Local Emergency Department doctor urges community to “keep an open mind” on opioid crisis

Lethbridge News NOW reached out to Dr. Wilde to ask him about his blog, his perspective on the opioid crisis in Lethbridge and what suggestions he might have to help mitigate some of the issues the community has been experiencing.

He is clear during the interview that he accepts being publicly identified, and that his views do not represent those of Chinook Regional Hospital or Alberta Health Services.

WildeandRandom Blog

“I have often had people interested in my thoughts and how I explain things and thought it would be nice to share my thoughts with family and anyone else who was interested. And up to this point it’s usually just been a small group of people who read the things I wrote,” he told LNN.

In his blog post, Dr. Wilde described how as an emergency department doctor in a “medium sized” Alberta city that also has a safe [supervised] consumption site (SCS) he worried misinformation and a lack of background understanding amongst some members of the public had been generating a lot of unfocused or misdirected anger towards people and institutions that are either not responsible for, or unable to directly address people’s concerns.

“I’m thinking specifically of calls to close the safe consumption site, with the belief that that would stop needles from showing up around the city, which I think is looking in the wrong direction for a solution to that problem,” said Wilde.

He told LNN that he wanted to add some perspective about what he and his colleagues experience in the emergency department on any given day.

Emergency Department

Wilde says the uproar over needle debris, vandalism, theft, illicit drug use in parks, and panhandling did not begin in the last six months – and people need to know that.

“From our perspective, what people are seeing now with the needles and the open drug use is not a new problem. It’s more of a symptom of a deeper problem that’s been worsening, and we’ve been aware of it for quite some time. That includes the number of overdoses that occur in the city.

“About a year to two years ago from now, it was a daily or multiple times a day occurrence. And when I say that I mean having people brought in who had overdosed on an opioid of some sort and were either near death or had been resuscitated by the paramedics or sometimes people that were dropped off by friends or family who needed immediate intervention to save their lives.”

But in the last several months, he says he has experienced a sharp decline in the number of overdose patients brought to the emergency department. Sometimes they can go weeks without having an overdose patient being brought in.

He believes it’s related to what’s available on the street, that there’s more education out there about the potentially fatal effects of street level drugs, and because EMS, police, health care workers, members of the public and addicts themselves carry Narcan (naloxone) kits.

As an emergency department physician, he acknowledges that now he and other doctors may have become a sort of “last line of defence.” But that does not mean that the number of overdoses and deaths have abated.

“I think that’s probably accurate,” he said. “Certainly, the first responders, the police, EMS, firefighters and now the staff at the safe consumption site will see more than we do now because they’ll usually go through on of these services before they’re brought to see us, with the exception of those brought in by friends or family.”

Supervised Consumption Site

“I have been past it, but I’ve never been inside it,” said Wilde.

When asked if he thought it might be valuable for a doctor to see or experience what goes on inside of the SCS, he thought it might be for certain groups or professionals.

“For those that are involved in the organization and the planning of the addiction response in the city, that’s a very important thing to get the perspective to see what’s happening there; to see what’s been set up. As I’ve said in my post, I think it is very appropriate to discuss how a site is managed looking at any unintended consequences that come out of it and addressing those. I have not gone before, because I’m not involved in this beyond this post [blog].”

AHS Reports

In his blog, Dr. Wilde suggests that from his perspective in the ED, he is seeing fewer fatal and near fatal overdoses, along with anecdotal observations from his colleagues indicating that they too are noticing the same thing.

However, Alberta Health’s Opioid Response Surveillance Report 2018 Q2, shows during the first six months of 2018, there were 17 fentanyl-related deaths in Lethbridge; one more than the total number of deaths in 2017. In 2016, there were eight fentanyl related deaths.

The total number of apparent accidental deaths from ANY opioid in the South Health Zone in 2016 was 29, in 2017 it climbed to 40. Numbers are only available for the 2018 Q1 (Jan.-Mar.), with 14 deaths reported in the South Zone.

The report also indicates that during the first six months of 2018, the Municipality of Red Deer had the highest rate of apparent drug poisoning deaths related to fentanyl per 100,000-person years, followed by the Municipality of Lethbridge.

In the latter half of 2017 and so far in 2018, the rate of ED visits related to opioid use and substance misuse was the highest in the South Zone (402 visits per 100,00-person years); approximately 54 per cent higher than the provincial average over this period (261 visits per 100,000-person years).

According to the report’s Q2 Addendum, the SCS in Lethbridge as of July 31, 2018 has had 42,251 site visits, and has reversed 445 overdoses.

https://www.alberta.ca/assets/documents/opioid-substances-misuse-report-2018-q2.pdf

https://www.alberta.ca/assets/documents/opioid-quarterly-report-addendum.pdf

Dr. Wilde admitted he was unaware of the AHS statistics.

“Have you read the latest opioid reports from AHS, from Alberta Health?”

“Not the latest no,” said Dr. Wilde.

The doctor told LNN that while harm reduction services like those at the SCS or other organizations are necessary and provide a point of contact with other recovery services that those with drug addictions can access, they alone can’t “fix” the multitude of health and societal issues that come along with chronic drug use.

“They’re there to do what they can to reduce deaths, to reduce harm. And hopefully provide a point of contact with other recovery services that those with addictions can access.”

He says he advocates strongly for overall addictions services in Lethbridge and he knows efforts are being made, but they come slowly.

