Nesathurai: Start a conversation about substance abuse today

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Dorothy Bakker is a remarkable and vivacious woman and an accomplished medical school professor. Originally from Freelton, north of Hamilton, she is also the mother of Stephen Emslie.

Stephen was killed by fentanyl in 2017.

Stephen was an engineer. At the time of his premature death, he was a graduate student at the University of Guelph.

Throughout his life, Stephen struggled with substance use disorder, experimenting with various substances and experiencing episodes of psychosis that led to hospitalizations. Eventually, he was diagnosed with bipolar disorder.

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I met Dorothy in first year medical school in Hamilton. She was dating John Emslie at that time. They married, and a few years later, Stephen arrived.

I spoke to Dorothy recently. Like all parents, she was thrilled to reminisce about Stephen. Stephen was a “kid who talked early and walked early. … He was a really cool kid,” said Dorothy. She added Stephen “was just like his Dad.”

Dorothy and Stephen’s story could be my story. I am the parent of three young adults.

As a public health official, I am aware that substance use related deaths touch people of all social and cultural backgrounds.  These deaths affect people who live in comfortable homes with all the amenities, as well as those living in tents or sleeping under bridges.

Across the province, approximately 2,500 people died of opioid related deaths last year. This is four times as many people who died in motor vehicle crashes in the same time period.

Dorothy asserts that “there is a lot of stigma” related to substance use disorder. I agree. The stigma associated with substance use poses a significant obstacle to individuals seeking assistance and recovery.

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Stigma is the adversity individuals face as a result of possessing a socially undesirable trait, whether it be physical or behavioral. Stigma is frequently linked to feelings of shame and self-loathing, involving prejudice from others and a tendency for the affected individual to conceal their condition.

The perception that people who use drugs lack “self control” and make “bad” choice us stigma rooted in prejudice. The reality is substance use disorder is fundamentally a medical condition, similar to various other illnesses, with a genetic component contributing to the risk factors involved.

For some people affected by substance use disorder, concealment is one approach to mitigating shame. But concealment is also a barrier to getting treatment.

There are many diseases that have no effective treatment. However, stigma is something that can be treated.

The treatment for stigma is open, respectful, and explicit dialogue. So today, I ask each of you to speak to a friend or family member about substance use disorder. Affirm that the families affected could be just like you. Affirm that the substances being used include fentanyl, cocaine, and methamphetamines. Affirm the fact that people with substance use disorder should receive the same compassion and understanding as people experiencing heart disease or respiratory disease. Affirm that access to substance use services should be funded in the same manner as cancer treatment.

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Dorothy and John divorced when Stephen was six years old. Dorothy told me John suffered from substance use disorder, specifically involving alcohol and cannabis. Additionally, John struggled with an untreated anxiety disorder. Tragically, John’s life came to a premature end when he died by suicide in 2015.

Dorothy reminded me that adversity related to substance use disorder or mental illness does not have to end with a catastrophic outcome. It is important to note that many, but not all people, who use substances have an accompanying psychiatric condition.

Stephen’s grandmother was hospitalized for a mental health condition in St. Thomas as a young woman; she went on to have a wonderful family with five children. Stephen’s aunt was diagnosed with bipolar disorder as a young woman and was stabilized with treatment. She went on to have a successful career in the fashion industry.

The medical and public health management of substance use is complicated and sometimes contentious. Nevertheless, reducing stigma is one thing that will make a positive impact. I ask that you start the conversation at your home today. It is one small way to honour Stephen.

Shanker Nesathurai is the acting medical officer of health for Chatham-Kent Public Health. Since January 2024, there have been 29 suspected drug-related deaths in the Chatham-Kent community, of which many have been deemed opioid-related.

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