“When you come off of it, there’s vomiting and shitting and spasms and rolling on the floor,” explains Ryan, describing the symptoms of withdrawal from fentanyl use.
“Every pain receptor in your body is on fire — even your hair hurts. Everything is so bright and loud and your emotions are just a rollercoaster.”
With no resources available in Halifax to suit his needs, Ryan* weaned himself off fentanyl four weeks ago. And despite the fact that stories like his are becoming increasingly common, as the potent opioid becomes more readily available in the province, it has yet to reach the attention of Nova Scotia’s main political parties as the provincial election comes to a close.
Ryan was taking a gram a week.
“In the course of an average day I was taking enough fentanyl to kill several people.” At one point he was using carfentanil, which is more commonly used as an elephant tranquilizer, but he switched back to fentanyl.
He first started ordering increasingly strong opioids to supplement medication prescribed to him by a doctor for his chronic pain. He bought fentanyl over the dark web, paying with untraceable bitcoin. It arrived from B.C., Ontario, and Quebec, hidden in magazines with the pages glued together.
“I don’t think anyone in government either sees the storm that’s coming, or wants to talk about it.”
When he decided to quit, he spoke to a doctor who specialized in addiction. The doctor told him to contact the provincially-operated Addiction Services to sign up for a methadone program — but that program had at least a three month wait list. It also required clients to line up at 9 a.m. for treatment, which wasn’t going to work with his 9-to-5 job, and he was afraid someone would recognize him standing in line.
“It does come with a lot of shame,” he says. “It’s not a pretty thing. It’s not something you want people to know about you. It’s about as dark and dirty a secret as anyone can have.”
A total of 54 people died last year in Nova Scotia from opioid overdoses — four of those from fentanyl.
Ryan has read about the thousands of overdose deaths across Canada, but he never thought about dying.
“That happens, but never to me,” he said over the phone. “Which I know is a really stupid and arrogant thing to say. And I guess right now I’m probably in the most danger because [the time] when people tend to take fatal overdoses is when they’re in recovery.”
Despite 12 probable opioid overdose deaths so far in 2017 in Nova Scotia, and a warning from the province’s chief medical officer that the fentanyl crisis is coming to the east coast, the problem has failed to gain traction as an election issue.
Although health care has been front-and-centre of the election, especially improving mental health treatment, only the Liberals have singled out funding for opioid addiction.
The Liberals say they have committed $1 million for short-term action on opioid addiction, and are promising they will come up with a long-term action plan to address the problem.
“It used to hand out 20,000 syringes a year — now it’s 650,000.”
The governing Liberals, led by Premier Stephen McNeil, are facing a challenge from the Progressive Conservatives, with whom they are neck-and-neck in the polls, and the NDP.
The NDP does not mention opioid addiction in its platform, and doesn’t commit any specific funding for addiction services. The PC party told VICE News it would focus on putting more police on the front lines of the opioid crisis, and “further law enforcement efforts to dismantle the distribution of fentanyl and opioids.” The PCs also want more education in schools on the dangers of prescription drugs.
“I don’t think anyone in government either sees the storm that’s coming, or wants to talk about it,” Ryan says. “And it is coming, have no doubt. People like to think that it couldn’t happen to them, that it couldn’t happen to members of their family, people they love — it can and it does, all the time. And this stuff is just getting easier and easier to get ahold of, and there’s very little in place in terms of treatment and services to help people get off of it.”
While the topic has been all but ignored in Nova Scotia, the staggering rise in overdose deaths in British Columbia eventually drew the attention of the province’s main political leaders, in an election that wrapped up earlier this month.
The death toll on the west coast hit 900 last year, and has continued to rage into 2017. The governing B.C. Liberal Party inked an agreement with the federal government on healthcare in February, which includes some $65 million to fight the crisis, over 10 years, including $10 million in front-line emergency response. The B.C. NDP demanded more action during the election, calling for more rapid response centres and a renewed education campaign to combat addiction. The B.C. Greens, who now hold the balance of power in the legislature, promised $80 million in funding for a variety of programs, including supervised consumption sites, to combat the problem.
Federally, Ottawa has made a number of funding and policy announcements aimed at addressing the problem on a national level. Healthcare, however, is primarily a provincial responsibility.
And harm reduction workers in Halifax’s north end tell VICE News they desperately need more funding to fight addiction.
“I believe we should have drug consumption rooms, community detoxes, more safe housing and that there should be no cost for naloxone,” Diane Bailey, director of the Mainline Needle Exchange, told VICE News in an email, referring to an antidote that reverses overdoses. The province gave Mainline an additional $247,000 in March as part of its $1 million funding commitment.
The province also provided $152,000 to the Sharp Advice Needle Exchange in Sydney, Cape Breton, where front line addiction workers tell the Cape Breton Post the province isn’t doing enough. The Cape Breton Post reports the city’s Ally Centre is overwhelmed with demand for clean needles; almost two decades ago it used to hand out 20,000 syringes a year — now it’s 650,000.
“We need to be talking about addiction.”
“We’re beyond our means,” said Cindy MacIsaac, director of Halifax’s Direction 180 methadone program. The program currently has 484 people in treatment, but, using best practices, its funding only covers about 200 people.
“There have been overdoses related to fentanyl and other prescription opiates,” MacIsaac said. She believes Nova Scotia is in need of safe consumption sites like the ones opening in Vancouver and Montreal to stop the spread of HIV and Hep C, and to prevent overdoses.
“The volume of people that are served through the Mainline Needle Exchange speaks to that,” she said. “The health issues experienced by individuals who are injecting in unsafe ways speaks to that.”
Bill C-37, which makes it easier for cities to open safe consumption sites, is now law. It also gives border guards new powers to search envelopes weighing less than 30 grams if it’s suspected they contain fentanyl or other illicit drugs.
In March, the province funded $564,000 worth of naloxone kits. Direction 180 has received funding from the Nova Scotia Health Authority for training on how to administer naloxone. Direction 180 has reversed more than 20 overdoses using the kits in the last year, MacIsaac said. But they still need additional funding.
She believes the opioid crisis should be more of an election issue.
“I always say, if someone cannot get behind harm reduction with compassion and respect and hope to provide people with dignity, then they need to get behind the cost effectiveness of it, and it saves taxpayers money by investing in harm reduction,” MacIsaac said. “So I think this should be [on the] platforms of the candidates and the parties who are currently running, and I also think that we need to separate addictions from mental health.
“It gets buried in mental health. We don’t want to lose addiction, we need to be talking about addiction, and so it needs its own strategy.”
As for Ryan, he is four weeks clean and believes he’s through the woods.
“I’m done with that garbage,” he says. “For now I’m just enjoying being clean. The thought of going back to where I was a month ago, I would rather die.”
*Ryan is a friend of the author. His name has been changed to protect his identity.