Ask a doctor - about safe supply.

By Nanky Rai, Gillian Kolla, Andrea Serada, Jess Hales Emmet O'Reilly and Tom Man

This information is directed to a medial audience, but we at MSTH felt that many of our followers also want to learn more about #SafeSupply because the lives of those we love depend on it. We thank Dr. Nanky Rai and others like her who have decided to change the system, because we can’t wait.

In [square brackets] is text MSTH added for clarification.

Text from a twitter thread by Dr. @NankyRai

This is information about our program development process & guidance document [on safe supply] in the spirit of building greater community accountability and transparency. As clinicians and researchers its important for us to acknowledge that calls for ‘Safe Supply’ come from communities of PWUD [People who use drugs].

Demands have been clear: access to a regulated drug supply & decriminalization to address structural violence facing PWUD.

For #medtwitter [or any of our readers] interested in understanding #SaferSupply, I urge you to read the position statement on Safe Supply by CAPUD (Canadian association of people who use drugs) first: https://vancouver.ca/files/cov/capud-safe-supply-concept-document.pdf

Current Emergency Safer Supply Programs (ESSP) that exist in London & Toronto are HARM REDUCTION PROGRAMS that aim to respond to calls from PWUD re #SafeSupply AND use existing medical evidence to create a hybrid medicalized model focusing on opioids called #SaferSupply.

Medicalizing a community call to action comes with implications & demands more accountability from healthcare workers. Models that exist outside institutions altogether are desperately needed, example: #HeroinBuyersClubs read more on the BCCSU website https://www.bccsu.ca/wp-content/uploads/2019/02/Report-Heroin-Compassion-Clubs.pdf.

The scale of the devastation from #OverdoseCrisis has prompted direct action from PWUD. Right now, prescribers [primary care physicians and others] are uniquely positioned to act re: the poisoned drug supply. It means we [physicians] must embrace discomfort, act thoughtfully and urgently with tools we have access to. #WeActTheyLive

Safer Supply programs do not claim or aim to replicate the paradigms of traditional addiction medicine. Safer Supply programs are lower barrier community-based programs situated in primary care that meet people where they are at. We do not pathologize drug use.

Many PWUDs have had repeated negative experiences within the addiction treatment system. Many PWUDs don’t want to experience stigmatizing health"care". And many PWUDs in this fentanyl and analogues era feel 1st line options/meds (MMT/bup) [Treatment with Methadone or Suboxone] alone are not enough. Therefore ESSP [Emergency Safe Supply] programs are grounded in the belief that people who use drugs are experts. We are invested in treating our clients with dignity and respect and repairing their relationships with the health care system.

Our programs are trying to radically shift how health care protocols, programs & practices are created and evaluated by building direct involvement of PWUDs. Upholding the principles of #NothingAboutUsWithoutUs

We started with focus groups with PWUDs in our communities to better understand what would and  what wouldn’t work and/or feel respectful. Other ways we are building greater community accountability? Advisory committees made up of PWUDs for our programs. Based on the feedback we've received and the med literature we have access to, we've developed a guidance document for #SaferSupply. In this we offer clients access to dilaudid 8 mg IR tabs AND SROM to combat the toxicity and potency of the street supply.

And yes we do offer bup(+microdosing)/SROM [Naloxone and Slow Release Oral Morphine, e.g. Kadian]. We also have client health navigators that support people in attending appointments for MMT [Methadone Maintenance Treatment] when desired. But we can’t keep relying on the same tools & hope for different outcomes to get through this evolving unprecedented crisis.

We provide #SaferSupply because we can't wait for healthcare system to catch-up & provide anti-oppressive, non-stigmatizing care for PWUD (ex. methadone mills). Harm done needs to be repaired but we can't wait for that while people in our communities are dying.

We provide #SaferSupply because people have the right to access health care whether they want to stop drug use or not, whether they want to get high or not. People have the right to live and survive through this crisis.

We provide #SaferSupply because building just relationships is what's important. The antidote to violence is connection, not paternalism and oppressive medical institutions and providers.

This is why we are sharing our guiding document here & are open to feedback/criticism, keeping in mind we will be prioritizing feedback we get from directly affected communities. We are committed to centering PWUD in this process https://docs.google.com/document/d/1hXRmNaOTB60wbmNqhBi5P_xxktEZnXFDWKMkJMu5ALM/edit

We are grateful for the support & leadership of our respective institutions that are invested in building responsive programs accountable to the communities we serve.  @PQWCHC @SRiverdaleCHC @StreetHealthTO @HealthCentre

 We are also engaging in rigorous research of our work.

There has been widespread support for #SaferSupply from organizations including  @AllianceON @FCM_online and the federal government who launched the SUAP call for low barrier safer supply programs earlier this year: https://www.canada.ca/en/health-canada/services/publications/healthy-living/substance-use-addictions-program-call-for-proposals-guidelines-applicants.html#a3

We commit to valuing and supporting the lives of PWUD. We call on our colleagues to take brave, urgent action to stop the unnecessary deaths, marginalization & stigmatization of PWUD. Just like communities of PWUDs have always done, we need to Keep Six.

