Poverty fueling opioid epidemic in North Hastings

By Nate Smelle

In the past year, the number of overdose deaths in North Hastings has more than doubled. The fact that the majority of these deaths have been linked to the powerful opiate fentanyl has made it clear that the COVID-19 pandemic is not the only public health crisis destroying lives in North Hastings. In order to gain insight into the local impact of the opioid epidemic, over the course of several weeks, Bancroft This Week and The Bancroft Times will connect with the community members and stakeholders working to overcome this crisis.

As a physician with the Bancroft Community Family Health Team, and the clinical lead of the opiate management program, Dr. Ashley White is deeply involved in helping people struggling with addiction. Through her diverse range of experience from working to find solutions to addictions and mental health issues in places such as Ottawa, east Vancouver, Afghanistan, and now North Hastings, Dr. White has acquired a keen understanding of the opioid epidemic, and why it has become such a deadly presence in society.

Recognizing that people have used psychoactive substances for more than 13 millennia, Dr. White said it is important to question why it is that addiction has only been an issue for a relatively short period of time. When looking at why it is that addiction has become a product of modern society, she said it is also critical to ask why some people who use substances get addicted, while others do not.

“We know that among these people there's a prevalence of social dislocation," Dr. White explained.
"So, that is: anything from the experience of multi-generational colonialism, in the case of Indigenous peoples; it is multi-generational trauma; it's participation in violent wars; it's childhood sexual assault; child abuse; it's neglect. It's not necessarily all of these bad things - for sure those bad things can make someone extremely vulnerable to having a good response to an illicit substance - but, there are other forms of invalidating experiences that people go through, that can make them vulnerable to developing addictions.”

Explaining further how social dislocation fosters addictions, Dr. White gave the example of a LGBTQ+ person, who despite having been raised in a privileged home, is left feeling invalidated after they are marginalized by their family because of their identity. In a society where people experiencing social dislocation and invalidation are denied access to the supports they need to heal themselves, she said it is inevitable that more people will turn to substances for relief from their suffering.

Noting that “addiction is actually a symptom of a society where people are not safe,” Dr. White sees a direct connection between poverty, homelessness, mental health, and addiction. Providing an example, she pointed out how the more the housing market is inaccessible, the more children there are being raised in poverty; and, how when children are raised in poverty, they often grow up being told that they are less than others. Furthermore, she said children who are constantly being told by society that they are "not good enough' or "less than" become more vulnerable to addiction.

“We know that these adverse childhood experiences are very illustrative," said Dr. White.
"So, if we can help people deal with the stuff that happened to them as children, we can prevent them from going to jail, and we can prevent them from having to deal with addiction. A society that deals with addiction, is a society that deals with these kinds of dislocation. You have to deal with them at the policy level, and you have to deal with them at the community level. There's a very complicated map of how we deal with this, but it starts with making sure that people have access to housing, food, education, the ability to express themselves. And, the ability to live a life that is free of discrimination against the colour of their skin, the religion that they choose, the language that they speak, and the people that they love.”

One of the biggest obstacles when it comes to helping people struggling with addiction, Dr. White said, is that in most cases, the individuals tasked with addressing the opioid crisis focus primarily on reactionary measures that don't get to the root of the problem. While ensuring that substance users have access to treatment - including access to a safe drug supply and place to use - is an essential part of the healing process for people battling an addiction, she said there needs to be a broader discussion regarding how society is creating the opioid epidemic.

”There's treatment, which is only part of the conversation when someone says ‘I want to be treated," said Dr. White. "Then, if someone says, 'I want to be treated', as a doctor I say, ‘OK, what do I have available? I certainly can calm your receptors down. I can give you steady and free access to the drug that your brain wants, no problem. However, you're still going to want more if you don't have a place to sleep at night. The thing that got you here is still there. So, if you were raped by your uncle, that doesn't fix it; you were still raped by your uncle.' This is the level of dislocation that
people are living with. They're not even safe in their own body.”

Acknowledging how difficult it is to move on from such deeply-rooted trauma, Dr. White said it requires an incredible amount of patience. In order for an individual to beat an addiction, she said they first must overcome the impulse in their brain causing them to yearn for the profound release of dopamine which comes with strong narcotics such as fentanyl. Once an individual is able to override this impulse, Dr. White said it is then that they can weigh the pros and cons of using the substance. Basically, freeing oneself from an addiction is a process of un-teaching and un-learning, she said.

“People need time and space to unwind that reward system," Dr. White said.
"If you are sleeping on the street, or you are in a home where you don't feel safe; or, you are living in a body that you don't identify as your own, or you're in pain, you are just not going to be able to un-learn. Un-learning requires so much attention, and energy, and support, and love. And, then you also need to build different rewards structures, so you need to find other things that are rewarding. Nothing is ever going to be as rewarding as high amounts of a drug that offers you euphoria. Euphoria is a singular experience, and that's why people get addicted to it. There's nothing like it. When people don't experience any joy, or any rewards elsewhere, they are going to pursue euphoria. Even at the expense of your house, and your heart, and your life, because you have taught your brain that nothing else matters.”

Citing the gentrification of the Bancroft area as another major factor and driving force exacerbating the local opioid crisis, Dr. White said it is not a scenario that people can remove themselves from by simply "pulling up their bootstraps." Instead, what is needed is a fundamental transformation of society, and the economic structure on which it is based.

"I studied economics as an undergraduate, and I would say that I am a capitalist, but, capitalism has to be called into question here," Dr. White said.

"What kind of society makes it so that some people have so little that their life is not sustainable? How is it possibly true that that's their choice? How is it possibly true that that is a natural consequence of decisions they've made, if they have been homeless since they were 12? In societies where equities are preserved, all people do better, including rich people. There is evidence showing that if you invest in early childhood education - which is one of the highest yielding ways to spend a dollar on a good society - and, you make sure that people who want to be housed are housed as safely as possible; and, you give people a path to equity in that housing, so they have something to establish wealth upon, everyone does better."

She continued, "It's because we spend a lot of our taxes policing the consequences of poverty, and that's wasteful. The solution is one where we as a society are willing to except certain uses of our tax dollars to help other people, so that life can be better for everyone.”