Healthy Living in the North

Garry’s story: Coordinated team care + courage add up to a remarkable recipe for change

Headshot of Garry McPhee.

Garry McPhee, 50, is a member of the Tahltan First Nation in Northern British Columbia, which includes the communities of Telegraph Creek and Dease Lake. The Fort St. John resident had struggled with alcohol addiction, and also suffers from seizures. For much of the past 20 years, Garry has been homeless.

In June 2016, Northern Health’s Intensive Case Management Team (ICMT) became involved in Garry’s care. This story describes how the team was able to help Garry tap into his own inner strength and courage, and support him to abstinence, dignity, and independence.

The Intensive Case Management Team gets involved

The ICMT is a multidisciplinary team whose goal is to improve its clients’ health and social functioning. The team works with people who struggle with both substance use and mental illness. They provide case management and support navigating health and social services. The team also plays an important role in advocating with community services to ensure quality care for their clients. The team is made up of substance use specialists, life skills workers, and nurses.

The ICMT became part of Garry’s life in June 2016.

“Before:” A dangerous situation

At this point, Garry’s life was chaotic and his health was poor. He was drinking, his seizures became unmanageable, and he was in danger of becoming homeless again. During a 6-month period, Garry spent over 60 days in hospital due to his deteriorating health.

During the 113 days he wasn’t in hospital, Garry visited Emergency 190 times — an average of 1.6 times per day – often arriving by ambulance or RCMP. Fort St. John paramedics, emergency room staff, and RCMP officers all knew him on a first-name basis.

When ICMT became involved, Garry was living at the Northern Centre of Hope in Fort St. John, using his income assistance cheque to pay for room and board. Garry was soon housed in the Supportive Recovery Bed program, a housing program for homeless people who are struggling with substance use.

In the past Garry had tried residential treatment, but due to a negative experience, he was wary of attending again. He rarely saw his family doctor.

Building trust and setting the stage for change

When the ICMT started working with Garry, their first priority was to build a trusting relationship: they met him regularly, whether at the Northern Centre of Hope, the hospital, or on the street. With his participation, Garry and the team created a patient-centred plan to enhance his quality of care.

Sometimes their interactions with Garry would just be to say “Hi!” and ask about his day. At other times, the ICMT had a more varied role:

  • Helping Garry learn about being safe and healthy, despite his alcohol use.
  • Helping him manage his medications.
  • Attending medical appointments with him.
  • Arranging ongoing physical and mental health assessments.
  • Coordinating his care, including social services.
  • Ensuring he attended for regular lab work.

Together with emergency department staff, the ICMT team developed an emergency department care plan for Garry. This was to make sure that when Garry was in hospital, he’d get the best care possible.

The team also met often with Northern Centre of Hope staff to give them support around working with Garry, and to make sure he could keep his housing with them.

As well, ICMT encouraged Garry to:

  • See his family doctor regularly, and follow up with lab work when needed.
  • Visit community psychiatric services.

ICMT also collaborated with Garry’s family doctor and psychiatrist to ensure he was receiving the best care.

During ICMT’s involvement, there were significant changes. Garry had only 135 visits to the emergency department and spent only 20 days in hospital — a 29% reduction in emergency department visits, and a 67% reduction in hospital days.  

ICMT also helped Garry apply for BC’s Persons with Disabilities program (PWD). He successfully joined the program, giving him a more secure source of income.

Throughout, ICMT always respected Garry’s dignity and his right to make his own decisions. Garry was always the one in charge of any changes that were made.

Tragedy brings a fresh challenge

Garry is the oldest of five children, and he and his younger brother were very close. They lived together at the Northern Centre of Hope and spent most of their time together. The brothers were always looking out for each other.

But in July 2017, Garry’s brother passed away. This was a very difficult time for Garry and he thought about moving back to the Yukon, even though he knew that he would likely return to drinking. ICMT checked in with Garry regularly to offer any support they could.

Garry had been undecided about residential treatment for his alcohol use. His experience at the previous treatment centre wasn’t positive, and he had been worried about leaving his brother and mother behind in Fort St. John.

