THUNDER BAY — To be incarcerated where you are forced to face the consequences of your behaviour while undergoing the effects of opioid withdrawal would definitely make a person more fragile, said an expert in addiction medicine.
This statement was heard on day three of the inquest into the death of Kevin Mamakwa when that expert in addiction medicine took the stand.
Dr. Leonora Regenstreif was the fifth witness of the inquest, which began Monday, and testified via video on Wednesday.
The jury heard that Mamakwa, according to background information provided during the inquest, had a documented history of opioid use and receiving Suboxone treatment, was remanded into custody for the third time on May 28, 2020.
Regenstreif said there is a record of Mamakwa having four take-home doses of Suboxone on May 14, which would have been gone by May 18.
This was also, she pointed out, the time during the pandemic when lockdowns meant greater periods of isolation for inmates.
As Thunder Bay District Jail Superintendent Rylan Forrest explained on Tuesday, cohorts had to be created within the jail during Covid, which meant even tighter restrictions on day use area access. Inmates took their meals within their cells and were restricted to socializing within their cohorts.
Regenstreif said that in her experience working in addiction medicine, a physician can get a much clearer picture of an addict’s needs and withdrawal symptoms when there is time spent with the patient.
During Covid when everyone was masked, for example, assessments were even more challenging, she said, because without seeing a person’s whole face, you lack the full picture of what she called the “physical affects” in the features of their face.
It was documented that Mamakwa was suffering from insomnia but other possible symptoms were not recorded at the time. She said without knowing for sure, it is possible that he might not have been completely forthcoming about other symptoms he was suffering from.
The other fact of the time period of Mamakwa’s incarceration prior to his death, was that he would have been checked daily, as were all inmates, for signs and symptoms of Covid.
She also discussed how the multiple intake forms work in tandem to assess each inmate’s overall well-being and various risk factors.
She said that the availability of OAT – Opioid Agonist Therapy – is better now than it was in 2020.
She said almost anybody would experience withdrawal if put in a stressful situation, but some are more vulnerable to the mental withdrawal symptoms.
She referred to “recovery capital” – a term used in discussions of the addiction recovery process which allows the person to rebuild -get their job back, rebuild relationships.
She said some stay on Suboxone longer term and it becomes like taking anything else, like thyroid medication.
She said it is a very individualized process.
Another concern raised by Nishnawbe Aski Nation Deputy Grand Chief Anna Betty Achneepineskum during the inquest on Tuesday was that some First Nations people she knows of end up being on Suboxone for 20 years.
The inquest will continue Thursday.
