Healthy Living in the North

Saving lives takes a village: International Overdose Awareness Day is August 31

Two women sit at a table.

Charlene Burmeister (right), President of the Coalition of Substance-abuse Users of the North (CSUN), and Northern Health’s Reanne Sanford (left). CSUN was the first drug-user group to form in the North. Charlene is a local and provincial pioneer in harm reduction advocacy. She’s also one of the familiar faces from the Stop Stigma campaign.

Three years have passed since a Provincial Public Health Emergency was declared because of the overdose rates in BC. When it was first announced in 2016, I had just begun my current role as regional nursing lead for Harm Reduction. In this job, I’m responsible for supporting harm reduction services for the North, and my first piece of work was the expansion of naloxone.

Before my Harm Reduction role, I worked as a generalist public health nurse for 13 years. I also worked as the local street nurse in Quesnel, supporting marginalized individuals to access health care. I had 12 or so regular clients on my case load who I met up with or supported for several years. Today, all of these individuals are now gone.

People who use drugs are community members

Most of my clients called Quesnel their hometown — they did not come from an outside community. They weren’t transported by bus to make space for the Olympics in Vancouver, as some rumors claimed. They had families, loved ones, and children they left behind — and they loved their community. Despite this, very few of them felt included or had a sense of belonging. Many of these individuals relied on public space to exist and connect with services in the downtown core.

Reflecting on progress and loss

As Overdose Awareness Day comes around again (on Saturday, August 31), I’m reminded of those we lost, but also how far we have come:

  • Naloxone is now a regular part of the work we do.
  • Northern Health has partners in the provincial response: pharmacists, community paramedics, housing, First Nations communities, and local non-profits.
  • We’ve increased our capacity to treat opioid-use disorder.
  • Staff helped create opportunities for people with lived experiences to participate in local discussions, including a campaign called Stop Stigma Save Lives (stigma is one of the main causes of accidental illicit drug overdose deaths).

All of these strategies save lives every day.

Bravery in the face of crisis

What humbles me most about the work in the past three years is the bravery that people who use drugs have had throughout this crisis — the level to which they’ve taken grief and built networks of safety for each other. When other systems have failed, peers have stepped into lifesaving roles, offering community education and peer advocacy. On Overdose Awareness Day, I want to take time to honour and acknowledge their work.

It’s time for a new conversation

Despite the advances, I still feel the daily challenge of defending and advocating for harm reduction. I want to use my voice to start a new conversation – one that begins with agreeing that people do not choose to die or deserve to die because they use drugs.

Communities have a vital role to play and can be a part of the solution. Here’s how:

  • Get trained on naloxone and carry a kit: drug use is common in many populations in our community. Make a naloxone kit part of caring for one another.
  • Choose compassion: instead of thinking “what’s wrong with that person?” think, “what has happened in that person’s life?” Become curious instead of judgemental.
  • See the value of programs that save lives: trust that services and harm-reduction strategies, like syringe distribution, are rooted in research and backed by evidence. People use drugs for a variety of reasons, including poverty, mental illness, a history of abuse, neglect, and childhood trauma – not because of the services they are offered and access.
  • Uncomfortable with public drug consumption? Support and advocate for a safe place where people can use drugs, where they can dispose of their paraphernalia safely with trained staff available to help them.
  • Support and donate to organizations in your community that offer access to housing, food, low-barrier employment opportunities, and support services.
  • Challenge statements that minimize or ostracize members of your community: forcing people to exist in the corners of our community, out of sight, increases drug use and people dying alone.
  • Advocate for changes in drug policy.
  • Offer creative solutions.

As a community member, you have the ability to support the health and well-being of our entire community. It’s a shared responsibility, and it’s time we all made it a priority.

About Reanne Sanford

Reanne is the Regional Nursing Lead for Harm Reduction, and is based in Quesnel.

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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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What happens in Vegas doesn’t always stay in Vegas

The welcome to Las Vegas sign is an invitation for many people to release their inhibitions.

For many, this sign is an invitation to release their inhibitions.

I went to Vegas with some friends last year and it was actually pretty good (which is a Scot’s way of saying awesome!). We took in many great shows and even saw the Chieftains, who are still going strong after almost 40 years! Our trip wasn’t quite like the movie The Hangover, but we had our moments. It was a brilliant time.