 

 

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Opinion: Why MSTH and many grieving parents don’t support harsher punishments.

If murder charges were the outcome of overdose - every overdose would become a crime scene. Every person in the room a potential suspect. How often would the person in the throws of overdose be left to die alone? Most all of the time. Who will call 911 if a murder charge could be the outcome?

If we think murder charges will deter overdose death, in this moms opinion - we are sadly mistaken. It will increase them.

We want someone to be punished for the death of our children. All of us have felt that way. We feel powerful when that drug dealer gets locked up - at least one more is off the street and someone has paid the price.

What if your child didn’t have to die? Ninety nine percent of our kids willingly took the drugs they were presented with. Many of them purchased it, shared it and repeated this often over the years. Without consequence. Until today’s poisonous supply caught up with them.

Did the guy who sold it to them know it was poisonous when they sold it? Did your child know it was poisonous when they shared it? Who is the drug dealer?

I’m not suggesting we throw caution to the wind and everyone gets a jail pass. What I am suggesting though is we have to carefully consider outcomes of desired policies or laws that have broad brush approaches.

Since US President Nixon started this war on drugs we have seen nothing more then an increase in every outcome it was designed to deter. Careful what we wish for. It might put your child in a coffin when their friends bolt from the overdose scene... or your PHD student son in jail for the rest of his life after sharing a few lines of cocaine with buddies - people in suits do drugs. Drs do drugs. Students. Fathers. Mother’s and humanitarians - do drugs. Are they all murderers? Maybe they are .... but the outcome of that will be devastating.

Jail and death are not a deterrent.... this same game has been played out for over 40 years ... it’s not working. This is why we do what we do. To minimize the risk of death and disease. Improve services for those seeking help, and help families deal with the devastating outcomes....let’s not make it worse.

Marie Agioritis
Moms Stop The Harm - Saskatchewan Leader

Marie Agioritis - Moms Stop The Harm Regional Leader for Saskatchewan (Photo Credit Lorna Thomas)

Marie Agioritis - Moms Stop The Harm Regional Leader for Saskatchewan (Photo Credit Lorna Thomas)


Federal Election 2019 - Questions to ask candidates & parties

Here are some questions that we encourage you to ask of your candidates and the parties vying for your vote on Monday, October 21st, 2019. Don’t know who your candidates are for your riding? You can find the information here. Please review and consider the background information below the corresponding questions and help to bring more awareness to this public health crisis that is killing 12 Canadian's per day an make it an important election issue! You can help us by sharing this widely to friends and in social media using these hashtags: #OverdoseCrisis #Elxn43 #CDNpoli.

Questions to ask candidates and their parties:

  1. What will you/your party do to address the overdose crisis?

  2. Where do you/does your party stand on the decriminalization of personal possession of illicit substances?

  3. Where do you/does your party stand on providing safe supply of prescription grade substances in order to stop the preventable overdose deaths from tainted illicit drugs in this country?

  4. Where do you/does your party stand on harm reduction measures, such as access to naloxone free of charge, distribution of harm reduction supplies and supervised consumption services?

Background information to Question 1:

Canada has a "Four Pillar Drug Strategy": Harm Reduction, Treatment, Prevention and Enforcement. In the past, most investment (90+ %) has been in enforcement and only in recent years more investment has been made into harm reduction and treatment. Prevention still falls short in many ways with mental health issues, trauma, poverty and other contributing factors going unaddressed. Ideally, we would like to see candidates support the four pillars approach, with a strong focus on harm reduction and treatment including safe supply (see below) to address the immediate crisis and a long-term prevention focus that addresses underlying issues. Currently investment in each of the pillars, other than enforcement, is not proportionate to the magnitude of the crisis, so we are looking for parties to commit to greater investment to address the crisis.

Background information to Question 2:

People using and dying alone is closely related to the stigma and criminalization of substance use. Criminalization also means that a disproportionate amount of resources goes into the criminal justice system. Portugal has shown that decriminalization and shifting resources to treatment and prevention can drastically reduce overdose rates and provide more people with the help they need. While this model does not address the issue of the tainted illicit supply, it is an important step to reduce stigma and see problematic substance use as a health rather than criminal justice matter.

Background information to Question 3:

Overdose data has shown that in the worst hit provinces, including BC, AB and ON, over 80% of the deaths are attributed to toxic street drugs, in most cases involving fentanyl and fentanyl analogues. The high number of deaths (12 people die in Canada every day) has resulted in a drop in the overall life expectancy in BC and Alberta and a plateau across the country, after years of increases in overall life expectancy.  Models for "heroin assisted treatment" in Switzerland and in BC have shown that providing people who use drugs with safe prescription grade supplies not only reduces deaths, but also contributes to a decline in overall problematic use and in crime rates. This is referred to as #SafeSupply by the drug policy community. There are models of #SafeSupply in BC, however, they reach too few people in few places and have a high threshold of criteria to enter the programs. Large scale #SafeSupply models are needed to immediately address the crisis and models for substances other than opioids, such as stimulants and benzodiazepines, are needed. Once people are stable they are in a better position to deal with the issues that contributed to problematic use. Using drugs should not mean that people need to risk losing their lives.

