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overdose-induced brain injuries: hard to diagnose and even harder to get the right care
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advocates are calling attention to the relationship between brain injury and other aspects of life, including addiction, mental illness and housing.
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as the toxic drug crisis continues, another hidden epidemic is growing across canada: overdose-induced brain injuries. the cumulative effects of repeated overdoses can lead to acquired brain injury, making it harder for people to access critical services such as health care, treatment and housing.
advocates are calling for more integrated services and enhanced support for those with brain injuries to access the services they need to live healthy, meaningful lives. they say the current system isn’t set up to address the intersecting needs of those living with brain injury, addiction and other mental-health concerns. without appropriate services, they say, the system is failing too many people.
prof. mauricio garcia-barrera of the university of victoria researches the associations between the toxic-drug and brain-injury crises. he estimates there are 15 non-fatal overdoses for every fatal overdose in canada. using national data, he estimates that more than 600,000 overdose-related brain injuries have occurred in canada since 2016.
people who survive overdoses and are left with an acquired brain injury can experience a number of cognitive impairments, including problems with attention, memory, decision-making, impulse control and emotional regulation. they are also more likely to die by suicide or accidental poisoning than the general public.
it’s difficult to know the number of people who are living with overdose-induced brain injuries because many don’t even know they have a brain injury. garcia-barrera says that the stigma around drug use and addictions drives people to use alone and not seek medical attention after they overdose. he says this leads to a lack of data and surveillance. “we have very accurate data on (fatality) numbers, but the people who survive an overdose are not necessarily accounted for.”
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for those who do access medical care, garcia-barrera says, it can be hard to diagnose overdose-induced brain injury even when neuroimaging is available. the damage caused from an overdose is generalized in the brain instead of impacting specific areas, making it more difficult to diagnose through scans.
as a result, they sometimes rely on symptoms to diagnose brain injury, garcia-barrera says. but it can be difficult to tell if the symptoms are a result of the brain injury itself or a compound effect of other life stressors. “if you have a person that has been experiencing homelessness, chronic stress, malnutrition, that has a history of other kinds of brain injury … a history of substance use, all of those will affect the brain in different levels.”
substance use stigma and the barriers to proper care
even when they are diagnosed, brain injuries often coexist with other factors, such as mental illness and addiction, and this can create barriers to care.
shirley wilson, a school trustee in abbotsford, b.c., became a strong advocate for brain injury awareness based on her family’s own experience. wilson’s son, jacob, died at age 24 in november 2021 from a fentanyl overdose. but his story begins years before that. after jacob was run over by a pick-up truck in august 2018, leaving him with a brain injury, he began using street drugs to relieve his “mental anguish,” his mother says.
wilson says that despite their persistence, she and her son were turned away from several treatment centres. she blames the stigma in the healthcare system around substance use. she says staff deemed his case too complicated because of the combination of brain injury and addiction.
“there’s so many, so many bad stories about access to service. … he went in twice (and) was sent home twice by the hospital in 48 hours,” wilson says. “he died within hours of that second discharge.”
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a spokesperson for fraser health said it is unable to comment on a specific patient’s case but that “when making decisions regarding a patient’s treatment, their care team will work closely with the patient to ensure they understand the benefits and risks involved with the course of action, including discharge. prior to their discharge from hospital, the patient’s care team will work collaboratively with the patient and their family to connect them to additional community-based services as needed to support their longer-term health needs.”
the link to addiction, mental illness and homelessness
advocates are calling attention to the relationship between brain injury and other aspects of life, including addiction, mental illness and housing. a 2020 study by researchers at the university of british columbia found that 53 per cent of people experiencing homelessness have a history of brain injury and 22 per cent of those cases are moderate to severe.
michelle mcdonald, chief executive officer of brain injury canada, says people with brain injuries face additional challenges when navigating shelter systems. “the cognitive impairments that they’re left with can cause behaviour problems (such as) impulse control and anger management, and many of these places are not set up to support people (with those needs).”
mcdonald says that these behaviour issues can make people with brain injuries ineligible for housing and supportive housing.
a “housing first” approach with wraparound services is crucial for getting people the support they need, she says. “without these strategies in place … we’re asking people with cognitive impairment, memory issues, orientation- and information-processing issues to navigate a really complex health-care system and housing system without any support.”
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advocates say better integration of health-care and social services are needed. “we have great services in place for psychiatric clinics for mental-health disorders or symptoms,” says garcia-barrera. “we have great services for addictions and substance use…and we have great services for brain injury, but they are not joint.”
joint support is what jacob wilson needed, his mother says, but his case was considered “too complicated” when they approached treatment centres. “nobody at the time would even acknowledge that brain injury and substance use went together. nobody. i couldn’t get help for both.”
mcdonald agrees that better integration is needed and says that it’s important to look beyond the symptoms. “brain injury is the root cause of so many of these intersections, but for some reason … it’s not the focus. we look at homelessness, but we’re not looking at the brain injury. we look at mental health, but we’re not looking at the brain injury. and you can’t do one without the other.”
beyond housing, areas of increasing concern related to brain injury include intimate-partner violence — those experiencing such violence are at a higher risk of brain injury — and incarceration. people with a brain injury are more likely to be incarcerated than the general public.
pushing for change and recognition
janelle breese biagioni, who lost both her first husband and brother to brain injuries and associated complications, advocated for policy change around brain injury for 35 years. finally, in june 2024, bill c-277, the national strategy on brain injuries act, was passed unanimously by the standing committee on health. the next step would have been a vote in the house of commons. the bill calls on the minister of health to develop a national strategy to support and improve brain-injury awareness, prevention and treatment.
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but now that parliament has been prorogued, the current session’s legislative work has been stopped. this means that bill c-277 will not progress, but advocates are clear that the work will continue on in the next session.
breese biagioni says she remains hopeful based on how far the bill progressed and the recognition it has received. “it was a win for us in the sense that this is the most that brain injury has ever been discussed in the house of commons, and to have all-party support all the way through … has been pretty amazing.”
what comes next for wilson’s advocacy work? “i’m not quitting, i’m not giving up. i’ll do it again. i’ll be there for whatever role that i need to keep up this awareness,” she says.
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