I could sleep.”

The hurt continued into adulthood.

“The men I dated abused me. I’ve been sexually assaulted and physically beaten. I’ve been raped more than once. I just accepted that as the way my life would be.”

“I am an addict. I’ll always be an addict."

Gordon, 29, is a single mother on a methadone regimen and, in spite of being haunted by the nightmares of her past, she is hopeful about her future. She watches clouds drift over the ocean from her small Dublin Shore home as she nurses Harrison, her son, who just turned one.

“I am an addict. I’ll always be an addict, but I’ve been clean for almost three years and I never want to go back to the dark places, the horrors I’ve lived,” she said looking down at her son.

Gordon started using cannabis and drinking on a regular basis when she was thirteen. At seventeen she became addicted to opioids when her supplier suggested she “try something different.”

“I figured those pills were prescribed by a doctor so what harm could they cause? I didn’t know I was getting into something so heavy.”

Gordon was addicted to opioids “within a few weeks” and for seven years she crushed pills and snorted the powder.

“I knew I was in trouble. I hated the addiction. I went through detox a number of times, but I only went when I ran out of money for drugs. I hated myself. I hated the drugs, but I always went back to my supplier when I could pay for them.”

Drugs continued to tighten their grip on her life.

“After seven years of snorting I started to inject opioids. It got to the point where I was injecting myself 20 times a day. I could lose myself in the euphoria intravenous use gave me, but at the same time I detested my failure to get away from drugs and face my problems without being high.”

In 2010, in a desperate attempt to escape her self-hatred and the drugs, Gordon impulsively bought a ticket to Europe where she worked as a nanny in Spain. She hoped being away would free her from her addiction, but her demons followed her.

“I drank two bottles of wine nearly every day and, when I could get it, I used cocaine.”

After 10 months in Europe she returned to Nova Scotia. She told herself that she had left her addiction to opioids behind, but in her heart she knew she was lying to herself. As her plane approached Halifax she found the effects of withdrawal and the anticipation of getting “a fix” surfaced with a vengeance.

“Suddenly I was an emotional and physical wreck. I was out of control. It was a nightmare. My mind was dominated by past trauma, I was hot. I was cold. I was sweaty. I was shaking. Nauseous. I was very, very depressed.”

She was suffering the symptoms of withdrawal. Gordon called her supplier before her plane touched down.

For the next several years Gordon’s life was a terrible mix of drug induced euphoria, self-hatred, and futile attempts to free herself from both.

At one point, when she was in rehab, Gordon reconnected with an old friend, a crystal meth user. They agreed to travel together to Edmonton to get away from the drug scene in Nova Scotia. They thought that because they were addicted to different drugs they could help each other get free of their addictions in a new environment.

Instead, things went downhill fast. Gordon and her new boyfriend were quickly drawn into the drug culture in Edmonton. Both became regular users of a concoction of heavy drugs including crystal meth, cocaine, and fentanyl. Gordon shared her IV needles and opioids with the man who had promised to help her get off drugs.

"I couldn’t watch them die. They were near death when I injected them with Naloxone and thankfully they came around.”

Paying for her drugs was always a problem for Gordon. She worked when she could, but the money she earned wasn’t enough.

“In Edmonton we lived in flop houses with other drug addicts. Everyone was so desperate to get high and stay high. We weren’t friends. We just used each other to get drugs. We stole from each other. We stole from anyone we could. We were reckless. I never sold sex, but I lived with men and women who did.”

Gordon saved the lives of two people who were the victims of a “hot shot.”

“A hot shot is when one addict intentionally gives another a lethal overdose in order to steal their money or drugs. I saw that happen twice. I couldn’t watch them die. They were near death when I injected them with Naloxone and thankfully they came around.”

ROCK BOTTOM: HOMELESS, SICK AND 80 POUNDS

After 10 months Gordon found herself homeless in an Edmonton winter. She had contracted Hepatitis C from dirty needles. She weighed 80 pounds.

Her life had hit rock bottom.

“I had to leave my boyfriend and get out. I knew we would both die if we stayed there. Freezing to death, being murdered. Suicide was something I thought about.”

Gordon came home to Dublin Shore feeling that she had one last chance to turn her life around.

