Opioids and COVID-19: A Crisis Within a Crisis — Josée Joliat

Alex Maheux:

With the Covid-19 pandemic evolving at a rapid pace, it’s possible that circumstances may have changed since this interview was originally recorded, and this interview may not accurately represent the current situation.

Hello, and welcome to the Canadian Health Information Podcast. I’m your host, Alex Maheux.

In this program from the Canadian Institute for Health Information, we’ll be taking a look at Canada’s health care systems, with the help of some highly qualified experts. Stay with us to hear more about our health policies and systems and the work being done to promote the health of Canadians.

Today, we’ll be discussing 2 overlapping crises: the opioid crisis and the COVID-19 pandemic. We’ll be talking with Josée Joliat, a public health nurse on the mental health and substance use team at Public Health Sudbury and Districts in Ontario. Josée is the community drug strategy coordinator for the city of Sudbury, and works to address problems around opioids and other substances by taking a global approach.

Keep in mind that the opinions and comments of our guests do not necessarily reflect those of the Canadian Institute for Health Information. So let’s get down to business.

Hello, Josée. Welcome to the CIHI podcast.

Josée Joliat:

Hello. Thank you.

Alex Maheux:

So, the spread of COVID-19 here in Canada and around the world over the last 18 months has had severe consequences for the health of all Canadians. But we also know that some groups have been disproportionately affected, including those who are living with substance use. In your role as a public health nurse, how do you find a balance between this pandemic that’s taking a huge toll, the opioid crisis, and other problems in the community?

Josée Joliat:

Mm-hm. And let me also say that I think it will take a little while to understand the effects that the pandemic has had on our communities. Once we get out of the pandemic, it’ll be interesting to see what things will look like, basically. But as far as balancing my work, it’s certainly true that the pandemic has taken up a lot of our time and a lot of our resources, of course, but I think it’s important. And what our agency has continued to do is just make sure that we’re keeping in mind the different communities that we do have to provide services to, and who do deserve to be considered, especially the people who are disproportionately affected in our community. We think about social determinants of health, we see the results, we see the reports coming out on people living in poverty or facing career issues, housing issues, and so on.

But I think that what’s helped us is our community drug strategy, which is our group of local collaborating organizations where we have various agencies, various sectors involved to look at the impact of drug use in our community. I think the collaboration in that group has really helped us. We’ve seen programs and initiatives coming out of that. We think a bit outside the box so we can respond to different needs, and I really think it’s those collaborations that have helped us out a lot. We know that when it comes to drug use and reducing the harm it causes, that this is work we need to do as a community. So it’s important to keep that in mind when we’re doing this work.

Alex Maheux:

We hear a lot of numbers around opioids, but of course we’re actually talking about real people. How are things going on the ground right now, and what message would you like to share with us?

Josée Joliat:

Well, I think what’s important to remember is that right now, as far as the illicit drug market, it’s really the levels which are toxic, but also the fact that they’re unpredictable, which makes it so dangerous for people. These are people who are in survival mode, and we’re continuing to lose a number of people in our community. We just got our annual statistics for 2020. We knew that the numbers were going to increase because they’ve been increasing since 2017, but it’s really a shock to see how each of these people had a family, had a community, and had people around them. And having lost those people, it really hurts to see the devastating impact that’s had on our community. But I also think we just need to remember that there are so many different things we can do in our community, too, in order to support those people.

In 2019, we came out with a campaign called “We Are Jeff,” which looks at the different things we can do to support people, no matter what our role is in the community, whether it’s with small children, in the workplace, in the health care system, etc. Every person can have a role to play to make a difference in a person’s life — that’s basically the moral of the story in our campaign. So it’s just about keeping that in mind and continuing with those interventions, which help us a lot.

Alex Maheux:

The most recent CIHI report describes the unexpected consequences of the COVID-19 pandemic. Specifically, we’ve looked at the harm caused by substance use and we’ve seen that emergency room visits and hospitalizations relating to fentanyl and opioid poisoning have increased by 28% and 49%, respectively, in the past year. How are the pandemic and the health restrictions affecting your work? What are the biggest challenges?

Josée Joliat:

Well, at the start of the pandemic, we saw that the recommendations from public health for people to protect themselves from COVID-19 kind of went against the precautions we encourage people to take to reduce the harm associated with substance use. For COVID-19, we tell people to isolate themselves and stay away from other people, but as far as substance use, isolation can kill a person, not having someone around to watch over you and be able to respond if you end up overdosing. So those messages are kind of contradictory. But in the communities, people were again able to think outside the box — I think that’s pretty much been the big recurring theme of the pandemic — and to put solutions in place as best they could.

There are things like overdose hotlines that were set up that we strongly encourage in our communities so that people can feel reassured. What the person can do, if they have access to a phone, is to call this number and get someone on the line who can respond to their needs. And what’s good is that it’s a hotline that was created by and for people who use these substances. There are also things like isolation centres for people living with homelessness. These are different methods or different interventions that we were able to react and set up quickly because we saw the need, we saw that it was very important to set something up. <inaudible 07:03> the data, exactly, I think it was really a shock for our communities when we saw those figures.

