Pubdate: Sat, 09 Dec 2017
Source: Montreal Gazette (CN QU)
Copyright: 2017 Postmedia Network Inc.
Author: Charlie Fidelman
Pages: A12-13


Part One in a series of profiles about the escalating opioid crisis in

Martin Pare's fascination with syringes started as a child at a
racetrack. He saw a veterinarian stick a needle in a horse's neck.
What's he doing? the boy asked his father. It's to make the horse run
faster, his father replied. After the horse won his race, the boy
furtively took the needle and empty vial from the garbage. At home, he
filled his syringe with water and began injecting his toy stuffed animals.

"I love the needle," said Pare, now 48.

This fall he checked himself into a Montreal-area rehabilitation
centre after a 17-day heroin bender.

He called within a week of binging, consuming large quantities in a
short amount of time, but the centre was full. He kept using until a
spot opened 10 days later. While he waited, three of his street
friends died of overdoses - all of them of heroin laced with fentanyl,
a synthetic opioid 50 to 100 times more powerful than morphine. A
fourth friend, a woman, overdosed twice. Pare saw her inject and stop
breathing. An ambulance crew revived her.

A three-milligram dose of fentanyl, the size of a few grains of salt,
can be fatal. That's what's happening now - fentanyl, the powerful
pain killer and surgical anesthetic - is contaminating street drugs,
Pare said, his blue eyes rarely blinking.

The Montreal Gazette has followed Pare's struggle with addiction on
and off since 2014. It began with a chance encounter, leading to a
photo essay documenting a day in his life, driven by finding a fix. At
the time, he was living on a patch of concrete with other homeless men
in Viger Square, panhandling for drug money. When veins in his arms
collapsed, he bared his throat and let a friend stick him in the neck.

A photo of that injection moved many Gazette readers, including
officials of a Montreal rehabilitation centre who covered the costs of
Pare's therapy. When he graduated four months later, his father was
waiting for him with a job in construction. However, addiction
recovery can be a harsh road; 40 to 60 per cent relapse within one

On a weekend pass from L'Envolee, a men's rehab centre in Granby where
he's been since Sept. 8, Pare is telling his story. Again.

Why? Because, he said, he wants others to know there is a way out of
"this hell." That message is increasingly important as fentanyl-laced
drugs make the lives of addicts even more dangerous than they already

Initially Pare loved the life - most of it. He started as a teenage
punk goth, chasing the next high on cocaine, speed, psychedelics and
mushrooms. A job injury and a prescription for pain medication led to
an obsession with opioids - codeine, morphine, hydromorphone
(Dilaudid), heroin.

Fentanyl, because of its more intense, longer-lasting high, became his
favourite buzz.

Pare knows he's lucky to be alive. He almost died several

Fentanyl-laced drugs are driving the opioid crisis in North America.
Recently declared a national epidemic, fentanyl-laced drug overdoses
killed more than 60,000 last year in the U.S., about one person nearly
every nine minutes. Roughly, 20,000 succumbed to fentanyl. Canada
recorded nearly 3,000 fentanyl-linked overdose deaths last year,
mostly in British Columbia, Alberta and Ontario. But Canada's chief
public health officer, Theresa Tam, warns no province is safe - the
public-health catastrophe is spreading across the country.

"Everyone tells me I have a guardian angel," Pare said. "I had to try
everything, and I always pushed further and further, going to the
extreme, to the edge; I had to be better than everyone else."

The only thing that held him from toppling "into the abyss was my
father holding me back with an invisible cord. My Rock of Gibraltar."

The father who never raised his voice in anger, Pare said, and who
hired him back every year as a painter in his construction business.

"I had a marvellous childhood," he wrote in a letter to his father
from rehab this fall, "but I dreamed of drugs ... I hope you
understand that you had nothing to do with this. It's not your fault I
chose this life."

Addiction is defined as compulsive behaviour despite negative
consequences. Top experts say addiction is not a mere habit but a
severe chronic illness characterized by compulsive seeking and
escalated intake of drugs. A pioneer in the neuroscience of addiction
as a brain disease, Nora Volkow, head of the U.S. National Institute
on Drug Abuse (NIDA), says the human brain is hardwired to respond to
reward or pleasure, otherwise no one would ever eat or have sex.
Addiction is the brain's reward circuitry gone awry, she said.

