Dawn Rae Downton is a writer living in Halifax.
Imagine my surprise, on reading the news last spring, to find that I'd contributed to the spike in fentanyl street deaths in Vancouver.
Me? A writer leading a quiet life far across the country, in Halifax? My only connection to the "opioid epidemic" – a story that still dominates the news a whole year later – is fentanyl. I've used it for the past 12 years under the care of a pain specialist with 35 years of expertise treating serious, intractable pain, because, at 39, I suffered a rare-ish form of inflammatory arthritis so painful it eventually kept me from walking, standing, sitting and sleeping.
I don't use fentanyl to get high. I don't inject or snort it; I don't take pills. Like most chronic-pain patients on fentanyl, I wear transdermal patches (which are tricky to trade and use on the street). I use fentanyl to contain my suffering and have a tolerable life. I wouldn't dream of "diverting" it to the street; I need it too badly.
So why finger me for colluding in a so-called "opioid epidemic"? An epidemic, by definition, is a widespread infectious disease rising quickly in a community. (Webster's allows for the colloquial "excessively prevalent," but even then, opioid street deaths, measured against Vancouver's or Toronto's populations, don't add up.)
Do we even have a "crisis"? It's hard to pin down numbers when even front-line workers appear to be inflating them. One front-line worker in Toronto, who probably wanted bigger numbers to justify more aid, told Vice that 1,400 people in British Columbia had died in the past 18 months – "that's four people a day." It's not; it's 2.6 people a day.
Certainly that's 2.6 people too many, but it still has nothing to do with me, other than I'm collateral damage. Contain access, the government says, and so contain the "outbreak."
It won't happen. That's because the wrong supply – medical fentanyl rather than the raw powder smuggled in from China – is being choked off, with new national physician guidelines out this week cutting patient doses drastically, or cutting them off altogether. The Pain Medicine Physicians of B.C. Society pointed out to regulators nearly a year ago that the guidelines – already a legal "standard" in B.C. – were incomprehensible, unsafe and unusable, and that more than 100 points in them needed clarification
Nonetheless, the redoubtable Dr. David Juurlink, a Toronto drug researcher who likes the guidelines, said last week that there's a lack of "good evidence for [opioids'] long-term use."
Sure there is. There's me, and millions like me. One in five Canadians suffers miserable chronic pain; many have used opioids safely for years. They don't abuse, sell, overdose or continually raise their doses. I cut my dose by 25 per cent every winter, when I'm less active, and in less pain, than I am in summer. Undertreated chronic pain, on the other hand, is deadly. Undertreated patients risk immense physical and emotional dysfunction, endocrine failure, cardiac collapse, immune problems, dementia and early death, sometimes by suicide.
But the most outrageous statement of all came from Prime Minister Justin Trudeau. At the same time he was telling Vice that Ottawa may bring in prescription heroin, in a single swipe he slagged fentanyl, and pain itself, by saying that chronic pain is "low-grade, but very annoying."
Pain clinics ask patients to describe their pain by choosing from words such as "searing," "lancinating," "anguished," "unbearable" and so on. "Very annoying" didn't make the list. Pain patients include those with cancer and multiple sclerosis. One thing we can be sure of about Mr. Trudeau is that he's thought little about chronic pain.
We should all be glad, not shocked, that Canada is the world's second-biggest user of opioids per capita. It means we have a sound, integrated palliative-care system. If we're lucky to live long enough, we'll all need pain therapy some day; I just got there early. Let's hope it's still there when you need it.