Let's talk about . . . opioid use disorder

The community I reside and work in is relatively small, called home by just a few thousand individuals. Our composition is not unlike that of other rural communities, made up mostly of retirees, an aging workforce and, more recently, a scattering of young families. In our typical community of southern BC, Opioid Use Disorder (OUD), aptly nicknamed “the other epidemic,” is becoming more visible. While even a pandemic such as COVID will come and go, OUD is not that temporary. The conditions that lead to an individual consuming opioids are many, varied and complex. While not everyone who is a user will find their lives impacted, especially at first, there often comes a time when abstaining is no longer a voluntary option. Our pharmacy has participated in the distribution of harm reduction supplies for a number of years. A health-centered organization, we are trusted by our community. Users, like our patients, enjoy a non-judgmental environment and we gradually get to know each other from repeated visits. On occasion, someone will express a desire to change their situation and we are well positioned to put them in touch with local resources. Despite this, it can be a hard road ahead for even the bravest and most successful amongst them, with setbacks along the way. Not unlike nicotine or alcohol addiction, it often takes several tries to quit an addictive habit; after all, that is the nature of addictions! Still, I am cautious in my discussions with friends and coworkers about OUD, the same way people refrain from discussing smoking or chronic alcohol use: opinions vary and I am not one to enjoy conflict. After all, people are very protective of their habits: they choose to smoke or drink in excess of the Canadian guidelines. Still, when I smell cigarette at the pharmacy counter, I let clients know about BC’s smoking cessation program. And if someone isn’t interested or fails their attempt to quit, I don’t judge them. Rather, I suggest that another method might be more effective to them. I see no reason I should act differently with people struggling with OUD. There is also a marked connection between those dealing with mental health issues, including OUD and those who are unhoused. While harm reduction supplies and resources are available to people who need them, they will have low rates of success if they are bunking down at a nearby compound or tent city. Sadly, despite the fact that the scope of the issue is becoming better known, funding for “wet” housing was just turned down in a community near us. Instead, their tent city, which has grown to include more than 100 people, will continue to spread as it welcomes others in need. Because regardless of what challenges they face, people need somewhere to rest and others to watch their back while they do so. I don’t claim to know the solution to the ailments of our time, but to paraphrase Dr Gabor Mate, Tent Cities are but a symptom of much bigger social issues. Until we address the root causes of our broken social net, there will always be people falling through the cracks. While housing is but one of the multiple determinants of health, it has the most potential for positive outcomes, providing the stability needed to pave a way to recovery. As a person recently housed put it: “I had 99 problems, housing solved 90 of them.” While it is too late for the local project that was turned down (a reflection of their community’s divided opinions on the matter), maybe we can educate our friends and families on the topic before the next project is voted on. Maybe we can set up the foundation that will catch those falling through the cracks and give them a chance to climb out when they are ready. Because for health care to be truly inclusive, it cannot ignore the basic needs of the most marginalized members of our society.

Let's talk about . . . opioid use disorder

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Selena Despres

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