By Reka Szekely
For Oshawa resident Peter Payne, being able to quickly access opioid treatment is a matter of life and death.
Payne is a client of Lakeridge Health’s Rapid Access Addiction Medicine (RAMM) clinics who has struggled with a heroin and fentanyl addiction for about five years.
“This place is life-saving,” he said of the clinic, located at Pinewood Centre at 300 Centre St. in Oshawa. “It’s just the chaos of drug use in the community. This is a safe place for people to come, it saves a lot of lives.”
The are two RAAM clinics in Oshawa: one located at Pinewood, a facility that provides addiction services including residential withdrawal management and a walk-in crisis clinic, and the second at the Oshawa hospital, which can be accessed by people visiting the Lakeridge Health emergency room.
Helen Manohararaj, the lead nurse practitioner for the RAAM clinic located at Pinewood, explains that RAAM clinics offer a low-barrier walk-in service for people struggling with opioid addiction and alcohol addiction — that means no referral is required by a doctor, and clients can be seen the same day.
The Pinewood site is staffed by a nurse practitioner and two addictions counsellors, as well as physicians who rotate through on a regular basis. Clients receive a medical assessment, and can be prescribed medication to help manage their addiction on the same day. It’s a new model for Durham, with the clinics opening at the end of January of 2018.
Payne, 34, started using opiates after a divorce.
He first accessed Pinewood services on March 6 of last year, staying clean for seven months after undergoing detox, but he relapsed in November; in February, he once again attended Pinewood, this time accessing the RAAM clinic.
“I just couldn’t do it on my own, I just kept relapsing and relapsing, I just couldn’t stop,” he said.
He explains that within two hours of being at the clinic, he was able to access medication to treat his addiction.
Payne was prescribed Suboxone, which is made up of two drugs: buprenorphine, which only partially activates the brain’s opiate receptors, as well as naloxone, which blocks opiate receptors and is individually used to treat overdoses.
Patients on Suboxone receive relief without going through full withdrawal — the two-drug combination has a ceiling effect, where the body doesn’t build up additional tolerance to opiates.
“It’s almost like a broken key that doesn’t fully activate the (opiate) receptor, but just enough to satisfy the brain to trick it say you don’t need to go into withdrawal,” said Manohararaj. “It also keeps them afloat, keeps them alert, they’re able to get back control of their day, go on and do other things and not be fixated on getting the next dose.”
Whether the client eventually tapers off Suboxone after six months, or continues using it long-term, depends on the individual. For someone with chronic pain, it may be safer to continue to use Suboxone as opposed to other drugs that can build up tolerance, said Manohararaj.
Payne explains that people who use Suboxone still have to want to stay away from opiates like fentanyl — and that it made a big difference in his life.
“It sets you free, it lets you have your life back,” he said. “It kind of helps your regulate your life, you’re no longer spending all your time and your resources trying to find and use drugs, so I was able to go back to work, function normally.”
Beyond the physical relief, he believes that accessing support is important.
“There’s lots of support: having a drug counsellor, other programs you can enter, Narcotics Anonymous, the groups, a lot of things I didn’t participate in the last time I was here,” he said. “Probably reasons for my relapse.”
He stressed the importance of addressing the mental health aspect.
“For a drug user, serious addiction, I’d have to say 95 per cent — including myself — there’s undiagnosed mental health issues that develop from the drug use, the abuses in the environment that you’re in,” he said.
“Everyone has trauma or something that has been done to them that first pushed them to use or to turn to substance use,” said Manohararaj. “A lot of the times, in the clinics the addiction’s the focus and often the mental health is neglected, and being able to recognize it and offering support for both areas is important.”
Once the client is stabilized on treatments for alcohol or opioids, Manohararaj works with other local clinics to take on patients who don’t have family doctors — but also does followup visits at the RAAM clinic.
“People do come in and I do have more time to work through the mental health aspect, and people with chronic pain I’m able to refer out and kind of get them better control, and we do work with psychiatrists on the team.”
Since the RAAM clinics opened in Oshawa, there have been more than 500 individuals who have accessed services accounting for more than 1,700 visits; clients come from as far as Windsor and Orillia to use the services.
"The RAAM provides that quick access: they walk in, they don’t wait, which I think is key when it comes to addiction," said Manohararaj. "They don’t have time to wait, we may not see them again.”
Payne is now back to work, and said that his goals are to reclaim some of the things he has lost. He wants to own a home and a vehicle again. With support from his family, he considers himself more fortunate than many in the community.
“I’ve lost everything in my life and it’s just trying to move forward, not reflect on the past,” said Payne. “I think that’s what keeps a lot of people in that same position. They just want to escape the pain and the loss, the drug use. The worse your life is, the easier it is to use drugs.”
Payne said that he feels like the services at the RAAM clinic were a breath of fresh air, with no judgment.
“It’s harm reduction, it’s not to blame you or put you in jail or call the cops on you. It’s just a safe environment.”
