More opioid poisonings in rural areas likely a result of drug volatility, not more use

In early December, RCMP and paramedics received two calls within minutes of each other for drug overdose deaths in Springhill.

Within a week, Public Health and Nova Scotia Health’s mental health and addictions program had set up sessions to inform the public and answer questions about the drug in the area, and offer resources for people struggling with addictions.

Emily Percival-Paterson, a harm reduction consultant with Public Health, said a lot of the information the department has is anecdotal because there isn’t a robust drug checking program on abuse overall, but there has been an increase in fatal drug poisonings in rural areas in the last few months.

“I think a misconception about substance use is that it happens in the city and people think (those) folks are unhoused or living on the streets and so on, and they don’t necessarily think people use substances in rural areas,” Percival-Paterson said in a recent interview. “People use substances in every community in Nova Scotia, it’s not just a city problem.”

There are currently harm reduction sites for addicts in Sydney and Halifax, but none outside those high-population centres.

“Anyone who uses unregulated drugs is at risk of a drug poisoning and we’re seeing the detrimental effects of that increasingly in our communities,” she said.

“I can say from our drug harms alert (system), we have sent out more alerts this calendar year than in any since the system was introduced in 2020.”

The majority of those warnings have been in the urban centres, but they are based on reports from community organizations that Public Health partners with, and most of the organizations are in those centres. Those reports include non-fatal overdoses as well as deaths.

The department can also get an idea of the numbers through use of Naloxone, which can reverse an overdose from opioids. The department gives out free take-home Naloxone kits that people can use to help someone who overdoses, and there is a reporting method for people who use the kits.

As of mid-December there were more than 700 reports of people using the kits, “but we assume that the number is much higher because the reporting is optional,” Percival-Paterson said.

“There are more poisonings than deaths, but I couldn’t tell you the exact proportions, and I don’t think anyone could with any certainty because there are poisonings that happen that never connect with our health-care system.”

By late December there had been 56 recorded deaths due to opioid poisoning in Nova Scotia.

She said the drug supply is changing and becoming increasingly volatile and contaminated, and unpredictable in its makeup and effects. She said that may be having an effect on the increasing number of incidents in rural areas more so than there being a significant increase in use.

“A factor that may influence when you see a cluster in a rural area is that folks may be more likely to be using the same things. Folks may come to the city, stock up . . . and then share and be using that same supply.”

In late 2023, Public Health saw three different drugs test positive for fentanyl at the harm reduction site in Sydney “which is something we’ve never seen before. As we see the supply become more variable and more unpredictable, we’re going to see the harms spread.”

While there are harm reduction sites in rural parts of the province, Percival-Paterson said users in those areas can still take advantage of the National Overdose Response Service, a phone-in line that people can call while they use drugs so that if they become unresponsive, the call taker will send help.