I thought that it was about time to tackle a problem that I've been thinking about for quite a while: drug addiction. Just to put things into perspective, according to Statistics Canada, in this year from January to March, across Canada there were a total of 1,018 deaths by drug overdose---96% of which were deemed accidental (ie: not suicide). Compare that with the number of deaths by COVID-19, which was 1,193 as of October 4th. Clearly more people are dying by addiction pandemic than viral.
In Guelph the latest numbers I could get for opioid overdose deaths was a CBC report of July 14th, that said that there had already been 14 in 2020 alone. In contrast, Guelph Today reports that as of October 5th there had only been 11 deaths in Guelph because of COVID-19.
It's important to not read too much into this comparison. There are a lot more people getting the bug than who are addicted to drugs. Moreover, many of these folks are getting really sick but aren't ending up dead. Moreover, compared to other places---like the USA---Guelph is doing exceptionally well controlling the spread of the virus. In contrast, it might be the case that we are doing an abysmal job controlling addiction here. This could well mean that we are seeing the worst it can get with opioid addiction and almost the best it could be with COVID-19. Having said that, it is important to compare these death numbers in order to get some sense of scale.
I don't really know much more about this subject than anyone else. Nor do I have a lot of contacts in this world. To that end, I put out feelers through social media looking for someone with some experience as a healthcare worker who could "clue me in" about the issues people should think about. The person I ended up interviewing was Morgan Dandie Hannah, who spoke clearly and persuasively on many different sides of the subject. What follows is a conversation we held on September 30th of 2020. As usual, I've split the audio files up into segments and then tried to expand on the issues raised by research after the fact.
Hannah mentions that she worked in a facility that did "Holistic Treatment for Concurrent Disorders". I think that it's important that readers understand exactly what she's talking about. According to a publication from the Centre for Addiction and Mental Health (CAMH) titled Concurrent substance use and mental health disorders: An information guide:
People who have combined, or concurrent, substance use and
mental health problems are said to have concurrent disorders.
Concurrent disorders can include combinations such as:
• an anxiety disorder and a drinking problem
• schizophrenia and addiction to cannabis
• borderline personality disorder and heroin addiction
• depression and addiction to sleeping pills.
and
• 30 per cent of people diagnosed with a mental health disorder will also have a substance use disorder at some time in their lives.
This is close to twice the rate found in people who do not have a lifetime history of a mental health disorder.
• 37 per cent of people diagnosed with an alcohol disorder will have a mental health disorder at some point in their lives. This is close to twice the rate found in people who do not have a lifetime history of a substance use disorder.
• 53 per cent of people diagnosed with a substance use disorder
(other than alcohol) will also have a mental health disorder at
some point in their lives. This is close to four times the rate found
in people who do not have a lifetime history of a substance use
disorder.
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| Amy Winehouse, public domain. | |
I seem to have repeated an untruth about Amy Winehouse. It had been reported by several prestigious sources---including the New York Times---that she died as a result of trying to kick her alcoholism through going "cold turkey". (More evidence that it's important to be skeptical about what you read on-line.) But the consensus after an official inquest seems to be that she consumed a great deal of vodka and ended up dying by aspirating on her own vomit. (Alas, like many other famous singers.) Yet another story of a young person with a lot to offer the world dying far too young---.
Having said that, there are significant physiological problems that come from trying to get off an addictive drug without medical help. In the case of many different types of addicts, after prolonged abuse of the drug, their brains learn to compensate for the high levels of whatever they are abusing. This adaptation causes problems once the drug has been removed from their system because the "new normal" isn't functional without it.
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| Alcohol Kills, public domain. |
In the case of alcohol, this unfortunate situation can lead to a variety of symptoms, including: anxiety, depression, fatigue, headache, insomnia, headache, vomiting, heart palpitations, excessive sweating, and, tremor. In extreme cases of long term alcoholism, a small percentage develop delerium tremens (Ie: "the DTs"). People often make jokes about people seeing pink elephants, but this is a serious and sometime fatal illness. This is something that the French public health poster to the right does a very good job conveying.
