Experts call for stronger Sask. services to meet complex needs of opioid users
Increased capacity, long-term supports key for recovery
The opioid crisis is showing no signs of slowing down. Now, addictions experts are calling for detox, treatment and recovery services in Saskatchewan to be expanded and strengthened in order to meet the complex needs of those addicted to drugs like fentanyl.
According to the provincial coroners service, there were 204 confirmed and 217 suspected drug deaths in the province in 2022. That's a total of 421 deaths compared to 401 in 2021.
Fentanyl is the drug that killed the most people, having been identified in 127 cases.
New preliminary data shows there have already been 199 suspected drug deaths and 92 confirmed drug deaths in Saskatchewan between Jan. 1 and Aug. 1 of this year. Fifty-eight of those are determined to be fentanyl. That means 2023 is well on its way to being a record year for drug deaths.
Fentanyl is one of the drugs that Chantel Huel found herself taking when she was struggling with addiction more than five years ago. For Huel, it all started with an OxyContin prescription.
"One pill and I fell in love and I was hooked. That led me down a path that I never thought possible for myself. It led me in and out of jails. It led me to the street criminal lifestyle. It led me to gangs. It led me to dealing drugs, destroying communities," said Huel.
As the years went by, Huel wanted to get sober.
"I would go to detox because it was my last option before this, right? Or I would go to treatment because it was my last option before that," Huel said.
"But I came out to the same people, places and things, and I would go right back to what I was doing before. I would live one foot in the good life, one foot in the negative life, hoping to walk the fine line and balance it. But it never worked."
Often when she wanted to detox, Huel had to wait for a spot to open up for her in a facility. But waiting is very difficult for those who are in a cycle of using.
"By the time it's my turn to get into that detox centre, I'm too high to even care. I don't want to go anymore."
And then, finally, the day came when Huel made the decision to get sober for good. She was once again in a correctional facility, but wasn't alone. Her daughter was incarcerated there with her. Enough was enough.
By the time it's my turn to get into that detox centre, I'm too high to even care. I don't want to go anymore.- Chantel Huel
Huel said that because she was federally charged, she had access to extensive treatment, counselling and guidance from elders. She said there should be a clear path from detox to wrap-around support like that in Saskatchewan communities.
"I should not have had to have been incarcerated to access those services 24/7. Why are we not providing these services for people out here who want it?"
'Untenable' case loads
Dr. Peter Butt, a clinical associate professor in the college of medicine at the University of Saskatchewan and an expert on addiction medicine, said the best way to begin the road to recovery from an opioid use disorder is to go directly into opioid agonist therapy. It offers medication like suboxone or methadone to help with cravings.
"There are opioid agonist therapy programs throughout the province. The problem is capacity and access," said Butt.
Butt said that in addition to clinical treatment, it's key that patients engage in counselling and start dealing with any of the core issues to their cycle of addiction. But he said counsellors are in short supply.
"Typically an addiction counsellor in mental health and addictions might have a caseload of 30 to 50 clients. There are some opioid agonist therapy programs where the ratio of counsellor to client is one to 400. It's enormous. It's untenable. They're just doing crisis management and they also have limited space."
When those with addictions do not have the support they need, relapsing is often the outcome — as it is for those who want go to detox centres and have to deal with wait lists.
"The window of opportunity opens and closes very quickly — so, frequently, they're living in chaos," Butt said.
Another challenge, according to Butt, is that people who get seven to 14 days of detox may not be connected to residential treatment options like the traditional 28-day programs.
He said three months of no drug use is early remission, and 12 months of no drug use is considered by health-care workers to be sustained remission.
Typically an addiction counsellor in mental health and addictions might have a caseload of 30 to 50 clients. There are some opioid agonist therapy programs where the ratio of counsellor to client is one to 400. It's enormous. It's untenable.- Dr. Peter Butt
"So we really need to be thinking of supporting people in one form or another as is appropriate for at least a year," said Butt.
"Over time … people can put together a life worth living without using. We need a system that's very client oriented, very client responsive, that's integrated, that's holistic."
Sask. hopes to expand services
Everett Hindley, minister of mental health and addictions, said everything from detox to treatment and post-recovery services in Saskatchewan need to be improved upon to ensure that the person in need is successful long-term.
"We know we have some wait times that, frankly, aren't acceptable," he said.
The Saskatchewan Health Authority told CBC that Pine Lodge Addiction Recovery in Regina, an inpatient addiction treatment centre, currently has wait times of nine weeks for male participants and six weeks for female participants. The SHA said social detox in Regina has wait times for detox beds up to three days.
Wait times are also an issue in rural communities, according to Hindley.
He said a lot of the system currently in use in the province is based on the traditional 28-day treatment plan, which is based on alcohol recovery.
"Knowing that while we still have people that are struggling with alcoholism, there's other things that people are dealing with that are just as serious, if not more serious around opioid addiction, which requires much, much more lengthier stages of treatment," Hindley said.
He said his ministry wants to build a more robust addictions recovery system that reflects how much more challenging addictions have become during the opioid crisis.
We know we have some some wait times that, frankly, aren't acceptable.- Everett Hindley
"Some of the challenges that people might face [are] not having perhaps the necessary identification to be able to pursue this. So they might not have the tools or know where to start or how to begin that road to recovery."
Hindley said the ministry is working "aggressively" to get 150 additional treatment spaces operating throughout the province. He said there is no date yet for when that will happen. Meanwhile, he said the need for expanded addictions services in the province is expected to be reflected in the 2024/25 budget.
"I anticipate that you will see continued growth from this government in the area of treatment and recovery."
ABOUT THE AUTHOR
