Preventing Overdoses ... Harms From Crystal Meth

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"It's not a substance that any of us are very happy about. It causes us so much social disorder and so many problems in the community because people, when they're high, they're so unpredictable. It's often very loud, very public, very erratic and it's frightening to be around and it's very hard to know how to keep our other clients and our staff safe from people that are high on crystal meth."

"Crystal meth was something that would sort of appear in Ottawa periodically, but for the longest time Ottawa was really a crack cocaine [area]. We were a crack city."

"There was a very sudden blip of crystal meth use. Once people make the switch, they don't generally have an interest in going back and so that introduces to our community a problem that frankly we haven't had before and frankly, truly, one we are not prepared for."

"The reality is we don't know the dose of these things yet. We haven't had enough time to get the science down to really know what it is we're dealing with."

"There's no great way to grieve. The deaths just keep coming. At the same time as you're very upset and sad about somebody who has died, you still have to go to work each day and deal with the overdoses that are occurring in front of you to try to prevent more people from adding to those numbers."

Wendy Muckle, executive director, Ottawa Inner City Health

 

"They become twitchy. They're humming, they're unable to control their body movements so they're jerking around, they're in and out of consciousness. They appear to be in a lot of psychological distress."

"We're monitoring them to make sure they're OK and that gives us a chance to engage with them, to do info gathering, find out if there are other supports they need."

"Can we help them with a welfare application? Do they have court coming up" Do they need us to check on that?"

"So when somebody is using crystal meth and they're tizik and they're feverish and they're distressed psychologically, it's very challenging to engage with people."

Adrienne Paddock, diversion case manager, Shepherds of Good Hope, harm reduction worker 

Adrienne Paddock, a diversion case manager with the Shepherds of Good Hope, says crystal meth use is way up in Ottawa and because "God knows what's in it," there's also an unprecedented amount of overdose deaths, she says. Photo by Julie Oliver /Postmedia

Ottawa's streets are presenting front-line workers with a new reality; a sharp increase in stimulant use of crystal meth, which has a myriad adverse effects posing a danger to users and the wider community at large. Until recently the stimulant of choice was crack cocaine ... and then along came the COVID-19 pandemic and the closing of the border between Canada and the United States, making it far more difficult for smugglers of cocaine to bring their products into Canada. Scarcity means higher prices and crack became not only difficult to access, but too expensive.

Dealers, looking for alternatives, settled on an easy substitute; crystal meth; cheap, easy to produce. No expensive imports, the chemicals readily available: fertilizer, cold medication, lithium batteries and a basic laboratory. While crack produces a short high, crystal meth's effects last for hours. People were asking for clean meth pipes given to them by Ottawa Inner City Health, or they could consume crystal meth at safe consumption sites.

 

Ottawa safe injection sites

 

People get a sensation of elation, high on crystal meth, the drug stimulating the nervous system and causing the brain to release dopamine in large quantities; a neurotransmitter associated with pleasure. And then there are the side effects, where meth users can be more susceptible to violent behaviour, and to suffer from anxiety, seizures, nausea and vomiting. Which even then isn't the worst potential of a drug that can lead to "meth mouth" which the American Dental Association describes as "severe tooth decay and gum disease which often causes teeth to break or fall out".

The drug has other deleterious effects, keeping users from sleeping, with the eventual effect of reaching a state of "tizik", and in that state people are not able to be communicated with, a problem when front-line workers do their best to carry out the basic necessities of giving aid to people in need. With crystal meth on the scene, the opioid crisis worsens. At a time when harm reduction workers were on the cusp of knowing how to deal with one substance such as coping with fentanyl overdoses, the drug of choice suddenly changes.

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The spike in meth consumption is now straining the system, which had struggled to come to terms with fentanyl use and overdoses resulting from the drug. "Supports and services for people who use methanphetamine and other stimulants are limited and not currently meeting the need", noted Ottawa Public Health in a new reality where stimulants are contributing further to an increase in overdose deaths, up 75 percent, from 124 fatal overdoses in 2019 to 218 in 2020.

According to the Office of the Chief Coroner, during the pandemic in Ontario a significant increase in the percentage of opioid-related deaths with stimulants as a contributing factor was realized. The Ottawa Paramedic Service has seen an increase in people using multiple substances in stimulants such as crystal meth along with opioids. People in despair caused by the chaos of the pandemic have been provoked toward poly-substance use, say both Paddock and Muckle, even as paramedics see a shift in patients they transport to hospital.

"People think that because they're not buying fentanyl that they're not at risk of overdosing, and that's the danger. If you have a dealer who is selling multiple substances, all it takes is a small amount of fentanyl to taint that crystal meth."

"And then you have a client who's smoking crystal meth in a stairwell by themselves because they're not a fentanyl users and they're not expecting any risk of overdose, and those are the people that we worry about finding too late."

Adrienne Paddock, harm reduction worker