Brain injuries an emerging epidemic amid the opioid crisis

The dangers of the toxic drug crisis have continued to rise since the provincial health emergency began eight years ago. Much of the focus has been on the deaths that occur or nearly occur as a result of using toxic drugs. But another epidemic is emerging for those who survive an overdose: brain injuries.

Research conducted by UVic, led by clinical psychologist Mauricio Garcia-Barrera, has highlighted the link between overdoses and brain injury. The research study took place over three separate consensus day events at the school—one occurring each year since 2022—bringing together 100-200 participants each year to explore factors and concerns around brain injuries.

The third day took place last month. The data from this year’s consensus event is still being collected by the team, but Garcia-Barrera says key learnings showed the prevalence of brain injury among those living without housing—and that housing stability significantly improves the risk of dealing with these injuries. The opioid crisis hangs heavy over both of these concerns.

Preventing overdoses key to fighting the rise in brain injury

When people stop breathing from an overdose, they become hypoxic—oxygen cannot make its way to the brain. If the oxygen supply is cut off for a couple minutes, brain cells begin to die. While the majority of people are revived on the scene when paramedics are called to treat overdoses—paramedics can receive up to 100 calls a day in BC—these people will likely carry the effects of the overdose for years after.

Garcia-Barrera says while many people think of areas like Victoria’s Pandora or Vancouver’s East Hastings when talking about the toxic drug crisis, addiction and toxic drugs can be an issue for everyone across the socio-economic spectrum. Keeping everyone safe requires widespread awareness of overdoses.

“I will say that there is no one area that is fully protected from the risk,” said Garcia-Barrera.

He argues that all organizations should “comprehensively start raising awareness” of the importance of naloxone kits and how to use them, teach people how to administer rescue breathing and chest compressions, and develop an action plan for when an overdose occurs.

He says “the top tools we have” are harm reduction, naloxone training, and rescue breathing.

Both naloxone and rescue breathing are key in stopping the effects of an overdose in its tracks. Naloxone—also known by the brand name NARCAN—is able to reverse the effects of an opioid overdose, such as heroin or fentanyl. But it’s ineffective on benzodiazepines, which have become increasingly tied to overdose deaths. This is where rescue breathing and chest compressions become important to ensure oxygen reaches the brain.

Using these approaches could significantly reduce the chance that a person overdosing will end up with brain damage, according to Garcia-Barrera’s research. ‍

Lack of protocol led to devastation at UVic ‍

The lack of awareness and protocols at UVic became evident when first-year student Sidney McIntyre-Starko, 18, overdosed in her dorm room in January.

McIntyre-Starko’s parents have criticized the school and how the incident was handled by campus security, saying her death could have been prevented. Her parents wrote in an open letter that, although campus security and 911 were both called, security waited nine minutes to administer the naloxone they carried and 12 minutes to begin CPR. It took nearly as much time for paramedics to be dispatched. A person can survive approximately four to six minutes without breathing before brain damage begins.

When the news of her death became public, post-secondary Minister Lisa Beare developed a committee to create protocols for all schools to follow to prevent overdoses. These new protocols will be rolled out across all public post-secondary schools this fall.

Garcia-Barrera says while it's a positive step for schools to implement these, other institutions and companies should be working to create their own guidelines—whether or not managers think it’s needed. Reducing the rise in brain injuries is dependent on preventing overdoses from occurring.

Mauricio Garcia-Barrera (third from the left) with the UVic graduate students on his research team. Photo: UVic

‍ Cause and effect with brain injuries and substance use ‍

The intersection of brain injuries and issues obtaining housing became abundantly clear to Garcia-Barrera as his team worked through year one and two of the study. Initially year three was meant to focus on brain injuries caused by sports-related concussions, but during each consensus day, housing and homelessness were consistently brought up by patients.

This was not a surprise to Janelle Breese Biagioni, founder of the CGB Centre for Traumatic Life Loss in Victoria where she offers holistic counselling to those dealing with brain injury and their families. She has studied brain injuries, trauma, and grief for 35 years after losing her husband, RCMP Constable Gerry Breese, who suffered a traumatic brain injury in the line of duty. She acted as the community lead for the BC Consensus on Brain Injury.

