GODERICH — Nearly three years ago, Jordan Bartosek stared down a bottle of whiskey and contemplated ending things for good. The one-time odd-job contractor, who lived with his father in Fordwich, Huron County, an hour-and-a-half drive north of London, had spent the past two and a half years sober.
But lately, he’d been plagued by thoughts of suicide. “I lost passion for a lot of things,” Bartosek, now 40, recalls.
He turned once again to the numbing combination of booze and pills — lorazepam, Percocet, clonazepam — that had been his companion during his 20s and early 30s before he kicked the habit at a rehabilitation centre in Guelph. Relief followed, but he soon found himself spiralling out of control.
He lost his licence because of impaired driving charges, so when he wanted to stock up, he’d have to get a lift to the liquor store from his father or drive on back roads. He begged girlfriends to share their medications. There were emergency room visits, a heart attack after he tried to withdraw on his own. Sometimes, he’d wake up in the front yard outside his father’s house and wonder how he’d gotten there.
Huron County, population 59,300, bills itself as having the best of both urban and rural worlds. Its rolling fields are among the most agriculturally productive in the province, and the sandy Lake Huron coast is a prized destination for cottagers. Some proudly claim that Queen Elizabeth II once declared Goderich, population 7,600 and Huron’s largest community, to be the prettiest town in Canada (although she has never, in fact, paid a visit there).
An early October sunset drive around the town’s trademark octagonal civic square reveals a picture-perfect community of the sort idealized in 1950s and 1960s television shows. Couples stroll with their dogs and greet each other by name as a lone seagull circles above. Three boys on bicycles drift quietly along a street that leads away from the square like a spoke in a wheel. There are no traffic jams, no bars on windows — none of the drug dealers, panhandlers, or prostitutes that would be in evidence on Dundas Street and Hamilton Road in London’s core. Here, any suspicious public behaviour receives prompt police attention.
Yet Bartosek’s experiences are not unique in Huron County — or Goderich. Federal statistics show that in 2014, more than one in four people in the county reported heavy drinking, well above the regional and provincial average of under one in five. Other drugs are also on health workers’ radar: marijuana, methamphetamine, cocaine, and, since the early 2000s, opioids such as oxycontin, a drug once considered by doctors to be a safe pain reliever until years later it was revealed to be highly addictive.
There are hints that the use of more potent opioids is growing, too. Heroin and fentanyl, an illicit synthetic opioid hundreds of times more potent than morphine, were found in a drug bust last May. One source, who requested anonymity, estimates that emergency room doctors at Alexandra Marine and General Hospital in Goderich are using naloxone, an antidote for opioid overdose, two to three times per month. So far this year, county paramedics have administered naloxone three times — the same number of times they administered it over the four previous years combined.
But although frontline health workers are racing to prevent an epidemic, the town and county of which it is a part have been slow to act.
“A rural community tends to be a very conservative community, and so issues of addiction would not get the attention that they probably deserve,” explains Michele Hansen, a Goderich town councillor and a former executive director of a women’s shelter.
Goderich did introduce sharp containers in public areas a few years ago when needles began showing up on the town’s beaches. But Huron County has no detox centre and was among the last counties in the province to introduce needle exchange services. When an exchange opened two and a half years ago in Goderich, some local councillors were upset that the town council hadn’t been consulted first, Hansen says.
The twice-a-week exchange runs at night at the request of clients, says Elise Metcalf, the clinical lead at Choices for Change, a non-profit agency that operates the exchange and other addiction services on behalf of the Huron County health unit. It’s easier for them to arrange rides later in the day, and “there’s a lot more anonymity in the dark.” Even then, people are cautious. On one October night when it was open, no one appeared. Metcalf says often one person will volunteer to collect needles to distribute to others, who want to protect their identities.
The stigma associated with addiction creates a major barrier to care. University of Waterloo researchers studying youth opioid use in the region have found that youth in Huron County and neighbouring Perth County face negative feedback and even repercussions after seeking help from community supports, such as teachers or pastors. Feng Chang, the study’s lead researcher and a professor in the School of Pharmacy at University of Waterloo, says such experiences can be enough to deter people from seeking treatment.
In recent years, though, frontline workers in the county have made progress in bringing addiction issues to the fore. Last year, community forums about drug use among youth took place in Goderich, Wingham, and Exeter. More than two years ago, a twice-weekly methadone clinic was successfully established in Seaforth in the county’s south end. (Previously, people had to go to London or Kitchener to obtain methadone and suboxone prescriptions.) Needle exchanges operate two days a week in Clinton and Wingham. The health unit has forged strong partnerships with other organizations, such as Choices for Change, and with family health teams, educators, pharmacists, and libraries to broaden the reach of prevention and harm-reduction programs.
