At death’s door

Opinion

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This article was published 26/11/2016 (3020 days ago), so information in it may no longer be current.

She had never used fentanyl before, at least not intentionally.

She took it that day because it was what she could get her hands on.

She was out before she felt the rush. Her lips turned blue. And, in the parking lot of a shopping mall, death was approaching fast.

She’s alive today because her boyfriend, also addicted to opioids, had a naloxone kit, the opioid antidote.

“Thank God we had that kit,” he says. “She wouldn’t be here.”

That was July 10, 2016. They’ve been sober since July 12. Nearly five months later, the couple are in a downtown coffee shop, recounting their struggle with addiction and recovery. They agreed to speak on the condition they remain anonymous. He’s 33 and grew up in the suburbs. He’s gregarious, with an easy, infectious grin. She’s 21 and grew up just outside the city. She’s an opinionated spit-fire, and strikingly tiny, swallowed by a winter coat rendered unseasonable by a warm November. They’ve only been together a year, but they already have the familiarity and rhythm of an old married couple, often finishing each other’s sentences.

They’ve been through a lot together, and have lots to say about the opioid crisis claiming hundreds of lives across the country.

That July overdose scared them into sobering up, but what’s happening on the streets these days continues to frighten them.

“Since January, I’ve had about seven or eight close people die from overdose or drug-related deaths,” he says. “Very close people. It’s more and more every day. Like, every day. It’s crazy.”

It is primarily methadone users who will seek out fentanyl because it’s potent enough to still get them high, he says. Most drug users, however, either ingest it because it’s only what’s available, as his girlfriend did that day, or because it’s in other drugs.

He remembers when fentanyl was an obscure drug — it is now the most common form of opiate on the street — and worries about what the future looks like. “You’re always thinking, ‘What’s going to be the next drug?’ Sure enough, it’s fentanyl for elephants,” he says, referring to carfentanil, an even more potent form of fentanyl that is used to tranquilize large animals.

Both agree that there’s too much focus placed on drugs themselves, and not enough on understanding and treating addiction.

“There needs to be way more done about that stuff. Like, way more done,” she says. “That’s the problem. Drugs and alcohol aren’t the problem, they’re the solution. They need to get people into treatment. People shouldn’t have to wait months and months for treatment, because by the time you get in, you’ll be dead.”

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She started using drugs and drinking at 13. She had tried “every drug” and had a regular dealer in junior high. By age 17 or 18, she was drinking daily and popping opioids such as OxyContin and Percocet. She marvels now at how easy they were to get.

“I was into opiates, but I never shot them until —”

He finishes her sentence: “—she got with me.”

He also started young. Cigarettes in Grade 6. Marijuana in Grade 7. Psychedelics in Grade 8. By high school, he was lacing his joints with coke. “The addictive behaviours were there, and there was a complex trauma that occurred that spun me in that direction,” he says. “Sure, there’s addicts out there who didn’t have trauma occur in their lives—”

“— and if not, it’s a traumatic thing to be an addict,” she says.

He got into opioids the way many people do, as prescribed painkillers. He was living in Vancouver, and was prescribed Percocet for kidney stones and a series of accidents. The high was unlike anything else he’d ever experienced. “It was what I was always looking for.”

When asked to describe discovering a high they didn’t know they’d been chasing, they answer in unison. She says, “complete ecstasy.” He says, “safety.”

“No negative anything,” she says. “Butterflies.”

“I’m not saying this to start a fight, but it’s honestly like finding your true love,” he says.

“That’s exactly what it is,” she agrees. “After shooting opiates — it’s a love. It’s a love that I’ll never forget. That’s the first thing my mind goes to. It’s a struggle every day.”

They were sober when they met. They relapsed separately, and then they started using together.

He has more than a decade on her, and she notes the difference a generation makes. “He was into putting coke on weed at the same age I was snorting it every day. I was a full-blown addict,” she says.

“It’s scary. What’s it going to be like in the next 10 years?”

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When they used, they were careful. They asked questions. Last year, after reading about fentanyl, she started worrying about it appearing in her cocaine and would only buy it from a trusted dealer. They never shared needles. They underwent regular STI tests. They always had two naloxone kits on hand, from Street Connections, a harm reduction program. “We used their services all the time,” she says. “There’s no judgment.”

Different opioids result in different highs. It might be pins and needles, or a warm feeling, or a knockout, which is what fentanyl delivers. Their preferred drug was morphine.

It’s not a cheap habit. At the height of their addictions, they were spending $300 to $400 a day.

