1

Current Opioid Crisis

Over the past eighteen months, the number of drug

overdose incidents in Canada related to the misuse

and/or abuse of opioid drugs has risen steadily &

now described as a national public health crisis.

Initially considered to be an acute issue primarily in

the Vancouver area but overdose rates in Ontario

steadily rising throughout 2017 and 2018

Simcoe Muskoka region has not been immune to

this tragic crisis2

Test Your Knowledge

Match wits with others to showcase your

knowledge about the opioid crisis in Simcoe

Muskoka

Team RED vs. Team BLACK

3

Opioids

Family of drugs used to treat pain, often referred to as

prescription painkillers (e.g. fentanyl, morphine, oxycodone,

codeine, etc.) but also includes heroin, methadone &

suboxone

Opioids are depressant drugs: they slow down the part of the

brain that controls breathing

This is the inherent danger with taking more of an opioid than

the body can handle: respiration can cease and death results

Current crisis is primarily a result of the misuse and abuse of

the synthetic opioids fentanyl and carfentanil

4

Important Facts

Fentanyl is 40 times stronger than heroin and 100 times

stronger than morphine

Carfentanil, a drug developed to sedate large animals such

as elephants, is 100 times stronger than fentanyl and

10,000 times stronger than morphine

Just a few grains of carfentanil are enough to kill a human

Carfentanil-related death in Simcoe County in 2017

Elevating the risk is the fact that many drug users mix

opioids with alcohol, or with other drugs like sedatives,

anti-depressants and anti-anxiety medications5

Access to Fentanyl

Fentanyl is inexpensive and readily available over the

Internet from Canadian sources – but China remains the

main source

Illicit cocaine in Ontario almost always laced with fentanyl

Generally available in powder and patch forms

Legitimately prescribed patches are cut into small squares

and sold – uneven distribution of drug on the patch creates

major hazard

Powder can be turned in liquid and injected

https://www.erowid.org/

6

The Drugs & Effects Wheels

7

A new model for substance awareness For use by addictions specialists and by those

who consume illicit drugs http://www.thedrugswheel.com/

Mark Adley • Version 1.2 • 31/03/2016 • mark@thedrugswheel.com

The Drugs Wheel

The Drugs Wheel is updated regularly to reflect emerging chemicals and/or changes to the law.

Opioids:HeroinMethadoneBuprenorphineTramadolDihydrocodeineMorphine FentanylMT-45AH-7921O-desmethytramadolW-15W-18NortilidineKratom

Mark Adley • Version 1.2 • 31/03/2016 • mark@thedrugswheel.com

Effects Wheel

Mark Adley • Version 2.0.2 • 26/05/2016 • mark@thedrugswheel.com

Effects Wheel

Effects of opioids:

Confidence, sense of well-being, feeling invincible, warm safe death, constricted pupils, itching, euphoria, sleepy, sweaty, withdrawal, vomiting, visual/auditory hallucinations, reduced sex drive, increased sensitivity to pain, constipation, loss of consciousness, exhaustion, heart & lung problems, sleep disorder

The Antidote to Opioid Poisoning

The antidote to opioid poisoning is a drug called

naloxone (trade name: NARCAN)

Fentanyl binds to the naloxone and reverses the

respiration depression – but the effect can be short-

lived and medical care should be sought

Naloxone is distributed freely to anyone who wants it

via the Health Unit, most pharmacies, and some

community agencies

Recently, the nasal spray has been made available in the

free kits11

Complications

Fear of interaction with the police

Acquiring naloxone is not anonymous:

Required to provide health card (possibly about to

change)

Lack of access to addiction treatment services

Creative uses of naloxone; rainbow parties

Fundamental causes of addiction are rooted in the social

determinants of health which cannot be easily addressed, e.g.:

Poverty, unemployment, inadequate housing, social

isolation12

Root Causes

According to the results of a recent survey of

people living with the impacts of opioid use

disorder, administered by agencies in Simcoe

Muskoka, the root causes of opioid addiction are:

Inability to cope with trauma – sexual assault, childhood

abandonment

Existential despair arising from lack of purpose, poverty

Legitimately prescribed high doses of opioids for pain

management

13

Prescribing Practices

Opioids prescribed for pain, cough, diarrhea

Historically, opioids including Percocet, oxycodone,

morphine & codeine have often been prescribed in high

doses for prolonged periods

In some cases, this has resulted in addiction

When sources of prescribed opioids fail, those who are

addicted to prescribed opioids often turn to street drugs

New national and provincial standards for the

treatment of and prescribing for non-cancer pain

have been released14

Demographics

Majority of overdoses occur in males, 18-34

Majority of overdoses happen in private homes

Uncertain how many people who overdose are

administered naloxone and then do not seek medical

attention

Recent Simcoe Muskoka survey of people who consume

street opioids revealed the top 2 places for their street

drug consumption:

#2: Public libraries

#1: Tim Horton’s15

Recent Findings in BC

High rates of overdose & deaths continue

More males are addicted to opioids but females are

addicted to opioids at younger ages than males

Few addictions related to prescribed opioids

85% of drug overdose deaths have fentanyl findings

Focus is now on building health and social services

system resilience re: social determinants of health

and disrupting stigma

16

National report: Apparent opioid-related deaths in Canada (released March 2018)

