SUDBURY — Strolling through the alley between Kuppajo Espresso Bar and the Church of the Epiphany, Joel Boivin spots a familiar face. Three people are huddled together on a stoop, one with a baggie in hand.
“Hey, Joel, how are ya?” asks a woman in the group, beaming at the Sudbury Action Centre for Youth outreach worker. “Hey, not bad. Yourself?” he asks.
Her smile fades. “Not so good.” Boivin kneels down to face her. “I’m having problems,” she whispers in his ear. “I’ve relapsed.”
He’s there conducting his daily needle pick-up rounds, but he stops to listen, looks her straight in the eye, tries to reassure her. She begins to cry. A man enters the alley and says to the group, “Hey, brother, whaddaya got?” One of the woman’s companions responds, “Nothing, man. I’m out.”
Eventually, Boivin gets up. “You take care now. Stay safe,” he tells the woman. She wipes away her tears, and her smile returns. She nods. Boivin exits the alley and takes a right onto another back street, scanning for orange needle covers. “Sometimes,” he says, “life gets in the way.”
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The opioid crisis in Canada has steadily gotten worse since it was declared an epidemic five years ago, and it show no signs of abating. In May, British Columbia reported 171 suspected drug-toxicity deaths — the highest ever in a month — only to see that record broken again in June, with 175 deaths.
Here in Ontario, the situation is also grim. Front-line workers are often the first to tend to people who use drugs in the community. When tragedy strikes, Ontario’s coroners are among the last. Both have seen increases in their respective metrics since the onset of the COVID-19 pandemic. In May 2020, SACY collected 21,622 needles — 8,064 more than in May 2019 and 9,335 more than in May 2018. The number of needles collected from May to July 2020, Boivin says, is on pace to exceed needle-collection numbers in the same three-month span in 2018 and 2019.
And the spread of where needles are being found in Sudbury has bloomed outwards, toward the outskirts of downtown. “As far as the public areas where use is constantly happening,” Boivin says, “we can go by every few hours and still find another 20 to 50.”
The Ontario Coroner’s Office is reporting a surge in suspected drug-toxicity deaths; the median number of suspected overdose deaths in 2019 was about 44 per week, but it’s seen higher-than-expected numbers in each of the 15 weeks since Ontario’s physical-distancing measures were put in place. Nine of those 15 weeks saw roughly 25 per cent more deaths than the median of 2019, "compared to only 4 of the first 11 weeks of the year,” a spokesperson for the coroner’s office tells TVO.org via email.
“Around 55 people are dying per week [of suspected overdoses] in Ontario. That's huge,” says Dirk Huyer, Ontario’s chief coroner. “Of those, somewhere between 65 to 80 per cent turn out to be opioid-related deaths.” The coroner’s office has seen significant increases in the number of deaths in recent years — 2019 saw 1,520 deaths, a 3 per cent increase over 2018. And the number of deaths represents only a fraction of opioid activity. “Death is a rare circumstance,” says Huyer, citing an estimate from the Centers for Disease Control that says that there are up to 825 unreported or untreated overdoses for every overdose death.
Public-health measures introduced to curb COVID-19 have affected opioid activity, Boivin notes: services and agencies have closed their offices or limited their capacity, resulting in less access to services. Shops, libraries, and other public spaces were closed until recently in most areas, limiting opportunities to cool off or find temporary shelter from the elements. And job losses, financial uncertainty, and shortages at food banks continue to wear down those in need. “I've been seeing what I've termed as suffering the crisis,” says Boivin. “With that, if you increase suffering, you increase people's need to escape their pain. If people get housed, use goes down. If people are homeless, overdoses go up. If people are fed, use goes down. If people are hungry, use goes up.”
Josée Joliat, a nurse with Public Health Sudbury and Districts, says that its website tracks opioid incidents, emergency room visits, and naloxone distribution but that those metrics have yet to indicate an increase in opioid use locally during the pandemic. “I think it's going to take some time for us to truly understand the impact that that's had within our community,” says Joliat. Front-line harm-reduction agencies, however, gather qualitative data that can inform them of increased usage or changes in the drug supply, Boivin says.
Huyer agrees that those on the front lines provide vital insights into the local situation. “The people that are live with that information are much more timely, much more available, because they're doing the testing,” he says. “They can talk to the people, and they can find that information out.”
Both Joliat and Huyer say that a comprehensive approach to the ongoing epidemic must be driven by communities and the public. “I think it’s a shared responsibility,” says Huyer. “But anticipating and expecting government to always answer those questions [isn’t enough]. It really needs to be a multifaceted solution to a very complex problem.” Joliat notes that “one of the biggest advantages we do have in our community is that the community drug strategy has some very strong collaborations and partnerships.”
PHSD works to build awareness of the epidemic and to change attitudes about drug use, Joliat says — but the public has to want change: “The goal is to develop compassionate and caring communities that are willing to have open conversations on substance abuse with their friends and family. So we're still not quite there yet.”
This is one in a series of stories about issues affecting northeastern Ontario. It's brought to you with the assistance of Laurentian University.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.