Volkow is fond of saying she's never met an addict who wanted to be an
addict. Her work shows brains of drug users are modified in key areas
involved in memory, motivation, judgment, decision-making and
self-control over one's actions. Drug abuse alters the ability to
exercise free will, Volkow says, so even the most severe threat of
punishment isn't enough to stop an addict from taking drugs.

Pare recalled one of his worst heroin incidents. It hit him so fast,
he passed out with the needle still stuck in his arm in a house on
Rachel St. Before passing out, he yelled, "Help!" to a friend in the
next room.

"He took one look at me and knew right away," he said. "He saved my

Ambulance technicians slit the unconscious Pare's T-shirt, put paddles
on his chest and shocked his heart back to a regular beat.

"But when I woke up, the first thing I did was ask when I could get
out. I wanted to leave the hospital so I could shoot up," Pare recalled.

Within two hours of being resuscitated, his torn T-shirt flapping,
Pare walked into a bathroom of the restaurant closest to the hospital
and stuck a needle up his arm.

"It was a stupid and dangerous thing to do. I had a big quantity of
dope in me and I was adding more. I was lucky I didn't die," he said.
"The (antidote) stuff they give you in the hospital, some people say
it makes you dope sick. That's not how I felt. But the drug is too
powerful. It f---s your brain - you don't have the capacity to think

Addicts often tell stories of broken families, early trauma, violence
and sexual abuse. Pare said he had none of these vulnerabilities
experts associate with higher risks for addiction. He grew up with
loving parents, excelled in private school (ranked 17th in math
provincially) and attended college but quit studying mathematics in

Once, he had everything he wanted: a home, a 14-foot Zodiac boat,
scuba gear. He worked in construction, travelled extensively in Europe
and sold illegal drugs. He felt invincible. Then he lost everything.

He was using fentanyl years ago, as a skin patch under the brand name
Duragesic, which he distilled into an injectable. As his drug habit
escalated, he couldn't get out of bed without a fix. When addiction
rules your life, you need it just to feel normal, he said. By his own
reckoning, he's detoxed 25 to 30 times, just to get a break from being

He also tried methadone, an opioid used to treat addiction, in a
supervised harm-reduction program. Methadone, however, does not work
for everyone. When it failed Pare, he went back to shoplifting and
trafficking. One stint in jail in 2006 lasted eight months. His forced
detox was severe: 10 days of sweating, shaking, vomiting and diarrhea.
Not one second of sleep for 10 days, he said. Constant pain wracked
his body. It was so unrelenting, he sought relief in another agony,
trying to break his ankle against his prison cot.

In the debate on criminalization versus rehabilitation, health
advocates say punishing people by imprisonment for having a disease is
wrong. Volkow, for example, has called on medical professionals and
society to help reduce the shame and the stigma of drug addiction.
Similar to those with diabetes, heart disease, cancer or other
illness, people suffering the disease of addiction should not have to
overcome obstacles to get the help they need, which is evidence-based
treatment, she said.

A Quebec coalition for the promotion of drug users' health has called
for the immediate removal of "systemic barriers" to overdose prevention.

Although a junkie most of his adult life, Pare said he finally hit
rock bottom after a random incident. He crashed his bicycle in 2013,
flipping face-first into the back end of a truck and smashing his
teeth. He developed sepsis - a life-threatening infection that damaged
his heart - and spent months in a hospital on massive doses of
antibiotics. This medical emergency reintroduced him to morphine. He
said he warned hospital staff not to give him, a junkie, narcotics for

"Once I use morphine, I'm done. I have to do it again," he

When he left that hospital in January 2014, Pare was homeless,
addicted and panhandling for a shot to get him through the day. He
didn't mind living on the street, he said, but it's rough on the body.

He knew he wanted his life back. But detox and harm-reduction programs
were full. Then his luck turned when a photo of him with a needle in
his neck got him an offer of rehab from Addington House.

Pare said the first few months of rehab were torture. Life seemed so
bland. He didn't believe in rehab - it was all about willpower. But he
changed his mind after a counsellor, also a former addict, told him
getting clean is the easy part. The hardest is learning to slay the
opium dragon.

Pare said finding spirituality without religion opened a path toward a
life with meaning that he craves. During the past four years, he
relapsed three times.

"Almost everyone relapses," he said of the viciousness of drug
addiction. But it's different now. Fentanyl, like a neglected
paramour, is waiting for him to return to the street.

He hopes this stint, his third, in rehab will be his last.
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