When Tina Kavanagh's son David got out of rehab this September, she got a knot in her stomach.
"I was really worried knowing he was out because fentanyl was introduced to Cambridge [Ont.] six months prior to him getting out of rehab," she said.
She suppressed the urge to warn her 24-year-old about the potentially lethal opioid and instead listened to his cheerful chatter about the future.
"He was on cloud nine," said Ms. Kavanagh, who grew up on Newfoundland's Bell Island but now lives in Mississauga. "It was almost too good to be true when I look back on it. He said, 'Mom, when are we going to go to Newfoundland for a trip, for a holiday? I'm back to work, Mom. I've still got my job!"
Tina Kavanagh counts the sterile cookers while looking through inventory in her RV.
Darren Calabrese/The Globe and Mail
David never made it back to Newfoundland.
On Oct. 12, two weeks after he left a halfway house in Kitchener, Ms. Kavanagh got the call. David had received his first paycheque – from a job mixing chemicals to make vinyl – and was living with his cousin in Cambridge. At 6:15 in the morning, his cousin's wife went to wake him for work and found his lifeless body on the floor, a syringe in his hand.
The toxicology report is not yet complete, but Ms. Kavanagh believes David injected heroin laced with fentanyl, a prescription painkiller 100 times more potent than morphine.
A recent Public Health Agency of Canada report called the country's opioid crisis "serious and growing" and said it's devastating families and communities nationwide. The number of opioid-related deaths was expected to hit at least 4,000 by the end of last year. In November, 2016, the federal government launched an action plan to address the far-reaching crisis with the provinces and territories.
So far-reaching, in fact, that it has found the town of Wabana on Bell Island – Ms. Kavanagh's hometown – where a group of mothers of intravenous drug users are taking the problem into their own hands,
stocking an RV with clean needles and information on harm reduction, recovery options, rehab programs and drug counselling.
In the excruciating days after David's death, Ms. Kavanagh connected with the women on the island, which is about a 40-minute ferry and car ride from St. John's.
One of them was Susan Boone, who had come up with the idea of establishing a needle exchange in Wabana after her 24-year-old daughter, Nicole, almost died of an accidental overdose a year and a half ago.
"Harm reduction is paramount. If they're sick and dying of disease, they're never going to get better," said Ms. Boone, who is caring for Nicole's three young daughters.
The problem was space. The mothers were in a desperate search for somewhere to house a needle exchange after a verbal agreement to use town property fell through. "At this time, we do not have sufficient space to offer your group what is required for your program," said the letter from Tourism Bell Island, which was using the property.
As a stopgap, Sheila Lahey, whose son is also a drug user, has been running a needle exchange out of her home with support from the province's Safe Works Access Program and from Brian Rees, a local man who has worked as a harm reduction activist in Vancouver's Downtown Eastside. Mr. Rees voluntarily makes the four-hour return journey to exchange the dirty needles for clean ones. Mrs. Lahey said about 12 people use the service daily. In a three-month period, more than 12,000 needles were collected and disposed of in Wabana, which has a population of about 2,500.
Tina Kavanagh, right, and her sister Michelle Kavanagh look through their inventory of syringes, swabs and other supplies.
Darren Calabrese/The Globe and Mail
"I was shocked at how much they're going through – how really bad this situation is," said Mrs. Lahey, whose 33-year-old son went from being a full-time electrician to a social assistance recipient with debts stemming from a cocaine habit. "Before this, one needle would be shared between four and five people. This was a common thing – like an everyday thing."
When Ms. Kavanagh heard about their plight, she reached out, at first offering to help pay for rental space. But when that didn't pan out she bought an RV for $1,200, using her son's life insurance money, to be used as a needle exchange. She christened it "In Good Hands."
"Everybody hopefully will be in good hands because [David is] going to be watching over them, right," she said.
Wabana Mayor Gary Gosine, who lost his 35-year-old nephew in February to an overdose, is also leading grassroots harm-reduction efforts and addiction support.
About 20 people, including parents and drug users, regularly attend the education meetings he has organized.
"It's a big problem," Mr. Gosine said. "I don't think there are a lot of users in this community, but the people who are using are fully addicted."
He wants the province to offer more addiction support on the island. "There's no one here helping the individual. The addiction problem in our province is overwhelming, and I don't think they're doing anything on our island," Mr. Gosine said.
Bell Island and Wabana fall under the jurisdiction of Eastern Health, the largest health authority in the province. Currently, a mental health and addictions counsellor is available on Bell Island once a week. Families can get free naloxone opioid overdose reversal kits through the public health nurse.
But drugs used to treat opioid addiction, such as methadone or Suboxone, are not available on the island. However, Eastern Health says it's exploring how to make them more accessible in the area.
While more counselling and support is available off the island in Torbay and St. John's, residents say the ferry is sometimes unreliable, and some people don't have access to a vehicle.
In a statement, Eastern Health said it is working with a local support group to develop a drug prevention and promotion plan for the public and the local school.
Meanwhile, the mothers of Wabana have trained in the use of naloxone and continue to advocate for harm reduction – despite pushback from some in the community who suggest the RV is just a spot to do drugs.
While more counselling and support is available off the island in Torbay and St. John’s, residents say the ferry is sometimes unreliable, and some people don’t have access to a vehicle.Tina Kavanagh purchased the RV for $1,200.
Darren Calabrese/The Globe and Mail
"It all comes back to mothers," Mrs. Lahey said. "If we don't try to do something to help, they don't get any help. These are young people that put themselves in this situation, yes, but now it's out of control. My son cannot function if he doesn't have some form of opiate in his system. He can't move.
"To see your child's life crumble before your eyes and be absolutely helpless – … [The needle exchange] at least gives us parents hope that our children can stay alive until they come to the realization that this is not the life they want and will get the help."
Ms. Kavanagh, meanwhile, is spending her days keeping David's memory alive amid a tide of grief. She still can't bring herself to wear the heart-shaped silver locket that contains some of David's ashes. But every day she cracks the books, staying on track to complete a McMaster University addiction studies program and become a counsellor – something David also wanted to do.
"As long as I keep myself busy with keeping David's memory going, I'm okay," she said. "I just want to keep his memory alive."