As deaths from drug overdose cut a swath through every province, parents are agonizing over what they can do to protect and support their children.
Whether their loved ones are experimenting with or abusing substances, addiction experts say there is no easy answer, as each situation is unique. But there are things on which most agree: don't blame, don't shame, don't slam the door, or be naive.
Kids are surrounded by drugs. Peer pressure is intense. And parents need to be on high alert because "it's unrealistic to think children won't try drugs," says Donna May, a Mississauga-based harm-reduction advocate, whose 34-year-old daughter Jac, the mother of three girls, died of an opioid overdose in 2012.
"We know more people are dying from first-time and recreational use. When I first got involved in harm reduction, it was all about addiction," says May, whose daughter battled drug addiction for years before contracting a flesh-eating disease from unsafe needles.
"Back then, I don't know if anyone stood out for me who died from occasional use. Now, it's all the time," says May, a founding member of mumsDU (moms united and mandated to saving the lives of Drug Users), a coalition of Canadian mothers who have lost sons or daughters to overdose and other drug-related harms. "We're dealing with an opioid overdose crisis."
An April 29 column in The Globe and Mail reported that, in 2017, between six and seven Canadians lose their lives to drug overdose every day. The Office of the Chief Coroner of Ontario says someone in the province dies of an opioid overdose every 13 hours. Increasingly in both Ontario and British Columbia, an unregulated, illicitly produced opioid fentanyl is responsible. The BC Coroners Service says 120 overdose deaths occurred across the province in March, bringing the three-month total to 347 – on track to surpass the record 922 illicit drug deaths across British Columbia last year.
Hakique Virani, medical director of the Metro City Medical Clinic in Edmonton, says parents are in an unenviable position. "We can't expect parents to automatically start thinking rationally when they're in the difficult position of trying to figure out what is best for their child," Virani says. "They, too, are struggling and trying to reconcile resentments with what their child is doing. They are struggling with the two feelings: one of intense love for their child, and the other, is intense dislike with their behaviour. It's not easy to grapple with."
Virani, an assistant clinical professor at University of Alberta's department of medicine, says he is increasingly alarmed by the rise of fentanyl and carfentanil cases they are seeing at the clinic. Fentanyl – a synthetic opioid detected in cocaine, crack, MDMA (ecstasy), crystal meth, heroin and fake oxycodone and Percoce – can be fatal, even in a few grains. It is 40-50 times more toxic than heroin; and carfentanil is many times stronger than that. "Fentanyl is pretty much all we see and carfentanil is beginning to play a huge role in Alberta," Virani says. "Between Jan. 1 and Feb. 11, 2017, 15 out of 51 fentanyl deaths detected carfentanil."
Virani says he and his staff are always relieved to see a young person come into the clinic with a parent. "Parents are on the front line, and it gives us the opportunity to explain to them what's going on, and help reconcile their resentments with what their child is doing. Our job is to offer support to the parent and the child."
As unpleasant as it may be, he says parents have to be around if their child is using substances and they have to stress how important it is to never use alone. "Both our jobs is to offer youth help and/or medication without judgment."
At Toronto's Renascent treatment facility – which offers an abstinence-based recovery program for people with addictions – Sunil Boodhai, manager of the family program, says addiction is a family disease. "We help parents to understand that addiction is a disease, just like cancer or diabetes. It's something neither they, nor their child, wanted for themselves and can control. Our job is to give them both hope.
"If someone refuses treatment, the parent may have to stand back and allow the child to make a choice and suffer the consequences. Sometimes,that is what it takes to give them the motivation to change.
"We call that loving detachment and it's the hardest thing for parents to accept. But, of all the people I've counselled, the one thing those in recovery say is that they always had someone to talk to," Boodhai says. "I can't underscore how important it is to keep the pathway open back to the family home – even if it's for Sunday dinner."
May agrees. "As a parent, you have to remember it's not about you. It's about them. Communicate your expectations, but put the emphasis on asking your child what they want for themselves."
British Columbia's Leslie McBain also lost a child to opioid overdose: Her son, Jordan Miller, died in 2014 at the age of 25. "As hard as it may be, don't give up on your loved one," she now advises other parents.
"If you get angry or judgmental, the child will shut down. That's just the way life is," McBain says. "The conversation has to be calm and measured. No blame. No shame. No stigmatizing. But it also has to be straight talk on what can happen."
McBain, who is a harm-reduction advocate, also advocates naloxone kits be carried by anyone using, or taking care of, someone using drugs. "It's saving lives." (Naloxone is a medication used to block the effects of opioids, especially in overdose).
For parents of younger children who want to have a talk that helps prevent drug use, experts stress again the importance of being conversational, not critical.
"Talk about what you're reading or seeing in the news and tell them why it's concerning," says Rob Boyd, program director of the harm-reduction Oasis Program at Ottawa's Sandy Hill Community Centre. "Ask their thoughts. Encourage an open dialogue. And, as they age, watch for signs and symptoms of substance use."