She and her mother approached Dr. David Martell who arranged for Gordon to receive her initial treatment at the Opioid Replacement Treatment Program in the Annapolis Valley. Eventually The South Shore Opioid Outreach Team, based in Lunenburg and Queens counties, had space for her which meant that she could continue methadone therapy closer to her home under Dr. Martell’s supervision.

“He’s a great and wonderful doctor. I can’t say how much he’s helping me.”

“I’m happy. I’m finally happy.”

At the same time she sought medical help, Gordon disassociated herself from former acquaintances who she knew were still part of the drug scene. And she distanced herself from the people who had taken advantage of her sexual vulnerability.

“I know now that I was always running away, from myself, from my addiction, and from the people who could see what was happening and tried to help. I was terribly hurt and I hurt everyone who cared about me.”

Since she’s been home, Gordon been treated successfully for Hepatitis C. She has renewed friendships, building a network of people who give her love and support. She has a part-time job. Dr. Martell is gradually reducing her methadone dosage. She has now been free from illicit opioids for three years.

She has turned her life around.

“I’m happy. I’m finally happy,” she said. She looked down at her son and hugged him. “I have so much to live for.”

Opioid outreach: Healing the person, not just the addiction

Dr. Dave Martell gave up a successful 20 year family practice to devote all of his time to helping those suffering from opioid use disorder.

“It took me two years to make the decision. I had to say goodbye to 1,500 people who had been my patients for many years without knowing if they would be able to access care after I left. It was a very, very difficult choice to make.”

Dr. Martell said he wanted have the “biggest impact” he could as a doctor. Along with Dr. Pascal Gellrich, he formed the South Shore Opioid Outreach Team in March 2018. The Outreach Team includes three physicians, two Licensed Practical Nurses, a social worker and an administrator. Case management is a shared role. It is the first opioid use disorder clinic on the South Shore formally funded by the Nova Scotia Health Authority.

Headlines about illicit opioid use are alarming. According to the Government of Canada website there were 11,000 opioid-related deaths in Canada between January 2016 and December 2018. In Nova Scotia there have been an average of 60 deaths every year between 2013 and 2018.

While images of first responders rushing to save someone near death in a Vancouver back alley are dramatic, they encourage us to see the “opioid crisis” in oversimplified terms. The problem is more extensive and more complicated than reviving someone who has overdosed.

The South Shore Opioid Outreach Treatment Team provides medication therapy for illicit opioid use and help with other physical health needs including vaccinations, acute care, and Hepatitis C treatment. But Dr. Martell says there's more to be done than just filling medical needs.

"Illicit drug use is a symptom of complex problems. The whole person must be treated," he said.

“A major component of our team’s approach is to help patients establish a normal routine in their lives by addressing a wide spectrum of issues including simplifying getting to appointments on time, working out problems associated with income and housing, and supporting those who have suffered childhood trauma.”

WHERE TO GET HELP

The South Shore Opioid Outreach Team conducts clinics once a week in each of the following locations:

• Bridgewater, Thursdays 9 a.m. to noon
• Caledonia, Mondays 9 a.m. to noon
• New Germany, Wednesday, 4 p.m. to 8 pm.
• For further information or to make an appointment call 902-634-8807 extension 1713307.

For more addiction treatment services in your province, follow these links:

There are three clinics along Nova Scotia's South Shore: Bridgewater, New Germany, and Caledonia. In addition, services are often provided at the central hub in Lunenburg at the Wellness Clinic.

“Travelling to appointments is a major barrier to treatment. We are helping with that problem by establishing clinics in small rural towns.”

The first step toward treatment is an hour long discussion with members of the outreach team to assess the patient’s specific needs.

“There is no waiting list,” Dr. Martell said. “Assessments can be done anytime during normal working hours, Monday through Friday between 8:30 and 4:00. Treatments generally start the next available clinic day.”

The central purpose of the assessment is to discover deep-seated problems that are at the root of the opioid use. In most cases the euphoria provided by drug abuse is an escape from the stress of painful realities including psychiatric problems, poverty, health issues like HIV and Hepatitis C, physical trauma, childhood neglect, and the misuse of other drugs, including alcohol.

