Transcript Beneath the Radar:

An exploration of substance use in
rural Ontario
Kathy Hardill, RNEC
Doing the Work
North Bay,
July 2012
Town of Bancroft population 3,500
 250 km NE Toronto
 Just south of Algonquin Park
 Mineral capital of Canada
 Mining – uranium, iron, corundum
 Logging
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More likely to have low income, low
education than rest of Ontario
High unemployment
“dry” town until 1970s – bootlegging
Religious fundamentalism
Political conservatism
Back to the landers
Visible drug culture
› Where to go for drugs
› Cannabis cultivation
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Advanced Clinical Practice Fellowship
RNAO and The Bancroft Medical Clinic
› Literature review
› Key informant interviews
› Interviews with substance using individuals
 3 nurses developed q’aire
 2 administered survey
 Flyers, postings, snowball sampling
 10 respondents
 4 more 1:1 interviews later
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More substance use
Fewer services (of all kinds)
More barriers to service
More stigma
Poverty, unemployment, class selective
migration  generational poverty, similar
risks as inner city neighbourhoods
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70,000 Ontario students since 1977,
CAMH
SE LHIN highest of all LHINs for:
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student use of opioid pain relievers without a
prescription (23.7% vs 18% Ont)
student drinking and driving(17.6% vs 12% Ont)
ecstasy use by high school students (7.9%)
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Cluster 5 suicide deaths 2010
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Male, 18-55
Ongoing substance use
Minimal contact with health care system
ongoing overdoses, suicides 2011, 2012
“ as (people’s) addiction increases, so does
their isolation and their ability to access
mainstream services becomes really limited”
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Younger age – median age 40
Child rearing age
Low incomes/precarious employment
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Seasonal, part time, social assistance
6/10 < $999/mo
Precarious housing
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7/10 renting, 1/10 homeless
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Early drug use 9-15 years
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6/10 alcohol, 4/10 cannabis
Polydrug use – marijuana, percocet,
benzos
100% tobacco use
Top three drugs of choice?
“Oxycontin, Oxycontin, Oxycontin”
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7/10 named an opiate as drug of choice
9/10 had been unable to obtain their DOC:
“It was horrible – I wanted to cut my legs off”
“I went through hell for a week – I thought I
was dying”
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Mental health – 6/10 depression/anxiety,
2/10 PTSD, 1/10 hx child abuse, 1/10 self
injury, 1/10 hospitalized for suicidality
Pervasive low self esteem
“Low self esteem takes on a life of its own
– there is just a hopelessness, a sense of
not being able to accomplish anything,
just an awful hopelessness”
Bancroft NEP located in pharmacy
 Long hours of being open
 Lack of confidentiality, data, teaching
 Exponential increase but why?
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› More aware of NEP? more trusting?
› More drug use? use of drugs requiring more
frequent injections?
› NO ONE KNOWS!!!!!
Year
# needles
distributed
#
needles/month
2009
3168
264
2010
12592
1049
2011
31620
2635
(608/week)
Needles found in several parks by public
works employees - town liability issue
 Lack of education? Lack of material
resources? Stigma?
 Outdoor drug use inherently unsafe
 Need to know who is using what, where,
how
 Lobby PHU to conduct research
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Diverse lack of services (72%) –
addictions, counselling, primary care,
residential treatment, crisis, child care,
methadone
“It is our responsibility as a community to
provide what people need, so they can
get the help they need”
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Call for proactive, innovative
collaboration between agencies
“We’ve got to stop being territorial about
our clients and start thinking outside the
box to reach people who will not be
picking up the phone and calling to say
they have a problem”
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Transportation
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To counselling, detox, primary care, NEP,
methadone
Price of gasoline, insurance, unreliable
vehicles
Gas pumps - $7!!!
Stigma/isolation
“I kept my addiction very hush hush”
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“It’s harder in rural areas because labels stick,
there is usually a small pool of providers, and
some labels are even generational. The
‘mental memory’ of people and their family
connections never fades”
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Lack of awareness/understanding by
providers
9/10 had primary care provider, only 1 could
think of anyone to go to for help re drug use
“We have to remove the sense of being
punished for revealing a health condition to
your provider”
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Methadone maintenance therapy (MMT)
Replace opiate with prescribed
methadone to stabilize people
Prohibitive zoning by-laws
“I used to hitchhike from Pembroke to
Peterborough every week to go to clinic”
(260 km one way)
Lack of woman safe space – being
“thirteen stepped”
 When women attending 12 step
programs are repeatedly approached
sexually even after rebuffing advances
and this is accepted in the culture of the
group
 “it becomes a balancing act to choose
between your sobriety and your safety”
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distance and travel
 poverty
 lack of anonymity – not wanting to
“out” oneself as a drug user
 Lack of understanding of substance use,
harm reduction by service providers
 Lack of services
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 Questions?
 Report
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available:
http://www.substanceusestrategynetwork.org/resources.html