Addiction goes by many names, but none seems more relevant today than “the disease of isolation.” A common trigger and effect, loneliness fuels a dangerous cycle that is broken through connection and fellowship.
So when the treatment for a pandemic becomes worldwide isolation, the treatment for addiction takes a back seat. But those in recovery only suffer more, especially at a time when the world has already been battling another complex health crisis: opioids. In the last four years, this epidemic has claimed the lives of over 14,700 Canadians.
Those at risk of addiction face a particularly dangerous time with fewer resources. Face-to-face counselling sessions are no longer an option, nor are in-person group meetings, which are a key part of 12-step recovery. Several of the nine supervised consumption sites in Toronto have temporarily closed, reduced their hours or reduced the number of booths available for injections for physical distancing.
One site, located at the Works at 277 Victoria, closed temporarily on March 18 for an unspecified period of time as part of Toronto Public Health’s (TPH) response to COVID-19 after several cases of the virus had been found among staff.
“This action was taken to investigate new physical distancing measures to protect our staff and clients and confirm our infection prevention and control procedures,” says Dr. Michael Finkelstein, acting director of communicable disease control and associate medical officer of health. “We understand this news is upsetting given the current overdose crisis and we are actively working to identify solutions to quickly resume providing these critical life-saving health services to our community.”
Finkelstein says TPH is investigating alternative delivery models to support staff and clients. Harm reduction supplies are still available through the Works, while fencing has been installed at the office’s front entrance to ensure clients can safely access these supplies while practising physical distancing.
Still, the number of visits to all of these sites has been dropping in recent weeks. In early April, the city reported a rise in overdose deaths. In March alone, Toronto paramedics responded to 345 overdose calls, 19 of which were fatalities. This isn’t just a result of increased use, but a toxic street supply of drugs.
“Substance use is a coping mechanism for many, and when access to other coping mechanisms are removed, it’s likely to increase people’s substance use,” says Nicola Bangham, executive director at Toronto’s Breakaway Addiction Services. “Some who use substances have reported to us that they are convinced that COVID-19 will kill them due to not having the privilege to socially isolate in a home. As a result, they are not being as safe with their substance use, for example, by using clean needles, confirming the source of substances, using with a buddy or drinking to a limit. There is a very concerning ‘what’s the point’ feeling going around.”
But there are options, as many medical and rehabilitative facilities are making efforts to bring community to those in recovery.
Breakaway, for example, is offering food and harm reduction supply drop-offs. Many other facilities, including the Edgewood Health Network (EHN) across Canada, are providing treatment options over the phone, email or live chat, and are still accepting new clients in the hopes of helping them get and stay sober.
“An important part of inpatient treatment is bringing people out of isolation and showing them the value of community,” says John Hastings, national director of admissions at EHN and Toronto’s Bellwood Health Services, which offers residential treatment programs for alcohol, drug, gambling and sexual addiction.
“It is a dangerous time for people in active addiction, but they need to know that they are not alone,” he continues. “More than ever, it is important for people to avoid isolating with their substance of choice, and we can help with safe, medically supervised environments. It can be argued that this is an ideal time for inpatient treatment, given that many people struggle with taking extended time off work, and now they may – through no choice of their own – have that time. The world has slowed, so for some, this might be a window of opportunity to start living sober with less outside distraction.”
How to access recovery services
Alongside supervised injection sites that remain open, there are services around the city, including at the Works, South Riverdale Community Health Centre and Parkdale Queen West Community Health Centre, where drugs bought on the street can be assessed.
As active drug users are more likely to use alone, they are being advised by health-care professionals to have someone with them or on the phone during use, or to call the Overdose Prevention Line (1-888-853-8542). Naloxone kits are also recommended for all active users they are available to purchase at select pharmacies, and are free at both South Riverdale Community Health Centre and the Works, the latter of which also offers training sessions on how to use them.
The pandemic also does not spell an end to 12-step recovery. On an average day, pre-pandemic, there are roughly 500 Alcoholics Anonymous meetings. Now, meetings for all groups all over the world have moved online, whether daily or weekly. While that makes them more accessible for some, it’s quite the opposite for those who don’t have access to a computer or internet, especially now that public libraries are closed.
“Traditionally, 12-step service work involved members hosting meetings in shelters and correctional facilities, which are currently not happening,” says Hastings. “This means 12-step outreach is significantly lessened. I fear for the newcomer who can’t drop into a 12-step meeting in person.”
Why the LCBO should remain open
Seeking out alternatives is especially difficult for some due to the stigma surrounding addiction. There was a social media firestorm when province allowed liquor stores to remain open as an “essential” service. Some questioned why access to alcohol is considered essential and feared alcoholics might rely on the substance even more in isolation.
However, as the most common drug used by Canadians “access to alcohol is essential,” says Bangham. In fact, it’s a life-or-death issue with 3.2 per cent of the country having reported alcohol abuse or dependence. This is why, in Ontario, liquor stores are an essential service.
“It would be a public health disaster if they were closed,” she says. “Alcohol is not an indulgent substance for many. Rather, being without and going intro withdrawal has significant consequences that can result in death. People would need to access different substances that could be unsafe or require admission to hospital if they are physically dependent on alcohol and access is removed.”
That could result in a strain on the health-care system, which is already struggling under the weight of the pandemic, even with facilities like Bellwood providing medically supervised detox services. And liquor shop closures might cause those living with addiction to stockpile substances, leading to more use.
In other words, the path forward for those living with addiction is a complex and often misunderstood one, made more difficult amid the pandemic.
“Human interaction is the lifeline for folks that struggle with substance use disorders,” says Bangham. “Social isolation can be triggering for people who rely on the support of others to stay healthy, engaged and alive. In the aftermath of this crisis, I believe that folks who suffer from mental health, addictions and poverty will be one of the greatest hit in this city.”
The key is finding and providing community wherever and however possible.
“Not being able to get to meetings means I need to work even harder to stay connected – it is essential to my sobriety,” says Hastings, who himself is in recovery. Through online meetings, he’s discovered an international support group, which has lent a sense of strength and hope, as has a focus on self-care.
“Going to meetings gets me out of the house, gives me somewhere to go where I can be with others who struggle with the same feelings,” he says. “Isolation during the pandemic means we can’t do this and that’s frustrating. But at the core of 12-step recovery is action. Picking up the phone and calling someone else in the program, or focusing on how I can be a positive agent of change in my own home are activities that allow me to get out of myself, which is a silver lining in a difficult situation.”
Boiling down the recovery process – not just for the months ahead, but as an everyday rule – Hastings keeps it simple: “Take things one day at a time.”