Charlotte Munro, a survivor of opioid-related cardiac endocarditis, at her home in Stratford, Ontario.Galit Rodan/The Globe and Mail
Charlotte Munro was in pain. Her thigh muscles ached. Her legs and feet were swollen. It hurt just to sit down. “I felt like I was dying,” she recalled recently.
The Stratford, Ont., woman, who had become addicted to opioids after taking painkillers for a bone disease, asked her mother to drive her to hospital. She passed out on the way and fell into a coma that lasted two weeks, the result of a serious heart infection related to her drug use. Her condition was so dire her family started discussing funeral arrangements. She woke up on Christmas Eve, 2014, fortunate to be alive.
Fatal overdoses are the headline news in the opioid crisis. The numbers are staggering and they are getting worse: British Columbia just reported more than 200 deaths in a single month. What is often overlooked is the toll on the survivors – the walking wounded of the crisis. Some get through overdoses and suffer brain damage or other disabling consequences; others struggle with rashes, abscesses, collapsed veins or hepatitis C.
“It’s easy to project the spotlight on overdose deaths, but there are far, far more people who have experienced an overdose, lived and had long-term effects from that,” said Seonaid Nolan, a doctor at Vancouver’s St. Paul’s Hospital. Though they cheated death, “their trajectory in life has just markedly shifted.”
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As the crisis has deepened and the potent synthetic opioid fentanyl has taken over as a mainstream street drug, Dr. Nolan has been seeing more and more patients whose brains were starved of oxygen when overdoses slowed their breathing. The effects can range from mild cognitive impairment – they may have trouble remembering the date or year – to a vegetative state. They can also suffer liver or kidney failure and immobility of the arms or legs.
One woman in her early 40s who recently came into Dr. Nolan’s hospital with an overdose spent five days on a ventilator and was left with mental and physical damage. Her devastated family had to transfer her to a care facility.
Infections, too, seem to be getting more common. A study by the Ontario Drug Policy Research Network found that between 2013 and 2019 the rate of spinal infections among hospitalized drug users went up 394 per cent. Bone infections went up by 191 per cent, and skin or tissue infections rose by 147 per cent.
At a clinic in Vancouver’s Downtown Eastside, Christy Sutherland sees patients with infections of the skin, blood and bone, often the result of using drugs with unsanitary water or needles. Some users develop open sores that cause them extreme pain. The clinic treats their wounds and gives them antibiotics.
“I often see young people with medical complications you wouldn’t normally see until someone is much older,” she said. Those include heart failure and COPD: chronic obstructive pulmonary disease, a lung condition that can leave sufferers short of breath. Like many in the addictions field, Dr. Sutherland wants users to have access to sanitary drug-use equipment and a supply of safe, regulated drugs.
Portraits of loss: One hundred lives felled by an overdose crisis
Indigenous people are disproportionately affected by the secondary health problems of the opioid crisis. On the territory of the Blood Tribe in southern Alberta, health officials have been coping with 300 to 350 cases of hepatitis C, an infectious disease spread by contaminated blood that can damage the liver. It is common among intravenous drug users. Local doctor Susan Tallow Christenson said she is also seeing cellulitis, a bacterial skin infection; infections of the extremities; and malnutrition, anemia and pneumonia – not to mention a big spike in overdose deaths.
One of the most serious complications for drug users is the one that afflicted Ms. Munro: endocarditis, an inflammation of the heart lining that put her in a two-week coma in December 2014.Galit Rodan/The Globe and Mail
Thankfully, hepatitis C is now curable through a course of oral medication. Former autoworker Jeff Lovelock, 57, of Oshawa, Ont., said the meds cleared him of the disease, which he suspects he carried for many years before he overcame his addiction to drugs. But he said many drug users have unstable lives and struggle to keep the routine of taking their hep C pills.
One of the most serious complications for drug users is the one that afflicted Ms. Munro: endocarditis, an inflammation of the heart lining that develops when bacteria flow through the bloodstream and get trapped in the heart. It can erode or destroy the heart valves.
The Ontario study showed that the number of cases went up 167 per cent between 2013 and 2019. It also showed that one in four drug users with endocarditis died in hospital or within 30 days of discharge.
A cardiologist at Toronto’s St. Michael’s Hospital, Chi-Ming Chow, said endocarditis sufferers often complain of unexplained fatigue or a fever that won’t go away. “This is one of the conditions that very few people know about,” he said. “We have to be extremely vigilant because it can easily be missed.”
Bacteria can spread from the heart to the lungs or to the brain, causing stroke. Dr. Chow tries to tame the inflammation by putting patients on aggressive doses of antibiotics. If the damage to the heart is already done, he may have to perform surgery to replace a ruined valve with an artificial one.
A U.S. study published last month in The Lancet Public Health said endocarditis and other infections linked to injection drug use are “increasingly common,” and that hospitals need to get better at providing treatment tailored for people suffering from addiction, as well as linking them up with help after they leave.
In Canada, some hospitals already do that. Ontario has opened a string of Rapid Access Addiction Medicine (RAAM) clinics that help patients get quickly onto addiction medicines that help control their disorders. The clinics connect patients with treatment programs and medical help for their health complications.
Overdose-prevention sites, which were pioneered in Vancouver and have since opened up across the country, help reduce other health issues. They supply visitors with sterile needles, cookers and other gear. Nurses treat common problems such as abscesses, painful pockets of pus that intravenous drug users can get in their skin and muscle.
But many in the addictions field say care still falls far short of what it should be.
“My concern is that we make this broad-sweeping assumption that if people survive the overdose they’re okay,” said Tara Gomes, a scientist at St. Michael’s who was one of the authors of the Ontario study on infections. “It’s not enough just to think the overdose is reversed and they’re just back to where they were before.”
Because of the stigma that still comes with drug use, she said, many patients aren’t taken seriously, given the proper tests or treated in a timely way.
Ms. Munro, the endocarditis patient, went to hospital three times before her collapse. No one discovered how sick she was. She said she was looking rough at the time and felt labelled. A lab technician told her he didn’t understand why people would stick needles in themselves every day – as if her addiction was a choice. In the eyes of the world, she had gone from being a person in pain to “a junkie not worthy of medical care.”
After months of treatment following her coma, she made a remarkable recovery. Now 35, with a job as a social worker, she has been sober for six years and is expecting a baby.
Proponents of safe supply say it’s a way to curb the growing number of Canadians dying each year to a street drug supply saturated with dangerous substances such as fentanyl. Safe supply programs offer pharmaceutical alternatives and studies show they can prevent overdoses and other crime, while critics worry that recipients may sell their prescribed drugs to buy other substances.
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