Frequently Asked Questions

At River Stone Recovery Centre we believe that all people who use drugs -- not just those who are both willing and able to embrace a rigid path to complete abstinence -- are worth saving from toxic drug poisonings due to an unpredictable and unsafe street supply of illicit drugs. We enthusiastically help people who want to eliminate substance use. We just as enthusiastically support people who want to reduce their use or make it safer.  

Harm reduction approaches are used to reduce negative consequences of substance use, just like seatbelts, bike helmets, and cigarette filters are used to reduce harms from risky activities. Perhaps the best examples of harm reduction outside of substance use are condoms and dental dams, which allow people to engage in non-procreative sex safely so that sexual abstinence is not the only protection against unwanted pregnancies and sexually transmitted diseases.  

Harm reduction is also a social justice movement that believes in and respects the rights of people who currently use drugs, whether or not they want to or are currently able to work toward abstinence. 

Harm reduction principles: 

• Understand that both legal and illicit drug use are part of our world. Choose to work to minimize their harmful effects rather than simply ignore or condemn them

• Make quality of life and well being  — not necessarily cessation of all drug use — the criteria for successful interventions and policies

• Value the voices of lived experience.  Ensure that people with lived or living experience of substance use have a real voice in the creation of programs and policies designed to serve them

• Recognize that social inequalities affect how vulnerable a person is to drug-related harms, AND and how capable they are of dealing those harms

• Understand that drug use is a complex, multi-faceted phenomenon. It includes a continuum of behaviours --  from severe use to total abstinence.  Acknowledging that some ways of using drugs are clearly safer than others

• Reduce harm to people who use drugs and the communities they live in by providing non-judgmental, non-coercive services and resources

• Affirm that people who use drugs (PWUD) are the primary agents of reducing the harms of their drug use. Seek to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

• Do not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use. 

Adapted from the (U. S.) National Harm Reduction Coalition: https://harmreduction.org/about-us/principles-of-harm-reduction/

Recovery is unique to each person -- it depends on where they start from and where they want to get to.

In some cases it means being stable enough not to have to engage in dangerous behaviour to stay out of withdrawal.

In other cases it means being stable enough to access regular care from support workers to work on housing, health and mental health issues.

For others it could mean stabilizing enough to connect with family and loved ones again.

For some it may mean sobriety.

For some it may mean feeling better in general, or going back to school, work, and hobbies.

What it does not look like is the same thing for each person.

It also does not look like a line that goes in one direction. Relapse and remission are anticipated aspects along the journey.

River Stone Recovery Centre is focused on person-centred care, so our definitions of recovery in general reflect what people's self determined ones are.

- Dr Sara Davidson, Medical Director

iOAT stands for injectable Opioid Agonist Treatment. (We pronounce it "EYE-oat.")  It is a treatment that can help people diagnosed with refractory (or stubborn) opioid use disorder that hasn't responded well to traditional OAT, such as methadone. 

iOAT patients are each prescribed an  individualized, appropriate dose of liquid hydromorphone to inject up to three times each day at a River Stone clinic. They are under medical supervision the whole time. Patients are also prescribed a long-acting oral OAT dose to keep them from experiencing withdrawal sickness overnight. 

Although it is a new treatment in New Brunswick (since 2020), iOAT has a long history of success in Europe and has been available in British Columbia since 2012. Many scientific studies show that it is safe, it works, and it is a cost effective way to treat refractory opioid use disorder. iOAT works best when it is combined with psychosocial supports. 

Traditional, once-a-day oral Opioid Agonist Treatment (OAT) works very well for 80-85% of people who commit to treatment, but it doesn't work for everyone. Troublesome side effects or an overwhelming psychological desire to inject can keep the other 15-20% of people seeking treatment from finding success. For patients who are not able to stop or ready to reduce their use of non-medical opioids with other options, iOAT offers an evidence-based alternative that saves lives and reduces harm.

