The Rainy River District is in the grips of an opioid crisis, according to front-line workers who see the devastating impacts first hand.
In a press release from the Canadian Mental Health Association (CMHA) issued for Bell Let’s Talk day in January 2024, CMHA Fort Frances branch CEO Charlene Strain was one of several regional CEOs who shared a look at what damage the stigma surrounding addictions can do when it comes to combatting mental health crises and addictions issues. In that release, Strain noted that the Rainy River District has been hit hard by the opioid crisis, with local emergency room visits due to overdoses having increased by 500 per cent since 2019, with highest rates in Fort Frances.
A few months down the road from that release, things have not necessarily changed for the better.
“I would say we’re in a terrible crisis,” Strain said.
“The Rainy River District, particularly the southern Rainy River District, has the highest levels of ER visits, highest level of opioid poisoning deaths in the province. We’re in a complete crisis.”
The term “opioid poisoning” might be new to many, but Strain said the vernacular surrounding addictions has changed in recent years. The new term reflects the science of the drugs and addictions, with less emphasis on the word “addiction” itself.
“Its ‘substance use disorder,’ or ‘substance use,’” Strain said.
“They’re indicating that it’s opioid poisoning, or opioid poisoning death, because the idea is, and it’s based on science, is that addictions, substance use disorder, such as opioid use disorder, is a health issue. It changes the composition of the brain.”
Strain notes that someone who uses a drug like an opioid once, in something like a recreational fashion, is not necessarily suffering from a substance use disorder. However, as that drug is used repeatedly, it changes the very composition of the brain, and Strain says training staff have received at the CMHA has taught that those who experience that change have a very difficult, if not impossible, time experiencing positive feelings once they try to stop using the drug.
“It gets to the point where it actually changes the brain,” she said.
“We’ve had training here that you can’t feel certain joy or euphoria once you stop using it, because it has actually changed the composition of the brain. It takes months and months to be able to feel joy and happiness again, and that’s why people relapse. That’s the science behind it.”
In a PowerPoint presentation provided by Strain, and created by Kerry Manthenga who holds a Masters in Social Work, drugs create intoxication by either blocking the reabsorption of dopamine which creates a surplus of the neurotransmitter in the brain, leading to a high, or by increasing the amount of dopamine released into the synapses of the brain. Methamphetamine, another serious drug, can actually do both.
However, the production of massive levels of dopamine through drug use leads the brain itself to produce less naturally, and so quitting the drug means the body has to learn to re-adjust to normal dopamine production, which can take extended amounts of time, sometimes years. This means some drug users could experience years of feeling very little when it comes to the happy emotions associated with dopamine while their bodies readjust, while another use of the particular drug would immediately provide the sensation. Thus, like Strain said, the slippery slope to relapse.
“People relate it to criminal behaviour, ‘pull yourself up by your bootstraps,’” Strain said.
“It really is a medical and social issue.”
While there is no one cause for substance use disorders, Strain said the region has experienced a fair amount of trauma throughout the years that could contribute to individuals turning to substance use in order to combat negative emotions or mental health.
“I think it’s multi-factored,” she said.
“I think that we have a lot of intergenerational trauma. We have a lot of residential school survivors. We have COVID, where people have long periods of isolation, complex grief, uncertainty. And it’s the chicken and the egg; is it mental health or addictions first? We know that they go hand in hand. It used to be that we would talk about them in two separate categories: mental health and addictions. But we have a long way to go in regards to stigma and understanding substance use. We still, all of us, are guilty of not understanding if you’re not in someone’s shoes like that. This is a health care issue.”
While the situation feels bleak, Strain notes there are still ways to help combat substance use disorder in the district, along with the stigma that accompanies it, and help to save lives. Strain said that CMHA supports a harm reduction approach rather than an abstinence based approach, but that overall, organizations in the region doing the work to help combat these issues need funding from the government to continue their work.
“We need funding for our RAAM clinic, the Rapid Access to Addiction Medicine Clinic,” she said by way of an example.
“Right now it doesn’t receive any funding, base funding, so it’s all in kind from established organizations. So you have CMHA Fort Frances providing peer support, you have Riverside who is providing the building and I believe some nursing staff, counselling too. You have Giishkaandago’ikwe and [Gizhewaadiziwin Health Access Centre] and the Family Health Team. We’re all coming together to provide a service, but it’s not properly funded and people are falling through the cracks.”
Strain said the region is in need of “a whole basket” of services in order to help support those struggling with substance use disorders, which includes detox and transitional beds, stabilized transportation, affordable housing and more. But something that can be done in the short term is to change the way we as a community and society think about substance use disorders and those who live with them.
“One of the first steps is to realize, to change the thinking, that it’s a healthcare behaviour, and it’s not based on criminal or poor choices,” Strain said.
“Nobody wakes up in the morning and says, ‘today I’m going to have a problem with substance use and I’m going to overdose on the street.’ I think we have to look at those upstream approaches too, like making sure that we’re focusing on child and youth because child and youth become adults. So we need to have those services in place for families to succeed, and so that kids have access to pro-social activities so they don’t have to turn to substances.”