Although there are more services available now than there were five years ago, they are scattered unevenly and thinly throughout the county, which covers an area about half the size of the GTA and takes an hour and a half to drive from north to south.
Those distances create huge challenges for people seeking help. When he lived in Fordwich, Bartosek had to travel 18 kilometres to Listowel to see his addictions counsellor. There are no buses, so if his father couldn’t take him, he had to rely on a cab arranged through social assistance. (Social assistance programs, such as Ontario Works, are responsible for ensuring that their clients can travel to medical appointments and obtain medications, and in Huron County, government agencies regularly use taxis to transport clients seeking addiction services that are available only outside their communities).
If he needed urgent medical help, there was a 50/50 chance the ambulance would arrive in less than eight minutes. That response time is quadruple that of London to the south. Had his treatment required a methadone prescription (which it didn’t), he would have had to travel 54 kilometres south — a 40-minute drive — to Seaforth to get one.
The provincial government has pledged new funds to tackle addiction — $222 million over three years. But the money is earmarked specifically for opioids. Beginning this year, the county will receive $150,000 annually to implement an opioid response strategy. Further funding will go to the county health unit’s needle exchange/syringe programs and be used to support the distribution of an inhalable form of naloxone to community organizations.
Michelle Carter, a public health nurse with the Huron County Health Unit, says the agency began working on its opioid response strategy in the summer with the goal of completing it by next spring. The new initiative will help tackle another factor that’s allowed drug problems here to be swept under the rug: the lack of statistics and place-specific information.
Information about drug overdoses comes from coroners’ offices, which in turn obtains the information from emergency rooms and other medical facilities. But until recently, it sometimes took years for the health unit to receive coroners’ reports. The reports rarely captured information about whether a fatality involved opioids, mostly because emergency rooms lacked standardized reporting requirements.
Last spring, the provincial government began requiring that emergency rooms report overdoses in a standardized way and that coroner’s offices collect more information about drug-related fatalities earlier in their investigations. The changes should speed up the release of information. “If [other drugs are] causing overdose situation, yes, potentially we will be getting that reported as well, but for right now we’re going to stay focused on opioids,” Carter says.
While Metcalf and other frontline workers welcome the new funding, they’re uncomfortable with the fact that it can be used only for activities that directly address opioid use. They see many trends in addiction. For instance, more than half of Choices for Change’s hundreds of clients seek help for alcohol dependency, and agency research shows that the number of clients seeking help for methamphetamine use now stands at nearly 400 — double what it was a year ago.
“Methamphetamine is cheap, and [clients explain] it’s a great high,” Metcalf says. People can now make it anywhere using just a two-litre bottle. “You shake [the methamphetamine ingredients] up, throw it out a car window, and if it doesn’t explode, come back in a day.”
Metcalf would like to see money made available for a more holistic approach to tackling addiction in the rural area. Establishing mobile syringe and outreach programs, for example, could help reach people in remote communities. Such a service — which is offered in London — could also include a nurse or nurse practitioner, who would provide primary care.
More housing support is also crucial, says John Robertson, executive director of the Canadian Mental Health Association-Huron Perth Branch. “The least expensive thing a government can do is provide affordable housing,” he says.
Homelessness is one of the greatest challenges facing those with addictions in the county, and there are no men’s shelters in the region. Apartment rentals in the comparatively service-rich Goderich generate fierce competition and a market rent ($800 per month for a one-bedroom) that’s far too high for those who rely on social assistance — but there’s a three-to-five year wait for social housing.
“Once we can get clients a decent place to live, then life starts to look completely different and they’re able to see the addiction in a different way,” Robertson says.
Late last year, Bartosek found the path to sobriety through an addiction supportive-housing program run by Choices for Change and the Huron Perth CMHA. The county-funded program offers a rental supplement and intensive support to eight people a year.
The program made it possible for him to move to Goderich, where regular counselling, his psychiatrist, Alcoholics Anonymous meetings, volunteer work, and other supports are all within walking distance. Bartosek now has nine months of sobriety under his belt and has enrolled in a two-year college program in social work.
He’s made progress, but he’s wary of the possible pitfalls, too. “This is a life-long disease,” he says.
“You don’t get a certificate when you’re done; you don’t get a reprieve. It goes quiet for a bit, and I will be tested down the road. It’s those coping skills that I learn along the way that will make my chance of success that much better.”
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
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