But after his brother died, Garry’s feelings changed. When he was offered a spot in a residential program in Prince George, he took the brave step of deciding to go. ICMT worked with the treatment centre in advance to make sure that Garry would have the best possible chance for success.

Before attending treatment, Garry stayed in the Prince George Detox Centre. There he attended recovery groups, met the staff, and heard other clients’ stories about recovery. After hearing many positive reviews, he was excited about going to the treatment centre. After he completed detox, Garry attended residential treatment for 42 days.

“After:” A new life of abstinence and dignity

Since finishing treatment and returning home to Fort St. John, Garry’s life has been a catalogue of independence, self-care, and confidence. It’s a stunning contrast to his old life. His experience is a testament to the support from the ICMT staff, and proof of this man’s courage and strength in making real change:

  • Garry has abstained from alcohol, and he’s been attending AA meetings. Instead of drinking, he spends time with friends at the Northern Centre of Hope or cooks meals with them, which they eat together while watching sports.
  • He attended the treatment centre’s refresher program in June 2018, and may attend again in June 2019.
  • He regularly visits the hospital to see his mother in Peace Villa or to say a quick “Hi and thank you” to emergency room staff.
  • He has been arranging his own medical appointments without ICMT’s help.
  • He’s currently renting a room in the high barrier housing program at the Northern Centre of Hope.
  • Garry is a caring and responsible pet owner, ensuring his 15+ goldfish are always fed and happy.
  • And, finally, Garry volunteers weekly at the Salvation Army clothing store in Fort St. John.

This inspiring story shows the massive difference that coordinated team care can make to a person’s life and health. It’s also a deeply humbling story that reminds all of us that it’s never too late for change.

Northern Health thanks the Intensive Case Management Team for their outstanding work with Garry, and most importantly, we thank Garry for sharing this uplifting story – we know it will inspire many others.

Bailee Denicola

About Bailee Denicola

Bailee is a communications advisor in the Primary Care Department and was born and raised in Prince George. She graduated from UNBC with an anthropology degree and loves exploring cultures and learning about people. When not at work, Bailee can be found hanging out with her dogs, building her house with her husband, or travelling the world.

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Overdose Prevention: Northern BC’s Naloxone Champions

Thursday, August 31 marks International Overdose Awareness Day (IOAD), a day that aims to raise awareness of overdose and reduce the stigma of drug-related death. Since the recent rise in overdose deaths, Northern Health staff and physicians, as well as community partners, have responded quickly in providing take home naloxone training and naloxone kits to people at risk of overdose as well as their friends and family members.

In 2017 alone, records show 105 naloxone kits refilled in northern B.C. – that’s 105 kits used and 105 lives saved thanks to training and dispensing taking place in our region!

Over the course of the last year, staff at the 41 take home naloxone sites across northern B.C. have had diverse experiences and developed unique strategies to get naloxone kits into the hands of those who need them. We want to share one of these experiences now, from the Intensive Case Management Team in the northwest.

team van, naloxone

Part of the NW Intensive Case Management Team

In what ways do you work with community members?
First and foremost, our team is non-judgmental and comes from a place of caring and support for individuals experiencing difficulties with substance use, regardless of their history. We work at street level with many clients, building rapport over time, providing wellness checks, harm reduction supplies, and supporting clients with access to various services. Our team also attends shelters, clients’ homes, and conducts meetings within the office as well, based on what the community member is comfortable with. For some community members, it takes time for trust to form to ask for services, including take home naloxone or harm reduction supplies.

What’s the message to your audience?
We try to convey that our intentions come from a place of caring and that we hope to help keep them healthy and safe, not to judge or push for a change that they may not want or be ready for. We’re humble and recognize the immense value of lived experience in the work we do.

Our team tries to be flexible and take the direction from the individual we’re working with and support them in their journey, whatever journey that may be. We help empower them to access resources based on their own choices to reduce harms, and our team truly believes in the work they’re doing and the people they engage with.