Key findings The opioid crisis has affected every part of the country, but there are

clear differences in death rates and the substances involved across

provinces and territories. According to data reported as of March 22,

2018:

In 2016, there were 2,946 apparent opioid-related deaths in Canada

88% were accidental/unintentional

From January to September 2017, there were at least 2,923 apparent opioid-

related deaths; 92% were accidental

72% of accidental apparent opioid-related deaths involved fentanyl or

fentanyl analogues, compared to 55% in 2016

Most accidental apparent opioid-related deaths occurred among males (76%)

and among individuals between the ages of 30 and 39 (28%)17

Provincial Statistics

18

Provincial Snapshot

19

Regional Statistics*Public Health Ontario Interactive Opioid Tool

2006 Simcoe Muskoka:

99 opioid-related hospitalizations in

122 emergency department visits

24 deaths

More recent data:

20

Year

Emergency

Department Visits Hospitalizations Deaths

2008 121 86 19

2016 271 126 46

Jan-Sept 2017 346 87 36

http://www.publichealthontario.ca/en/DataAndAnalytics/Opioids/Opioids.aspx

Crude Opioid Poisoning ED Visits (per 100,000)Simcoe County and Ontario, 2003-2017

21

Opioid Poisoning Crude Death Rate(per 100,000 population)Simcoe Muskoka 2005-2016

22

Simcoe Muskoka Opioid Related ED Visits by Age

23

Impacts of Low Income

For the time period from 2013 to 2016 (combined)

in Simcoe Muskoka, emergency visits for opioid

poisonings increased significantly in areas with a

higher prevalence of low-income.

Simcoe Muskoka residents living in areas with the

highest prevalence of low-income have nearly four-

times the rate of opioid poisoning emergency

visits when compared with those living in areas with

the lowest prevalence of low-income.24

Simcoe Muskoka Opioid Related ED Visits by Income Level

25

Preliminary 2017 Data

26

Simcoe County 2016 Low Income Data

27

Ontario Opioid Strategy

Modernizing Opioid Prescribing and

Monitoring

Improving the Treatment of Pain

Enhancing Addiction Supports & Harm

Reduction

MOHLTC EOC has been activated to

coordinate situational awareness and

operational response activities28

Simcoe Muskoka Opioid Strategy (SMOS)

29

SMOS Steering CommitteeChairs: Dr. Lisa Simon, SMDHU and Dr. Becky Van Iersel, NSM LHIN

PreventionLeads: Claudia

Swoboda-Green,

SMDHU and Karyn

Baker, Georgian

College

Treatment/Clinical PracticeLead: Meredith Fryia,

CMHA

Harm ReductionLead: Mia Brown,

SMDHU and April

Hawke, CNCC

EnforcementLead: Frank Bates,

OPP

Mass Overdose Response Lead:

Cathy Clark, Simcoe

County

Data & Evaluation (Early Warning System)Lead: Kelly Lowther, NSM LHIN

Persons with Lived Experience

Foundational Pillar

Action Pillars

Emergency Management Pillar

Chair: Emergency Management Simcoe County

Representatives: SMDHU, County of Simcoe &

District of Muskoka Paramedic Services, NSM LHIN,

Simcoe County Fire Chiefs Administration Group

Goal: to develop an inter-agency communication &

response protocol for opioid overdose outbreaks

Opioid overdose outbreaks may be at a single site, or

multiple sites within a limited timeframe

Emergency Management Plan has recently been

completed30

PreventOD.ca

The County of Simcoe has launched a website to

promote opioid use disorder prevention, harm

reduction, primary care pain and prescribing

guidelines, and addictions treatment and support

www.preventod.ca

Anonymous reporting of bad drugs

www.reportbaddrugssimcoe.ca

31

Current Response Protocols

Until the work of the 5 Pillars is substantively advanced, the

primary response to opioid overdose cases that are immediately

life-threatening will continue to be the administration of the drug

Naloxone

Naloxone rapidly reverses the breath control effects of opioid

poisoning on the brain

Simcoe Muskoka District Health Unit and pharmacies across the

region distribute Naloxone at no cost to patients at risk

County of Simcoe Paramedic Services continue to administer

Naloxone as medically appropriate & continue to provide training

in the administration of Naloxone to allied emergency response

agencies32

Potential Human Resources Implications

Are significant numbers of staff/family in your workplace

being prescribed opioids typically prescribed for pain?

Are significant numbers of staff/family in your

workplace being prescribed methadone, which while an

opioid itself, is the primary drug prescribed to treat

opioid addiction

How can we better support staff and their families who

may be suffering from or at risk of addiction, beyond

EAP?

What education and resources might we provide?33

Review

What is the website recently launched by the County to

provide opioid-related resources?

What is currently the most common street opioid in our

communities?

How much stronger than morphine is carfentanil?

Who is most at risk of opioid use disorder?

Is there a link between addiction and other social determinants

of health, like poverty, unemployment, inadequate housing?

Is there anything your community can do to alleviate existential

despair and hopelessness for the vulnerable, for those who have

suffered trauma and painful loss?34

Next Steps

Simcoe Muskoka Opioid Strategy Report to be

released in late June/early July

Investigation underway for the establishment of a

permanent safe consumption site (aka safe injection

site)

Application has been submitted to MOHLTC for a

temporary overdose prevention site in Barrie

Prevention strategy work with schools and families

and families is underway35