This is one in a series of feature stories by Black Press journalists on the effects of the opioid crisis in Greater Victoria.
In his 21 years of practising emergency medicine, Dr. Jason Wale has always felt a little frustrated when it came to dealing with patients with addictions in the emergency department.
“We can deal with complications, people in withdrawal, people who overdose,” he said. “We can deal with the abscesses and infections, but we didn’t have a whole lot of tools for treating the addiction itself.”
Many people who are addicted to opioids are using four to five times a day, Wale explained, a situation that makes it hard for them to stay organized enough to get to a referral appointment, even if it’s the following day.
In 2016, in response to the increasing rates of opioid use disorder, the province relaxed restrictions around Suboxone, a substance that, like methadone, is used in opioid replacement therapy.
Wale seized the opportunity and started a project through the Special Services Commission in B.C., which provides funding to physicians for work on quality of care improvement projects.
His project focuses on three principles: providing every person who shows up in the emergency department with opioid use disorder the option of starting agonist therapy with Suboxone immediately; linking them with addiction care providers within 24 to 48 hours, and facilitating peer support to help patients book appointments and actually get to them.
“I want to do everything possible to provide people with help,” Wale said. “I wanted to make a model that would work for community hospitals and could adapt wherever there is an emergency department.”
Wale remembers a 21-year-old woman who came into the emergency department with an abscess on her arm. He asked if she wanted any help with her addictions.
“She said no … she said she just wasn’t ready for that yet,” he said. “She was dead three days later.”
Wale’s program also involves treating people in withdrawal by using Suboxone therapy. Suboxone blocks opiate receptors and reduces a person’s urges to use opioids. It also helps reverse the side effects of opioids.
But patients need to be far enough into withdrawal stages to begin Suboxone treatment, which is not only uncomfortable and sometimes painful, it means they cannot wait in busy emergency departments.
“If somebody is in an emergency department waiting room for three hours, they’re not going to wait longer,” Wale said. Withdrawal symptoms can present themselves just hours after an individual’s last opioid dose.
A rapid access diagnostic unit at Royal Jubilee Hospital, however, allows patients to be admitted for up to 23 hours for observation, so Wale set up withdrawal protocol in that unit to help patients with addictions. He has also linked up with the Umbrella Society in Victoria. The society helps patients make connections with counselling and doctors and helps them make it to their first and subsequent appointments.
“Peer support is crucial,” Wale said.
The Umbrella Society helps garner trust between patients and their care providers, which can make all the difference when it comes to deciding to begin therapy. “They’ve got to 100 per cent believe that the plan you’ve got for them is not going to put them in withdrawal again,” Wale explained. “We let them know if they’re willing to trust us, we will go to the wall for them.”
For every five people the program and emergency department has engaged with, one person is staying on the therapy, he said.
The emergency department also has small cards that they pass on to patients they suspect are struggling with addiction. The cards let patients know someone cares for them. They also provide patients with the phone numbers to opioid treatment, overdose prevention and peer support services in the community.
Funding for Wale’s program has now run out, but he continues to work on it off the side of his desk. The protocols are all still in place, it’s just a matter of integrating it as part of a permanent Island Health framework.
“Our role is one small part of the puzzle but it’s an important part. I’m optimistic that it’s going to make a difference.”
Opioid crisis by the numbers:
• In 2018 in B.C. there were 1,310 illicit drug overdose deaths with fentanyl detected, seven-per-cent higher than in 2017.
• Fentanyl or its analogues were detected in approximately 87 per cent of the total number of illicit drug overdose deaths last year.
• By region in 2018, Fraser Health Authority recorded the highest number of deaths with fentanyl detected (435), followed by Vancouver Coastal Health (382) and the Vancouver Island Health Authority (215).
– BC Coroners Service
You can read more from this special report on Greater Victoria’s opioid crisis at vicnews.com. For resources in Greater Victoria, find Black Press Media’s Overdose Prevention Guide online or pick up a printed copy at our office, 818 Broughton St.