Detoxification is an attempt to alleviate withdrawal symptoms, usually with a longer acting drug that can be administered in a controlled way to comfortably lower the dose while the body adjusts. This approach, by itself, has a dismal success rate because it fails to deal with the primary causes that are intertwined with addiction.

The outreach team views illicit opioid use as a symptom of a collection of personal problems the patient faces. After the initial assessment, the Team devises a treatment strategy that begins by addressing the drug use and, just as importantly, the deep-seated pain that has accumulated over the patient’s lifetime.

Patients are immediately offered medication to eliminate withdrawal symptoms. The medication, a less potent opioid, is administered by a pharmacy to diminish craving and to minimize the physical distress of withdrawal. The patient is monitored by the pharmacy to ensure adherence to the program.

“Our first priority is to stabilize the substance use disorder. However, when a patient presents significant mental health or acute physical health problems we treat both conditions at the same time.”

Over time, the dosage of the replacement drug is reduced, and, if there is no evidence of illicit drug use and if the patient is in a stable social environment, the patient earns the privilege of taking medication doses at home. Even then, “the patient must be tested periodically to determine that continued dosing of the medication is safe for the patient and for the community.”

In addition to administrating medication, the community pharmacist provides some psychological and social support.

During treatment, the outreach team offers support and counselling tailored to meet outcomes chosen by the patient.

“The goals of treatment are set by the patient and those goals are not always to completely abstain from drugs,” Martell said.

“Our objective is harm reduction. Substance use can be made safer without a focus on, or requirement for, abstinence. Opioid use disorder is a chronic disease. There is no endpoint to treatment. Success is measured by improved psychological and social functioning – staying out of jail, reconciling with family, maintaining employment, furthering education. Sometimes success is having less risk of contracting HIV or Hepatitis C, or being subjected to less violence.”

In short, the program offers hope for opioid users, not for a perfect life, but for a better, safer life.

Opioid addiction: Arrest can be first step to recovery

Opioid addiction can be so devastating that some seek to end their lives rather than endure them.

And for many, the first step toward treatment comes when a police officer knocks on their door.

Arrest for illegal possession is feared. Not many illicit opioid users would expect the police to extend a hand to help them deal with their drug problem.

But sometimes compassion comes in a uniform.

RCMP Corporal Ted Munro of the Bridgewater detachment has seen the worst of opioid addiction and known those who have died.

He recalled a grown man lying on the floor in a fetal position at his detachment in Cookville. The man was crying and begging Munro to unlock the exhibit room and give him drugs held for a trial so that he could quiet the pain of withdrawal. He knows mothers so driven by their addiction that they have left their babies alone to go and buy opioids. Young girls have asked him if they can get treatment sooner if they get pregnant.

While he’s describing a young farmer who suffers from opioid addiction he seems to forget that he’s being interviewed. He stares out the window. He gets choked up. There are tears in his eyes.

Cpl. Munro talks about opioid users who have been rejected by their friends and their parents, socially isolated because those close to them can’t cope with their behaviour.

Illicit opioid users are so compelled to obtain drugs that they commit crimes that almost guarantee getting caught—shoplifting, robbing the homes of neighbours, writing bad cheques, stealing copper wire and pipe, and robbing stores where the staff know them.

Do users want to free themselves from addiction?

“One hundred percent,” Munro says.

The Mountie has made a point of understanding the complexities of drug addiction. In 2013 he helped form the South Shore Opiate Committee which included police, probation officials, pharmacists, representatives from social services and child protection services, and income assistance personnel.

“We met monthly for a couple of years. The committee was formed to discover the extent of addiction in this area, to educate ourselves and everyone concerned about addiction, and to understand the social problems it creates. With that knowledge we developed best practices to deal with all aspects of addiction.”

While the decision to seek treatment has to be up to the substance user, Cpl. Munro does everything he can to help. If an opioid user chooses to seek help, Munro will make a referral to a clinic that offers drug substitution therapy and counselling or to a doctor who has the training to offer treatment. One of the first steps in treatment is taking methadone under carefully monitored conditions at a pharmacy. When RCMP officers escort patients to their appointments they do so “as discreetly as possible.”

