Wider Horizons

Story by Curtis Gillespie
Photos by David Guenther


“Everybody’s just miserable there. It’s a bad vibe. I’m just trying to get back on my feet. Every day I try.”
- Bruce

Bruce came into the healing circle, a quiet room across the hall from a supervised consumption site in Lethbridge. He sat down, twisting one leg over the other, chewing on a fingernail, looking hesitant. Bruce (not his real name) moved to Lethbridge to be closer to his son, who came to the city with his mother.

Things haven’t worked out quite the way Bruce had hoped. He is homeless and living in a nearby shelter. “I try to stay away from there, though,” he says softly. “Everybody’s just miserable there. It’s a bad vibe. I’m just trying to get back on my feet. Every day I try.”

Bruce is using drugs, mostly crystal methamphetamine, and has experimented with others, including fentanyl. He started doing drugs when he moved to Lethbridge. That’s how he found himself in the supervised consumption services area of ARCHES, a non-profit organization in Lethbridge that offers support to people with HIV, AIDS and hepatitis C, as well as drug users.

“I’m kind of new to the whole situation. I never really did drugs before I came here,” he says. “It’s hard. The racism really gets to me here. When I look for work, nobody will even look at me when they see I’m First Nations.”

He isn’t giving up. He is trying to get into a treatment program, and is working on his own to reduce his intake. “For me, the path is to cut down. I haven’t done drugs in four days now. I haven’t used and haven’t been here.” He stopped and looked around, out the windows, into the crowded reception area and over to the door. “I actually try to stay away from here, but only because I associate it with using.”

Bruce knows he has to stop using. A month earlier, he overdosed. He was revived with naloxone, but the experience scared him. “After that happened, I realized how much I still want to do in my life.”

Bruce is one of 950 or so people who have used ARCHES’ supervised, secure consumption site in Lethbridge. You have to be buzzed in to the area, which has about 17 booths, each the size of a toilet cubicle, and two inhalation rooms. Each inhalation room has a door with a window, so that everything happening inside is visible. A nurse’s station is in the middle of the room. There are at least two staff on hand. One is always a nurse.

The site opened in February 2018 as a way to reduce overdose deaths, disease transmission, public drug use and inappropriately discarded drug gear, as well as to increase the uptake into treatment. It is for people using drugs, including depressants (the opioid family, which includes fentanyl, carfentanil, heroin and methadone) and stimulants (such as cocaine and meth). People take the drugs four ways: injecting, snorting, inhaling or smoking.

On that fall afternoon, most booths were occupied. Once a person has finished using, they exit their cubicle and are encouraged to hang out in the observation room for about half an hour. Most overdoses take place within 10 minutes of using, so this allows medical staff time to intervene. The overall environment is clean and sanitary, almost like a hospital emergency department.

“The supervised consumption services are one part of harm reduction. We’re recognizing that people are already engaging in high-risk behaviours. It aims to reduce their potential for harm,” ARCHES health coordinator Graham Black says. “We meet people where they are at in their current usage and, then, when they are ready, we connect them to other services like detox or finding housing.”

Sometimes interventions (such as immediate medical procedures like administering oxygen or naloxone) are even more direct. “Since the supervised consumption site opened,” Black says, “we’ve had around 900 people who have had medical emergencies including overdoses, and we have successfully managed all of them.”

In other words, no one has died.

Elsewhere in the province, however, that hasn’t always been the case. In 2011, six people died from overdoses. Now, it’s more than two people a day. Last year, 733 people died from unintended opioid overdoses in Alberta. But the statistics are not just about the deaths. In the first eight months it was open, the supervised consumption site in downtown Lethbridge was used more than 90,000 times.

Numbers this high can only lead one to wonder about the actual scope of the drug crisis, in Lethbridge and across the province. How many people are affected? Who are they? And why are they using drugs?

 

 

 

“Addiction knows no boundaries. I don’t think there’s a typical profile of a user. I think we’re all susceptible at one point in time or another.”
- Trevor Inaba

 

 

Lethbridge has individual characteristics that make the city, and its current addiction scenarios, unique, such as its close ties to rural communities and the bordering Kainai Nation (Blood Tribe). But the reality, says Trevor Inaba, the executive director of Addiction and Mental Health for Alberta Health Services’

South Zone, is that the drug issue affects everyone. Whether due to adverse experiences, or an injury we are having trouble recovering from, or chronic pain or poverty, the truth is that anyone is vulnerable. The strength and lethality of opioids is new, but the underlying reality of addiction—to drugs, alcohol, you name it—is not. “Addiction knows no boundaries,” says Inaba. “I don’t think there’s a typical profile of a user. I think we’re all susceptible at one point in time or another.”

