Pembroke – Last week saw Renfrew County paramedics on foot in the city, reaching out to the most at risk in an effort to stem the growing tide of opioid deaths in the area.

For Renfrew County is in crisis. There is an opioid crisis and paramedics are responding with an ever-increasing frequency to overdose calls, many resulting in deaths.

“Last year 39 people died, some with no knowledge of what they were taking,” said Renfrew County Chief Paramedic Mike Nolan. “I don’t think the intention is to kill but it is a race to why your drug is sought after.

“Dealers and users can’t tell you what is in it,” he said. “Some dealers do not know what they are selling.”

Each year county paramedics are responding to approximately 900 calls related to mental health and substance abuse. This only factors in calls where this is the primary health issue.

Right now paramedics are responding to at least one overdose call a day, sometimes more.

“It is one a day, every day. Minimum,” he said.

The supply is readily available and toxic. Some people overdose repeatedly. While drugs are nothing new, the prevalence of opioid overdose and the steep rise is, as well as the change in the type of drug in the area. The chances of an overdose have increased dramatically with an incredibly toxic supply as producers mix various concoctions to make the high better than ever.

“We noticed a sharp increase in about 2020 and we have noticed a significant rise year over year,” he said. “People overdosing repeatedly is speaking to the level of addiction and the power of addiction and the lack of resources.”

In response, paramedics are taking a new approach through mobile response teams and reaching out to people offering support, and information about existing services and referrals, all before an overdose occurs. It is a pro-active approach similar to the community paramedicine program pioneered in the county and another way of responding to an individual to help before the call is received for an overdose death.

Chief Nolan said this approach is looking at the best way to respond to addiction issues, while also addressing mental health issues and other factors. It is the continuation of an effort to engage with a very vulnerable population which has been identified as being at risk.

“Last week we began with foot patrols with the OPP in Pembroke and we have been working at The Grind for a few months,” he said. “VTAC (Virtual Triage Assessment Centre) has provided support and now over the next three months we will be increasing our presence.”

The new paramedic teams serving different areas of the county are in some ways an extension of the community paramedicine program which sees paramedics responding before people reach a crisis point with their health. They will travel in the well-marked SUVs and have with them either a mental health crisis worker or addictions worker, as well as having back-up support from the Renfrew County homeless coordinator support team.

“We are identifying people proactively who have had a crisis in mental health,” Chief Nolan said. “We are trying to take a broader net than simply if you are unhoused and have mental health issues.”

Social determinants of health are affected by no housing or precarious housing, lack of access to health services, limited access to support services, low income and precarious employment, among other things.

A report from the county shows 19 percent of Renfrew County’s population identify with having mental health or addiction challenges, which is higher than the provincial average. Of these people, one in seven do not have a primary care provider.

The report also showed both 911 and emergency room data indicate the number of mental health related calls are increasing and there are between 1,500 and 2,300 mental health related emergency department visits made annually to Pembroke Regional Hospital, Renfrew Victoria Hospital and St. Francis Memorial Hospital in Barry’s Bay.

The highest concentration of opioid-related deaths is in Pembroke and area, which includes Bonnechere Valley, Laurentian Valley and Whitewater Region. In recent years, the incidence rate was 17.7 per 100,000. In Deep River and area, including Head, Clara and Maria and Laurentian Hills, the incidence rate was 12.4 per 100,000. Barry’s Bay and area had an incident rate of six per 100,000. Deaths in Pikwakanagan were not included in the county data presented.

Growing Crisis

The opioid crisis is not unique to Renfrew County and the City of Pembroke. The Algonquins of Pikwakanagan First Nation declared a state of emergency recently to deal with the opioid crisis and signs leading into the community point to increased police presence as a result. Other parts of Ontario have identified a crisis and there are calls to do more. This is not a crisis facing only this area, but the response, like many others before it, is being tailored to suit the area and once again is being led by paramedics on the ground.

Chief Nolan has no easy answers as to why there is a growing opioid crisis. The pandemic created a mental health stressor and then there have been economic pressures post-pandemic, but he admits it is more complex than this.

“There are issues of access to care, amplifying issues,” he said.

In Renfrew County it can be difficult to access treatment services. There are addictions programs but a full rehab centre is not available locally. Factors of mental health and access to mental health services are also impacting the number of people dealing with substance abuse problems. While Chief Nolan stressed addiction is not all about mental health, it is a component in some cases.

Perhaps there is an easier access to a toxic supply, and many users are searching for a high without realizing how deadly some of the drugs they are taking are.

“We have seen deaths in recreational drug users who did not know there were opiates in their unsafe drug supply,” he said.

Some people are first prescribed opioids for surgery, even dental surgery, and when their prescription runs out, they seek out recreational drugs. The drugs can manage the pain and perhaps other trauma or anguish which has surfaced. The drugs are becoming more readily available and the chance of addiction and overdose ever more present.

“There was always a risk,” he said. “You can get something that looks like a prescribed drug through the mail.

“What I am learning is the unsafe supply comes through various channels – organized crime, street users,” he said. “There is a desire for the latest and greatest high.”

