City, ARCHES face fractured spectrum

THERE ARE GAPS IN SERVICES TO HELP VULNERABLE PEOPLE SEEK TREATMENT

The opioid crisis is a complex problem with many moving and interlocking parts.

In response the City is moving in a number of different directions in terms of how that problem is addressed.

Front and centre is the work of ARCHES, a harm-eduction organization in the city which operates a clean-needle distribution program as well as the supervised consumption site.

Its job is to meet vulnerable people, build relationships with them, and then move them along a spectrum into other areas of care and towards wellness.

In Lethbridge, that spectrum is fractured. There are gaps in services. The city has a limited number of treatment beds. There are long waiting lists. The city lacks transitional and supportive housing.

“We are an entry point into service and we’re meant to move them along the spectrum,” ARCHES executive director Stacey Bourque told The Herald in June.

“(But) the spectrum doesnt exist. It makes it very difficult.

“Essentially, we’re a hamster in a wheel,” she said. “We’re trying to keep people alive long enough that they get to make that decision (to enter treatment) on a day when there is a treatment bed available and they are ready to go.”

Last December, construction began on eight new detoxification beds at Chinook Regional Hospital.

Anticipated completion by late summer and usage starting in mid-fall.

In June, a report by the Office of the Child and Youth Advocate Alberta highlighted a number of areas related to preventing and intervening in opioid abuse in young people.

In Alberta, since 2015, 229 people age 24 and younger died from opioid poisoning — 76 in 2017 alone.

There were a number of recommendations made in the review, including:

• Alberta Education and school authorities should increase the level of health promotion and age-appropriate substance use education in curriculums from elementary to high school;

• Child-serving ministries should have appropriate substance use intervention training to increases the capacity and knowledge among direct-service professionals to ensure young people get the right services at the right time;

• AHS should strengthen their substance use-related interventions for young people, including special attention to those interventions directly related to youth opioid use;

• AHS Youth Addictions and Mental Health programs should be more inclusive when it comes to the involvement of family and significant individuals, including specific attention to prevention and treatment of substances by young people; and

• The Ministry of Health should review the Protection of Children Abusing Drugs Act and its policies in order to better meet the needs of youth and their families.

Abstinence-based recovery programs have an important role to play for many people hoping to overcome their addiction issues alongside other harm reduction efforts in the city.

“Harm reduction has its place and it’s a fantastic program, but it’s not the only concern,” said Ron Fromm, executive director for Southern Alcare Manor, back in June.

Last year, SAM served 124 clients and reported a success rate over 50 per cent.

With a six-week waiting list and patients prioritized based on need, those hoping to enter the program are screened and then encouraged to keep calling in to make sure they are still interested in the program.

The Abstinence Model is based on four stages, including initial treatment, early abstinence, maintaining abstinence and advanced recovery.

There are 25 beds at the manor, and another eight beds available through a fourth-stage facility.

There are also some options being explored that are more controversial in nature.

At Providence Crosstown Clinic in West Hastings, Vancouver, for example, chronic drug users line up for a shot of medical-grade heroin in one of the hardest-hit places in the country.

The clinic is the only one in North America providing diacetylmorphine, or medical-grade heroin, and the legal analgesic hydromorphone in a supervised injection setting.

The treatment operates as a stronger version of accepted Opioid Agonist Treatment therapies such as methadone or Suboxone, and intended for the roughly 10 per cent of opioid users who do not respond to those treatments. It is not to be confused with a supervised injection facility that provides the space for illicit drug use.

Hydromorphone is readily available in Canada and is easier to secure. Because of this, it is currently part of a pilot project scheduled for this fall in Calgary and Edmonton — and could be made available in Lethbridge at some point.

The Alberta hydromorphone pilot program was announced late in 2017 and will involve 50 patients each from Edmonton and Calgary at AHS Opioid Dependancy Program clinics. Participants would receive treatment up to three times per day, as well as wraparound services.

The services will begin in the fall with ongoing evaluation. It will be the second program in the country to make use of hydromorphone as an Opioid Agonist Therapy

Funding for the program is provided through the Opioid Emergency Response Commission as part of Alberta Health.