An estimated 10,000 to 20,000 Canadians have died from overdosing on prescription opioids like oxycodone, hydromorphone and fentanyl in the last 10 years. As CAMH calls on the federal government to strictly regulate high-dose prescription opioids such as fentanyl, it is also supporting clients and their families with a new handbook on opioid treatment.
TORONTO, November 14, 2016 - When Sean Winger looked down 12 floors from his apartment balcony and considered ending his life, he found a lifeline in his back pocket. It was an Addiction Research Foundation (ARF) pamphlet on opioid treatment that he had picked up from his doctor’s office, and it provided the ARF (now CAMH) helpline number. Sean was 21, caught in a daily use cycle of cocaine and the prescription opioid OxyContin. He picked up the phone and made the call.
“I’m grateful I had that number,” Sean says today from his home in Grey Highlands, Ontario. “I knew that I needed something to help manage my opioid withdrawal. The person who answered listened to me without judgment. She provided me with an option to suicide -- she connected me with a local methadone program.”
Sean Winger and his mother Charlene Winger
Now 36, Sean continues to give back to help others caught in a cycle of opioid use. He and his mother, Charlene Winger, were key contributors to a new resource published this month by CAMH.
Making the Choice, Making It Work – Treatment for Opioid Addiction is CAMH’s new handbook for clients and families.
The book answers many questions about opioid treatment options including methadone and buprenorphine (Suboxone) – treatment also known as opioid agonist therapy or OAT. The book can also help clients know what questions to ask their doctor, pharmacist, counsellor and others. “There’s information for those who are thinking about OAT, for the new client and the client who is already taking OAT, and for family and friends,” CAMH editor and Product Developer Michelle Maynes notes in the book’s introduction.
Building on a previous CAMH methadone handbook, the new book explains emerging treatments, overdose risks and response, and new evidence on issues such as pregnancy. Most importantly, it is informed by the voices of clients and families who reviewed it. Their quotes populate and personalize the book.
Dr. Lisa Lefebvre, CAMH’s Medical Lead for Continuing Professional Development and a physician who practices addictions medicine, was a key reviewer.
Dr. Lisa Lefebvre
“This resource really addresses the broader spectrum of patients we’re seeing who have developed opioid addiction starting with chronic pain issues, or from street use of heroin or prescription opioids,” she says. The book provides more detail on more recent treatments such a buprenorphine (Suboxone), which can be provided in tablet form with lower risks around dosage compared to methadone. There is also information on naloxone, a life-saving drug used to counteract opioid overdose.
By incorporating the voices of clients and family members, “this book empowers a disempowered group” – giving them a voice in treatment and education for others, Lisa says.
The new handbook also normalizes opioid agonist therapy for those who may receive it for many years. “There may still be a stigma for a person who is on methadone treatment,” notes Shannon Greene, CAMH Manager, Addiction Medicine. “But this is a medical illness, like diabetes, that requires medical and psychosocial treatments that over time will allow the patient to improve their quality of life.”
Sean can empathize. He’s carving a new life for himself, literally and figuratively. He is now a wood artisan, turning works of wood art on a one-way lathe. He also mills some wood on the family property. The family dog Felkin, a Silken Windhound, is a constant companion in the great outdoors. In moving to the country, Sean also made positive lifestyle changes. He’s made new friends and lives in a separate apartment in a home his parents purchased recently on 100 acres of hardwood, meadows and trails.
Sean, Charlene and Felkin with one of Sean’s art pieces, a hand-made cherry wood bowl.
Most importantly, Sean continues to advocate for people who are struggling with addiction. He was a contributor to the Ontario Minister of Health’s 10-year Strategy for Mental Health and Addiction, and a member of the province’s Expert Working Group on Narcotic Addiction. He has provided addictions counselling and peer support to many people who’ve faced similar challenges. Sean is currently on the faculty of the Opiate Dependency Treatment certificate course offered to physicians and pharmacists through CAMH. He’s obtained an addictions counsellor diploma and attended undergrad courses at university.
“I remain on a methadone program and likely will for the rest of my life,” Sean says. “It has helped stabilize me from returning to street drugs and risk overdosing.” Like all of us, he has his ups and downs, but continues to try to find “new ways to find meaning in the world.”
Sean, second from right between Ontario Premier Kathleen Wynne and former Minister of Health Deb Matthews, was part of the province’s Expert Working Group on Narcotics Addiction.
“While methadone is an effective, evidence-based approach to managing opioid dependency, it’s not a cure for addiction,” Sean says. “It does not address cravings or dependencies for other addictive drugs such as crack or cocaine. Addiction is unique to each individual. Treatment needs to be multi-faceted and tailored to address complex situations.”
Sean’s mom Charlene has worked in the field of mental health and addictions for nearly three decades.
“I’ve often heard others speak of taking a "tough love" approach towards loved ones struggling with addiction,” she says. “I believe that taking a punitive or simplistic approach to a complex and desperate situation is dangerous. For example, telling a loved one that they should just quit "cold turkey" may lead to decisions that end in a death due to suicide.” Quitting suddenly can also result in accidental overdose later due to reduced tolerance.
Treatment decisions need to be determined by the individual client. “They need to know all of the effective options,” Charlene says. “In this case, a harm reduction approach through OAT is considered a best practice for managing an opiate dependency.” Both Sean and Charlene have shared their insights as members of CAMH’s Persons with Lived Experience Advisory Group.
“Family members and other loved ones must do their own personal soul searching to understand what responses are authentic to their needs,” Charlene says. “For me, my goal is for my responses to come from a place of love. Not always easy to do, but that’s always my intent.”
The new handbook is available in print and as a free online resource.
Related resources from CAMH include a new brochure, Opioid Agonist Therapy: Information for Clients, which provides a short form of the new book, and opioid treatment guides for pharmacists, physicians and counsellors.