The producers add tranquilizers, stimulants and narcotics to drugs, trying to create something with a more powerful effect and something which addicts will want. The drug user tries something new, many times overdosing, sometimes fatally.

“There is a belief they can handle it,” he said.

Systemic Approach

Chief Nolan said in dealing with the crisis, the county is looking at a systemic approach and addressing some of the many issues which affect people and put them in crisis. The response by paramedics is one of a multi-pronged effort to respond to needs which lead people to a crisis point.

“There is a lack of affordable housing and services are not easily aligned,” he said. “We don’t have a detox program. We have addiction services, but no comprehensive strategy.”

Looking at transitional housing and modernizing the social housing stock is one aspect of dealing with the crisis people are facing. In December there were 1,465 applications for social housing in the county. The majority are for adults seeking a one-bedroom apartment.

“How do we rise out of this?” he asked. “It is about putting all these blocks in place. If they choose to accept assistance, then that assistance is aligned in a way that sets them up for success.”

Chief Nolan acknowledged it is one thing to ask someone if they want to kick their habit but quite another thing to have an immediate plan to help. He points at other programs, like the Salvation Army program in Ottawa, which has a 95 percent success rate in helping people off the street, as a model.

“We are trying to learn from the experts but do it in a way which aligns with the programs we have,” he said.

Locally, the new paramedic response teams are similar to a program already in place in Ottawa but tweaked to suit Renfrew County. This Mental Health and Addictions Model of Care in Ottawa had a response team for mental health and addictions clients and resulted in a 66 percent ER diversion rate. Challenges in the county not only include the lack of addiction treatment services and mental health services but also the vast geography.

The two new paramedic teams will be reaching out in the community 12 hours a day, seven days a week in two different locations within the county. Working with community partners, when they identify someone who needs help, they have supports in place, he said.

As far as the cost of the program, Chief Nolan said it was not taken out of the levy – the amount taxpayers pay to the county for county programs – but found in other savings. The program is now being supported through the service’s operating budget, which in itself does receive provincial funding. However, the county will be seeking out additional funding opportunities and long-term funding to keep the program going.

The chief pointed out paramedics helping people before they are in crisis and helping them deal with other related issues is a far more cost-effective alternative than seeing people escalate in their behaviour where they are either facing incarceration or hospitalization. A recent study from the county showed the costs per month on a hospital ward are $32,500, while a provincial jail costs $15,000 a month, a shelter $7,000 a month and supportive housing is $3,500 a month.

“You pay a heck of a lot more if we don’t find some local solutions,” he said.

County Mesa Initiative

The paramedic teams are part of a Renfrew County initiative called Mesa, which is described as a collaborative approach to compassionate care. Essentially it is a three-pronged approach dealing with people at risk. Initiatives include dealing with homelessness, substance abuse and addictions and mental health. The initiative involves Renfrew County Community Services, Paramedic Services and the Development and Property Department, as well as partner organizations serving in the county.

County CAO Craig Kelley said the initiative began last August at an Association of Municipalities of Ontario (AMO) conference which focused on issues dealing with homelessness. He said while many of the issues are the same, the vastness of Renfrew County called for a different approach.

“We need something mobile. We want to reach urban centres and hinterlands,” he said.

Bringing senior staff together, they came up with Mesa and are in the process of implementing it.

Phase one of the approach was the County of Renfrew’s involvement in the “Out of the Cold” Warming Centre offered by The Grind Pembroke this past winter in partnership with the City of Pembroke, Township of Laurentian Valley, and Town of Petawawa and private partners. Mr. Kelley noted the $80,000 contribution from the county was from homelessness initiative funding from the province and the county directed it toward this program.

The second phase is where the paramedics come in with the response teams created with community paramedics and addictions and crisis workers responding to calls across Renfrew County. According to the county, the idea is to meet individuals where they are in the community to provide the necessary supports and connect them with existing service providers. Once again, this project was not funded by property tax money, Mr. Kelley said.

“We had surplus money from some COVID funding,” he said. “Many of the mental health and homelessness issues were stressors from those times.”

As well, there was some reserve money pulled which should fund this project for between 18-24 months, he said.

“It doesn’t need to be on the backs of taxpayers through property tax,” he said.

Work has already begun on phase three of the project – to provide transitional housing supports for individuals in the community. The county promises more will be announced in coming weeks. As well, Mesa also addresses gaps identified through the Housing and Homelessness Strategy. 

“We are building new units in Pembroke now and we are designing a modular village for seniors,” he said.

The county is also looking at the possibility of transitional housing spaces for people who have been using the warming centre, he said.

“We don’t want to throw taxpayer money at everything,” the CAO said. “Health care is a provincial and federal responsibility.”

However, the paramedic initiative is an example of working together for the best outcome, he noted.

“We have the teams to put this in place,” he said.

Mesa is described as an evidence-based “escalator model” designed to transition people out of harm and towards an equitable community landscape. The goal is to support individuals to move towards health, well-being and a safe place to call home. According to the county, “the one direction, fluid model provides the innovative care and access to secure housing required for community members to thrive independently.”