Day after day for five weeks, Hilda Bertrand and Brenda Toupin-Wiles sat in a Brockville, Ont., courtroom and listened to strangers dissect their children's deaths.
The inquest into the fatal 2008 overdoses of Ms. Bertrand's 41-year-old daughter and Ms. Toupin-Wiles's 19-year-old son has given both families a crash course in pharmacology and prescription-drug abuse.
"It's been educational. And disturbing," Ms. Toupin-Wiles said. "I've been educated on how to crush, smoke, snort, inject every kind of drug you can imagine."
Dustin King and Donna Bertrand were found dead in the latter's apartment. He died after snorting half a pill he shouldn't have been able to get, passed out on a couch. She died in the same residence 11 days later.
For the previous 13 months, her doctor had escalated her dosage of potent opioids despite cautions from police that her reports of stolen medication were questionable.
Local police pushed for a coroner's inquest. The nature of the deaths – so close together, intertwined and preventable – was a factor. So was the officers' exasperation with trying to quash the illegal trade in legal drugs.
They got their inquest. Deaths linked to prescription painkillers have become enough of a public-safety hazard, says Deputy Chief Coroner Albert Lauwers, that action on their availability should be viewed with the same urgency that spawned seatbelt laws. In fact, according to Mr. Lauwers, the number of opioid deaths in Ontario in 2006 was equal to the number of drivers killed in motor-vehicle accidents.
With the inquest's close last week, five jurors are left to figure out what doctors, pharmacists, police and lawmakers should do when drugs meant to alleviate pain are also behind a growing frequency of abuse, diversion and overdose deaths.
"You just don't speak for Brockville. You don't just speak for the members of this community," commission counsel Curt Flanagan said in his closing arguments to the jury. "You're in a great position to make recommendations to change the way we do things."
Donna Bertrand started taking painkillers the way most people do: on doctor's orders, after a back injury sidelined her at Kemptville District Hospital, where she worked as a nurse.
Hilda Bertrand isn't sure when her daughter turned to street drugs, but by 2001 she was so worried she took custody of her five-year-old grandson.
Donna was in and out of rehab and detox. Her mother picked her up at the train station and drove her to doctors' appointments; when Donna visited her parents' house, Hilda would hide the valuables and stock up on juice to quench her daughter's drug-induced thirst.
The teenager who died at Donna's apartment, Dustin King, "was a fearless kid," Ms. Toupin-Wiles said. "If there was a party, Dustin was there."
In his case, partying meant drugs – "pills, pot, booze," said Dan King, who thinks his older brother met Ms. Bertrand a few months before his death. "He probably went from one drug to another; somebody offered it to him and he did it."
Dustin's death was hard on an already fractured family. "He was the one who kept in touch with everybody," Dan King said. "It's kind of like the glue went missing."
The two deaths jarred Brockville, population 22,000.
"For a small community like this," said Leigh Bursey, "it hurts. It's huge."
Mr. Bursey is the youngest city councillor of the Eastern Ontario town, whose bucolic waterfront and Upper Canadian downtown fades into single-family homes, then strip malls and superstores hugging Highway 401. The highest structures on the horizon are church spires and a water tower, and a crane working on a riverside condo development.
Some things have gotten better: The grey stone King Street walkup where Ms. Bertrand lived and where she and Mr. King died, once notorious for drug use, has been cleaned up; businesses nearby say they're less worried about break-ins.
But prescription-drug addicts – many of them youth – continue to overwhelm the area's only addictions centre. And the problem extends across the region.
In a two-year period, prescription opioids are believed to have killed nine people in Cornwall, about 100 kilometres east. At the same time, says Cornwall Community Police ServiceStaff Sergeant Shawn White, seizures of trafficked pills almost quintupled in a year. Pharmacy robberies skyrocketed.
The striking number of opioid deaths in the province, argues Deputy Chief Coroner Lauwers, should be enough to galvanize policy-makers. If public-safety concerns around car accidents are enough to justify seatbelt laws, he reasons, medical professionals should be obliged to override their patients' privacy rights if those patients are putting themselves or others in danger.
Ontario has already taken some action in this direction. A provincial strategy stemming from its 10-month-old Narcotics Safety and Awareness Act aims, among other things, to create a database for tracking what drugs are dispensed to whom.
"I see it as an incremental step they're taking to a good policy," Dr. Lauwers said.
Detective-Constable Tom Fournier of the Brockville Police Service has been following the King/Bertrand case since its inception.
"You've got a drug that's paid for by the Ontario drug plan," he said. "You've got licensed physicians prescribing this drug, paid for by the taxpayers of Ontario; and you've got pharmacists who are dispensing this. It should concern us all."
Alan Redekopp told jurors he was "obviously" concerned that Donna Bertrand was diverting pills.
But as Ms. Bertrand's doctor, he kept prescribing and upping her dose at her request, sometimes without even seeing her in person. Dr. Redekopp is awaiting a disciplinary hearing before the Ontario College of Physicians and Surgeons on allegations of incompetence, scheduled for this fall. In the interim, he's prohibited from prescribing narcotics.
"I felt sorry for her. I believed her. I liked Donna. I was committed to helping her," he told the inquest.
Then he got the news that a teenager had died in her apartment of an Oxy overdose. "I felt heartsick. I just felt terrible" to get the call, he told jurors.
It was then he sent Ms. Bertrand a note. "Dear Donna," Dr. Redekopp wrote on Nov. 24, 2008. "Effective immediately, I will no longer be seeing you as your family doctor. This is due to the misuse of your prescription medication."
It was their last communication before she died on Dec. 2, overdosed on sedatives and antidepressants.
"Any way you look at," her mother said, "it's still suicide."
Neither family had a lawyer acting for them at the inquest.
Ms. Toupin-Wiles spoke on her son's behalf. The task of legally representing the Bertrands fell to Donna's older sister, Joanna, who swore years before Donna's death she'd have nothing more to do with her sister's troubled life.
"I just said, 'I'm not putting my kids through that,'" Joanna Bertrand said.
But when the inquest was called, the family couldn't find a lawyer to take on their case pro bono.
"I was in shock. I'm still in shock" at some of the testimony, she said. "To have to stand up and… " She paused, blue eyes steely. "You stand up and you do what you've got to do."
She's convinced, though, that the inquest will have an impact. "They have to act.… It may take a few years, but it's going to happen. More people are going to die."
EXPLAINER: THE DANGER OF OPIOIDS
What are opioids?
Drugs derived from opium – used as painkiller and cough treatment in various incarnations for five millennia (in synthesized form for about a century).
How do they work?
By grabbing onto receptors in your neurons and blocking pain transmission while releasing dopamine, your brain's pleasure chemical.
What's the problem?
The euphoric high they cause is addictive. And too much of it can kill you.
While prescription opioids were originally marketed as a drug that ought to be dosed "to effect," some argue physicians should use much more caution when prescribing the potent medications.
What happens now?
Lawyers have urged jurors at inquest into the deaths of Dustin King and Donna Bertrand to make recommendations on
- The way doctors and the public are educated (and whether this should be mandatory);
- The way opioids are monitored, so doctors and pharmacists know who’s getting what;
- The way opioids are policed, so health-care professionals could override patient confidentiality by informing authorities;
- The way Health Canada and the province’s Health Ministry regulate the drugs (Should there be more trials? Should prescriptions be capped? Should certain pill sizes be eliminated?)