Background information to question 4:

#HarmReducationSavesLives! This has been shown in a study in BC that showed overdose death would be 2.5 times higher without these measures, including naloxone distribution and supervised consumption (the study also considered the impact of opioid substitution treatment), yet, in the general public and amongst politicians harm reduction is often seen as "encouraging" substance use or "giving up on people". Our answer is that harm reduction encourages life, and dead people don't recover. We have learned that substance use occurs regardless of risk, but if we keep people safe we can build relationships and give people a chance. This is shown by over 10,000 referrals to treatment services made by Alberta supervised consumption services (SCS) in the past 2 years, as well as studies from BC that show that people using an SCS are 30% more likely to enter treatment. We also recognize that some people don't seek treatment for a range of reasons, including severe trauma. We repeat: Using drugs should not mean risking your life.

Available information based on party platforms:

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My sister died alone at the age of 18. Zoe might be alive today!

Max is speaking ins support of Supervised Consumption Services to the SCS Review Panel Open House on September 18, 2019.

Hello my name is Max.

I have 2 sisters, one is alive and one isn’t. We grew up in a middle-class family. My father started his own construction company when he was 24 years old and was a respected tradesmen and business owner for over 30 years.  Both my parents worked hard to provide for their family. We traveled more than many other families, both abroad and across Alberta as my dad would pack up my sisters and I when he had projects out of town. We loved spending time with him and getting to know the Alberta that he loved. 

In 2014, our father was diagnosed with terminal cancer and my youngest sister Zoe, who had just turned 16 took this news very hard and became depressed and withdrawn. My parents did the best they could to support her as all parents do when their child is ill while our family faced my dad's cancer diagnosis as well. They visited our family doctor who suggested they keep my sister busy and prescribed medication for depression. A psychologist and later a psychiatrist were also consulted who also prescribed medication.

Somewhere during this time of trying to find Zoe proper help, she discovered cannabis, and she liked how it calmed her much more than what she was taking already. When Zoe started high school, the anxiety worsened and in school she discovered the availability of oxycodone, MDMA, ecstasy and other forms of illicit drugs. Make no mistake that junior high and senior high school is sadly where dependency oftentimes begins for youth and Zoe was no exception. Before my family realized it, she had developed a dependence on these products. We watched a vibrant, athletic, extremely bright young girl wither into someone unrecognizable and troubled. Her addiction to drugs alienated her, criminalized her and stigmatized her before a lethal poisoning from fentanyl killed her on November 7, 2016.

I’m here today because our provincial government has chosen to evaluate the social and economic impacts of the current and proposed supervised consumption sites in the province and I needed to voice my concern about this. The sites both open and proposed in this province are extremely important. These were not in place in 2016 when my sister began using drugs intravenously. This is something that my family and I are concerned with every day when we hear about sites being targeted for closure or not being funded appropriately. My sister died alone at the age of 18. The people she lived with did not have naloxone and were frightened to call 911 for fear of being arrested. If she had had access to supervised consumption services she could have used safely and not have overdosed because of the poisoned drugs she purchased.  Zoe might be alive today.

To the panel members, I’m sure you have heard of all the merits of these sites as we come towards the end of the process, but I will state them one more time for myself.  The medical efficacy of supervised consumption services in keeping people as safe as possible while connecting them to services that could help them further is critical. There has not been an overdose death at any site in Alberta. And for every dollar spent on harm reduction, we save 5 dollars in other medical costs. 

You have heard stories from citizens who are scared of sites in their neighborhoods. People have spoken in previous town halls about finding discarded needles and how they feel that sites are a haven for degenerates and criminals. These words sting. My sister was more than those words. Drug dependency does not discriminate and people who used drugs have pasts and families who love them deeply. 

What is important is that we ensure that the proper services are available to keep people alive not just with supervised sites, but beyond the sites with medically assisted treatment for some, as well as supportive housing, detox facilities and treatment spaces. All people in this city and province are worthy of care. All people. When my dad was battling cancer not one oncologist told him he wasn’t worthy of care and he was shown respect and compassion until he passed away in May of 2018.

I understand that there is also so much frustration and misunderstanding towards people who use drugs. Before my sister died of fentanyl poisoning I was ignorant to the failure of the drug policies in our country and around the world. I felt that people who were addicted to drugs had made a choice and that they were to blame for their behaviour and that they should just stop using drugs. After seeing my sister brain dead in a hospital bed I do not feel that way anymore. This wasn’t something she could have just stopped doing. Unless you experience this, you don’t understand. I hope everyone sitting in this room thinks about the families that are affected the next time you see a person on the street who is vulnerable. 