“I had RRSPs,” she says. “I had a tax-free savings account. I had an education fund. I worked two full-time jobs. And still, my next option was prostitution. That was definitely an option for me. That was something that was for sure going to happen if I didn’t sober up. No matter how much money I made, it was never enough. We were spending hundreds of dollars a day. I used to think, ‘How can people afford to have habits like that?’ But you make it work, somehow. Steal, lie. To me there was never a no. There was never a no.”

“I have a bad criminal record,” he says. “It’s not drug charges. It’s theft and fraud to support the behaviour.”

It’s a common belief among the public that drugs are something you just stop doing, as though addiction is a matter of willpower and not a complex disease composed of many physiological and psychological pieces.

Even when they were actively using, they wanted to stop. Opioids are not something that can easily be quit cold turkey. The euphoric highs have equal and opposite lows. “Dope sickness is the worst,” he says. “Death seems like a more comforting option.”

And so, addicts go to great lengths to avoid getting sick. After she overdosed in July, she left the hospital against medical advice in pursuit of oxycodone. She believes if he hadn’t thrown out the fentanyl, she would have continued to use it.

“The risk doesn’t matter in that moment. Even if it does happen, it’s worth the risk,” she says. ‘It’ might mean overdose. ‘It’ might mean death.

“When you want it, it’s scary. Addiction is scary. My mind will justify it. If we could just stop, we’d stop. It hurts me that my mom cries every day and is in debt for sending to me to treatment and I started using again the day after I got out. That hurts me. If anything was enough, I would have done it.”

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Both have gone through treatments and relapses. Both are frustrated with the current health-care system and how it deals with addiction. She would like to see more addiction and mental health services be integrated. She would also like to see treatment be delivered more compassionately, and on demand. “As an addict, you hit a jumping-off point. When you’re ready (to seek treatment), you’re ready. Tomorrow, I might not want help no more. Or I might be dead.”

Last April, she completed a treatment at a private facility with a $22,000 price tag — it was either that, or languish on a list waiting for a spot elsewhere. While there are several places an addict can receive treatment in the form of counselling and educational support, there are only two detoxification facilities in Winnipeg: the Addictions Unit at Health Sciences Centre or Main Street Project.

Both agree harm reduction strategies go a long way in keeping people alive long enough so that they may seek out treatment — which is why he was disappointed to see the $10 fentanyl testing kits that were being sold at Brothers Pharmacy on Selkirk Avenue pulled from the shelves at the behest of the College of Pharmacists of Manitoba over concerns about accuracy.

The province is launching a naloxone program early next year where kits will be distributed for free, but she’d like to see the government move quicker on increasing the availability and accessibility of suboxone as an alternative to methadone. Methadone is an opioid medication used to help people withdraw from heroin addictions.

Suboxone is a combination pill of buprenorphine and naloxone. Unlike methadone, which must be taken at a clinic and closely monitored, suboxone can be taken in sublingual tablet form. Suboxone is also much harder to abuse, which means there’s a lower risk for overdose.

Both are currently on suboxone as part of their recovery plan. They dose every second day, and prefer it to methadone. “I was a prisoner on methadone,” she says. He says suboxone has an added mechanism: if you use opioids while taking it, or attempt to misuse the drug itself, you go into withdrawal. “It’s insurance,” he says.

There is no one-size-fits-all treatment and recovery program for addiction, which is why it’s critical health-care professionals get to know the person struggling with the addiction. “Nothing changes if nothing changes,” she says. “The stigma toward addicts — I can go to the doctor for anything, and everything is related to my addiction. Nobody takes you seriously. The stigma needs to change. They need to focus on more compassionate delivery of options.”

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The couple also credits their sobriety to Alcoholics Anonymous, as well as supportive family members. “I don’t think I would have made it to 21 if I didn’t have support from my family,” she says. “They laid down the rules, and they don’t give me money. But they understand addiction.”

Without familial support, he says, your “support” system becomes drug dealers and buddies.

This is the longest she’s been sober, and she recognizes that it’s a critical time. “I’m being extra careful. The more time I get, the more careful I am.”

And he knows there’s no such thing as a one-time only. “There’s no such thing as a casual junkie. You’re not a needle user and doing it casually.”

Neither of them are their addictions. Both are in post-secondary education; she’s nearly finished her degree. They have goals and dreams for the future, but right now, their focus is on staying sober.

“My plan is to keep going to meetings, get through the steps again. Stay on track,” he says. “Last year, I relapsed around Christmas time. I know what to look out for this time. Her and I are constantly working on each other all the time.”

“My short-term goals are to stay sober,” she says. “Going to AA, going to counselling. And staying clean.

“There’s no doubt in my mind I don’t have another recovery in me. I just don’t. If I go back out there, I’ll die.”

jen.zoratti@freepress.mb.caTwitter: @JenZoratti