How do you train people to use naloxone and/or when dispensing kits?
It really depends on the audience, but we maintain that we’re adaptable and that the client can take the lead. This means to be effective, sometimes our strategies toward naloxone training have to be pretty fluid.

Recreating life-like scenarios dealing with overdose, similar to if you were learning CPR training, has been an effective way of teaching individuals the steps to how to handle an overdose scenario. Diving into the realities of what people may see if they witness or come across someone who has overdosed can be unsettling, so we make sure to create a safe space for individuals to ask questions and practice drawing up and injecting the medication. Take home naloxone is comparable to having a first aid kit, and our team respects a person’s privacy around their use of it or the use of it on someone close to them.

Our most important training assets, of course, are our amazing peers who champion take home naloxone. They hand out their cards, nurture relationships with the at-risk population, and let them know where they can get naloxone, training, and other resources. They work within the community and seize any opportunity to offer naloxone training and kits!

naloxone kit overdose

Naloxone kits are easy to carry, and include application instructions.

Can you tell us about the experience you’ve had when developing community partnerships to dispense naloxone?
The support we’ve received from community partnerships has been awesome. We started building relationships within the community by going out and introducing our team, and then created a space for collaborative dialogue amongst Northern Health partners and other community agencies. Our team provides support to community agencies if they are wanting assistance navigating naloxone information and access to take home naloxone kits. In turn, the community service providers are able to alert us when a person is ready and willing to receive services.

We’re very thankful our partners have been open to welcoming us into their space to work alongside them in service provision, as this is where the clients are and feel most comfortable. Partnering with various agencies and various emergency responders has helped us better connect with individuals that may be at risk of overdose, which has proved to be invaluable when it comes to helping people in a timely manner.

Where can naloxone and other resources be found?
Naloxone kits are available to be dispensed for free to community members at risk for overdose and their friends and family members. The more naloxone kits we can get out into the community, the better equipped our community members are to respond to an overdose and save a life!

Harm Reduction Sites supply naloxone and other health and wellness resources – get to know the one in your community! Northern Health also has an Overdose Prevention page on their website that has lots of great overdose information, including how to recognize overdose and the SAVEME steps to help in an overdose situation.

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Learning to stop an overdose: can you?

Take home naloxone kit includes safety equipment and everything needed to administer naloxone

After completing a training program, you can receive a take-home naloxone kit to stop overdoses

When we think of the problem of overdose, we are often picturing the strong drugs such as narcotics and opioids that people use on the street, but what about the opioids that are prescribed drugs like morphine, heroin, methadone, Percocet, or OxyContin? These drugs are used every day by people, maybe even you, with chronic pain, cancer, addiction, or recovering from surgery or trauma. When you consider that all opioids can cause an overdose, leading to problems breathing or even death, it is not so difficult to see why stopping overdose may be for you.

Naloxone stops overdoses by reversing the effects of an opioid drug and it is saving lives every day. How does it work? Naloxone is an antidote to opioid overdose that can be given by injection. It binds to the same sites in the brain as opioids and works by pushing out and replacing the opioids. It acts quickly to restore breathing. Naloxone decreases the effect of an opioid drug for about 15 minutes, but has no effect on other types of medication. It starts to wear off in about 30 minutes, so if you use your naloxone, you need to go to the emergency room, too, because the overdose can come back. You may be asking yourself: doesn’t it take a medical degree to recognize an overdose? Not necessarily. Research has shown that with some basic training, anyone can save a person from overdosing just as well as a medical professional.

So what can you do to stop or prevent an overdose? With the help of the BC Centre for Disease Control, Take Home Naloxone programs are being developed in northern communities supported by partnerships between public health, mental health, and doctors trained in the naloxone program. In Smithers, public health and mental health nurses are working together to provide this basic education to the public. Once you have completed the Take Home Naloxone training, a doctor will prescribe the naloxone, you then bring your prescription to the public health office to receive a kit to take home. The kits are portable and should be kept in a visible and accessible location to be readily available if needed. Having naloxone with you to prevent an overdose is like carrying epinephrine or an EpiPen when you have severe allergies. You never know when you will need it.

