Mary Ackenhusen | January 11th, 2017
We are all aware of the exponential spike in overdose deaths due to fentanyl being added to drugs. Though I’m normally immune to ambulance sirens, every time I hear one I think it’s another overdose (hopefully I’m wrong about that!). Even when I was visiting family in the States, I had that same Pavlov reaction to hearing a siren.
Deaths from overdose in 2016 are now twice what they were from drugs and AIDS during the “public health crisis” of the 1990s. But we are trying to do something about it. I spent a half day this past week touring some of the resources and staff that were quickly put in place in mid-December to improve our ability to rescue those suffering from overdose.
Mary receiving Narcan training from a member of the PHS Spikes On Bikes team in the Downtown Eastside last week.
Among them is the Mobile Medical Unit, where ambulances bring overdose victims and walk-ins are welcomed. This MMU was mobilized in record time, running 18 hours per day, fully staffed, and gives immediate access to care as well as connections to addiction services.
There are also five overdose prevention sites run by not-for-profits like PHS, VANDU, and Sarah Blyth’s Overdose Prevention Society, plus trained staff based in supportive housing units operated by Atira. These are scattered through the DTES and close to the alleys and laneways where the most drug use has traditionally occurred. They are non-medical sites run by caring people and volunteers who are experienced veterans of the world of addiction, either because working in this area has been their life’s work, or because they have experienced addiction themselves and found a path out. Interestingly, none of them are clinicians, though they are supported by a host of physicians led by Dr. Christy Sutherland.
What did I learn from talking to staff, volunteers and experts? The dedication and capability of the staff from PHS, Atira, VANDU, Providence and VCH as well as BCEHS (BC Ambulance) is amazing. They are living their values by actioning the belief that every person counts – and every person deserves the best we can give them. This did not surprise me as I have known and admired this group for many years.
I did gain an increased appreciation, however, of the value of the dispersed overdose prevention sites and the ability for not-for-profits to make a huge difference to the epidemic. In addition to their dedication, they are an integral part of the community of marginalized individuals who live in the DTES. This is hugely valuable when providing care for those suffering from chronic opioid addiction. It is something that a large, unionized and regulated health organization can strive to be, but will likely never manage to the same extent. The value of their approach is the ability to have knowledge and trust within the community and provide low and no barrier entry into care.
This is a strong bridge to enabling connection to addiction treatment options and because of their structure and how they work, the not-for-profits offer a much less expensive alternative to traditional service delivery. This raises several questions. Should we invest future dollars in supervised injection sites such as Insite? How do we provide the most value in terms of preventing overdose deaths? What is the best way to introduce injection drug users to other treatment? Continuing to leverage the not-for-profit NGOs is, I believe, part of the answer.
Further, I learned a lot about opioid substitution therapy and its value in slowing the overdoses and improving the lives of those who have a chronic addiction to illicit opioid drugs. I understand that this approach has huge potential because so many addicts have not yet even been offered substitution or have fallen off the “wagon”. Is this because we have not made it as easy as we might to stay on the “wagon”? Is more substitution therapy the answer (suboxone, methadone, hydromorphone)?
It appears to me that this is a large part of the answer for where we are right now in the course of this epidemic. It is something that is possible to do relatively quickly and cost effectively. Actions are underway to train more doctors to offer these alternatives and I would suggest that the well-meaning groups and individuals advocating for more treatment beds, may want to reconsider. Beds are expensive, have a long timeline, and from what I understand, are not a cure for addiction which is chronic relapsing condition. Put simply, adding more beds – as with so many other aspects of our system – is not the solution.
We change lives
And what else? We should never have gotten to this point in the first place. We need to work with government to change the factors that leave people susceptible to addiction such as appropriate housing, welfare rates and conditions, opportunities to work and education. I hope we can stem the tide of death soon. Then we can put our full effort into taking action to better support the people who are susceptible to the chronic disease of addiction.
Our role is not just to save lives. It is to change lives.