The current opioid issue crosses the demographic spectrum: seniors, teenagers, middle-class working people, athletes who’ve suffered a sports injury, crash victims. It’s not caused by just one thing, either. It is the intersection of multiple issues—drugs, mental health, poverty, injury, homelessness.

“Chronic substance use is all-consuming. It replaces relationships with friends and family. It becomes a full-time job, it floods our environment and it changes our neurological pathways,” says Stacey Bourque, the executive director of ARCHES.

“We give people medication or detox or residential treatment and expect them to be well. However, if nothing else changes in their lives, recovery is nearly unattainable. Their environment hasn’t changed. Relationships are still fractured. They may still be experiencing homelessness or an absence of employment or income or all of those things and more.”

And while many look at addiction as something that happens to weak people, this crisis is showing that addiction can happen to anyone. “Opioids are pain killers, and often the reason people get addicted is because they are in significant physical and/or emotional pain. Our options for pain management are limited and rooted in social privilege,” says Black. “For people who are already marginalized and face discrimination, opioids are a cheap, readily available means of coping with that pain. We need other methods of pain management.”

The drug crisis is changing the way many people in Lethbridge and the rest of the province—healthcare workers, journalists, police, nurses, doctors and other healthcare specialists—work, too.

Dr. Josh Fanaeian, an emergency department physician in Edmonton, says that in the past, if an ED doctor discovered someone was on opioids, they’d either prescribe more—or not—and then send them on their way with no follow-up (after treating the issue that brought them to emergency, of course). “Even when I was a medical trainee, I encountered instances of stigma against addiction in the ED,” Fanaeian says. “For some, there was a kind of pride for ‘busting’ people illicitly using prescription opioids and then sending them on their way.”

That is no longer the case. “We’re starting to realize how powerful and unfortunate this epidemic is,” Fanaeian says. Much of the new approach is about education, Fanaeian says. The Emergency Strategic Clinical Network (ESCN) is an AHS provincewide network that connects Alberta’s 103 emergency departments and six urgent care centres.

The ESCN recently started a pilot program to screen emergency department patients for opioid addiction, and, if necessary, to prescribe Suboxone (which curbs cravings and is related to naloxone) and to provide follow-up options for community treatment.

wh-wn19-numbers-graph-2.pngOver a three-month period this past summer, the program referred 28 patients to community clinic appointments and 11 of them followed through. A 40 per cent follow-up is considered very successful, since about 20 per cent of all people who die from an overdose have visited an ER within 30 days of their death.

The program was offered at two hospitals in Edmonton and one in Calgary. It’s now rolling out to all major hospitals in Calgary and Edmonton. The goal is to expand to all regional and rural centres, including Lethbridge.

 

 

 

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Health professionals use effective medical and therapeutic methods—such as harm reduction, prevention, education and residential treatment centres—to address the destruction that addiction causes. Increasingly, addiction treatment also includes examining the experiences that lead to addiction.

Many people who contributed to this article noted there’s a shift in the approach in Alberta—namely that successful addiction prevention and treatment means creating better relationships and stronger communities.

Cheryl Andres, the director for Public and Primary Health Care in AHS South Zone, says that primary care, whether it’s a family doctor or a clinic, is often the first place people go for healthcare. (Found across the province, primary care networks are joint ventures between AHS and physicians and are designed to simplify healthcare.)

“We need to do treatment, and we need to offer support, and supervised consumption sites, and evidence-based practices, all those things,” Andres says. “But as humans, we also need human interaction. There are things transpiring in our communities that are a result of loneliness and disconnection. And we have a population turning to other things to fulfil themselves.”

Chris Windle, a health promotion facilitator for AHS Addiction and Mental Health in Lethbridge, shared a similar perspective. “People just do better when they have community connections, positive relationships and a purpose, and a meaningful way to go about their day,” Windle says. “Of course, you can medically treat someone, but there are other issues and concerns that need to be addressed and supported.”

Each person with an addiction has their own story and healthcare workers can’t treat them properly without knowing that story. In other words, yes, you might get a person off fentanyl for a month if they stay at a treatment facility. But if you don’t understand and deal with what caused the addiction in the first place (whether that be poverty, childhood trauma, a mental health issue, or a combination of these and other factors), it’s like putting new tires on a car without tightening the bolts.

Only 60 km away from Lethbridge, Standoff is the administrative centre of the (Kainai) Blood reserve. About 14,000 people identify as members of the reserve; roughly half call Lethbridge home, while most of the others live on the reserve.

Jacen Abrey, the tribe’s director of Emergency Medical Services, says they receive funding for about 1,800 emergency response calls a year, but typically make double that—around 3,600 calls for a place where only about 7,000 people live. In the past few years, the reserve averaged close to 30 overdoses a month and two or three people a month were dying from those overdoses. Naloxone has changed things for the better; they have had just four deaths by overdose in 2018.

