Greg Isley thinks the change happened while he was in a hospital bed, getting surgery to treat tongue cancer in 2010.
His son, Kelsey, had been taking oxycodone to dull the pain of his two spinal conditions since high school.
Now, in his mid-20s, Kelsey was left at home alone with the stress of his father’s condition.
That’s when Isley believes he went from using the opioid oxycodone to treat his chronic pain, to abusing the drug. He wishes he could have been there to help.
“I did my best, developing cancer right at the time, I wasn’t there to support him … so it didn’t help at all,” said Isley, who lives with his son in a rural area near Saskatoon.
It was the beginning of a downward spiral that culminated this month with Kelsey facing federal drug charges.
Earlier this year, according to Greg, Kelsey ordered what he thought was the potentially deadly painkiller Carfentanil from a Chinese website. The opioid is 100 times stronger than fentanyl.
On Nov. 7, police charged the 27-year-old with one count of possession of fentanyl derivatives and one count of unlawfully importing fentanyl derivatives into Canada. He was also charged with possession of marijuana.
The substances are yet to be formally identified and have been sent to a Health Canada lab for testing.
But Greg Isley said his son’s addiction is the consequence of a long-term struggle with chronic pain, mismanaged treatment and an early introduction to opioids with a lack of education about the risks.
‘He tries to be bigger than his pain. And he’s really not.’
– Greg Isley
For doctors specializing in the treatment of opioid addictions and chronic pain, stories like Kelsey’s are not uncommon.
“One of the challenges, particularly with chronic non-cancer pain, is that there historically has been an inclination to rely on opioids rather than physical therapy and other modalities to help people deal or cope with the pain that they’re experiencing,” said Dr. Peter Butt, an addictions consultant for the Saskatoon Health Region.
Butt treats opioid addicts through the health region’s methadone and suboxone program, and he said it’s not uncommon to see patients whose legal use of prescribed opioids has evolved into an addiction that is fed by breaking the law.
He said it is generally considered that between 10 and 20 per cent of people taking prescribed opioids will develop addiction problems.
27-year-old Kelsey Isley was diagnosed with scoliosis and Scheuermann’s disease when he was 13.
As a teenager he was put in a hard-plastic brace around his rib-cage to correct his spinal curve. But in the long-term, Greg said his son was unable to tolerate it and sought other ways to dull the pain.
Over the years, Kelsey tried various treatments ranging from corrective equipment to inter-muscular injections to reduce spasms.
“It wasn’t [a case of] stub your toe and you need something for pain. This was something [that] as his body grew, only made the problem worse,” said Greg.
He said his son has managed well in the circumstances, holding a full-time job for the past four years.
But in the meantime, he said Kelsey has been self-medicating.
Opioids first prescribed during school years
He was first prescribed oxycodone around 2008, when he returned to school to finish Grade 12 after dropping out.
The pills were to manage the pain of sitting at a desk all day, something Greg said was concerning to his son’s orthopedic specialist, who wrote to the prescribing physician to raise concerns about the risk of addiction.
Over time, Greg said he and his son were able to educate themselves about non-pharmacological treatments. They found ways to treat the pain through physiotherapy, chiropractic treatment, and with an “inversion bed.”
But Greg said his son’s addiction had already taken hold, and eventually it progressed to the point that he sought treatment through the methadone program in Saskatoon.
Late last year, he started searching the internet for ways to order the deadly opioid, Carfentanil.
According to Greg, he found a Chinese pharmaceutical company purporting to sell “samples” of the drug, and he made the purchase that could put him behind bars.
Greg didn’t find out about the mail-order drugs until Kelsey ended up in the hospital.
Based on the treatment he received and the reaction of medical workers at the hospital, he does not believe the drug that came in the mail was actually Carfentanyl. He thinks his son was swindled by the Chinese seller, and that they sent him a different drug.
Greg stands by his belief that although his son broke the law, he did it out of desperation.
“He was desperate. It’s always been instilled in him, ‘Get up and go to work’, and he always has,” said Greg.
“This is a way of him coping with his pain so he could get up and go to work and he suffered. He paid for it.”
Greg believes the drugs that police found in the house were mixed with baking soda, and that his son had tried to ingest them before he landed in hospital. After that, he thinks Kelsey had stopped using the drug but left the unwanted powder in the house.
“My biggest fear is that he will be incarcerated on something that — his own stupidity,” he said.
“If he would have realized the penalty, I can’t imagine he ever would have done it.
“He’s treated with methadone for his addiction but he won’t express himself and his pain, he tries to be bigger than his pain. And he’s really not.”