“We know every back door of every pharmacy in the county.”

Treatment can last for months and even years. As long as he is in contact with an addict, Munro offers whatever emotional support he can.

“These are people who have lost family and friends. They have lost their identity. They are broken. I tell them that their families and friends will take them back. Once they’ve chosen treatment they can look forward to support from the larger community. I’m part of that community.”

Police, province working together on solutions to opioid crisis

No place is immune to the impacts of opioid use and misuse. Lives are ruined and people are dying in the cities and in every rural community.

“The illicit use of opioids is increasing right across Canada,” according to Dr. Robert Strang, Nova Scotia’s Chief Medical Officer of Health. Since 2011, he asid, an average of 60 Nova Scotians have died each year from overdosing on opioids.

Strang says availability is increasing, but the number of overdoses and deaths due to overdoses has remained relatively stable.

“The Opioid Use and Overdose Framework is holding the line in spite of the fact that we are seeing more of these drugs."

The program is helping, Strang said, but more needs to be done.

"We have a great deal of work ahead of us.”

GETTING THE DATA

The Department of Health and Wellness tracks opioid overdose deaths monthly, reports them to a national data base, and posts them online. Emergency Health Services calls to where Naloxone is administered are now also being tracked.

In an effort to reduce the use of opioids, Nova Scotia joined the government of British Columbia and Health Canada to launch an anti-stigma marketing campaign in June 2018. The province is also training police to “help direct individuals facing addiction and trauma to proper care”.

GETTING HELP

“Those who misuse drugs tend to see the police as their enemy,” Dr. Strang said. “But, as long as they’re not selling drugs, we are more interested in seeing those people in treatment instead of being prosecuted and put in jail.”

Education, in schools and in society at large, is another avenue the province is pursuing to stem the use of opioids. Dr. Strang emphasizes that understanding the social and emotional trauma many opioid users face is at the heart of making a truly significant difference in drug use.

Realistically, opioid abuse will be with us for the foreseeable future.

“As long as we have poverty, physical and sexual abuse…as long as we have these and other social ills we will have a drug problem,” Strang said.

HARM REDUCTION

To reduce the number of overdose deaths, the province has established a harm reduction team to oversee funding and to “work toward safer consumption models”. The province has provided $2.76 million ($1.38 million annually over the last two years) to fund three community-based harm reduction organizations in the province that provide needle exchange, distribute Naloxone kits and “support individuals to use drugs in a safer way.” The province is also funding community pharmacies so they can provide free Naloxone kits and free training in their use to all Nova Scotians who request it.

“The kits are free for the asking,” Dr. Strang said. “If there is any reason you might think you would witness someone overdosing we urge you to pick up a kit. Up to this point 10,000 kits have been given out and hundred and thirty-five opioid overdoses have been reversed with Naloxone injections. That’s a hundred and thirty-five lives saved.”

TREATMENT AND PRESCRIBING PRACTICES

In partnership with the Federal Emergency Treatment Fund, Nova Scotia has increased funding to $1.8 million annually for “opioid use disorder treatment expansion”. There are five satellite treatment clinics available in Nova Scotia now including one in Bridgewater, one in Caledonia, and one in New Germany all operated by the South Shore Opioid Outreach Team.

“For those seeking treatment, wait time for an appointment has been a serious impediment,” Dr. Strang said. “Now, anyone who has made the choice to get help should be able to get it right away.”

The number of people waiting for opioid use disorder treatment has been reduced from about 250 before November 2017 to 25 people as of September 1, 2019.

CRIMINAL JUSTICE AND ENFORCEMENT

Workshops on opioids have been conducted for the police and front line-line investigators and first responders. Naloxone kits have been supplied to police, sheriffs, and, correctional facility personnel. With assistance from the province, The Nova Scotia Chiefs of Police established a drug committee to provide direction on the issues of drugs, including opioids.

“Opioids not only damage individuals, they damage families, and they damage our society in general,” Dr. Strang said. “Our programs are constantly evolving, changing, and getting better. It’s a long way off, but I’m hopeful that someday we’ll live in a society free of illicit drug use.”

FURTHER READING: Click here for an overview of Canada's opioid crisis.

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