Terri-Lynn Fox is the director of the Kainai Wellness Centre. Located on the Blood reserve, it offers mental health and addictions programs and referral, a clinical therapist and other intervention programs that integrate the community’s traditions. “Our spirit is lost, it’s gone, it’s not connected,” she says. “We have to find ceremony and connection to the old ways that are our protective factors. And if we don’t go back to that, we may not change it. Because what’s happening here is real. It’s not a statistic in a book.”

Her brother, Derrick Fox, the Blood finance director, echoed her words. “Part of the problem is that we have started to normalize the dysfunction,” he says. “That’s really our challenge—how to unlayer the dysfunction. We need to know the past and see what’s going on today to understand what we need to do, like detox, treatment, the aftercare, prevention and harm reduction. But we can’t do any of that without addressing community, and the treatment in relation to the culture.”

Everyone has a space inside us somewhere that needs filling, and most of us fill it with things that give us meaning and purpose—family, friends, work, faith. We might also use or abuse alcohol, sex, drugs, gambling, or any number of things, but if we have protective factors in our lives, we can keep the scales balanced.

For others, however, the scale tips the wrong way.  “Elders talk about dark times when people actually see their spirits leave themselves, whether because of abuse or addiction or whatever. Our spirits get lost,” Derrick Fox says. “We need to heal and reconcile to bring our spirits back home to fully live again.”

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Back at ARCHES in Lethbridge, Jack (not his real name) is another person in the grip of addiction. He went to good schools in Lethbridge, had a solid middle-class upbringing.

At 33, Jack now lives on the street, and came in carrying half a dozen grocery bags full of his earthly belongings. A tall and handsome man underneath his four grimy coats, Jack detailed his downfall.

“I was using marijuana until I was about 18,” he says, “but then I got my girlfriend pregnant.” The pregnancy was terminated against Jack’s wishes, and he acted out. He began experimenting with harder drugs. His parents moved away from Lethbridge. He was diagnosed with borderline personality disorder. His life spiralled downward. “The time that it got really problematic was when I started using cocaine heavily,” he says. “It was probably a reaction to trying to come to terms with everything I’d been through, but also to losing my family.”

He lost his job, lost his home. He says he’d been using methamphetamine heavily for the last six months or so, and although he’d been in addiction counselling previously, he wasn’t currently seeking medical help or in any programs, other than using the supervised consumption site. Through the trauma and pain, Jack says being homeless and on drugs has increased his understanding of what the people around him are going through. “You have such a low quality of life. It can be pretty dehumanizing,” he says. “It’s made me stop and look around and take a look at what people are experiencing out here.”

Including himself. “I’ve experienced discrimination from places I normally thought I’d be welcome—places from my past,” he says. “I opened up about some of the addiction issues I was facing and unfortunately some of those people latched on to that and shunned me.”

When the healthcare, counselling and healing professions look at addiction, they consider the combination of factors that create risk and foster protection. Jack’s current state is all risk and no protection. “Addiction is not just about a substance,” Inaba says. “It’s about understanding what role that substance plays in a person’s life. Some would say addiction is related to overcoming some type of pain or void or disconnect. That’s where a lot of our focus has been right now—how do we prevent death while we continue to tackle addiction in a broader sense?”

Part of that healing process involves “helping that person find something of meaning to attach to,” Inaba says. Except that the word meaning is hard to quantify and the absence of it is hard to treat. The desire to treat individuals as unique entities with souls and histories is vital, but how do you fold meaning into a system?

“Every day, I’m just trying to get back on my feet, get in shape, get into detox, then treatment. I have to do it for my son. I want to be in his life.”

Carol Griffiths-Manns, AHS Addiction and Mental Health manager, believes the opioid situation—in Lethbridge and elsewhere in the province—is simply too complex to summarize. “We have to look at this with compassion and understanding,” she says. “Everybody has a story.”

And it’s often the stories of those suffering with addiction that are the most powerful: stories of the past, as well as the stories they still want to create. “The truth is that if you stay addicted, you’re going to keep getting worse until you’re lost,” Bruce says.

But he was quick to add: “I want to go to school. I want to go back home. I want to do addiction counselling. I’ve actually helped a few people here and there. They need someone to trust and talk to. I have hobbies. I write. I want to write about my experiences.”

He knows that to do that, he has to get clean. “Every day, I’m just trying to get back on my feet, get in shape, get into detox, then treatment. I have to do it for my son. I want to be in his life.”

 

This special feature on opioid drug use in Alberta has been created thanks to a partnership between Lethbridge College and its Wider Horizons magazine and Alberta Health Services and its Apple magazine. If you have feedback on this special feature, please email WHMagazine@lethbridgecollege.ca.

 

This is the second part of our special feature. Click here to read part 1.

Wider Horizons
By Curtis Gillespie, Photos by David Guenther
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