Some people believe that safe consumption sites are enabling people who use drugs and view them as a band aid solution. The reality is that before people can move to recovery from the crisis of addiction and overdose that is gripping our country, they have to be alive to do so.  My family learned the hard way that forced or mandatory detox is not effective. Supervised consumption services offer overdose reversals first and then provides mental health support and other services to help people. By meeting people where they are, SCS can connect them to life saving resources, curb illicit and unsafe behaviors and ultimately reduce the public costs associated with addiction and overdoses as I mentioned earlier.

It is my hope that this review panel will do the right thing in honour of the life of my sister Zoe and the other 2,182 people who have died since January 2016 from overdose and the hundreds of clients who are using SCS every day. I respectfully ask that your review will show that all Edmonton sites remain open and that they are funded accordingly and that furthermore more sites should be opened to address the rate of death that we are experiencing. 

My sister died alone from fentanyl poisoning – it could be your loved one who dies alone tomorrow. 

I fully support harm reduction and safe consumption services and hope you will too.

Thank you.

Max

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Ask a Nurse: How does a supervised consumption site really work

Taliesin Magboo Cahill, September 22, 2019 on Twitter

Is anyone up for a #tweetorial about what it's like to work as a nurse in a supervised consumption site? Not sure if I've seen one before and I feel like there are some things I could clear up. #harmreduction

FYI - It's not all nurses! Some sites don't have nurses at all! All sites in Canada have harm reduction workers (oft. with SW background) and people with lived exp of drug use employed in their sites. Some have RNs or RPNs as well. [Some sites have paramedics on staff to respond to overdoses and have limited nursing support to address other medical issues, such as infections, wound care, and other.](*) Supervised Consumption sites (SCS) and Overdose Prevention Sites (OPS)(**) are variable in terms of staffing, vibe, usage patterns. Personally, I've know of sites with as few as two booths and as many as 12. Staffed by 1 to 3 or 4 people.

Our main goal is to respond to overdoses (opiate and stimulant) and keep people alive, using stimulation, supplemental O2, and Narcan. We are also trained in responding to other medical emergencies (e.g., anaphylaxis, cardiac arrest, hypoglycemia) and mental health crises.

But we aren't a hospital! We have some medical supplies, but no advanced airways, no cardiac monitor. Common equipment includes MANY pulse oximeters, AED, ambubag and oral airway, BP machine, glucometer, maybe a vein finder. Any emergency requiring more than this - we call 911.

Although we are here to keep people alive, we only spend maybe 10% of our time responding to overdoses. We also do wound care, referrals to all different kinds of treatment/health care, and personally, I spend a lot of time playing DJ and just chatting.

At all sites in Canada, nurses or PWUD will give advice on safer injection techniques and finding veins to use. In a few sites in Canada, peers can help each other inject. The idea is to keep people using IN the site.

The sites vary in how medical they appear, but the idea is to make them welcoming for people who use drugs. Clean, but ideally a little more comfortable than a doctor's office. Welcoming, non-judgemental, fun. Or people won't use them.

Liability - in Canada, these rooms are exempt from laws against possessing and being around drugs. I'm not endangering my license as long as I am responding in an appropriate and safe way to an overdose.

Safety - Most sites don't have security as it exists in the hospital. No chemical or physical restraints. There are often panic buttons as there are in many community health settings. All sites have behaviour standards.

What is great about my job: getting to know/talk to all different kinds of people, the feeling of providing an essential service that saves lives, working in a team, having a standard intervention that I do over and over again so I become really confident in what I'm doing.

What sucks about my job: seeing ppl I know almost dying, hearing some very sad stories, and yes sometimes people are [angry/using foul language] (not very common). Mostly feeling powerless to help people in the long term. Sometimes overdoses are scary.

Addendums: - We don't provide the drugs! (although there are small pilot safe supply programs in Canada) - I get paid! I've done this work as a volunteer before but currently I get a paycheck/benefits/pension. As do the PWUD who work at the sites.

Vibe can lean medical or casual, but most have easily cleaned injection surfaces, lots of mirrors, decent lighting, sharps containers. Some play music. Some have time limits. Some have security. Some have a lot of rules, some have close to none.

Why do people use SCSs? The people who do use them could address this best, but I can try: preventing overdose, clean space, protection from cops, medical care. Access to wraparound services.

What drugs are people using? That varies as well although it's absolutely not all opiates - estimates from sites I've worked in or visited vary from 40 to 60 percent fentanyls or 'heroin'. Other drugs include meth, speed, rx opiates and stimulants, cocaine (crack).

Policing: That depends on the site, but they aren't just allowed inside to check for people without a warrant. Ideally, they aren't parked outside deterring people from coming in either.

Getting people help: Do you talk to your patients about their motivations for using, med assisted treatment, going to rehab/non-profit centers, getting clean? Yes we do, but when they are ready. When someone is dopesick, I know their motivation in the moment. Clients are the ones who will initiate conversations about motivation and recovery when they begin to trust us and feel safe in the space. Trauma/culture informed care is a must.

