Cutting Addictions : Saving Lives

"We need to understand that opioid addiction does not occur in isolation. All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions."
"So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes."
"It's not black magic: There is neurobiology at play. Tobacco is the king of addiction, and it causes structural changes in your brain, in the receptors, and it amplifies the response."
Dr. Smita Pakhale, respirologist, The Ottawa Hospital

'We’re trying to understand if e-cigarettes can be in our toolbox,' said Dr. Smita Pakhalé of trying to find ways to help homeless people stop smoking. Jean Levac / Postmedia

"When I was able to see that I could reduce my nicotine intake, that gave me a good feeling, and the more I reduced, the better I felt. I thought that if I could do that, why can't I reduce my drinking?"
"Unfortunately, I started [smoking after cessation] again, but I'm still working on trying to quit."
Tara Finnessy, 50, client, Bridge Engagement Centre

Tara Finnessy was, she tells an interviewer, nine years old when she first began smoking. By the age of 11 she was a veteran smoker, completely addicted to tobacco. From there her addiction began to escalate as she grew older until she became dependent on cocaine, followed by heroin, all crutches to help cope with personal tragedies in her life. Hoping to cope in a more reasonable, less-death-defying manner, she turned to methadone, and has been on it for the past fifteen years of her life.

And she is a client at the Bridge Engagement Centre in Ottawa whose mandate is to give aid to people living on the streets, to the addicted, the mentally challenged, the drifters. Medical specialists from The Ottawa Hospital donate their time and expertise to this community project to give help and hope to the seemingly hopeless. Out of this group has come a new study published in the online open access journal, BMJ Open.

Researchers at the Bridge Engagement Centre enlisted 80 inner-city Ottawa residents offering them free nicotine replacement therapies inclusive of patches, gum or inhalers, in concert with peer support, mental health counselling and life-skills training, all of which comprised a study in a comprehensive approach to addictions and the background issues that lead people to become victimized. Dr. Pakhale is director of the Bridge drop-in centre and she led this new study.

Over a six-month period, participants who remained in the program were found to have reduced their daily cigarette use from an average of 20.5 cigarettes a day to 9.3. Study participants reported an 18.8 percent decline in illicit drug use. The breakdown: heroin (6.3 percent), OxyContin (3.8 percent, and fentanyl (2.6 percent) declined among those study participants who had acutely reduced their smoking habit.

The study suggests that smoking cessation represents an opening in people's fixed routine dependencies to be treated for their multiple addictions. Both tobacco and opioids are reactive to the brain's reward centres. One addiction reinforces another, pointed out Dr. Pakhale. Among the homeless and marginalized populations, smoking becomes an endemic addiction.

A study of 858 drug users in Ottawa's inner city undertaken in 2013 concluded that 96 percent smoked cigarettes on a daily basis in comparison to roughly nine percent of the city's general population who did the same. While the vast majority of inner-city smokers would like to quit smoking according to research, a persistent belief exists that smoking represents a minor problem in comparison to housing, mental health and other issues related to addiction.

"That translates into a disproportionate amount of disease and premature death -- preventable deaths -- in this population", pointed out Dr. Pakhale.