Father had own struggles with chronic pain
Greg has had his own struggles with chronic pain, and has himself been prescribed opioids as pain medication.
He broke his neck when he was 19 and injured his hand when he was 21. Although he tried to work through the pain, he too was given a prescription for oxycodone.
Although Greg took the drug for four years, he never found that it alleviated pain to the point that he was tempted to abuse it.
But he empathizes with his son’s struggle to stay on top of a persistent pain with the knowledge it might never completely go away.
“I know that opioids do look after his pain but I’d really like to see him with some other support or modality of control,” said Greg.
‘A North American phenomenon’
Dr. Butt said the over-prescription of opioids is a North American phenomenon. In the U.S., opioid addiction has been declared a “national health emergency.”
In Canada, it is a substance abuse crisis that lands 16 people in hospital every day. In 2016, 2,458 Canadians died from apparent opioid-related overdoses, according to the Public Health Agency of Canada.
Of the major prairie cities, Regina and Saskatoon have the highest rates of hospitalizations for significant opioid poisoning, according to the Canadian Institute for Health Information.
The institute said there were 70 cases of hospitalization in Regina from 2016-2017, and 84 in Saskatoon during the same period.
In an effort to limit opioid abuse, Saskatchewan’s Ministry of Health said it provides funding to the Prescription Review Program, which monitors the prescribing and dispensing of the drug.
The province also has a computer application that gives pharmacists and physicians access to patient medication histories. Community pharmacies are required to enter all of the drugs they dispense into the system.
The problem is also being attacked from a national level, with new guidelines announced this year to help doctors treating chronic pain.
The guidelines reduce the recommended maximum amounts allowed to be prescribed and increase the emphasis on non-pharmacological treatments. In cases were prescribed drugs are needed, they recommend trying drugs other than opioids first.
Doctor says more investment needed in Sask.
Dr. Butt said the message is reaching doctors in Saskatchewan, but does not believe the province is doing enough to provide holistic treatment for chronic pain.
He said dedicated and affordable chronic pain clinics are needed to assess patients then direct them to the relevant treatment.
A typical clinic might have a kinesiologist, counsellors, a specialized chronic pain physician, a physical therapist, a pharmacist and an occupational therapist to help people stay productive.
“Typically these are conditions that are permanent, they’re not going to go away, so the question is, how do we help people to be as functional as possible?” said Butt.
“And all too often what happens is that people focus exclusively on the pain and ignore the function, and if the pain condition isn’t going to go away then trying to get rid of the pain without paying attention to function means they may very well be prescribed too much.”
Butt said he knows of one existing clinic in Saskatchewan but its services are not covered by public health insurance.
Physicians pushing for better services
Susan Tupper is the strategy consultant for pain quality improvement and research at the Saskatoon Health Region.
She said stories like Kelsey’s are “heartbreaking” and far too common across Canada.
Tupper said opioids are most effective in treating acute pain, such as pain from a recent surgery, but people sometimes slip through the cracks in the transition from acute to chronic pain.
Although the health region does have programs to support people with chronic pain, Tupper agrees with Butt that a more holistic service is needed to help people find the right combination of treatments.
She said the need for such a service has been identified by Saskatchewan physicians working in the area of chronic pain, who are advocating for more resources.
In the meantime, the health region is educating the public and health workers about treatment options that combine the “four Ps” of pain management: pharmacological, psychological, prevention and physical strategies.
Hope for people with chronic pain, says doctor
The LiveWell workshop, which is available in a number of health regions, is one way caregivers or individuals with chronic pain can try to develop management skills.
“People may have learned over the years, and they may have been given this information from their healthcare providers, telling them that chronic pain is a progressive, debilitating disease, and it’s absolutely not,” said Tupper.
“We have a very plastic nervous system that responds very positively to good approaches, that ‘four Ps’ approach to pain management.
“And so people really can make a difference in the pain that they’re living with. Of course, it’s not easy.”
The University of Regina also offers an online course to help people manage their own pain.
Father sharing story to warn others
But Greg Isley sees that as a sign that there aren’t enough professionals to give people the help they need.
He said he understands his son broke the law when he ordered what could have been an extremely dangerous drug off the internet.
Isley believes it is important that the public hears Kelsey’s story so people with chronic pain know how far opioid dependence can go.
He believes access to a chronic pain clinic at an early age could have saved Kelsey a lot of pain and reduced his reliance on a drug that could lead to his son — already sentenced to a life marred by pain — spending time behind bars.
“He should have been taken into a setting where, probably an in-patient setting, and referred [to] what could happen to him and develop some coping mechanisms so that he wouldn’t become addicted,” said Isley.