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What you need to know about COVID-19: September 18, 2020
People from across Atlantic Canada, ranging from doctors to community advocates to those living with addiction, have shared suggestions on how to bring about change for our communities. Most of their priorities are similar and include increasing government funding, improving access to services, providing more community support, reducing stigma and considering decriminalization. Each present challenges, but none appear impossible. This week, we connect the dots and look at what steps individuals — and society as a whole — must consider in order to move forward.
WHAT NEEDS TO HAPPEN:
Improve access to services
Atlantic Canada’s largely rural environment means people who use drugs outside urban areas may not have the same access to services.
Wayne Bishop, manager at the Provincial Centre of Excellence for Opioid Dependence Treatment in St. John’s, N.L., said there are gaps across the province.
“Certainly, in rural areas, and we need to really identify and make sure that people have access to those life-saving medications in their communities.”
In Prince Edward Island, Chris Craig works with young people at the Reach Foundation, and he sees the problem of access to treatment there, too.
Stop the stigma
The prevalence of stigma has come up in conversations again and again throughout this project. It seems all agree that one of the biggest obstacles we need to overcome as a society before we can start to truly address opioid addiction is stigma.
“A lot of people are in recovery, they may not have a vehicle – well, most people, most haven’t worked in quite some time – so, of course they couldn’t afford a vehicle, and getting a drive to one of the two cities is sometimes tough, especially when you live out in the rural communities. So, it is a big barrier here for sure.”
Another aspect to access is having a safe place to use.
Currently there is one overdose prevention site slated to open by the end of the summer in Atlantic Canada – HaliFIX Overdose Prevention Society received exemption to the Controlled Drug and Substances Act in July.
“It’s all about reducing the harm,” said Bonn.
An overdose prevention site allows people to use drugs in a safe environment where there is access to clean supplies, health care professionals and life-saving medications in the event of an overdose.
Bonn said people all across Atlantic Canada should have access to such sites, not just in Halifax.
– Julie Dingwell, executive director at Avenue B Harm Reduction in Saint John, N.B.
Further, Bonn believes access to a safe supply is also needed. That way, drug users don’t need to turn to the black market where drugs are often laced with fentanyl.
It’s something Julie Dingwell has been saying for 20 years.
The executive director of Avenue B Harm Reduction in Saint John, N.B. said when people have a safe supply, then they aren’t scrambling every day to get drugs and are able to focus on other aspects of their lives, such as housing.
In Prince Edward Island, Craig said consistent funding would be a “big step” in the right direction.
He said the Reach Foundation is not the only non-government organization in that situation.
“We’re all struggling. We’re all fighting for the same dollars, too, which is tough.”
Even in Halifax where the first overdose prevention site is set to open, Bonn said it was made possible because of community donations.
This is when one person discriminates against another based on their perception. For example, when a person is treated differently or even shunned by others, including being denied access to a business or facility, because of their addiction.
Currently, HaliFIX has enough donations to operate the site for one year.
“The biggest barrier has been receiving sustainable funding from the province,” he said.
“This isn’t a service you want to give to substance users and take it away after three months, (or) six months a year.”
In Saint John, Dingwell said her organization would love to open a safe consumption site but they simply don’t have the funds to make it happen.
“This is where I think the provinces and the feds need to come together because you can’t be leaving these things up to charitable organizations. We can lead the way in the fight, but we certainly can’t do these things – we just do not have the capacity.”
– Dr. Melanie Van Soeren, a family doctor who practices in both Vancouver, B.C. and St. John’s, N.L.
Focus on community supportSt. John’s, N.L. family physician Dr. Melanie Van Soeren said we must continue working to ensure people have all the supports needed to feel fulfilled in life.
This is when a department, organization or policy contributes to public perception or access to resources. For example, if a person is denied access to pain medication or treatment because of their medical history related to addiction.
“So often addiction comes from not just the substance itself, but a lack of connection, a lack of support, a lack of a sense of purpose. And if people are better cared for in other realms of their lives, if they have more access to economic options (and) to social supports then perhaps we would see less people needing to resort to substances just to get through their day-to-day.”
Memorial University professor Chris Smith said psychologist Bruce Alexander’s studies on rats indicate that when people aren’t socially integrated and supported, they may seek out substitute lifestyles, such as substance use.
“In order to solve this problem of mass addiction, this requires a fundamental restructuring of our society in many ways, that’s (Alexander’s) argument.”
Stop stigmatizing, criminalizing people
Two things must change in order to access the myriad of needs already discussed, according to the Toronto Overdose Prevention Society.
That group says the stigma against and criminalization of people who use drugs are impeding the public health response.
Bonn sees it happening in Halifax.
“In Nova Scotia, and I think in Atlantic Canada period, there’s a lot of stigma around substance users, and generally we’ve been underserved as a part of Canada.
“We don’t have a lot of resources, we don’t have a lot of the best harm reduction practices that have been going on out west for over 10 years in Alberta and Ontario, and I think it’s due to the stigma, due to the government.
“And we do deal with different – we have a different environment here than out west, and thank God for that, but we still see a lot of people overdosing, contracting HIV, hepatitis C, and we just don’t have the resources to deal with it, or the services.”
DECRIMINALIZATION AS A SOLUTION
Could it work?
Scott Bernstein, director of policy with the Canadian Drug Policy Coalition, says he is aware of jurisdictions such as the one in Portugal which have decriminalized opioid use, but says he doesn’t expect to see an exact replica unveiled in Canada anytime soon.
“Ultimately, we’re choosing to address the problem not through a health-based angle but rather a criminal justice one,” he said, adding that when we criminalize people for using drugs or selling small amounts to fund their own addiction in Canada, barriers to help are created.
