'Sad and chaotic time' for drug users as COVID disrupts illicit supplies

Overdoses and forced withdrawal are becoming common in Nova Scotia as travel restrictions brought on by the pandemic disrupt the supply of illegal drugs entering the province, say people with knowledge of the situation.

"It's a very sad and chaotic time for people who use drugs because you never know who may be next and who may potentially have a fatal overdose," said Matthew Bonn, a program co-ordinator with the Canadian Association of People Who Use Drugs.

Bonn, a drug user himself, said he's already lost one friend to an overdose during the pandemic. He nearly died himself when he overdosed after a drug binge last month. 

But he said no one has a handle on the size of the problem.

"A lot of people have close calls with overdoses that don't get reported," he said. "I know I've overdosed. We never called 911. There are a lot of unreported overdose reversals that happen."

There have been 18 deaths from opioid overdoses in Nova Scotia this year. Most years there are more than 50 such deaths, according to the provincial government.

Health Canada has seen a rise in drug users getting hurt during the pandemic.    

"Tragically, during the COVID-19 outbreak, people who use drugs are experiencing increased risks in many communities across the country, with several jurisdictions reporting higher rates of overdoses, including fatal overdoses and other harms," said Health Canada in an email.  

Health Canada went on to say that there are concerns that the illegal drug supply in parts of the country has become more dangerous, at the same time people who use drugs may be experiencing reduced access to health and social services.

Matthew Young, a senior research and policy analyst with the Canadian Centre on Substance Use and Addiction, is seeing similar trends.

The disruption in the illicit drug supply has led to a shortage of some drugs, a surge in drugs contaminated with other chemicals, while other drugs have a different level of potency than usual, according to Young.

"If somebody doesn't know exactly what they're consuming, or how much of the active ingredient they're consuming, it's very hard for them to use in a way that's safe and poses low risk of them overdosing, or having some other kind of health consequence," said Young.   

He said fentanyl has been mixed with other opioids like hydromorphone.

Fentanyl is a powerful synthetic opioid. A lethal dose for a typical adult can be as low as two milligrams, equal to two grains of salt.

Benzodiazepines and synthetic cannabinoids have shown up in other drugs without buyers knowing they are present.

Benzodiazepines are tranquillizers that are commonly used to treat seizures, anxiety and insomnia. Synthetic cannabinoids are lab-made substances that mimic some of the effects of marijuana.     

Since some illegal drugs are in short supply, one theory is that they're being bulked up with other chemicals to increase the limited and unpredictable stock of drug dealers, said Young. 

In Nova Scotia, and many parts of Canada, there's been a shortage of benzodiazepines on the street, which has driven up the price, said Bonn.  

"We did hear that from a lot of people that the price has gone up a lot and they had to go through a benzodiazepine withdrawal, and that's scary because it's similar to an alcohol withdrawal and that can actually cause death," said Bonn. 

On the flip side, the stress of the pandemic and the social isolation has driven some to use drugs more often, and by themselves, said Bonn.

Bonn had a near fatal overdose in July. He spent four days alternating rounds of Xanax, a benzodiazepine, and cocaine.

On the fourth day he decided to take some fentanyl. That's when he overdosed. 

Friends who were with him at the time injected Bonn with two vials of naloxone, a drug that can reverse opioid overdoses.

Then they performed CPR to keep him alive until paramedics arrived. Bonn only regained consciousness after he was given an intravenous administration of naloxone.

"I think the pandemic affected me more than I thought it would," said Bonn. "I was using drugs throughout the duration of it, but when I started to use this time, I kind of ended up bingeing.

"It's a big toll on you emotionally, mentally, physically, to go through an overdose like that."

Bonn would like to see governments across the country put in a safe drug supply system similar to what exists in British Columbia. That system aims to protect drug users from the dangers of the illegal drug market by having doctors prescribe a regular amount of opiates and other substances to people struggling with addiction.

It's an idea that the Canadian Centre on Substance Use and Addiction backs as well. 

Health Canada has poured millions of dollars into setting up safe-supply programs. It has approved funding for 10 safe-supply projects located across B.C., Ontario and New Brunswick.

Nova Scotia offers free naloxone kits at pharmacies. There is also an overdose prevention site in Halifax, but it is not funded by the province.

"It's time for every level of government — the municipalities, the provincial government, the federal government — to implement progressive measures like decriminalization, like safe supply including heroin and cocaine," said Bonn.      

In an email, Nova Scotia Health said it offers numerous harm-reduction programs to help people who use drugs.

Public Health funds Mainline Needle Exchange, Northern Health Connections Society and the Ally Centre. Those programs handle safe needle distribution and disposal, provide health education and offer referrals to health care and addictions treatment.