Sharing drugs:  People are not sharing because it's considered trafficking. It's unfortunate because people often buy together and want to split it at the site, but not sharing is one of the conditions of the exemption that let's us operate. [In most sites people are also not allowed to help each other inject, called “doctoring”, which is problematic, as some users inject in hard to reach locations or have difficulty injecting themselves This is more common for women than men, which might be a contributing factor in lower fatal overdoses in women.]

Link to the original tweet https://twitter.com/tmc_RN/status/1119269129293221888

(*) Text in [square brackets] was added by MSTH

(*) An Overdose Prevention Site (OPS) is a “supervised consumption site lite”. Approval is typically time limited (from a few days to 12 month), but can be extended. It is used as a response to an immediate crisis while steps for a full SCS are taken. It is at times in temporary locations, such as trailers/tents and has fewer or no auxiliary services, such as nursing, counselling, social work. Some are funded by government or grants, some through donations, most have paid staff, but some are run by volunteers. When approvals and funding for SCS in Ontario was put on hold by the Ford government volunteer groups managed to keep many of the sites open as an OPS, with federal approval and in some cases federal funding and fundraising. We might see this situation evolve in Alberta, depending on the outcome (expected November/December 2019) of the SCS reviews currently being held in that province.

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SCS are an essential health service within the fabric of our Canadian Charter of Rights and Freedoms - SCS Review in YEG

Shelley Williams – Ex Director at HIV Edmonton for 8 years, I was Chair of the Coalition known as Access to Medically Supervised Injection Services Edmonton, and was the executive director of Bissell Centre for 10 years. Bissell Centre has been providing supports and services to people in these communities for over a hundred years. These are not new issues in the community. 

Crime, garbage, tent cities, homelessness, poverty, real estate prices, policing, and the success of businesses cannot be tied directly to SCS.

These issues and dialogues have been around for a long time and continue to be important.  We do need to address them but Consumption services should not be the punching bag for these or for the lack of governments’ leadership in addressing them.

Taking them away – the issues being identified will NOT disappear.

The indisputable evidence clearly shows that SCS has a positive impact in our community. The reversal of an overdose means a life has been saved! To support a person who inject substances by helping them out of the back alleys and into a safer and respectful environment is the right way to address a societal issue that has been shunned. Punishing, telling people to stop or putting our heads in the ground - hoping that it will go away -- hasn’t worked. It takes acknowledgement, effort and quite frankly leadership to develop a range of supports. I commend the community organizations for their leadership. Consumption Services is the first critical service within the spectrum that is necessary because it keeps people alive AND provides the opportunity to develop a relationship and information as appropriate, when people are ready, of other possibilities. 

Edmonton tailored a strategy to meet the complex issues of people who would be using the services. Rather than building one stand-alone, storefront facility, such as Insite in Vancouver, the unique model took one site of 13 booths and dispersed micro sized services within community agencies that are already within the area and where the people are - who would utilize the program. The three sites have booths of 5, 5, and 3 making up the equivalency of one site. This is important - they are not 3 stand alone sites as being suggested. They also provide other health and social supports. 

There is work to be done, we need solutions - more services, more innovation, support to communities, and better municipal, provincial and federal strategies to address the range of issues that have been brought forward. BUT it cannot be at the cost of SCS. It is an essential health service and one that is within the fabric of our Canadian Charter of Rights and Freedoms – both sections 7 and 15; legal and equality rights. It is an effective service to support the being in human being.

I implore the panel to be just and thoughtful. Ensure you decipher the comments heard appropriately, recommend that the document be public and make recommendations that include the continuation and expansion of SCS across the province. 


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I stand in honour of my son's life & the lives of the lives of thousands of others who have died because of a poisoned drug supply.

Presentation to the SCS Review Panel in Medicine Hat

Kym Porter, September 3, 2019

My name is Kym Porter. I am a member of MSTH, the MH Drug Coalition and the MH SCS coalition. I stand before you tonight as an advocate for the marginalized, vulnerable, stigmatized, voiceless members of our community. After my son, Neil’s death from fentanyl poisoning, I retired as a director with the MH Catholic Board of Education. Grief encompasses every aspect of my life.

I stand in honour of his life and the lives of the over 11, 577 who have died because of a poisoned drug supply.

Because none of us can legitimately comment on the socio-economic effects of a supervised consumption site here in MH, and because this panel has access to the many reports containing such effects of these sites in this province, specifically I refer to the Alberta Community Based Report on Alberta’s Supervised Consumption Service Effectiveness, I will propose solutions to the crisis as I would see that as the overarching goal of this review.

As like all harm reduction advocates, we believe in evidence-based solutions.

As garnered from Chief Medical Health Officers across this country, the current drug policies are not only creating much of the harm, they are also a catastrophic failure. Drug policies are making things worse.