What about safety? The needles in the kit retreat back into the syringe so no one else can get poked with a used needle. Naloxone does not make you high; in fact, it only causes withdrawal if you have taken an opioid. Everyone on an opioid should think about preventing an overdose, it could save a life: yours.

For more information, visit Toward The Heart: A Project of the Provincial Harm Reduction Program or the Canadian Centre on Substance Abuse.

Kathy Davidson

About Kathy Davidson

Kathy Davidson works in Smithers at the Smithers Community Health Unit as the northwest public health nursing practice development lead. Sharing new ideas and best practices with public health nurses enhances the services and programs provided to the public. Kathy enjoys the freedom of walking fields and trails in her rural neighbourhood as well as quilting. This year, Kathy's three garden beds grew a delightful green buffet for the deer and a few potatoes for the fall!

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Why do a video about methadone programs in the northern region?

I was recently at a forum where participants were asked to raise our hands if we had ever struggled with a habit that was harmful to us. The majority of us raised our hands. The question helped us all to recognize we are not talking about “them” when we talk about substance use. Removing “us and them” from the equation helps us to move past the stigma of harmful habits and to focus on what is really important.

Our stories of harmful habits are often about alcohol and tobacco, but some are about drugs like opiates and stimulants. When we think about the personal side of addiction, it becomes clear: many of our stories are related to coping with pain. The pain can be physical and/or emotional and sometimes what helps the pain develops into a habit with serious costs to health.

Many doctors will tell you addiction to substances has a brain biology connection and should be treated like any other health problem. Health problems sometimes need to be treated with drugs. As a drug, methadone has many uses, including pain management at the end of life, but the methadone programs discussed in the video are for people who have become dependent on prescribed and/or illicit opioids. These programs provide a range of supports including individual counselling to assist people to take back their lives from dependence on opioids.

Methadone is a synthetic agent that works by “occupying” the brain receptor sites for opiates. This relieves the craving for opiates, which is a major factor in relapse. It also relieves symptoms associated with withdrawal from opiates, and it does not cause euphoria or intoxication itself, thus allowing a person to work and participate normally in society.

Methadone is plainly the best treatment we currently have for opiate dependence. The reason for the Northern Health methadone program videos is to build understanding about substance dependence as a health issue, and about methadone as an important treatment option for opioid dependence.

Take a minute to check out the methadone program video above and the links to additional resources below. Stay tuned to the Northern Health Matters blog this week for more information about substance use issues in the north.

Additional resources:

Lee Anne Deegan

About Lee Anne Deegan

Lee Anne and her family moved north shortly after she completed her undergraduate degree in social work. She loves the north and has worked over ten years in mental health and addictions services in several rural communities in the region. She received her graduate degree in social work from UNBC. Her experience and relationships with northern communities have been very beneficial in her regional roles with the provincial government and Northern Health. As addictions knowledge exchange leader, Lee Anne works with groups and individuals encouraging compassion and inclusion and supporting the development of evidence-informed approaches for the treatment of problematic substance use. Lee Anne enjoys camping and hiking on the plentiful trails within and surrounding Prince George. If you live in Prince George, you may have seen her biking to her office downtown.
(Lee Anne no longer works with Northern Health, we wish her all the best.)

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The last inning

The bleachers at baseball diamond in Terrace.

Athletic venues are usually associated with physical activity, but they are also a place where bad habits can arise.

Recently, I was watching the news and enjoying my morning cup of coffee when something caught my eye. It was one of those lines that runs across the bottom of the TV screen. You know the ones – they keep you sucked into the news as you wait for the actual story.

Curt Schilling, the former Red Sox pitcher who helped lead Boston to the 2004 World Series championship, announced that he was being treated for mouth cancer. Schilling also revealed that he believed the source of his cancer was the chewing tobacco that he used for 30 years, saying: “I do believe, without a doubt, unquestionably that chewing was what gave me cancer.”

