Royal Alexandra Hospital Foundation

Over the past year and a half, the primary focus of public health discussion has, understandably, centred on the COVID-19 pandemic. However, another deadly public health crisis has more silently and subtly continued to harm Canada—the opioid epidemic.

And, this epidemic has been disproportionately worse for Western Canada. Due to many complex factors, the City of Edmonton has been particularly hard-hit by the opioid crisis, averaging 67.3 deaths per 100,000 person years (according to the Govt. of Alberta’s Alberta Substance Use Surveillance System)—a rate almost double the provincial average.

On the evening of November 16^th, 2021, nearly 300 guests tuned in to our latest virtual Speaking of Health lecture to discuss this topic, in an event titled, “The Opioid Crisis: Partnering Around a Person-Centered Approach to Care.”

Thanks to your generous donations, we were able to raise $1,495!

Our latest Speaking of Health lecture tackled many aspects of the opioid crisis such as the role the Edmonton Police Service, the Royal Alex, and members of the community play in response to the epidemic, as well as strategies currently in use by these stakeholder groups. Event attendees had the privilege to hear from Royal Alexandra Hospital Foundation president and CEO, Sharlene Rutherford; Inspector Kellie Morgan from the Edmonton Police Service’s Social Policing Division; Clinical Professor and Medical Director of the ARCH Team and Inner City Health and Wellness Program, Dr. Kathryn Dong; and Petra Schulz, founder of Moms Stop the Harm. Each of these presenters provided nuanced, informative presentations about this important and critical topic.

For those who were not able to attend, or for those who would like to review all the information and perspective that was shared, we have put together the following in-depth recap covering each speaker’s remarks, key actions anyone can take to help, and answers to many common questions.

Part 1 - Inspector Kellie Morgan

We first heard from inspector Kellie Morgan who shared her perspective on the opioid epidemic as a leader within the Edmonton Police Service.

Inspector Morgan has worked for the EPS for over 25 years, and currently runs the social policing division. She oversees a variety of crisis response teams, including the Human-centered Engagement and Liaison Partnership (HELP) team which work collaboratively with many community partners including but limited to Bent Arrow, Boyle McCauley Health Centre, Boyle Street Community Services (BSCS), The Mustard Seed Society (MSS), the Royal Alexandra Hospital, Assured Income for the Severely Handicapped (AISH), and Homeward Trust.

We learned from Inspector Morgan that under the leadership of Chief Dale McFee, the EPS is shifting course in the way it polices vulnerable populations—which in their definition includes people with addictions, mental health, those who face housing insecurity, and those who have suffered much trauma (including historical or intergenerational). The EPS is adopting a more progressive approach to social policing that focuses on addressing systemic issues instead of orienting vulnerable folks towards the judicial system.

By doing so, the police and the healthcare system can work together in the same ecosystem of community safety and wellbeing, helping people find the resources they need. One of the key partnerships putting this culture shift into action is the Police and Crisis Response Team (PACT) who work together with Addiction and Mental Health Access 24/7 out of the Royal Alexandra Hospital to create multi-disciplinary approaches to treatment, tailored to individual patients requiring care.

The EPS recently created the Community Safety and Well-Being Bureau and will soon pilot a new app called HealthIM, which aims to help police better respond to crises by asking a short set of pre-screening questions. The app offers tips for de-escalation and the best course of action based on the situation.

All these changes tie into how EPS is responding to the opioid crisis. Inspector Morgan reiterated multiple times that the key to combating the opioid epidemic in Edmonton is collaboration and changing the way the judicial system views those with substance use disorders. 

“This culture change needs to shift from within policing organizations. We are committed to stopping the policing of mental health, addictions, and homelessness. We are determined to stop the vicious cycle many people find themselves in, which sadly can often include historical or intergenerational trauma such as having experienced the residential school system. We now look at the root causes as to why someone is engaged with the judicial system and try to gauge the underlying issues that have brought them to their current situation.” - Inspector Kellie Morgan

Part 2 - Dr. Kathyn Dong

After inspector Morgan’s presentation, we heard from Dr. Kathryn Dong, a nationally respected researcher and addiction medicine clinician, and founder of the Inner City Health and Wellness Program located at the Royal Alex.

From Dr. Dong we learned about the healthcare perspective on the opioid crisis, and how the Royal Alexandra Hospital is responding in turn.

