There is a new kind of drug addict in the West Kootenay, and their numbers are overwhelming Dr. Joel Kailia’s methadone clinic in Nelson. He provides opioid replacement therapy to addicts to to counteract addiction to fentanyl, heroin, and other opiates.
Two years ago Kailia had 100 patients at any given time. Now it’s up to an unsustainable 300.
“Many patients are younger and more stable with no history of addiction or mental health issues,” says Tara Emery, a social worker employed by Kailia, describing the new demographic they are seeing.
“They are less likely to have serious abuse or trauma issues. They often have stable housing. As a social worker I was shocked to hear, over and over, their main reason for using: ‘I used because I was bored,’ or they started using for pain management and quickly realized that when they stopped they became very sick from withdrawal.”
She says they are spending $150 to $500 a day a day to support their addictions.
“There are a large number of recreational users of fentanyl,” Kailia says. “It’s stronger than heroin, and heroin is one of the most addictive substances out there.”
Clean but stigmatized
There are some older, old-style users also, like John, in his 50s, whose name we have changed because he has a steady job and he worries about the stigma.
“I have had addiction problems for many years — heroin, crack cocaine. I came here six years ago from East Hastings and I was in bad shape. I was hospitalized here. I was a mess.”
He says his life has changed since he joined Kailia’s program.
“As a result, I have been clean and sober for six years,” John says. “It has changed my life tremendously in many ways, physically, mentally, emotionally. I have been able to get back into the work force with a steady job. I love my work. I am not exaggerating when I say if it was not for the program I would not be alive today.”
John’s only problem with the program these days, since it moved from Kailia’s office in the Community First Health Clinic to the annex at Kootenay Lake Hospital, is lack of privacy. Kailia, Emery and medical assistant Robyn Runions all see different patients in the same room at the annex, simultaneously. They also have a part-time nurse who does blood work.
No privacy for patients
As Dr. Kailia talks with John about his methadone dose and the muscle pain in his legs, only a few feet away Emery is talking to a couple about their drug problems and health issues. And not far across the room, Runions is talking to another patient about his urine sample. (Urine testing for methadone, morphine, amphetamines, fentanyl, cocaine and oxycodone and more are taken every time a prescription is given.)
“I find this extremely stressful,” John says. “I don’t feel any privacy, it’s so wide open. Before, I would be with Dr. Kailia privately, share some stuff with him. Here, everybody knows my business. This setting is not good, not at all.”
The lack of privacy becomes all the more apparent when a female patient tells Emery about a skin infection on her chest, and Emery offers to hold up a sheet for privacy so Kailia can examine her.
Kailia runs a private practice in family medicine and pain management in the Community Health Clinic. Since 2008 he prescribed methadone or an alternative, suboxone, to about 100 patients, in a program not affiliated with the Interior Health Authority. But he had no choice but to move.
Feeling unsafe
“The skyrocketing fentanyl problem started taking over my business life in the office. It was turning into a Downtown Eastside methadone clinic,” Kailia says. “We were not feeling safe in the office. It was stressful because some of these patients are unstable and [because of the numbers] it was just chaos, taking a huge toll on my physical health. We lost staff members, and we were getting complaints from the building.
“I attribute the increase to oxycontin being taken off the market, creating a vacuum in the supply of opioids on the street and then synthetic fentanyl being imported from China and Mexico and other places, as well as the diversion of fentanyl from medical uses, and the fact that fentanyl is more addictive and has a worse withdrawal than oxycontin.”
Other than one Interior Health clinic in Castlegar that handles a maximum of 100 patients, Kailia’s is the only practice that prescribes methadone from Rock Creek to Cranbrook, and from Nelway to Revelstoke. About half his clinic’s patients are from outside of Nelson.
“People are overdosing and dying without this, so it is really hard to turn people down,” Emery says.
Started with painkillers
The couple Emery interviews when the Star visits are both addicted. The woman’s story is a litany of hospitalizations, serious illnesses, putting her child in care, all starting from an addiction to painkillers following a hospitalization.
“I was in the hospital and they gave me morphine there and I started using. I went from morphine to heroin because it is really hard to get morphine any more, and the heroin came into town and that was what everybody was using, and fentanyl.”
Emery asks them how much they are using every day.
“It depends on what we can find. If we are using morphine it is anywhere from 100 to 300 milligrams a day, and if it is heroin it is anywhere from a point to a gram a day.”
Her husband’s addiction came from prescription painkillers following a work injury.
It’s the first time this couple has been to the clinic, so Emery asks them many questions about their physical and mental health, housing, income, and any history of abuse.
Social worker on staff
“People like these have the highest needs, because addictions are still so stigmatized,” Emery says. “They are the most on the fringe, they lack housing and support. [Many] have a history of trauma or PTSD, anxiety, ADD. Some of them are involved with Mental Health services and some are not.”
Kailia and Emery say it is very unusual for a doctor to have a social worker on his staff.
“My job as a physician,” says Kailia, “is prescribing opioid replacements which is currently methadone or suboxone, dealing with any other drug use issues, liver disease, hepatitis, HIV, all the things that can go along with drug use, and then it is not really part of my mandate but a lot of these people don’t have family physicians, so I will do family physician type work. And then Tara is here as social worker and deals with a lot of the psycho-social issues that derive from chronic drug addiction. I could not do this job without a social worker.”
Kailia says he’s burned out. Emery says they feel isolated.
“The reason this problem exists is that we continue to stigmatize addictions and push these people away,” she says. “We still think they are making a choice in engaging in this behaviour, and I can see from the work I have done that addiction is not a choice. Even us, we feel stigmatized and isolated working in the addiction field. We have all been affected by addiction. By turning toward it and working together, I think that is how people get better.”
IHA response
Interior Health’s community manager for mental health and substance use says that this sudden upswing in a new kind of addiction, including the increased availability of fentanyl, is “a phenomenon that was definitely ahead of our strategic planning.”
Chris Huston told the Star the IHA has been working with the Kootenay Boundary Division of Family Practice on this issue and that as a result one additional physician in Nelson is now taking appointments to do opioid replacement treatment for people with serious psychiatric disorders, and another will start taking patients in April.