It’s time the province acted on opioid crisis
Declare public health emergency, say Christopher Doig and Paul Boucher.
As critical care physicians working in Calgary adult intensive care units, we are increasingly called upon to admit young Albertans in life-threatening conditions following cardiac arrest from opioid overdose.
Two years ago, these admissions would occasionally occur; today they are common. Despite our best efforts many of these patients do not survive. Sadly, many who survive have lives changed by brain injuries when they suffered cardiac arrest, which prevented oxygen from flowing to their brains.
What we see in the ICU is just a tip of the iceberg; there are many lives saved by first responders, and many who die prior to receiving help. The number of deaths exceeds deaths from many other conditions, including trauma.
These opioid-related deaths are needless. A more robust and vigorous response from all levels of government, the health system, and other sectors associated with mental health and addiction services is required; coordinating a more vigorous response is the responsibility of our provincial government.
The government has responded in a number of ways. One example is easing access to naloxone kits for administration by first responders and the public. This has been effective in getting help to patients who have experienced an overdose and has made a difference to many.
The patients we see have failed to improve with this strategy or did not have access to it. Naloxone is meant as a stopgap measure; our ultimate goal should be not to need it. We need to make efforts to prevent the addiction that leads to the overdose.
Drug dependency and addiction is a complex problem. It intersects areas such as mental health services, homelessness, social inequities and pharmacological management of acute and chronic pain. To this end, we urge the government to escalate its response.
First, government should heed the advice of Dr. David Swann and others and declare the opioid crisis to be a public health emergency. The Alberta health minister has not considered this necessary in Alberta. From the front line, it is hard to understand why not.
Declaring a public health emergency would mean the minister, through public health officers, has authority to direct resources beyond the health ministry from any department of the government to address a threat to the public.
An effective response requires Health, Human Services, Justice, police services, Housing, and other ministries and agencies to collaborate and communicate optimally, not only for emergency treatment of overdoses, but for prevention, early treatment, intervention, and chronic disease management.
Second, we urge the government to increase the medical expertise at its disposal. It should consider re-establishing a chief medical officer for addictions and mental health. We urge government to take advantage of experts in the medical profession through the College of Physicians and Surgeons of Alberta, the Alberta Medical Association, medical faculties at the Universities of Alberta and Calgary, and experts in allied health professions.
Third, others should act. Much of the access to opioids and other “at-risk” medications is from prescriptions. For some, this access is the start of their addiction, and for others it serves as a source of ongoing access. The college has recently developed a new standard of practice called Prescribing: Drugs with Potential for Misuse or Diversion. Standards are important, but individual physicians need to do more in learning and understanding how to help patients who suffer from acute and chronic pain.
Finally, as a community and society, we need to stop demonizing and stigmatizing those who suffer from drug dependency and addiction; those affected are parents, siblings, children, relatives, friends, and neighbours.
Dealing with young patients dying needlessly is dreadful. Conveying the worst news to family members is awful.
A terrible tragedy is occurring in Alberta that cries out for more aggressive and coordinated response. We need to recognize this horrible and preventable situation for what it is: a public health emergency.