Some aboriginal leaders are bracing for the worst after the production of OxyContin was halted two weeks ago.
Approximately one in every three residents, up to 9,000 people in an aboriginal population of 25,000 in northwestern Ontario, are addicted to the painkiller, which is also known as hillbilly heroin.
Remote aboriginal communities have some breathing room before a potential crisis begins because officials anticipated addicts built up illegal stockpiles of OxyContin after Purdue Pharma announced it would halt OxyContin production on March 1.
In Winnipeg, where OxyContin is one of a handful of street opioids, there has been an increase in calls to the Addictions Foundation of Manitoba for the last two months.
But it's impossible to tell if those calls are due to OxyContin -- city clinics have reached their capacity.
"We have two issues happening at the same time," said Dr. Lindy Lee, one of 20 physicians in Winnipeg licensed to prescribe methadone to addicts.
Addicts face three options: Tough it out through withdrawal, switch to another heroin-like street drug like Percocet, Dilaudid or codeine-based Tylenol 3, or apply for methadone treatment.
Manitoba is no different than the rest of Canada when it comes to addiction rates to prescription opioid painkillers, Lee added.
In Manitoba, the biggest opioid increase was between 2005 and 2010, as judged by the rise in the number of methadone clients in the province. Methadone client numbers leaped to 1,100 from 300.
"It was what was happening all across Canada and we were watching for it to happen in Manitoba and it did," Lee said.
No matter where addicts live, they won't be able to turn the new gel-like replacement, OxyNeo, into a powder, the same way users do with OxyContin. The new substance turns to tar if users try to heat it up to inject it and can't be ground into a powder to be snorted.
For addicts who run out of OxyContin, there will be seven days of sheer hell as they suffer through acute withdrawal.
"When people go through that, they consider suicide," said Mike Metatawabin, deputy grand chief of the Nishinawbe Aski Nation, which represents 49 northern Ontario First Nations.
"Our biggest fear is we're going to have a mass withdrawal from OxyContin," Metatawabin said.
Withdrawal is said to be so agonizing, yet there are 35 communities north of Sioux Lookout with addiction rates of 30 per cent or more that are bracing for just that.
"I've heard it's unbearable to watch. You're helpless. The person, they lose all dignity. They have no bodily control: diarrhea, vomiting, sweats, aching bones. It's excruciating pain. You can imagine the worst flu, the worst hangover. Then multiple that by 20," Metatawabin said.
The Island Lake region of northern Manitoba has close family links to northwestern Ontario First Nations and is considered to be the soft underbelly in the OxyContin trade, leaders say.
"I know it's very high in Ontario and there are some (dealers) who are trying to bring that problem into northeastern Manitoba," said David Harper, grand chief of Manitoba Keewatinowi Okimakanak, which represents northern Manitoba First Nations. "The police are watching it."
OxyContin holds entire families in its grip on First Nations north of Sioux Lookout, Ont., 450 kilometres east of Winnipeg, said Metatawabin.
"Our chiefs declared a state of emergency back in 2009 once it became increasingly evident the drug was causing extreme hardship on families and to the overall well-being of the community," he said.
Street gangs from Winnipeg and Thunder Bay supply the north with OxyContin, the aboriginal leader said.
Addicts without prescriptions in the north will face withdrawal with over-the-counter relief.
"That was the only option we had available," Metatawabin said. "We're encouraging our health centres to stock up on ibuprofen and Gravol."
Federal and provincial health officials only now realize the impact of OxyContin withdrawal in aboriginal communities, he said.
"Their work is based on statistics and the patients they deal with. They don't get the full picture. They're not on the front lines," Metatawabin said.