Solution # 1 -We need to end drug prohibition. The drug policies are as toxic as the drug supply. Read Chasing the Scream.

New policies, with a shift to a public health approach, instead of a political approach need to be developed quickly.

Solution # 2 - We need to deliver a safe supply as the toxicity will continue to drive the number of corpses increasingly higher.

Solution # 3 - We need to remove the barriers to harm reduction services, not take away what few life saving supports we have.

Solution # 4 - we need to connect people with life saving health services and supports such as safe care, ancestral healing practices, safe housing and income assistance.

Finally solution # 5 - we need to decriminalize possession for personal use.

In closing, I would like to share these words from Tommy Douglas, a pioneer and founder of Medicare:

We are all in this world together, and the only test of our character that matters is how we look after the least fortunate among us. How we look after each other, not how we look after ourselves. That’s all that really matters.

Thank you.

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My son is still a human being! AND HE STILL DOES NOT DESERVE TO DIE!

A Letter to the SCS Review Board Hearing in Lethbridge AB -

Lori Hatfield, September 4, 2019

As a mother of a son struggling with addiction (going on 11 years now), I have walked the path of our broken systems alongside my son and I come with a different perspective than those suffering in the throes of addiction.

My son has at times lived at home, lived on his own, and been homeless. He has lived in Lethbridge, Calgary, Medicine Hat, Victoria, and Vancouver. My son does not want to be an addict. Some days he wins the fight, some days he does not. But he is still functional! He still loves. He still feels. He still does everything everyone else does. He is still a human being! AND HE STILL DOES NOT DESERVE TO DIE!

The Supervised Consumption Site is doing EXACTLY was it is designed to do – keep people from dying from using contaminated drugs. It also points its clientele towards available services – now if we had more services, we might be able to see some real decline in people in active addiction.

When I brought my son home from BC, we went to the SCS first thing on a Monday morning. He made contact with the Virtual Clinic and had a prescription for Suboxone later that same day. It was wonderful! Previously he would have had to wait 3 or 4 weeks for the “travelling addiction doctor” to be in town to either get a prescription or a change to his prescription. I can’t say enough about this service. For those that can’t abstain (which is not recommended by the experts anymore with regards to opiates), this service offers that window of opportunity when the desire for a change presents itself to someone suffering with addiction.

The main flaw in Lethbridge is that there is NOT enough wrap-around services for the amount of people suffering from addiction. When that window opens up where someone wants help, it can be weeks before that first step is available – the window has closed long before help is available and our vulnerable people are suffering due to these lack of services. Those proposing to stop funding to the SCS are playing God and they have no right to do so. We have the means and the know how to keep people alive – who has the right to say, “no you should die”. Which is exactly what will happen – people will DIE! DIE, DEAD, NO LONGER HERE. No chance for change, no window of opportunity. Addiction can be overcome. It does happen. It’s a very hard road to travel, but by God it happens every single day and we need to make sure that that opportunity is available every single day.

Stopping funding, thus closing the SCS is NOT going to change the needle debris in Lethbridge, it is not going to end addiction – it is only going to cause deaths. That will be the only outcome of this action. When my kids were little, we always searched the parks and playgrounds before letting our kids play – looking for broken glass and dog and cat feces. We searched then and you still need to search, only now you have to look for needles in addition to the other stuff. Yes it sucks, but it’s the way of life now in EVERY COMMUNITY – not just Lethbridge.

As far as crime goes, the SCS has been a dumping ground for blaming all that is wrong in Lethbridge. It is unfair and unwarranted. Nobody ever brings unemployment into the equation – that due to the slow down in Gas and Oil there are hundreds of people that were making very lucrative incomes and are now desperate to make ends meet – oh but they don’t commit crimes, they would never steal – its only addicts that do that.

Do you know how many people the death of one addict impacts – well there’s the mother and father, wife/husband perhaps children, siblings, aunts, uncles, cousins, friends . . . too numerous to count. Not only that, but children suffer the most from PTSD and the death of a parent. Imagine the environment of elementary, middle and high schools as these children grow-up.

I do not know what more we can do to make people realize the importance of Supervised Consumption Sites ALONG WITH ALL THE NECESSARY SERVICES that need to be available to people suffering from addiction. I do not think Lethbridge would be in this state of turmoil if we had had sufficient services put in place at the time of the opening of the SCS. There is only one reason the Supervised Consumption Site should have its funding stopped and that would be because there is safe supply and people do not need to worry about dying from using  contaminated drugs.

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Alberta Votes: #MSTH and #CTF release report card on political leaders’ overdose epidemic response strategies

Addressing the Overdose Epidemic in Alberta: Most party leaders underachieve

April 3, 2019: When the next provincial government takes office, it must take immediate and decisive action to address the overdose epidemic claiming two Albertans’ lives every day.  While this pace of preventable death seems to some like a new normal, each loss rocks families, friends and communities and takes an unforgiving toll on Alberta’s economy. Addressing this unprecedented public health emergency must be a priority for our next Premier.