But Curt Schilling isn’t the first Major League Baseball player to suffer from oral cancer.

In June, baseball Hall of Famer Tony Gwynn died at age 54 as a result of salivary gland cancer. Like Schilling, he also attributed this to his use of chewing tobacco during his playing days.

In 1948, the legendary Babe Ruth passed away at 53. His heavy drinking and smoking affected his career. Just before retiring, he was diagnosed with nasopharyngeal carcinoma, cancer of the upper throat.

And then there’s centre-fielder Bill Tuttle. Tuttle’s baseball cards often pictured him with a cheek bulging from chewing tobacco. Thirty-eight years after his baseball career ended, Tuttle had a more ominous bulge in his cheek. It was a tumour so big that it came through his cheek and extended through his skin. Doctors were able to remove the tumour, but along with it came much of Tuttle’s face.  Chewing tobacco as a young man cost Tuttle his jawbone, his right cheekbone, a lot of his teeth and gumline, and his tastebuds. In 1998, Bill Tuttle succumbed to the cancer that left him disfigured. He spent his last years trying to stop people from using smokeless tobacco.

While smokeless tobacco is usually associated with baseball, it’s also present in other sports.  Hockey, football, and rugby are other sports where the use of smokeless tobacco is higher than you might think.

In the past, I’ve blogged about going smoke-free, but it is important to raise awareness about the dangers of all forms of tobacco use. Whether it’s smoked, sniffed, dipped, or chewed, tobacco can cost you the biggest game of all: your life.

So instead of chewing tobacco, how about chewing on the following quote from Curt Schilling for a while: “It was an addictive habit. I lost my sense of smell, my taste buds. I had gum issues, they bled  … None of it was enough to ever make me quit. The pain that I was in going through this treatment  … I wish I could go back and never have dipped. Not once. It was so painful.”

If you or some you know wants to quit using tobacco, they can receive free counselling, information, and support as well as free nicotine replacement products through provincial programs.

Reg Wulff

About Reg Wulff

Reg is a licensing officer with Northern Health and has his BA in Health Science. Previously, he worked as a Recreation Therapist with Mental Health and Addictions Services in Terrace as well as a Regional Tobacco Reduction Coordinator. Originally from Revelstoke, Reg enjoys the outdoor activities that Terrace offers, like mountain biking and fishing. Reg also likes playing hockey, working out, and creative writing. He is married and has two sons and believes strongly in a work/life balance as family time is important to him.

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Tales from the Man Cave: World No Tobacco Day

A picture of the sun in the sky with the headline World No Tobacco Day and the subheading the sun will still shine tomorrow

Will this sunrise be the one that sees you quit tobacco?

Last year, when writing about World No Tobacco Day, I challenged you to drop the “World” and make it “Your No Tobacco Day” so that you knew exactly who’s in charge of quitting tobacco products.

I’m happy to report that a friend, and a reader of this blog, took up that challenge and successfully quit. My heart is with my friend’s family, with hopes that they may continue to live smoke free for life.

Quitting tobacco is the most difficult of tasks. There are many theories surrounding addiction. Some are brain based, centered on the mind or psyche. Some suggest that vulnerable individuals are more likely to become addicted than “normal” people. Some say we’re all addicted to something. Maybe it’s work, cleanliness, or food. Perhaps it’s control, the internet, or your own beliefs. Some research suggests there is an empty space deep within each of us that needs filling. An abyss, if you like. Others suggest that we self-medicate to reduce the pain of a stressful world.

Personally, I feel that all of these things ring true to some degree and that if you have to be addicted to something, make that one addiction something positive, like exercise. Am I correct? I don’t think it matters.

At an individual level, there is only you and the struggle you face to be free of that which harms you. There is help out there, like nicotine replacement, and informed evidence suggests that using that help improves your chances of quitting.

But, regardless of the help, the battle is yours.

Sure it’s World No Tobacco Day on May 31, but really its world with a small ”w”, your world. I hope you take up the challenge and good luck to you.

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

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