International Overdose Awareness Day is a global event that takes place on the 31 of August each year and aims to raise awareness of overdose and reduce the stigma of a drug-related death. It also acknowledges the grief felt by families and friends remembering those who have died or have a permanent injury as a result of drug overdose.
SaultOnline spoke with Lisa Case, the patient care manager at Sault Area Hospital, about addictions and the resources available here in the Sault.
Case explained that the Sault Area Hospital is primarily a collaborator within the community, along with many other substance use services. These are mostly funded by the Northeast LHIN, but some do receive additional funding from the United Way and other fundraising events.
Within the Sault Area Hospital portfolio, they have Withdrawal Management Services, which is residential, and is open 24/7
“Most people would stay a relatively short stay – we’re a level one withdrawal management, so we are able to provide some acute stabilization, but we’re non-medical, and that certainly limits our ability to provide care for folks that need medication support in their withdrawal,” Case explained.
What does it mean to be a level-one centre?
In Ontario, there are three levels of funded withdrawal management. Level one is the most basic level available – psycho-social support, observation monitoring, and referral to other, more intensive levels of care. In Sault Ste. Marie, that’s the emergency department.
A level two centre is one where staff without medical training are able to safely manage the client’s symptoms. Symptoms are manageable through consultation with a physician, at after hours clinic, health centre and/or hospital emergency department, when needed.
A level three centre is one that offers full medical withdrawal management. This type of centre would be for individuals that are in need of a level of support where they can be medically monitored and treated.
Unfortunately, as Case explained, the Sault doesn’t currrently have any facilities that offer level three services. There are only three places in Ontario that offer level three care for addiction – Two in Toronto (Humber River Hospital and the Centre for Addiction and Mental Health) and one in Ottawa (Royal Ottawa Healthcare Group).
Case said the SAH is trying to both enhance and expand their level one to allow them to offer more services locally.
“There are many individuals in our community that can get their needs met at a level one, so with that psycho-social support, we can get them connected to links, communicate with any primary care providers that they’re affiliated with, that sort’ve thing,” she explained. “And then, obviously, there are people that have much more intensive needs. And that’s probably a lot of folks in our community right now. And we’re not able to offer that service.”
“And those folks end up needing to present to hospital, or be sent to hospital via emergency services and such. And because they’re voluntary, obviously, and it’s perhaps not the most appropriate place to get care, a lot of people decline or refuse and then conditions worsen. So it would be like needing specialized cardiac services, for instance, and needing to get that in an emergency department? It’s not that the emergency department is lacking the care, it’s just not the appropriate setting. So level one is very basic, and certainly our workers are incredibly compassionate, very well-versed in those psycho-social supports, so helping people get linked to other levels of support, providing psycho-education, skill building and such. But as far as the medication that can support someone and the monitoring around what other health risks they have, we’re not able to offer that. It’s outside of our scope and our mandate”
The SAH also has a safe-bed program, which is two beds that are funded through the Northeast LHIN, and are used for individuals that may have substance use problems or some co-existing mental health issues, who are often are affected by a housing crisis and/or involvement with criminal justice or the legal system, or are at risk of that.
In addition to that, the hospital recently opened the Rapid Access Addition Medicine Clinic back in April of 2018. The RAAM Clinic is located on East St., and is a facility where people in need can go for a consultation with a physician. There is also a nurse practitioner and an RPN that work in the clinic to provide of a rapid consultation and recommendations back to primary care or other care providers that that person might be working with.
“They may, in that then, start a prescription for a medication that would support reduced use and/or abstinence from the substances – and that can be any substance, but our primary substances that folks are presenting with are alcohol and opiods. But we have a mix of everything there,” Case explained.
On top of that, the SAH also runs the Addictions Treatment Clinic, which is for individuals who are that are struggling with substance use disorders and problem gambling as well, and their families. Case said they’re also seeing more people who, in addition to their substance use, are also struggling with some technology use behaviours as well.
“We’re seeing more and more of that, too,” she said.
Those three services work in coordination with each other, along with the emergency department and the SAH’s hospitalist group, which is for people who are in the hospital due to an infection they’ve acquired related to their substance use, or something related to that.
“Our hospitalist group will often make a referral then to both councilling or the Rapid Access Addiction Medicine Clinic,” Case said.