Researchers describe the connection between overdosing and brain injuries as being a chicken-or-egg situation—brain injuries can lead to substance use; an overdose from a toxic drug can lead to brain damage. Because of this, it’s impossible to leave brain injuries out of the conversation when looking at solving the drug and homelessness crisis. ‍

Homelessness makes it harder to heal from brain injuries ‍

In May, Our Place Society released the results of a survey conducted with people living on Pandora. Of the 77 people surveyed, 95% of them said they were dealing with mental or physical health issues. A UBC study of six countries showed that 50% of people dealing with homelessness have a brain injury.

Domestic abuse can also factor into homelessness and brain injury. Year two of the UVic study focused on this subject, finding that many women staying in shelters are dealing with brain injuries as a result of intimate partner violence.

Garcia-Barerra says people living on the streets or with precarious housing can’t access the resources needed to treat brain injuries—many may not know they have an injury. This makes tasks, such as scheduling appointments, remembering them, finding the location, and getting around in general, far more difficult to accomplish. This is especially true for those without housing. Garcia-Barerra says he heard from many people at the Consensus Day who get side tracked when seeking treatment.

“They wake up in the morning, they have been all excited about their appointment, and halfway between where they are leaving, or camping, and their clinic, they get derailed, they get lost,” he explained. “They don't have enough change for the bus, and they start talking to people trying to get a little bit of cash and they get into a fight with somebody that's trying to take something from them. The day goes by and they've never made it to the appointment.”

Garcia-Barrera says these brain injuries are treatable. But they require a low-stress environment and holistic care in order for people to get back to their lives pre-injury.

In psychology, it’s understood that the most basic needs for humans include food, water, and shelter—these needs must be met in order for a person to fulfill other high-level needs, like friendship and self-confidence. For those living on the streets, these basics are not guaranteed, leading to days filled with stress and uncertainty.

“[Housing] really gives you this sense of control or predictability of comfort,” said Garcia-Barrera. “It helps you to reduce stress, when you’ve had a hard day, you open the door and you get into your cozy home.” ‍

Progress to be made on a federal level ‍

Breese Biagioni has been working for years to get a national strategy to address brain injuries. In 2018 she requested Alistair MacGregor, MP for Cowichan-Malahat-Langford, put forward a private member’s bill to set the wheels in motion. An election put the bill on hold, but it began to gain momentum last October.

Last week, Bill C-277—an act to establish a national strategy on brain injuries—passed unanimously at its second reading in the House of Commons—a success that MacGregor says was exciting for its bipartisan support.

He says that many municipalities across the country are dealing with the challenges of the opioid and housing crises simultaneously and that Bill C-277 could “put a serious dent into finally tackling those issues that involve our criminal justice system, that involve the opioid epidemic that so many communities are suffering through.”

Breese Biagioni says while municipalities and provinces handle much of the concerns around healthcare and housing, the federal government has a duty to also address the crisis.

“Our federal government is responsible for Indigenous communities and our veterans, and those are highly represented in the brain injury community,” said Breese Biagioni. “That’s why I started there. I know that this will trickle down into the provinces and create better awareness and support.”

Breese Biagioni said when she began campaigning, local governments were quick to support. Victoria was the first municipality to sign its support for Bill C-277, with Langford, Nanaimo, and Penticton quickly following suit.

She says every level of the government needs to “be at the table to discuss” brain injuries if they hope to properly address the opioid crisis, housing crisis, and homelessness.

“If they're not all coming together to talk about this, we're never going to mitigate these problems,” she said.

She says she’s confident that once the bill is passed—it still needs to pass the third reading in the House—those living with brain injuries across the country will begin to see improvements in their life.

“It's historical for the brain injury community,” said Breese Biagioni. “I've been involved for 35 years advocating for change and working in the community and writing books and articles. We have not seen this level of movement until now.”