Traditional Opioid Agonist Treatment (OAT) is given orally once each day and usually must be witnessed by a pharmacist or other healthcare provider. It is usually given in a flavoured drink or soft food, such as pudding. Methadone, Suboxone and Kadian are the most frequently prescribed opiate agonists. They keep patients out of withdrawal, help manage pain, and reduce cravings. They can also block the euphoria (or "high") additional opioids would otherwise provide. 

Many pharmacies work with River Stone to witness these daily doses, so OAT participants rarely have to come to our clinic. Even the mandatory group medical appointments required every eight weeks can often be done virtually for participants who can't attend in person. 

Traditional OAT is safe and effective, and has saved many thousands of lives. But it doesn't work for everyone who tries it. For people with severe opioid use disorder who have not benefitted from traditional OAT, River Stone offers iOAT. 

The iOAT program is only offered onsite. Clients come to the clinic up to three times each day to inject their prescribed medication under the medical supervision of nurses. At the end of the day, they get one oral dose of a long-acting opioid agonist to keep them from having withdrawal symptoms overnight. 

The British Columbia Centre on Substance Use has a helpful document that explains both oral and injectable OAT : https://bcpsqc.ca/wp-content/uploads/2020/03/BCCSU-Handout-1-General-Info-on-OAT.pdf

Treating opioid use disorder makes communities safer by reducing illicit drug use and crime. 

Opioid withdrawal causes sickness and pain that our patients have described as being worse than the worst flu imaginable. Some have said there are simply no word to describe it adequately. Withdrawal symptoms begin within hours of each dose of illicit opioids, so people living with opioid use disorder are desperate to avoid withdrawal. It's no wonder that many resort to theft and other crimes to  obtain opioids. Access to safe, pharmaceutical grade medication that keeps people out of withdrawal reduces drug-related crimes. 

Some members of the community have expressed concern that a treatment program that includes injectable medications will attract more crime. Randomized controlled trials in the Netherlands, UK and Canada found that iOAT programs have no negative effects on public safety. A Vancouver study demonstrated that iOAT has high retention rates, reduces use of illegal opioids and decreases illegal activities. 

No. Correlation ≠ causation. 

River Stone Recovery Centre was founded in 2020 to respond to the increasing numbers of people living with opioid and/or stimulant use disorder in Fredericton, many of whom were also homeless. 

Since 2020, the prevalence of homelessness and addiction has continued to grow in all of New Brunswick's cities due to complex combinations of social, economic and structural factors, including Covid-19, a significant shortage of affordable housing, and lack of services in rural areas. New Brunswick's cities have more jobs and are the only places with shelters, hospitals, detox centres, and psychiatrists, all of which may draw vulnerable people. Only three clients not from Fredericton moved here because they heard about iOAT. Only one remains as of late 2023. 

River Stone's medical treatment for substance use disorders is combatting the problem, not adding to it.  In fact, by the time we had been providing iOAT for two years we noticed a wonderful trend. Only 20% of participants had housing when they started the program. By six months in the program, that percentage doubled. Up to 60% had housing at 12-18 months. By two years around 90% had housing. A few have moved in and out of homelessness, but most have been housed successfully for a long period so far. 

Visible homelessness is increasing in all of New Brunswick's cities, and invisible homelessness (couch surfing) is increasing throughout the province. Substance use disorders are also increasing throughout the province, among people with and without housing. New Brunswick needs effective treatments for substance use disorders available to all New Brunswickers regardless of where they live. 

No. 

River Stone is a health care clinic that offers medical treatment and various supports for people living with opioid use disorder and stimulant use disorder.. Our injectable program is only open to River Stone patients, who inject prescribed medication under medical supervision. 

While River Stone is not a safe injection site, it may be helpful to understand how these sites work in other communities. Safe injection sites, supervised consumption sites and overdose prevention sites do not (usually) provide medical treatment for substance use disorders, but they do save lives and are very important tools in the fight against substance-related deaths. These sites provide safe places for substance users to use their own illicit substances with trained staff onsite in case something goes wrong. Some allow users to test drugs they have bought on the street to see if they are contaminated with toxic ingredients. Most provide sterile supplies, educational materials about substance use, and access to counseling, and will facilitate entry into addiction treatment programs.