The Royal Alex sees the highest admission rates to the ER for substance-related medical problems compared to every other hospital in Alberta, likely due to its size and central location.

The Royal Alex was the first hospital in North America to embed a supervised consumption service for hospital patients. It is open 24/7 except for scheduled staff breaks. This service provides individuals with access to sterile supplies, safer use education, and the presence of health professionals trained in drug poisoning prevention and response. The service also helps to identify patients who could benefit from connection to addiction treatment and recovery resources.

People who use substances have identified the integration of supervised consumption services in acute care hospitals as a key strategy to help people engage in treatment and reduce stigma around drug use. Dr. Dong made it clear that patients accessing any of the services offered at the Alex are treated with compassion and respect, as many people with a substance use disorder avoid accessing healthcare services out of fear and mistrust of a system that has traditionally stigmatized them. 

The Royal Alex is also home to the Addiction Recovery Community Health (ARCH) Team. The ARCH Team includes physicians, nurse practitioners, nurses, addiction counsellors, peer support workers, social workers, and pharmacists who provide holistic care for patients who use substances. The team provides recommendations for the management of substance use disorders, health promotion interventions and, via a transitional clinic, they help patients to access social programs and community resources, like housing and income supports. The ARCH program recognizes that no two paths are alike to recovery and tries to tailor treatment for individuals in their care.

“Thanks to the tremendous work of the Emergency Strategic Clinical Network (ESCN) every emergency department in Alberta now has buprenorphine/naloxone on site. Naloxone is the first-line medication option for people who meet criteria for an opioid use disorder. This has been a huge step forward in improving access to a lifesaving medication for those that need it.”
-Dr. Kathryn Dong

Dr. Dong outlined four actions people can take to help fight the opioid crisis:

1. Reduce stigma around substance use by using inclusive language that is free of judgement.
1. Shame due to negative stigma around drug use is a major barrier many face when it comes to seeking help for addiction. Be someone people feel comfortable confiding in about their health and wellness – topics like addiction. For example, instead of “junkie” or “drug addict” say that a person has a “substance use disorder.”
2. Start conversation about substance use with those that you care about.
   
   
2. If you become a person someone confides in about substance use, know how to help people access treatment.
1. Learn about what resources are available and offer them as options. Here are a list of resources:
1. AHS Opioid Dependency Program
2. Virtual Opioid Dependency Program
3. Access 24/7
4. Addiction Helpline: 1-866-332-2322
   
   
3.  Know how to recognize and respond to an opioid poisoning event. Alway carry a Naloxone kit.
1. Naloxone kits and training are available for free at most pharmacies, and all emergency departments in Alberta. If you see someone experiencing opioid poisoning, administering naloxone could be the difference between life and death.
   
   
4. Be an ally.
1. Think and learn more about equity and how systemic issues such as class, gender, race, sexual orientation, et cetera, impact people and health. Listen to those affected by substance use to understand how you can be part of the solution.

Both the Addiction Recovery Community Health (ARCH) team and the Inner City Health Wellness Program were initially funded through donor support. These programs are now operated by AHS, and are integral to how the Royal Alexandra Hospital cares for patients. It’s thanks to our incredible community of supporters our foundation is able to help fund such impactful programs and initiatives that benefit public healthcare.

Part 3 - Petra Schulz

Petra Schulz co-founded Moms Stop the Harm with two other families in Edmonton after tragically losing her 25-year-old son, Danny, to a fentanyl overdose in 2014.

Through Moms Stop the Harm, Petra aims to create open conversations about the opioid crisis to change public policy, end stigma around substance use, and, most importantly, save lives.

Petra hopes to open hearts and minds by adding a human element to the opioid crisis by sharing her deeply personal experience with addiction.

Petra mentioned many of the fond memories she had of her son Danny, such as his love for classic cars and cooking gourmet meals. She also shared his struggles with depression, social anxiety and use of substances as an escape from these feelings.

Danny was one of the early victims of fentanyl at the beginning of the opioid epidemic in Edmonton. At the time, Petra found there was little to no information about Fentanyl, and equally little or no support from any level of government or the healthcare system. In response, Petra and a group of peers founded Moms Stop the Harm, an advocacy group now consisting of over 3,000 families across Canada.

