Panel of experts discuss opioid crisis, harm reduction in Lethbridge

By Patrick Burles - @PatrickBurles on Twitter
July 10, 2018 - 1:19am

LETHBRIDGE – The opioid crisis isn’t ending anytime soon.

Of all the messages delivered during a community meeting centred around the issue Monday night, July 9, that point was the clearest.

Approximately 200 members of the public and Lethbridge City Council had an opportunity to hear from a panel of experts and specialists at Lethbridge College, before getting a chance to have some of their questions answered.

While the panel – consisting of health, addiction and harm reduction specialists, as well as representation from the Lethbridge Police Service and Lethbridge Fire/EMS – agreed that the problem is no where close to being over, they all supported the work going on at the supervised consumption site (SCS) in our city and the needle exchange program.

It was explained that the crisis began to spike in 2014, largely due to a change in the drug supply. LPS Sgt. Robin Klassen told those in attendance that fentanyl filled a void in the drug community but carried the risk of “hot spots.” She said it’s virtually impossible for a user to know the concentration of fentanyl in pills obtained on the street – much like knowing how many chocolate chips are in a chocolate chip cookie.

“It’s a never-ending battle for police services across the country,” stated Klassen, noting that the drug trade is too profitable to be shut down by arresting the dealers. “We’ve been trying to do this for years and it’s not working.

“We’re never going to stop, we’re going to keep battling it,” continued Klassen, when asked by a member of the public why they bother arresting dealers. She added that if they were to ignore the issue it would be significantly worse than it currently is.

Support for harm reduction methods

“The evidence is very clear in public health that these programs reduce the risk of HIV transmission and that they reduce other behaviours that could lead to negative health outcomes,” said Elaine Hyshka, assistant professor at the School of Public Health at the University of Alberta, and co-chair of the Minister’s Opioid Emergency Response Commission. “They also not only improve health at an individual level, but they've been shown to have positive impacts on the community… they encourage proper syringe disposal and they also help connect a vulnerable group of people to different healthcare services.”

In regard to needle debris, Hyshka cited an American study that compared San Francisco to Miami. In San Francisco, where a long-standing needle exchange program was in place, 44 needles were found for every 1,000 blocks. In Miami where there wasn’t a needle exchange, they discovered 371 for every 1,000 blocks.

"A lot of people that are dying in the overdose epidemic are dying at home alone" - Elaine Hyshka, co-chair of the Minister’s Opioid Emergency Response Commission

Dr. Nick Etches, a medical officer of health with Alberta Health Services, also addressed the risks associated with discarded needles that are found throughout the city.

“There is no such thing as a safe needle lying on the ground, but in general, the infectious risks are not as great as many people initially think,” said Etches. “The sunlight and other environmental conditions degrade viruses that are living in the needle, so the risks are fairly low.”

Discussing HIV specifically, he said studies have shown the risk of contracting it from a discarded needle outside are about one in 300,000.

Etches stressed that discarded needles are still far from safe and noted that you should talk to your children about staying away from any they may find. He also touched on some steps you can take to protect yourself and your children.

“The other infectious risks associated with needle debris are often well-managed by immunization,” explained Etches. “In particular, I'm thinking about tetanus and Hepatitis B, so it's really important as well that folks get their kids immunized.”

Another major point that both Hyshka and Etches went over is the role stigmatization plays in preventing people from getting help.

“I think it's one of the biggest barriers to an effective response to the opioid crisis and the substance abuse crisis more generally,” stated Hyshka. “We know for example, if you look at the data, a lot of people that are dying in the overdose epidemic are dying at home alone. In fact, the majority of people that are dying are dying in private residences and they're dying alone.

“The reason they're alone is because they are potentially feeling stigmatized or judged and they're not able or willing to ask for help and they're worried about what their friends, their family members, their colleagues might think,” she concluded.

Hyshka says it’s important to recognize that addiction is a health condition and that the best way to help someone dealing with it is to be non-judgemental.

Moving onto the treatment and recovery options, Hyshka explained that harm reduction is critical when it comes to opioids, as detox alone can be dangerous.

“We know the vast majority of people – upwards of 90-per cent – will relapse when they just attend short-stay detox,” said Hyshka. “Their tolerance goes down because they've stopped using drugs… and they may take the same dose or even a smaller dose than they were taking before, and because their body doesn't have that tolerance buildup, that's really the most critical period where they could relapse and overdose and die.”

That said, Hyshka noted that detox should include information about how to handle a relapse and the options available to do so safely – acknowledging that it is often a part of the recovery process.

Questions and concerns from the public

A number of the answers provided by the panel elicited rounds of applause from the public. However, when the meeting was opened to a brief round of questions from the public, many asked why ARCHES wasn’t represented and were critical of the SCS’s impact on local businesses.

Lethbridge Mayor Chris Spearman responded that he felt ARCHES was taking on too much of the community backlash and that this was an opportunity to focus on the health issue, rather than a political one. He did acknowledge that there is potential for another meeting that would include ARCHES in the future.

Among those to share their concerns were John Davies and Robin James.

“I did not find tonight to be helpful,” said Davies following the meeting. “I found it to be sadly what I expected it would be: bring in a panel to convince us that what is being done now is correct and is the best that we can do, and I don't believe it's the best that we can do.

“I'd have liked to hear that we're going to solve the problem of addiction, not that we're going to accept it and say that it will continue to be a problem, it will continue to grow, and so all the best that we can do is try to manage the problem,” he added.

James’ issues came from personal experience. She said a loved one had voluntarily checked into a detox facility to get help, and that they were “triggered” when representatives from ARCHES talked to them about harm reduction and options available to continue using safely.

When asked if she took anything meaningful from the meeting, James was frank in her reply.

“I found it extremely frustrating. I support harm reduction, I understand it when someone is actively using. But when someone has chosen to no longer actively use, I don't see why or the purpose of the harm reduction piece being introduced in a detox facility where people are extremely ill from detoxing from drugs.”

The meeting was recorded by Lethbridge College staff, and it’s anticipated the video will be posted on the City of Lethbridge website by Thursday, July 12.

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