Opioid overdose numbers have dropped by 300 in Canada’s Niagara Region, from more than 1,000 in 2021.
One area expert says patients also are seeking help sooner than 10 years ago, but their condition is degrading faster.
Fentanyl remains the top overdose concern in Niagara Region, from Hamilton to Niagara Falls, and it’s an evolving issue, said addiction medicine physician Dr. Chris Cavacuiti.
Increasing attention is being placed on the use of carfentanil, a synthetic form of the opioid, and the potential for benzodiazepine to be mixed with fentanyl.
Those substances are particularly concerning because both reduce the effectiveness of Narcan, also known as naloxone, said Cavacuiti, who founded True North Addiction Medicine Program in Ontario.
“Something that can commonly happen is, you know, somebody has a potential overdose, and one of their friends gives them a dose of Narcan,” he said. “The Narcan wears off after an hour, the carfentanil’s still there. And so, when the Narcan wears off, they just go right back into their overdose. So, if they don't get themselves to a hospital, they can end up back in (an) overdose an hour later when the Narcan wears off.”
EMS crews responded to 636 suspected overdoses between January and November 2023, or about 58 per month, according to Niagara Region health statistics.
Safe injection sites are an important step, where there at least are safe needles available, but also where there are professionals who can discuss treatment options, said Niagara Region EMS Commander Marty Mako of the mobile integrated health unit.
Another asset is the EMS department’s street outreach team, which visits spots there might be encampments to build rapport, so people are more comfortable seeking help, he said.
The drugs being used often include blend of methamphetamine, fentanyl and benzodiazepine, said Dr. Robert Fallis of the Fresh Start Clinic.
This makes people dependent on three substances, instead of one.
Many people can’t make it through treatment from methamphetamine or fentanyl because the withdrawal symptoms are so severe, Fallis said.
“Opiate withdrawal is profound. It's like, the worst flu that you've ever had in your life, and it lasts for days to weeks,” he said. “If it lasts for two or three weeks, for example, eventually people are looking for something to take in order to reduce the pain, and the pain is significant. So, they get diarrhea and vomiting and sweating and achy muscles and joints. Like, they feel like their body’s going to break.”
One option that could help recovery and prevent relapses is more widespread use of suboxone, which decreases withdrawal symptoms for opioid patients, Mako said.
“One of the challenges with naloxone is you're reducing the overdose, but you're not treating the root cause of the addiction, right?” he said. “And so, you're creating this dope-sick state where, yes, you've brought the person back, but you're not really getting to the root cause of why they're struggling in the first place.”
The medication is commonly used by in-patient facilities, but Mako says it would also be a major asset for paramedics.
“One service in Ontario has already done it. It's often hard to go first because you have to get treatment from or approvals from the Ministry of Health, to have it be a new treatment that paramedics can offer,” he said. “But because this service up in Timmins -- which is the northern part of Ontario -- has received approval, I think we could follow their lead.”
Suboxone is invaluable when it comes to long-term care and staving off withdrawal, Fallis said. Methadone is an option that works similarly, but often proves less effective and is more difficult to provide than suboxone.
“Suboxone would be my first line of treatment for opiate, especially for people in school or who are working,” he said. “It just works a bit better or for them. And then methadone is still our second-line treatment, but it would be second-line for me.”
People seem more aware of the risks they incur while using opioids than in the past, but providing the resources for treatment is a challenge, Cavacuiti said.
He estimates that overdoses in Ontario as a whole have risen by five times over the past decade but that funding for medication has decreased by about 40%.
“The lack of stable funding for these programs, has just made it not an area where a lot of doctors kind of want to want to practice,” he said. “We've faced … a lot of challenges with trying to integrate, enhance improved services, while also experiencing, like, a 40% reduction in funding.”
