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The Opioid Crisis and Trauma-Informed Communities

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Written by Victoria Peters, Manager IMPACT and Mental Health & Justice

This year Canadian Mental Health Association Waterloo Wellington joins organizations across the country in observing National Addictions Awareness Week from November 26 to December 2.  Education and awareness are key components in dispelling stereotypes and reducing stigma associated with addictions and recovery.  At top of mind currently is the opioid crisis, an issue that has grown to epic proportions and has revealed itself locally in Waterloo Wellington. Eighty-five lives were claimed in Waterloo Region in 2017 and thirty-seven lives have been claimed to date in 2018. The numbers come from all walks of life and include addiction to prescription pain relievers, heroin, and synthetic opioids like fentanyl. The statistics are grim and have led Canada’s chief public health officer to warn that the opioid crisis is “not abating.”

One of these statistics was the son of a client* (details of story have been changed to protect privacy) with whom I recently worked.  My client had tried for years to help her son overcome his addiction and to connect him with help, but in the end the power of his addiction won over her valiant efforts to save his life.  He died after ingesting heroin that was laced with fentanyl.  My client is not alone in her grief; there were more than 8,000 apparent opioid-related deaths between January 2016 and March 2018 in Canada.   It is unbearable to think about the collective grief and pain related to those 8,000 lost lives.

So, what are we doing about this? Reading the attention-grabbing headlines is not enough; an innovative approach that has its roots firmly planted in our local communities is required.  Those roots cannot grow if our local systems – including daycares, schools, child welfare, hospitals, police and justice services to name a few – do not have a solid understanding of the underlying causes of addiction in the first place. Both social and structural stigma need to be addressed, and above all, we need to educate ourselves about the complexity of pain, which after all is at the heart of the opioid crisis.

Indeed, pain is complex and according to the innovative thinker, physician and author Dr. Gabor Mate, “… we don’t explain how physical pain is often a result of a combination of both physical and emotional factors. We don’t learn how to speak to people with pain and how to listen to them. We don’t learn about the roots of chronic physical pain and chronic emotional pain that often lies in childhood experience.” His book In The Realm of Hungry Ghosts, offers a view that counters the black and white notions of addiction being either a genetic disease or an individual moral failure. Dr. Mate says that the best question to ask is, “not why the addiction but why the pain?” He takes a trauma-informed approach to addictions that views poverty, isolation and painful childhood traumatic experiences as major risk factors for developing addiction.

Some may not understand the connection between trauma, pain and the opioid crisis, but essentially, opioids treat pain. They also produce a sense of wellbeing or euphoria, so they literally treat physical and emotional pain. Opioids can also be very addictive and so it makes perfect sense that people who have been prescribed opioids to treat physical pain may become addicted if they are also seeking to escape emotional pain. For those people whose social determinants of health include the experience of trauma, social exclusion and poverty, it matters that opioids, whether legitimately prescribed or purchased on the streets, are a powerful way to escape emotional pain.

A trauma-informed response to the opioid crisis therefore must include asking the question, “why the pain”? What if, as trauma-informed communities, we were to start asking that question to children who misbehave in school. What if we started asking that question to teens who turn to alcohol and drugs to escape their reality. What if we started asking “why the pain” to street-involved and justice-involved people who chase euphoria in a desperate effort to escape their pain?

A trauma-informed response views trauma (childhood or otherwise) as both the cause and the consequence of the opioid crisis.  It demands a response that is holistic and multi-faceted and does not just include limiting the supply of opioids in communities or giving physicians better guidelines for prescribing them.

What if my client’s son had been asked, “why the pain?” after he was abused by a family friend at the age of ten. What if his childhood teachers had asked him “why the pain?” when he began to misbehave in school. What if, after he dropped out of school altogether and began breaking into cars to steal money to support his drug addiction, the police or his probation officer or a crown attorney or a judge had asked him, “why the pain?”  Maybe he would be alive today and his mother would not be blinded by grief. Maybe the other 8,000 grieving families who have lost loved ones to this crisis would not be experiencing this pain either.

Addiction is not a moral failing. Pain, whether it is physical, psychological or both is real and we do have an opportunity to create resilient communities by adopting a trauma-informed systemic approach. The “unabating” opioid crisis affects everybody, whether we know somebody personally who struggles with addiction or not. It all starts with asking one simple question.  #allwalksoflife

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