Moms Stop the Harm takes the view that to end the opioid crisis, as a society we must end the negative stigma around drug use, viewing it as a health issue rather than a crime, with better access to mental health and social supports. Looking at the root causes for addiction is imperative to prevention. To Petra, current drug policy is based on morals, societal standards, and beliefs—not evidence. Safe supply, supervised consumption sites and decriminalization of substances are harm reduction policies supported by Moms Stop the Harm.

Moms Stop the Harm also advocates for the power of family, community and creating connection to combat the opioid crisis. The organization provides peer support for families such as the Healing Heart Canada group for families who have lost a loved one and Holding Hope for families whose loved ones are using substances.

Moms Stop the Harm believes using a human-centred approach to care equates to better health outcomes for individuals with substance use disorder, families, and the general population. From a healthcare perspective, this means providing harm reduction supplies and information to families, informing about evidence-based options, facilitating rapid access to treatment, creating systems to follow up and support patients post-emergency room visit, and employing people with lived experience to support patients and families.

“Families have a central role and need to be a part of the solution. Evidence based-interventions targeting families can improve health outcomes for all family members, result in better addiction treatment outcomes, and prevent adolescent substance abuse.”
– Petra Schulz

As mentioned by Inspector Morgan and Dr. Dong, Petra reiterated that showing individuals with a substance use disorder compassionate care, creating safe spaces where people feel comfortable disclosing their status, using inclusive language, and destigmatizing drug use are all essential steps in fighting the opioid crisis—and steps everyone can take today.

Part 4 - Q&A

As the topic of this lecture was so far-reaching, so too were the questions asked by those who attended. While this does not represent every single question and response, we’ve compiled some of the most prominent topics discussed at the event:

Q: Is there an explanation for why western Canada has been disproportionately affected by the overdoses?

Petra: The emergence of fentanyl is connected to spikes in death rates. This trend is making its way eastward in Canada, starting originally in B.C. There is a similar problem in Scotland. Wherever there is fentanyl, overdose rates go up. Death rates will continue to increase until we change our policy.

Q: What are the main goals of social policing?

Inspector Morgan: Opioid use is everywhere. In suburbia, in small towns, not just in the downtown core. An integrated response with social support is what we are finding to be most effective as a response. What we’ve been doing up to now hasn’t been working. We need to partner with social and health organizations to find solutions.

Q: What tips do you have if someone discloses drug use?

Petra: Listen, look at underlying issues. Danny was extremely depressed, out of money, dependent on substances. There is always complexity. Start the conversation much earlier. Be honest and open about substances, the same way we discuss sex and alcohol. A harm reduction approach is much more effective than abstinence-only approaches to education.

Q: Addictions are difficult to repair, rehab takes time, and reoffending is common. Where do recovering people go for long-term care if mental health isn’t the primary offender’s problem?”

Dr. Dong: There is no one-size-fits-all solution. There are lots of environments and programs people can access depending on their needs, and lots of community-based programs people can access from the comfort of their own home.

We are pleased to share news around a rather unexpected bright spot from this presentation—while the presentation and Q&A progressed, the chat window of the webinar was filled with an overwhelming outpour of messages of understanding, positivity, and offers of help. Many guests and attendees went so far as to share their personal email addresses and phone numbers, offering direct support for those going through tough times related to substance use or in need of info, advice, or a friendly ear.

To end the evening, our host, Sharlene Rutherford, expressed our foundation’s deep gratitude to the panel for so graciously sharing their voices and perspectives, to those working to make our province a safer, healthier and more compassionate place to live, and for all those who have added their support.

Thank you so much to our speakers for sharing their time and experience, everyone who attended our lecture, and to everyone who donated!

We sincerely hope you found value in this presentation of Speaking of Health, “The Opioid Crisis: Partnering Around a Person-Centered Approach to Care,” and we look forward to you joining us for the next event in the series.

For more information related to this event or for future Speaking of Health lectures, please feel free to reach out to Kirby at kzdrill@royalalex.org

If you would like to donate to aid efforts like the Inner City Health and Wellness Program, ARCH team, or other community-focused supports, please click here.

Community Resources:

• For bereaved parents, visit Healing Hearts Canada.
  
  
• For those seeking peer support, visit Holding Hope Canada.
  
  
• For addiction support, call the Addiction Helpline at 1-866-332-2322
  
  
• For those seeking immediate help, visit Access 24/7