How the N.W.T. is reducing addictions harm during COVID-19

The Tree of Peace Friendship Centre in Yellowknife counsels more than 200 people, but COVID-19 has isolated many of those clients from badly needed in-person services.

The centre's full reopening can't come soon enough, says community wellness manager Kathy Arden.

"When you're sitting with a client, you can read their body language and look in their eyes and see how they're actually feeling," she said.

"It's greatly affected many of them. Many relapsed and were struggling with the isolation. There was a lot of suicidal ideation going on."

The centre has offered telephone counselling since April, after COVID-19 restrictions started coming into effect across the territory. Some clients prefer in-person counselling, and others simply don't have access to a phone.

On occasion, counsellors will meet with clients at a park near city hall or go to a restaurant to have a physically distanced coffee with them.

In January, Arden said 285 clients accessed counselling, back when they could drop in and see someone right away.

"Many have expressed during COVID-19 that they can't wait for the Tree of Peace to open because they can have that face-to-face contact with counsellors," Arden said.

In March, when COVID-19 restrictions came in, the friendship centre saw 118 people — less than half the usual number of clients. By April, that number was down to 76. It's back up to 111 clients as of May, but the initial shock of COVID-19 has left the organization scrambling. 

Arden is preparing for a high demand for the Living in Balance programs, where clients can discuss things like banking, personality disorders, addiction and post traumatic stress disorder. 

With COVID-19 restrictions, they can offer 10 spots. Typically, up to 17 people attended the sessions pre-pandemic. 

"We're ready, we've got everything in place," she said. "We're just waiting to have our inspection" from the Workers' Safety and Compensation Commission.

Isolation biggest threat to wellness: doctor

During COVID-19, many of the supports like treatment, counselling and vocational training have evaporated and "destabilized" people, said Dr. Jennifer Harris, who leads the territory's opioid therapy treatment. 

The friendship centre also connects people with residential treatment, but places like Poundmaker's Lodge, Aventa for women and Fresh Start Recovery Centre, all based in Alberta, are operating at a reduced capacity. 

Then, there is the arrival of deadly opioids on N.W.T. streets.

In June alone, there were five suspected opioid overdoses in the territory. At least one of those overdoses was traced to carfentanil, which is 100 times stronger than fentanyl and considered one of the most toxic opioids.

Front-line workers like Harris say the greatest threat to wellness, still, is isolation from services.

Case managers are focusing on continuity of care. They send people from their appointments with multiple naloxone kits, which a client typically ends up using on someone they know.

The kits, which are used to reverse the effects of opioid overdoses, are available in all of the communities, health centres, community cabins and pharmacies across the territory.

A safe supply program gives a handful of high-risk individuals a supply of prescription opioids to complement suboxone and methadone treatments, which are often used to treat addictions.

Expanding safe supply without adequate oversight could be a risk, said Harris. 

How prevention measures could help

Harris wants a territory-wide chronic pain management program to keep people off the path of opioid addiction, but there is a shortage of practitioners.

Opioid addiction represents a smaller percentage of substance use disorders in the N.W.T., she said. Its presence is most severe in the southern N.W.T. and in Yellowknife. 

Criminalization of personal use of illicit drugs makes it harder for people to get the help they need, said Harris.

She looks to Portugal, which treats addiction "more like a health problem versus a reason to incarcerate somebody when they found small amounts of drugs on them."

Decriminalization in Portugal, for example, has helped lower overdoses, and contraction of HIV and Hepatitis C rates, she said.

This week, B.C. Premier John Horgan said he wants the federal government to decriminalize the possession of drugs for personal use, to address the stigma of illicit drug use.

Yellowknife North MLA Rylund Johnson said the criminalization of personal drug consumption makes it hard for police to find informants and build trust in the community.

RCMP in the N.W.T. have led major federal drug investigations that have been some of the largest criminal trials for southern gang members. They make efforts to overlook personal use, because without trust, police can't find informants to then pursue big traffickers.

"Users simply won't talk to the police because they're afraid, and so it's kept in the shadows," Johnson said.

He added that decriminalization will not lower drug use, but that it would allow the territory to put resources where they are needed.

"There is a lot of work that needs to be done to increase mental health and addictions support," he said.

"Yellowknife is fortunate that we have the Arctic Indigenous Wellness Foundation, one of the best programs in the North, but we need 33 of those. We need one for every single community."