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Alcohol isn't the only drug that causes significant changes in the human body. It's important really understand how complex the human/drug interface really is, and how it affects behaviour. Just to drive this home with readers, I'd like to share with you a truly horrifying side effect of addiction to both amphetamines and alcohol: formication.
This is the feeling that insects (the word "formication" is derived from the Latin word "formica" or "ant") are crawling over and even sometimes under the skin. I'm not a medical researcher so I won't get into the mechanism, but this syndrome is identified with people using or giving up amphetamines and alcohol "cold turkey". Indeed, it can get so bad that some alcoholics go into an even worse condition: delusional parasitosis. This is the delusion that one is actually suffering from parasites under the skin.
This is a common-enough condition that there are street names for it: "crank bugs" and "meth mites". ("Crank" was the 1960s word for amphetamines, or "speed".) The author Phillip K. Dick was a speed freak for a time and had a house where he rented out rooms to addicts. He wrote about his experiences in the auto-biographical novel A Scanner Darkly. This was made into a movie, which had an opening sequence that showed a person afflicted by crank bugs.
This is a significant problem for addicts, to the point where health professionals are told to be on the look out for people who have torn up their skin scratching at these invisible beasts. I had never heard about this until I researched this article, but now that I know about it, I remember seeing lots of folks in the pre-pandemic downtown Guelph who probably had this issue.
Here's a photo from an American Department of Justice website that shows the sort of harm that people have caused scratching away at their "meth mites".
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From my reading it appears that there are fairly well-established medical methodologies that can be used to deal with the physical dependencies from drug addiction. For example, diazepam (known to most people through the trademarked name "Valium") has been used for a long time to help alcoholics get off the bottle without suffering from the DTs.
Morgan also mentions the use of methadone and suboxone. Methadone was invented in Germany during the NAZI regime as a way of producing a cheap alternative to opium and was used extensively during WWII. Since then, it has become known mostly as treatment regime for opioid dependency. Indeed, I often see people downtown who are going to the two clinics to get their daily dose. This is done because methadone can get you high if taken in large enough doses. Forcing addicts to take their daily dose through a clinic stops them from either selling it for money or saving up their doses in order to get high. As a story about someone who was convicted of illegal methadone possession in the Duluth News Tribune says:
And his favorite type of methadone: the liquid form provided at methadone clinics, including at the clinic in Duluth, the Lake Superior Treatment Center.
"It gets you very, very high. I think it's stronger than (Oxycontin)," he said. "With pot, you get a little bit of a head buzz. With methadone, it was throughout your whole body. You'd get a warm glow, a sense of well-being."
Under federal law [US, not Canada], if patients prove their trustworthiness at methadone clinics, they can get up to a month's worth of take-home doses of the drug. It's intended to be a reward for patients, who start their treatment by having to go to a clinic each day, six to seven days a week to take their dose. Getting take-home doses is standard practice at methadone clinics around the country and is fully legal.
But the pressure to sell those doses can be extremely high, as they go for about $1 a milligram on the streets, with doses ranging from 50 to 300 milligrams, according to local law enforcement experts and current and former users of the drug.
For this reason, there was originally a great reticence towards methadone treatment. But because of the huge explosion of opioid addiction in recent decades, methadone clinics have become very common---to the point where in 2004 there was a proposal that the United Nations add it to their World Health Organization (WHO) list of "Essential Medicines". (I couldn't find out if it was added or not.)
Suboxone is a combination of two drugs: buprenorphine and naloxone. Buprenorphine is another synthetic opioid substitute---like methadone---and just like it, can be abused. When it is mixed with naloxone (that's the drug that is used by police, paramedics, etc, which can immediately pull someone out of an opioid overdose), it is then called suboxone. The naloxone prevents someone who abusing buprenorphine from getting high when they inject it, which makes it safe to prescribe to addicts.
