It rarely begins as a decision to use drugs. It begins with a fourteen-hour shift, a two-hour drive, a rotation with no real days off, and someone on the crew who has something that makes the back half of the day possible. In camp settings, where the work is relentless and there is not much else to do afterwards, that pattern establishes itself quickly and quietly.
Stimulant use in the northern workforce is more common than the silence around it suggests, and the men involved are usually not who the stereotype describes. They are working, earning, meeting obligations, and holding a job that depends on nobody finding out. That last part is precisely what keeps the problem from being addressed until it has become much harder to address.
What These Drugs Do
Cocaine and methamphetamine both act by flooding the brain’s dopamine system, which produces alertness, confidence and energy. Methamphetamine’s effect lasts far longer — many hours against cocaine’s relatively short window — which is part of why it has taken hold in shift-work settings where a short high is impractical.
The cardiovascular effects are the most immediately dangerous and the least discussed. Both drugs raise blood pressure and heart rate sharply and constrict blood vessels, including the coronary arteries. Heart attack, dangerous rhythm disturbances and stroke occur in men in their twenties and thirties with otherwise healthy hearts, and the risk does not require long-term use or large amounts. Chest pain in a man who has used a stimulant is an emergency, and it is worth saying that emergency staff need to know about the drug use because it directly changes appropriate treatment — certain standard cardiac medications are inappropriate in that context. Withholding it is genuinely dangerous.
Longer-term use damages sleep architecture profoundly, produces weight loss and dental problems with methamphetamine in particular, and drives psychiatric symptoms: paranoia, agitation, and in sustained heavy use, a stimulant psychosis with hallucinations and delusions that can be indistinguishable from schizophrenia while it lasts. Alberta’s drug supply also now carries a serious risk of fentanyl contamination in stimulants, which means an overdose can occur in someone who has never knowingly used an opioid. Carrying naloxone is a reasonable precaution for anyone using any street drug, and not using alone matters more than it once did.
The Cycle That Keeps It Going
The mechanism that makes stimulants so difficult to leave is the crash. After the drug wears off, dopamine is depleted, and what follows is exhaustion, flat mood, irritability and an inability to feel pleasure in anything. That state can last for days and is genuinely miserable. Using again is the fastest way to end it, and so the pattern reinforces itself.
Underneath, most men are using stimulants for a reason that predates the drug — untreated ADHD, depression, chronic sleep deprivation from rotational schedules, or the demands of work that is not humanly sustainable at the pace being asked. Treating the substance use without addressing what sits beneath it tends not to hold.
What Treatment Involves
There is no equivalent to methadone for stimulants — no substitution medication with an established role. What does work is a combination of structured psychological treatment, addressing the underlying conditions, and practical changes to sleep and schedule. Where depression, anxiety or ADHD are present, treating them properly removes a substantial part of the reason for using. Withdrawal is not physically dangerous in the way alcohol withdrawal is, but the low mood in the weeks after stopping can be severe, and this is the period where support matters most.
If thoughts of suicide are present at any point — and in the crash phase they can be — anyone in immediate danger should call 911, and the 988 Suicide Crisis Helpline is available across Canada by call or text, 24 hours a day.
A physician’s role here is medical, not disciplinary. What is discussed in an appointment is confidential, and the reason to be accurate about what you are using is that it changes what treatment is appropriate.
Dr. Isaac Klein sees men for substance use, addiction and the mental health conditions that often accompany them at Grande Prairie Men’s Medical Clinic. Confidential appointments can be arranged through gpmm.clinic or at (587) 416-8296. The above is general information and does not replace an individual medical assessment.