“As far as I can see from my perspective…the safe consumption site was set up rather hastily because of the overwhelming number of visits [at Chinook Regional Hospital] in the last quarter of last year, and the first quarter of this year that I think, prompted the need for a facility where a lot of those could at least be managed on site.”

Community Coordination

Dr. Wilde also believes while there are significant efforts being made by individual organizations, there’s an overall lack of coordination among them.

Currently, there are rehabilitation, counselling, cultural, housing, income support and other services in Lethbridge, but there are no detox beds or intox facilities. In November 2017, the Provincial Government announced that sometime in the fall of 2018, there would be eight detox beds opened and staffed at Chinook Regional Hospital. The detoxification wing in the southwest corner of the hospital could open its doors sometime in November.

“I know this just from hearing some things at the hospital about the addictions program that in conjunction with opening up these detox beds, the plan is to organize a more centralized ability for us to intake people into addiction recovery services and get them connected.”

Violent Incidents

In his original blog post, Dr. Wilde wrote:

“The details are not mine to share nor can I point to you any supporting evidence, but incidents apparently include groups of intoxicated bar goers looking for easy targets to beat up, attempted abduction of female users, and even the pelting of security officers with rotten fruit by a gang of minivan “soccer moms.” Most disturbing, is the detention of a man for deliberately driving on the sidewalk in an attempt to ‘mow down druggies.’ I bring up this less publicized side of crime associated with the safe consumption site mostly to urge caution in the spreading of inflammatory material that demonizes addicts and stokes the anger at the public and non-profit facilities that help them.”

LNN asked Dr. Wilde why he originally included that information in his blog when he admittedly could offer no supporting evidence of the alleged attacks.

“This is all second-hand from someone I spoke with that works there. I don’t have any other comments to make on that,” he said. “The reason that I mentioned that is if this is happening, it’s important people are aware of it. That there’s another side too… we need to not promote violence or intolerance of these people who have a problem, even though we may disagree with what they are doing.”

LNN contacted Lethbridge Police Service for specific information on the alleged incidents and for a statement.

According to the LPS, an attempted abduction of a female was reported, investigated and determined to be unfounded. There is no report of anyone driving on a sidewalk, nor is there a report of “soccer moms” or anyone else throwing fruit.

However, on May 26, 2018, “police responded to a report that a possible impaired driver and his friends were fighting with an SCS user. The complainant refused to provide the identity of the victim, however a license plate of the suspect vehicle was obtained. Police attended and spoke to the registered owner who stated his friends chased an unknown male to the SCS after the male had attempted to fight with them at a bar. He picked up his friends in the alley and they left the area. The registered owner did not display any signs of impairment and police warned him to stay away from the SCS unless he was attending to use the facility.”

Two other incidents of note included “staff at the SCS reporting that a male had been sprayed with bear spray outside the SCS. The male was uncooperative and refused to provide a statement to police, but the incident was recorded on video surveillance and police were able to identify the suspect. The suspect and victim were known to one another and a male was charged with one count of assault with a weapon.”

In another incident, “a security guard at the SCS reported that he reviewed surveillance footage and observed three known males exit a vehicle outside the SCS and approach a female. A cloud of smoke appeared around the female and the males left the area. The female was uncooperative with police and refused to provide a statement.”

Spokesperson Kristen Harding wrote, “police work closely with the staff at the SCS and they have been called on a number of occasions to investigate incidents outside of the facility. As far as users being randomly targeted by unknown subjects, there have been some instances reported, but the majority of calls police respond to involve negative interactions between users – between known parties – drug complaints, and quality of life issues. That being said, we do know that not everything gets reported to police.”

Dr. Wilde has since removed references to the alleged incidents from his blog indicating that while there have been documented incidents of violence at or near the SCS, he did not have first hand information about it.

Possible Solutions

“I would certainly lean towards the expertise of the police and other law enforcement organizations as to what works most effectively and what doesn’t.”

Dr. Wilde emphasizes that there are a host of addictions experts whose knowledge and experience can be drawn upon, if the City of Lethbridge wants to explore local solutions, he believes it’s a good idea as well.

The City is currently putting together an ad hoc committee made up of business owners, citizens, stakeholders, social services, religious organizations and others to try and find some short term and long-term solutions to address community concerns and to help addicts with a safe place to go once they use the SCS, along with daily meaninful activities.

“One of my reasons for writing blogs about things like this is mostly I just want to encourage people to keep an open mind and to look at multiple sides of a problem and be open to what solutions there might be and not close your minds too quickly on what may or may not help.”

In his blog, He writes: “Getting out of this addiction requires a community of supports and often complete socioeconomic and cultural life changes. This requires deliberate and repeated choices by the addict to accept help and make these hard changes, often developing an entirely brand-new way of thinking. That’s in addition to traditional medical detox. Detox can be an important step, but if you leave a facility and return to an old life with family and friends who are addicted and have little to no resources to change their circumstances, you have a very poor chance of staying clean. There are success stories, but not enough. The purpose of harm reduction is to hopefully keep a person alive and healthy enough through their addiction years that they have the chance to go through this process when they have decided it’s time to change and can achieve a reasonably healthy life in recovery.

To read Dr. Sean Wilde’s blog, and other blogs he has posted, go to

https://wildeandrandom.wordpress.com/2018/09/15/needle-debris-some-thoughts-from-the-ed/

by Lara Fominoff @LaraFominoff on Twitter

Local Emergency Department doctor urges community to “keep an open mind” on opioid crisis

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