Alex Maheux:

Mm-hm. You talked about hotlines and isolation centres.

Josée Joliat:

Mm-hm.

Alex Maheux:

Were there other programs and strategies that you used to find solutions to those same problems?

Josée Joliat:

Mm-hm. We even saw various agencies or organizations in our communities who went a bit above and beyond and got together so they’d be able to continue offering services. The Withdrawal Management leaders were able to continue offering those services to the community. Because with the need to close down all the services and adapt to the public health recommendations, it was difficult to maintain the services that people were so accustomed to having, like support groups and so on, and we couldn’t have those anymore. So you’d have a person who would find larger apartments to meet in so that there could be support groups where people could be a bit more physically distanced. So again, thinking outside the box.

Alex Maheux:

So you’re in Sudbury, which is a more isolated and rural community. Are there particular challenges that you have in your community?

Josée Joliat:

Yes, absolutely. There are challenges in all rural communities, especially in northern Ontario. There’s a lot of data to support that point. For example, we just got our data from the coroner’s office for 2020 about opioid-related deaths. The incidence in our region is the highest in our province. The top 5 regions in the province are almost all in northern Ontario. We see Algoma, we see the Timmins area, we see Thunder Bay as well. That’s the proof, when you look at the figures and the data, that it’s really northern Ontario that’s the most affected.

There are several reasons for that. There’s a lack of resources, and also just the fact that… You know, we put a big emphasis on our major urban centres, but the same problems that we see in major urban centres also show up in our rural communities. And another thing is that…I mentioned the lack of resources, but we also have populations that are minorities as well. So, the francophone population. We also have a larger population of people who are First Nations, or Inuit, in these isolated rural communities as well. So that adds a bit to the challenges that other centres or other regions may be dealing with.

Alex Maheux:

You mentioned a lack of resources in the more rural communities. I was also wondering, in the different cultural regions, how stigma might play a role in the use or consumption of these substances. What do you do to try and reduce the stigma in your community?

Josée Joliat:

Yes, absolutely, and unfortunately those stigmas kill. It’s the sense of being judged, and the prejudices, and also people’s shame about it that has such a big impact when we talk about substance use, and also setting up interventions. We see in various communities, and Sudbury is no exception, we see people who resist setting up harm reduction services, or services to try to help people who use these substances. That has a big impact on being able to set up those services, especially when we’re in a region that lacks the capacity to be able to really prioritize that work full-time. So, yes, it can be very difficult.

Alex Maheux:

I imagine that being a health care worker in this field is already a very difficult job. How do you manage that stress, and how are you feeling?

Josée Joliat:

To manage the stress, I think it’s just a matter of continuing day by day, and really knowing what the finish line is. The opioid crisis is a big issue, and it’s a big problem in our community. No one person will be able to end the crisis, but knowing that all the work we’re able to do in this area is doing some good, and thinking about that, and being able to just keep going. But I think what also helps with this role is seeing all the different initiatives that are coming out of the community. Since the pandemic, we’ve seen volunteer groups emerging, people who see the needs, who are able to help different people in our community and get together and adapt to find ways to help one another. Those are the things that really warm my heart, and seeing that people want to make a difference and that it’s worthwhile to keep putting in the work. So, I hope that with these groups, it’ll help us to amplify the message that we’re trying to promote, that the opioid crisis is something that’s a priority and that we have to continue fighting it and setting up interventions to save lives — because fundamentally, that’s what this is about, is saving lives.

Alex Maheux:

Mm-hm. And on that final message, what do you hope the future holds in this area?

Josée Joliat:

It’s hard to think about the future. I try to avoid it, because this field changes so much. The trends, the needs just change so much. But I think that our community, even at the international level, what we’ve seen is that when we commit to it, we can really change all of our systems. And with that, I hope we’ll be able to prove to ourselves that we’re able to set up some really major initiatives, the big changes we need, and that we’ll be able to help these communities that are disproportionately affected, and to save people who are using substances from an illicit market that’s toxic, unpredictable and dangerous. We see solutions that have been set up in other communities. So these interventions, like supervised injection sites or supervised consumption sites, just seeing interventions like those. I hope we’ll be able to see where people in all communities can have access to harm reduction interventions at that level. That’s really what I care most about.

Alex Maheux:

And I think that with people like you in the profession, we can certainly make a difference. Thanks again, Josée, for being with us today, and for the important work you’re doing in your community.

Josée Joliat:

Thank you for having me.

Alex Maheux:

Thank you for listening. We hope you enjoyed this episode. Join us again soon as we continue to present interesting perspectives and dive into health-related topics that interest you. To learn more about CIHI, visit our website at cihi.ca. If you enjoyed our discussion today, subscribe to our podcast, leave us a comment and follow us on social media.

This episode was produced by Jonathan Kuehlein, with help from Amie Chant, Marisa Duncan, Shraddha Sankhe and Ramon Syyap. I’m Alex Maheux. Thank you for listening to the Canadian Health Information Podcast. Until next time!

<End of recording>