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I dwell upon this issue of withdrawal symptoms because Morgan made a real point of emphasizing how much Guelph (and many other places too, of course) needs a specialized medical facility where addicts can be supervised and offered the treatment they need to minimize these sorts of severe physiological problems. Recently Doug Ford announced $176 million to help with addiction issues in the province. On the face of it, this seems like a lot of money. But when you drill down into the specifics, there seems to be a lot less than meets the eye. The highlights they identify are:
- $4 million for nurse practitioners for detox services to improve the medical management of clients who are withdrawing from substance use in residential withdrawal management facilities;
- $8 million for addictions day and evening care to increase access to intensive non-residential addictions and substance use treatment services for youth and adults;
- $3.5 million for in-home/mobile withdrawal management services to increase access to community withdrawal management services for hard to service clients, including those located in rural areas; and
- Over $900,000 for an additional four inpatient beds at the Centre for Addiction and Mental Health (CAMH) to support capacity pressures at CAMH.
For a province that has 14.5 million citizens, and who's annual medical budget is over $60 billion, this seems like pretty small potatoes----especially as over 1500 people died just of opioid over doses alone in 2019. With this small amount of money diluted across Canada's biggest province, I'm not holding my breath for Guelph being helped much as the province builds what the Ford government calls "a Modern, Connected and Comprehensive Mental Health and Addictions System".
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Another depressing article, another blue-lettered appeal for subscriptions. I know many readers can't afford to pay for this project of mine. But I know some of you can. Why not sign up for a monthly payment? Patreon and Pay Pal make it easy.
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Hannah also mentions the role of pharmaceutical companies in the epidemic of opioid dependency. I think it might be a good idea to do a bit of an overview of how much it has ballooned in recent decades. Here's a short video from a respected medical news site.
Dr. Carroll mentions the huge numbers of American citizens who are wrestling with chronic pain, how opioid prescriptions exploded for several years, and, how a small percentage of people who get these drugs go on to become addicted. But unfortunately, this still ends up being a big problem.
The question that comes immediately to mind is "why did the numbers go up so fast?" The consensus seems to be that a number of drug companies heavily promoted the idea they had come up with a relatively safe type of opioid that didn't cause dependency among patients. Several US states have sued several drug makers, with some out-of-court settlements. In Canada British Columbia is currently suing 40 drug companies for compensation.
What seems to have happened is that some very effective---if questionably ethical---marketing was aimed at doctors by sales people who convinced many of them that these new drugs were safe, effective, and, non-habit forming. Just to give you an idea of how much "hard sell" was going on by sales people working for companies that put the "bottom line" ahead of public health, I did some rooting around on line and found out that there seems to be something of a subculture of people who collect the "swag" that they used to dole out. Here's a small sample of stuff I gleaned from sources like Ebay ads.
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| How about an OxyContin combo pocket knife/wrench? |
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| Or maybe a fishing hat for those lazy summer afternoons? |
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| How about a mug for the lunchroom? |
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| Would your daughter like a doll? |
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| Here's pen with a built-in reminder----. |
(Isn't capitalism grand? Frankly, I'm of the opinion that since the free market doesn't play well with science, it should spend some time in detention until it learns to stop being such a bully.)
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I admit that this deep dig---like most of the ones I've done for this blog---is yet another downer. But I'd like readers to leave this post with the idea that the people who are dying from this epidemic are real human beings---just like you and me. Their lives can have just as much meaning as ours, and they have just as much to offer to everyone else. It's just like the 17th century poet James Donne wrote several centuries back:
No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend's
Or of thine own were:
Any man's death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.
To that end, I'd like to share with you this video by the late Amy Winehouse that echos part of what Morgan had to say about how scary rehab can be for addicts. I'd never heard it before I sat down to write this article. I'll admit that given the context, it brought tears to my eyes. She was a gifted musician and when she died all of our lives were "diminished"---to use Donne's language. Keep that in mind when you hear more statistics about people dying of overdoses.
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Moreover I say unto you, we have to deal with the Climate Emergency!
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