Two Alberta-based community groups – Change the Face of Addiction and Moms Stop The Harm – invited all provincial party leaders to complete a brief online questionnaire. The questionnaire contained four questions about leaders’ proposals across what are described as the “four pillars” of substance use policy: prevention, treatment, enforcement, and harm reduction. We also assessed the extent to which leaders have demonstrated a personal commitment to protecting all Albertans affected.

As of April 2, 2019, only David Khan of the Alberta Liberal Party responded directly. We therefore collected the remaining leaders’ available policy documents, public announcements and commentary. With the assistance of provincial content area experts acting as concerned citizens, we graded each leader’s approach.    

This exercise leaves us deeply concerned. Most leaders do not describe action that is proportional to the magnitude and urgency of this crisis, and some leaders endorse policy directions that are more likely to harm than help. For example, increasing drug investigation and enforcement may be politically appealing, but evidence shows these measures increase stigma, exacerbate social inequities and discrimination, and increase harms of substance use. In the meantime, the threat of punishment does little if anything to prevent substance use, and it increases violence in the drug trade.

Some leaders propose addiction treatments that research has proven relatively ineffective for opioid addiction. For example, mandatory detox services, abstinence-based residential programs, and “faith-based” treatment approaches do not achieve optimal health results. In some cases, candidates endorsed interventions that could increase the risk of overdose death. Besides being ineffective, some of the suggested treatments could not be scaled to the extent required to meet population demand. While more money for treatment is desperately needed, we need to invest in treatments that are shown to work. At least equally concerning is some leaders’ view that life-saving harm reduction services that have finally been established in Alberta should meet additional bureaucratic requirements that would at least delay their expansion if not cause their closure. Having reviewed party leaders’ positions, we fear – as do public health experts nationwide – that the progress made towards evidence-based services like supervised consumption could be undone following this month’s election.

Albertans should expect that in a public health emergency, our leaders will perform at an A-plus level, acting rapidly, resolutely, and consistently with the best available evidence to protect human life. This issue requires critical attention in the lead up to the election, and it appears our Premier-hopefuls have some schooling to do before April 16th.

Background:  Change the Face of Addiction and Moms Stop The Harm are two Alberta-based community groups made up of citizens who became advocates after they witnessed the lack of supports and services for family members experiencing addiction. Many members of these organizations have had loved ones die from overdose.

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In Memoriam Jordan McBain Miller August 28, 1988 - February 4, 2014

February 4th will mark five years since my son Jordan passed away from an overdose of prescription drugs. I miss him as much today as I have done on any day over these years.

Jordan was a person who cared deeply about family, friends, and animals. He did not have time to really develop a philosophy about his life in the world. Youth and addiction can do that to a person.  While he knew deep love, he missed out on marriage, children (he loved kids!), growing wisdom and the joy we experience in the world of the living.

He is remembered with love by his friends and his family. We knew him as funny, over-the-top, risk taking, caring, skilled, and smart.  But as a person involved in drugs, he was often anxious, scared, rude, irresponsible. Addiction does that to a person. It did not come from within the beautiful soul of Jordan.

You may be surprised that I include Jordan’s addiction in this piece as it was only a small part of who he was. But that is what took him away. My life’s work now is to support the lives of people who use drugs, families with a loved one using drugs, and to advocate for more compassionate, evidence-based drug policies. No one should lose a child.

Senseless, accidental and preventable drug deaths must end. The stigma around drug addiction must end. No one should suffer needlessly from drug harms. Jordan brought love and joy to my world for 25 years, and for that I will be forever grateful.  In Jordan’s memory I ask that everyone educate themselves on the nature of addiction and the treatments for it.

Leslie McBain

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Movie Review - A Beautiful Boy

I watched beautiful boy 2 nights ago. It seemed disjointed and somewhat superficial and impersonal.
It’s as though this family was swept into a terrifying journey through their son’s addiction and then the storm ended and that was it. It’s an experiential story that seems to lack the reflections and insights I was craving as the mother of a person who suffered from addiction. There is no moral to this story, no lessons or pearls of knowledge, nothing to educate us.

In fact, the message of this story seems to convey that everyone but the person with addiction is a victim with no choices, and only a person suffering from addiction can help themselves. Worse, it seems to suggest that being addicted to substances were a choice. Neuroscience tells us otherwise. With great actors and a timely and socially relevant theme, I think the implied promise of this film is misleading/disappointing and I give it 2 thumbs down.

Tamara Scullion, MSTH Leader for Quebec

An open letter to the mayor of medicine Hat Alberta in support of SCS

I grew up in Medicine Hat and consider it my hometown, although I now live and work in BC as a school psychologist. The topic at hand is an issue that no one is immune to – addiction and mental health. More specifically, I am writing in support of the proposed Supervised Consumption Site (SCS) in Medicine Hat based on first-hand lived experience as a sister and daughter of loved ones whose lives were lost to this epidemic, and as a professional who is informed about the science and evidence in support of these sites. I am also an ally of the group Moms Stop the Harm (MSTH), which is a network of Canadian families whose loved ones have died due to substance use or who hope for recovery. MSTH calls for an end to the failed war on drugs, which is a war on the people we love. We envision a new approach based on reducing harm, where people who use drugs are treated with respect, compassion and support.

