No 'cookie cutter solution' for opioid users seeking help, physician says

Eric Cashmore has been to half a dozen different rehab facilities across the province.

His road to recovery started last year at this time when he finally realized he needed help.

Cashmore's problem with illicit drugs began when he was sexually assaulted in Toronto in 2008 and contracted HIV. He eventually ended up on the streets. Drugs helped him cope with the trauma he'd experienced. 

Back in July 2019 he pleaded guilty to a 2017 charge of communicating with a male for the purpose of obtaining sexual services for consideration, and a 2018 charge of trespassing at night.

He received a fine and probation on the first charge. The second was withdrawn.

Last year in Sudbury, he had a bad trip and eventually ended up in the psychiatric ward at Health Sciences North.  

That is when he realised he had to do something or he would die. He also found out that getting help is not an easy thing to do. 

"So the mental health act says that you need to qualify in order for the government to pay for your rehab. So what that means is you have to do an assessment. If the assessment comes up that you're on the fence about treatment you can be rejected from rehab and rehab centres might not let you in."

And then there is the wait list.

"If you're going to start applying to rehab programs be prepared to wait," says Cashmore. "We have a crisis here in this province of people that are not well. I don't think the crisis is that people aren't well, I think the crisis is we don't have anything to support them when they need it". 

Cashmore did wait to get in. He learned how the system worked and managed to get himself onto six different rehab programs in the province. All in search of the one that works for him. He says if you want help, you need to do your research.

"Know what kind of treatment program is it. Is it a 12 step, is it a cultural program, is it a harm reduction program? How long is it? Generally a program is residential for 28 days."

Cashmore says knowing now what it takes to get help, he worries about what happens when someone in crisis is waiting. He says they may go into detox for a few days, come out ready for help but by the time they get into a program, they've relapsed. It is a vicious cycle.

Different needs, different treatment

One way that many people can get access to rehab is through walk-in clinics like Northwood Recovery centre in downtown Sudbury.

Dr. Tara Leary is the front line physician at the centre. She says 90 per cent of the people coming through their doors are on opiates, and getting them set up with rehab isn't always the answer. For some, success can be trying to decrease their drug intake by moving from intravenous drugs to taking them orally. It isn't as harmful and they will be able to better manage their lives, Leary says.

She compares the disease of addiction to a disease like diabetes that needs to be managed over a lifetime.

"I deal with the consequences of drug use and if I'm able to minimize those in the same way that I would prescribing insulin to somebody with diabetes, to allow them to better control their blood sugar, I will do the same thing for somebody who's struggling with drug use," she said.

That doesn't mean that she doesn't refer people to recovery services. There are those who can benefit from the programs that are offered at places like Monarch in Sudbury.

'Adjusting treatment' 

Monarch helps men and women recover from alcohol and drug dependency.

It offers everything from day programs to six month residential programs. CEO Roxane Zuck says she's definitely seen an increase in opioid users recently, and traditional residential treatment doesn't always work for them.

Zuck says people who are addicted to such powerful drugs are dealing with different challenges, one of which is many are on suboxone or methadone to help deal with the chronic pain. 

Suboxone and methadone are strong medications prescribed to help relieve pain and opioid dependence. In the past, those in rehab were not allowed to be on those medications.

"We've talked about having a separate program for people who are on opiate replacement therapy only because their needs are different," she said. "If they're on a stable dose then it's much easier."

Zuck says Monarch recently adjusted the program so that clients can now be on opioid replacement medicine in rehab.

She says in the end, people have to be realistic about what rehab has to offer and help has to continue once they leave.    

"Being in an environment where everything is controlled like a treatment facility. You may think that you've got you've got it you've got your you know here your strength or your conviction to not use again," she said.

"But then you return to your environment where there may be an abusive partner or there may be work stresses or just friends who are not in recovery who are encouraging you to continue using."

Dr. Tara Leary agrees that the supports need to be there for the person leaving rehab. She says we really should be thinking about helping people in terms of harm reduction, instead of believing there is a quick fix.

"The reality is we don't have that evidence based data that supports rehab being the panacea," she said.

"So I think that's important that people can recover and they can access services that will allow them to recover without it necessarily involving leaving home and being somewhere completely different."

'Hope in recovery'

Leary says all aspects of the disease need to be dealt with.

"There is no question though that for opiates the treatment should include both medication and psychological and social interventions," she said.

"I would never treat somebody as high blood pressure by telling them they had to exercise lose 10 pounds and never start them on medication."

Dr. Tara Leary is not only the front line physician at Northwood but she is also the medical lead for RAAM (Rapid Access Addiction Medicine).

It is a government run program set up about three years ago to help people all across the northeast get the right program for them. 

It is still in its development stages and the province is working to expand RAAM into more rural communities. 

As for recovering addicts like Eric, he now spends a great deal of his time helping others find the help they need.  

"I just want folks to know that there's hope in recovery," he said.

"Drug use can get chaotic and sometimes we can feel like it's hopeless and that we get desperate. I want folks to know that we are not defined by where we've been but we are defined by where we strive to be....and if you can just see how amazing you are for being able to survive this problem."