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Problematic opioid use: Your options for treatment

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Opioids are powerful narcotics with painkilling properties. Although many opioids are prescribed by doctors to help people cope with pain, they can be dangerous. Some people become addicted to opioids: they experience cravings and withdrawal symptoms, and have difficulty stopping their use even when they want to. Opioid use also puts you at risk for overdose: opioids work by relaxing the nervous system, making us less aware of pain. If the nervous system gets too relaxed, it can stop performing survival functions like breathing, sometimes leading to death. It can be very hard to accept that your opioid use is problematic; it’s normal to feel ashamed, frightened, or angry, and you might not be ready to stop. This pamphlet contains information about how to increase your safety and decrease your chance of dying from an accidental overdose, and how to seek help for an opioid addiction. For more information, please visit www.metaphi.ca.

What’s a RAAM clinic?

Rapid access addiction medicine (RAAM) clinics are drop-in clinics for people looking for help with their substance use. The people working at these clinics know how difficult it is to ask for help. You don’t need an appointment to attend this clinic – just show up during clinic hours with your health card.

Your history

The clinic team will begin by asking you about your history of alcohol use: when you started drinking, how much and how frequently you drink, the ways in which drinking has affected your life, and so on. Try to remember the clinic team is not there to judge you, and will be most able to treat you if you’re completely open about your drinking. The point of these questions is not to make you feel guilty or defensive, but to get a complete picture of you in order to determine how to help you.

Your diagnosis

Based on your history, the RAAM clinic team may diagnose you with an opioid use disorder, which is a problematic opioid habit that results in negative life consequences. It is a treatable condition, and with help, people can and do recover. People who experience withdrawal symptoms when they stop using opioids may be offered opioid agonist therapy. Methadone
and buprenorphine are both long-acting opioids that prevent withdrawal for a full 24 hours, helping people through the early days of recovery. Taking these medications is not “cheating,” and doesn’t mean that you are “not really sober.” The physical and psychological symptoms of withdrawal are very real, and the medications prevent these symptoms, allowing you to focus on establishing a healthy lifestyle.

Counselling

The RAAM clinic team may refer you to counselling as part of your treatment. Counselling can help people address the reasons for their drinking and come up with new and healthier ways to cope with difficult emotions. Counselling programs can include education on alcohol and healthy lifestyle choices, group and individual therapy sessions, help with developing coping skills, cognitive behavioural therapy, and peer support groups. The team will work with you to determine what form of counselling would be most helpful for you.

Chronic pain

Many people with opioid use disorders suffer from chronic pain, and worry that stopping their opioids will worsen that pain. However, it’s likely that your pain will actually get better if you stop using opioids. If you’re on a high opioid dose, you could be experiencing withdrawal several times a day as the opioid wears off, and while you’re in withdrawal your pain will be much worse. Treatment will resolve these withdrawal symptoms, so your pain will improve.

If you’re not ready to stop

If you’re not ready to stop using opioids yet, follow these tips to increase your safety and decrease your chance of dying from an accidental overdose:

  1. Never use alone. Make sure you have a buddy with you, and make sure you both know the signs of overdose so you know when to call for help.
  2. Watch your dose. Your tolerance goes down very quickly after you haven’t used for a while (even just a few days), so if you’re using for the first time after a period of abstinence, use a much smaller dose than usual.
  3. Don’t inject. This is the most dangerous way of taking opioids.
  4. Don’t mix, especially other sedative substances like alcohol or benzos.
  5. Always carry naloxone so you can temporarily reverse an overdose. Visit the Government of Ontario's website to find out where you can get a free naloxone kit and training.

Toronto RAAM clinics

(Due to COVID-19 outbreak, please call ahead)

Anishnawbe Health Toronto
179 Gerrard St. E (TEMPORARY LOCATION)
416-657-0379 ext. 234
Mon. 9:00 a.m.–12:00 p.m., Wed. & Thurs. 1:00 p.m.–4:00 p.m. (Indigenous patients)

Michael Garron Hospital
825 Coxwell Ave., 1st Floor, admitting/registration
416-469-6580 ext. 2517
Virtual care only – please call

North York General Hospital
(Addiction services for York Region partnership)
4001 Leslie St., 8th Floor
289-221-4839 or 1-888-399-8342
Mon. 12:00 p.m.–2:00 p.m., Wed. 10:00 a.m.–12:00 p.m. (virtual care)

St. Joseph’s Health Centre
30 The Queensway, 1st Floor
416-530-6486 ext. 3969
Tues. & Thurs. 10:00 a.m.–11:30 a.m.

Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room A146
416-480-6736 or raamclinic@sunnybrook.ca
Virtual appointments available Mon. 5:00 p.m.–7:00 p.m., Wed. 2:00 p.m.–4:00 p.m., Fri. 10:00 a.m.–12:00 p.m.

Centre for Addiction and Mental Health
100 Stokes St., 3rd Floor
416-535-8501 (Access CAMH)
Mon., Wed., & Fri. 10:00 a.m.–2:00 p.m.

St. Michael’s Hospital FHT

St. James Town Health Centre
410 Sherbourne St., 1st Floor
416-864-3082
Wed. 12:00 p.m.–4:00 p.m. (pregnant patients)

St. Michael’s Hospital
30 Bond St., 17th Floor, CC Wing
416-864-3082
Mon., Wed., & Fri. 9:00 a.m.–11:00 a.m.

Humber River Hospital
(Addiction services for York Region partnership)
1235 Wilson Ave., 5th Floor
289-221-4839 or 1-888-399-8342
Tues. 3:00 p.m.–5:00 p.m., Thurs. 12:30 p.m.–2:30 p.m. (virtual care)

Toronto Western Hospital
399 Bathurst St., 1st Floor, WW1-414
416-726-5052
Mon. & Wed. 9:00 a.m.–11:00 a.m., Fri. 1:30 p.m.–3:30 p.m.

Women’s College Hospital
76 Grenville St., 3rd Floor
416-323-7559 ext. 6
Mon., Tues., & Thurs. 10:00 a.m.–12:00 p.m.

For more information, please visit www.metaphi.ca