Vegas is glitz to the extreme. But underneath that shine is a dark side that can’t be ignored. It’s called “Sin City” for a reason – actually several reasons: gambling, drugs and alcohol, and sex – which Vegas is riddled with. Whether you’re going to Vegas or any other exciting destination, it’s often easy for people to slip into some bad habits while on vacation. After my Vegas vacation, I started thinking about the dangers of the “darker sides” of vacations, like slipping back into tobacco addictions, or bringing a new addiction home. So, here are some helpful tips for avoiding some of the things that give Vegas its rather scandalous reputation, but these tips are really relevant to any vacation. No matter where you go, keep in mind that you’ll be going home soon. Each topic is linked to helpful resources for your reference.

Gambling – The slot machines and other games are unavoidable. From the time you check into your room they’re everywhere. Remember, gambling is an addiction. Don’t go overboard. Consider setting a budget ahead of time and stick to it. I managed to stick to about $30.

Drugs and alcohol – Both addictive items are plentiful on many vacations and will drain your bank account, as well as that of your family and friends in a hurry if either becomes a problem. This includes tobacco use; a vacation from the snow doesn’t have to mean a vacation from quitting.

Sex – Some people often think being on vacation is the perfect time to loosen their inhibitions. But sexually transmitted infections don’t take vacations. Do yourself a favour and get educated on the dangers of unsafe sex.

There are many great events that happen in Vegas; I found the fountains at Bellagio to be magical, and luckily I avoided all of the dangers above. Some of these events should, no doubt, stay in Vegas. You don’t want to bring home a whopping credit card bill, a reemergence of an old addiction, or something more novel, like a STI. Don’t forget, these tips extend beyond Vegas to whatever sunny destination you might be visiting during the snowy season.

Happy winter vacation.

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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Helping with change, one stage at a time

Stages of change

Stages of change

In my twenties, I worked in a bar. It was an upscale place near the Winnipeg Stock Exchange. A broker who worked there – we’ll call him “W” – was a regular customer at the bar. He would come in at 10:30 in the morning for a double Manhattan and called it his breakfast. At lunch he would be back for another. At around four he would have two or three more to “round out the day.”

One afternoon W’s wife came into the bar. She told us he was suffering from a serious illness and his doctor had told him to quit drinking, but she was afraid he wouldn’t. Later in the day, I spoke to him when he came in. He said he had never thought his drinking was a problem until the doctor told him he was in danger, and even then, he wasn’t so sure. He thought it was only an issue because of his illness. He convinced himself that if he drank a little bit less he would be okay, so he cut down to singles instead of doubles and limited himself to three drinks a day. This became his new routine. Some months later his health took a turn for the worse and he was away for awhile. When he came back to the bar weeks later he switched to coffee, no booze.

I often thought of W years later when I began working with people with problems related to substance use. Looking back, I can see the stages of change in what he was going through. When I met him, he was precontemplative, sure he was okay and didn’t really have a problem. The illness was a crisis that moved him to consider that there was a problem. Still, he was so tied to his drinking that he didn’t want to think it was as serious as it was. His relationship with alcohol skewed his contemplative stage to justify staying with his routine. He developed a plan, put it into action and came to believe he had dealt with the problem. His life went on as before with a reduction in the amount that he drank, and he returned to a precontemplative state until there was another crisis that he could not ignore.

When we try to help people, we need to get a clear idea of where the person is, because for each stage, we can help in a different way. The precontemplative person can be helped by a reality check to shed some light on what’s really going on. The contemplative person needs some help to make sure they are seeing things accurately and realistically, not colored through the lens of their fears and desires. The planning stage needs some problem solving support and some detail work to make sure the plan is doable and complete. The action stage needs support to help with adjusting to new ways of being. The maintenance stage is a time to reflect and see the positives so that the person does not relapse and go back to old ways. People often go through the cycle many times before really getting to the heart of their problems and making significant and successful changes. With “W” it was alcohol but the pattern holds for tobacco, drugs and for other behaviors as well.

People change when they see a need to do so, when the change is a move to something better and when they can see it as such. The more you can help people work through their beliefs about what change is necessary, what that change will be like, how to make the change, how to adjust to the change, to maintain new ways of being and to celebrate success, the more likely the changes are to take hold and survive.

Have you ever helped someone through the stages of changes as they coped with a difficult issue or addiction?

Andrew Burton

About Andrew Burton

Andrew is a Community Integration Systems Navigator for Northern Health’s HIV and Hepatitis C Care team and works to support healthy living practices in communities across northern B.C. Andrew is developing positive activity and diet practices for two reasons: to deal with his own health concerns, and to “walk the talk” of promoting healthy living. Building on his training and experience in creative arts therapy, Andrew founded and runs the Street Spirits Theatre program promoting social responsibility among young people. This work has been recognized nationally and internationally as a leading method of social change.

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