'The last thing I would have expected'
Hardy and Amelia Leighton's deaths served as a wake-up call that fentanyl was threatening even recreational drug users, but the truth is more complicated, reports Andrea Woo
It was intended to be a quiet night in, a chance to get ahead on their packing. Hardy and Amelia Leighton had left their toddler son, Magnus, with parents; packing boxes filled their apartment.
Robin Malcolm, Amelia's mother, grew concerned when she couldn't get a hold of them.
Police located their bodies on a Monday, two days after they were last known to be alive. They were found next to each other on the kitchen floor of their apartment, a turquoise-coloured powder and straw nearby.
The following week, the BC Coroners Service confirmed they had ingested toxic levels of fentanyl.
The overdose deaths of Hardy and Amelia Leighton in July, 2015, broadened the discussion about the powerful synthetic opioid fuelling a surge in overdose deaths. Until then, the drug was reported as largely affecting entrenched users like those in Vancouver's Downtown Eastside; the deaths of the Leightons – young, high-functioning, middle-class parents from North Vancouver – were reported as showing that even recreational drug users were dying as well.
In fact, the Leightons were neither obvious drug users nor merely recreational ones. At the time of his death, Hardy Leighton, 31, had in his system fentanyl, methadone, alprazolam (Xanax) and clonazepam – some prescribed, some not, a coroner's report shows. Amelia Leighton, 30, had in her system fentanyl, methadone, alprazolam and codeine.
Their deaths shed light on the complicated truth of addiction, as well as a problematic culture of opioid prescribing and usage that North American health officials are just starting to sound the alarm over.
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Hardy Leighton met Amelia Malcolm in late 2010 at the North Vancouver fitness centre she managed. Hardy was caring, sensitive and athletic – he loved rugby, hockey and skiing – while Amelia was popular and outgoing, a former soccer player known to be aggressive on the pitch.
They fell in love quickly, marrying in the summer of 2012 and welcoming a baby boy the following year.
Amelia worked in communications and, later on, at a car dealership; Hardy had worked as an apprentice carpenter on residential construction projects until a neck injury sustained on the job in 2010 left him unable meet the physical demands.
For the chronic pain that often stretched down his arm and to his hand, a physician prescribed him the opioids hydromorphone, oxycodone and Percocet.
Over several years, Hardy required an escalating amount of narcotics to control his pain and eventually grew to be dependent on them. He spoke frankly about the issue with his family.
"His family doctor from Whistler absolutely knew what was going on," Hardy's father, Brian Leighton, recalled in an interview. "He talked to Hardy and said, 'You have to sort this out. I'm not going to be the doctor that prescribes you endless amounts of these painkillers.' But there was at least one physician in Vancouver, Hardy told me it was like going in there and getting a rubber stamp for prescription renewals."
Unable to return to construction, Hardy received retraining from WorkSafeBC to become an addictions and community support worker. However, he was only able to secure part-time, on-call work in this position, earning a fraction of what he did before his injury.
Pressures began to mount at home. With Hardy making significantly less money, the Leightons' parents stepped in to help cover their rent. Amelia, who experienced bouts of anxiety throughout her life, developed severe anxiety and postpartum depression.
"It started slowly; we didn't even realize she was under stress," Ms. Malcolm said. "But as the baby got older and she got into that first year of motherhood, the depression and the anxiety [got] worse."
Amelia began taking the oxycodone prescribed to her husband, eventually becoming dependent on them, as well. In early 2014, both Hardy and Amelia sought treatment for their addictions and were placed on methadone programs.
"He told us, 'I tried to quit cold turkey and I couldn't do it,' " Mr. Leighton said. "So he went to treatment."
Amelia spoke to her mother daily, but never of her addiction.
"It's not something you tell your mother," Ms. Malcolm said quietly.
In June, 2014, Hardy underwent surgery to remove the damaged disc causing his neck pain – a procedure that significantly improved his condition. He took further vocational training and returned to construction, this time on temporary movie sets that required less physical exertion to build. Work picked up again. Physicians began weaning him off his methadone. Family members agree there was finally a light at the end of the tunnel.
By the summer of 2015, the Leightons had their eye on a new home, the bright, ground-floor suite of a detached house that would have a yard for Magnus to play in. On a balmy weekend at the height of summer, they left their baby boy with Amelia's mother so they could pack up for the move.
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Acute pain is a common entry point for opioid addiction. Hakique Virani, an addictions specialist based in Edmonton, said he often sees cases similar to Hardy Leighton's.
"In my experience, a typical presentation involves some kind of work or sports injury, they're prescribed opioids, then [physicians] continue to prescribe them for longer than they should," he said.
Canada is the world's second-largest per capita consumer of opioids, behind only the United States. In 2015, American physicians wrote 775 opioid prescriptions for every 1,000 people; Canadian physicians 534 for every 1,000. A recent report from the Canadian Institute for Health Information found that hospitalizations for significant opioid poisonings have increased every year since 2007-08.
The current dialogue around prescription opioids recognizes that while they can be highly effective in relieving pain, there is a fine line between analgesia and addiction. Certain conditions can create risks that outweigh the benefits.
This spring, the U.S. Centers for Disease Control and Prevention (CDC) issued new guidelines for prescribing opioids, with recommendations such as first considering non-pharmacological therapies and prescribing the lowest effective dosage for the shortest duration needed. It cautioned against increasing dosage to more than 50 morphine milligram equivalents a day – a figure just one-quarter of that recommended in the current Canadian guideline, which has not been revised since 2010.
The College of Physicians and Surgeons of B.C. followed suit in June, updating its opioid prescribing standards to reflect the CDC's.
In August, U.S. Surgeon-General Vivek Murthy wrote to every physician in the country, asking for their help in turning the tide on the country's opioid epidemic. In his letter, Dr. Murthy signalled that over-prescription was at the root of the issue, spurred by decades of aggressive marketing from pharmaceutical companies.
The same month, the U.S. Food and Drug Administration introduced changes to drug labelling to require strong warnings against the concurrent prescribing of opioids and benzodiazepines, a class of drugs that is used to treat anxiety and insomnia.
When Hardy and Amelia Leighton died, they had in their systems both opioids and benzodiazepines, prescribed and illicit, at therapeutic levels. They had also been drinking alcohol and had ingested toxic levels of fentanyl.
Ms. Malcolm called their drug overdose deaths "the last thing I would have expected."
"It has been hard, because I think back: What could I have done, had I known?" she said. "When someone dies, especially a child, you spend a lot of time in your grief thinking, 'I should have, I could have.' You feel at fault, because you couldn't protect them."
She now cares for Magnus in the home the Leightons had planned to move into.
In the first 10 months of this year, 622 people died of illicit drug overdoses in B.C. – the highest annual death toll in more than 30 years of record-keeping. Fentanyl was detected in at least 60 per cent of those deaths.
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