The SAH works in conjunction with Algoma Public Health, who has the Community Algoma Drug Assessment Program and a needle exchange program. APH’s focus is more on harm reduction and assessment. Other community partners include Breton House, which is a woman’s home here in town, and Ken Brown Recovery Home, which is the male recovery home, as well as the Algoma District Social Services Administration Board, Ontario Works, ODSP, The Neighbourhood Resource Centre, John Howard – pretty much any social service provider – and primary care.
Case said the number of people that need these resources are climbing “at a steady rate.”
“We’re anticipating, at the current rate of growth, our annual admissions for addictions will increase by 53 per cent in less than five years,” she explained.
Based on previous cycles of the Canadian Community Health Survey:
- 14.8% of Algoma residents reported using an illicit drug in the previous 12 months compared to 13.0% in Ontario
- 50.2% of Algoma residents reported ever using an illicit drug compared to 40.6% in Ontario
Case told SaultOnline that they are working on a plan to combat those statistics – putting in a request to enhance the withdrawal management services the hospital can offer. Case said this has been in the works for years, and the request was sent in to the Ministry of Health this past spring.
“We have – endorsed by the Northeast LHIN and our community partners, and obviously our senior leaders of the hospital and our board of directors – put in a business case to the ministry of health and long-term care, to enhance the withdrawal management services and also co-locate a number of our mental health and addictions services and develop a concurrent day-evening program as well, so that the idea of care close to home would be one of our goals in that.”
She says that as well as being more versatile with what they can offer people, a level three centre closer to home would benefit people who may not be able to leave the city to get the help they need.
“And you look at all sorts of barriers that prevent people, right? They might be working in our community, they may have children that they aren’t able to leave, things that some of us might take for granted, like ‘who will take care of my dog?’ That sort’ve thing,” she explained. “If I leave, then I’ll lose my apartment, and I had to stay on a list for many months to get the apartment, some of that stuff, right? So if we’re able to provide an intensive level of care locally, that I think would help a lot of people.”
Case said she thinks, despite the stigma that’s still attached to it, addictions issues should be treated with the same importance as any other serious health issue.
“It’s a service that’s lacking – for many, many years, it’s been underfunded from a provincial health aspect – but it is, there seems to be a bit more awareness and I think some of that comes from much advocacy and lobbying across communities. So not just at the legislative level, or at the administrative level, but from community members, from family members, from grassroots organizations and that sort’ve piece. But I think ultimately it needs to be treated like any other serious health issue. Whether that be, like I said, cardiac care, oncology, renal, diabetes – where we see specialized services, we take into consider not only the financial cost – to the province, to the communities, to individuals – but from a people cost. So the impact it has on people’s lives when they’re not able to get the treatment and care that they need.
“I think I see cracks in the stigma, which makes me optimistic, but I still read the comments sections of articles you see posted and in the paper and such, and we have a long, long way to go. And that alone I think we see across – we see that stigma present in the general public, we see it sometimes in our legislatures, we see that in our healthcare providers at times. Some of that stigma comes out of fear, just not knowing, and treating people as diagnoses or problems as opposed to people,” she continued.
She said she thinks they are starting to see a light at the end of the tunnel, but there’s still a long way to go when it comes to helping people combat their demons.
“The Rapid Access Addiction Medicine Clinic is getting a lot of positive feedback from clients that are accessing the service. Just in the sense of an informal thank you card or people stopping back in and saying, you know, in two, three weeks’ time their life has changed dramatically, what they’re able to physically do,” she explained. “So when you feel like you’re trapped by a substance that you’ve been using – and it doesn’t matter to me how you started using that particular drug, whether it was prescribed as a result of an injury or an accident or something like that, or a surgery or something, or as a result of something you were dabbling in personally. When it’s got you trapped and you’re life is closing in on you, and when there are interventions and medications that can support finding your way out of that and then all of a sudden you’re able to, you know, play with your grandkids again, or you’re able to split wood again, or cut your grass, or participate in your life, people get pretty, authentically thankful or grateful for that.
“I think we’re making some headway and doing some good things, both directly in the Sault and then in our larger district, but we have a long ways to go, but we are seeing some success, we just don’t have enough resources to meet the demand. And I don’t think that’s unique, necessarily, and we certainly, I think we have higher than some of the provincial numbers and that’s been covered pretty broadly in the media, but it’s not a unique situation to Sault Ste. Marie or Algoma or Northern Ontario, even, it’s happening across, minimally across North America. And just trying to learn from others, and what’s worked and what to avoid.”
For more information on the Sault Area Hospital, visit their website here.