First, I’d like to say that the landscape and consequences of drug use have changed drastically over the decades with the rise of opiates and methamphetamine use. Speaking as a sister, I have been completely devastated by the suffering that I watched my brother endure that eventually ended in his early death at the age of 36. He spent nearly 25 years in active, severe addiction beginning as a pre-teen, fuelled by complex trauma, untreated mental health and neurodevelopmental challenges, and access to prescription opiates in the household as a teen. Those who knew him would remember his generous, soft-spoken nature, and the love he had for his little dog and for me, his sister. I can’t imagine loving anyone more than I love him. Though there were signs that his drug use had become extremely problematic, I never once entertained the idea that he was injecting drugs…because I believed it was “those people” – the dirty, disgusting ones living under a bridge who would resort to that sort of awful behaviour. Did I ever wake up when I found out that my handsome younger brother had been injecting for almost 10 years, and had by that time destroyed nearly all of the veins in his body through his drug use. He had also suffered a serious case of flesh eating disease that almost resulted in an amputation of his arm that he did not tell me about out of shame that I would find out about the extent of his disorder. I saw my brother deteriorate from a physically healthy young man to a person completely overcome by the devastating physical and mental effects of his addiction from which he saw no possible way out. No one in their right mind would continue self-harming behaviour with such devastating consequences if they were able to simply make a choice to stop. Addiction is a complex brain disorder that affects cognition, behaviour, and impulse control.

It is for him, and for all our affected sons, daughters, mothers, fathers, friends and partners that I write to advocate for the supervised consumption site in Medicine Hat. While I understand and appreciate the concern of the general public about this site, I implore each and every person to consider all of the evidence, statistics and probabilities involved in this particular issue in order to take an informed stance.

If my brother had access to the supervised consumption facility, I believe he would still be alive today. The reasons for this, based on his lived experience, are as follows.  1) Promotion of safe injection behaviours, meaning primarily, for my brother, that his veins would not have been destroyed. He would have been instructed on the proper methods, using the proper equipment and techniques to minimize the physical damage to his veins and skin. He avoided seeking medical help and treatment in general due to the intense shame he felt as multiple people tried repeatedly using fancy lights and techniques to locate veins in his body, all the while turning white and almost vomiting due to the intense anxiety and shame he felt. When a medical emergency arose that threatened his life, which happened multiple times due to the significant health complications associated with his drug use, doctors would have been able to draw blood and administer IV fluids and drugs quicker, an issue that was related to the cause of his death. 2) Increased positive interactions with medical/clinical personnel, meaning that he might not have had such intense fear and aversion to interactions with health care professionals. If he was more willing to engage with the health care system, he would have been much more likely to engage with supports to treat his disorder. 3) Increased likelihood of engaging him in treatment. I encouraged my brother at length in many ways to engage in various treatment options. The only interest he expressed was in connecting with a peer mentor he met in the community who had showed him personal interest and care. This peer did not provoke shame in him because he was kind, compassionate, and had experienced recovery. This peer made him feel like he mattered and that he was cared for. Each and every interaction with staff at the SCS is a relationship building exercise in which the client is treated with respect and dignity, which is often not the case for these individuals in the rest of society at large. It is through that relationship that trust is built, self-worth is discovered, and the chances of engaging in further treatment options is greatly enhanced.

Speaking as a professional who values science and research-based evidence, a recent meta-analysis of 75 studies found that at the population level statistically, supervised consumptions sites 1) enhance access to primary health care and social services, 2) greatly reduce overdose and death, 3) do not increase drug injecting, drug trafficking or crime in the surrounding environments, and 4) reduce public drug injections and dropped syringes (Potier et al., 2014). In Alberta, SCS’s have helped people who use drugs close to 85,000 times. Each of those visits represents a care episode where someone like my brother was treated with compassion and offered an opportunity to move towards positive change. The Alberta sites have saved lives by reversing 1070 overdoses, and the Edmonton site alone has received 5372 referrals to other health and social supports. (The availability of those supports is another issue that we as a society need to collectively tackle!).

Let’s provide our loved ones with dignity rather than shame, and with hope rather than despair. While I understand fears such as increased risks to the neighbourhood or decreases in sales, we are talking about our loved ones’ lives, and their deaths. They deserve access to evidence-based treatment and respect as much as your families and businesses do. Let’s come together in our common humanity and find ways to mitigate the risks that some community members are concerned about, while also providing respect, compassion and evidence-based treatment for those suffering wit substance use disorder. Each of those affected is somebody’s someone.

Dana Dee on behalf of my late brother.