However, rather than replicate what Portugal is doing, Bernstein suggests Canada is better off to review their model and learn from it.
He said removing the criminal law is helpful, but a second step could see more supportive services, expanded treatment and education.
What is needed is a Canadian-tailored program that takes advantage of and builds on our public health system and other services, he said.
Christine Porter, executive director of the Ally Centre in Sydney, N.S., feels the Portugal model is a perfect fit for Canada. She likes that the focus there is not on justice for the person who has only small amount of drugs in their possession, but instead is on helping treat their addiction.
In this war against drugs, Porter believes we are failing in Atlantic Canada and that in order to move forward we have to look at substance disorders as a health and social issue. Portugal looks at a drug user as a patient that is sick, she said, adding “That’s how we see it here (at the Ally Centre)… I think Portugal got it right.”
What impact could it have?
Porter believes a move to decriminalize opioid addiction in Canada could go much further than an opportunity for better access to treatment. She says it would also impact the impressions of the wider community – those directly affected by addiction and those who do not have a personal connection to the issue – because it could alleviate some of the stigma associated with addition.
While she believes stigma is getting better, she says this could be a real game changer.
“Some say (stigma) is worse,” she said. “It all depends where you’re sitting.”
Working closely with individuals with substance use disorders, she and other staff at the Ally Centre stories daily about how people living with addiction are not allowed in certain stores or are stared at in treatment line ups.
In these cases, she says it can be hard to believe the stigma has been lifted much.
However, seeing reactions and what’s happening around the opioid crisis federally and provincially, Porter says those in power are recognizing more and more that stigma kills and are taking a stance towards it, Porter said.
“We need the broader community to hear that. That’s where these people live. That’s who needs to be more compassionate and understanding.”
Bernstein agrees that any step towards decriminalizing individuals who are living with addiction would help with the challenge of stigma.
Once a person identifies someone as a drug user, he says their perception of that person changes. It comes to a point where in some cases a pharmacist or doctor will question if they want that client or patient, he said.
“You label them a criminal and run them through a system moral based.”
Bernstein said there’s also some stigma in police departments and social services which need to be addressed.
“My thought is we could decriminalize to solve that,” he said.
sites in British Columbia
sites in Alberta
in Atlantic Canada
P.E.I.'s MODEL AN OPPORTUNITY FOR OTHERS
Provincial innovative harm reduction program meets patients where they are
P.E.I. is years ahead of other provinces on a key public health program that has harm reduction at its core, according to an infectious disease specialist.
Dr. Lisa Barrett helped advise the province’s health-care decisionmakers on the development of a hepatitis C strategy. The strategy was launched in 2015, at a cost of $5 million, with a goal of eliminating the virus within 10 years. P.E.I. is the first and only province to have adopted a strategy to eliminate hepatitis C.
"There was political will on this Island to be interested in developing a provincial strategy for hepatitis C elimination, which was not present in almost any other province including my current home province of Nova Scotia,” Barrett said.
The strategy has had considerable successes, which Barrett believes has caught the notice of public health officials internationally. P.E.I. currently has 1,000 individuals who have been diagnosed with the viral infection, of which 45 per cent have received treatment. With treatment, the cure rate is 97 per cent.
Hepatitis C is a virus that is a leading cause of liver failure. Scholarly articles refer to the virus as an “epidemic,” although recent improvements in treatment have prompted the World Health Organization to set a target for its elimination by 2030.
Infection rates are especially high amongst individuals who have used drugs, as it can be spread through the practice of sharing needles. But infection rates are also substantial amongst individuals in nursing homes and long-term care facilities as well as amongst some immigrant populations. The virus can be spread through a number of means, including re-using tools for tattooing or re-using medical equipment meant to be used only once. Transmission can also occur during childbirth. Many individuals live with hepatitis C for up to 30 years without knowing it.
Despite the federal commitment of action on hepatitis C, a lack of coordination amongst provinces has stymied a unified national response.
P.E.I.’s hepatitis C strategy involves testing at key access points, such as emergency rooms, needle exchanges and methadone clinics. This treatment is aligned with other harm reduction efforts and can be provided without a referral from a family doctor or specialist.
"We just get them started on treatment that very same day. Many provinces in Canada still have a special authorization process if they're going to access medication and that takes time and it takes process,” Barrett said.
Early on, the design of the program involved a centralized intake and assessment of patients by a nurse coordinator, which also helped reduce the demands on physicians. Data collection tracking has also been a key component of the strategy.
Frontline staff have focused on an outreach model of testing and treatment. For some, this has meant testing for the hepatitis C in private homes. For others, it involves setting up free testing and treatment at the Island’s main correctional facility, known locally as Sleepy Hollow.
By contrast, Barrett said, no similar treatment regime exists for individuals in provincial correction facilities in Nova Scotia.
“I think it is hands down one of the most important things we do for harm reduction," Barrett said of P.E.I.’s program.
"The people who started care and treatment in P.E.I. also started going to get care and treatment for many other things including showing up at their traditional harm reduction appointments for opioid substitution therapy, methadone therapy more frequently. They started showing up for blood pressure appointments.”
Barrett believes the example in P.E.I. should be propelling other jurisdictions to implement their own hepatitis C elimination strategy.
"I work in Nova Scotia. There's no reason we can't be doing the same thing, with the exception that nobody has come forward and done it and committed the financial and human resources to doing it," she said.
WHAT DO YOU THINK?
Chances are you know someone living with an addiction or you have battled addiction yourself. The fact is most of us are not too far removed from this issue.
We’d love to know what you think about the information we’ve published and what questions you still have. Share your experiences and tell us about your ideas for treating opioid addictions at firstname.lastname@example.org.