War allusions abound on the front lines of B.C.'s overdose crisis
Credit to Author: Zak Vescera| Date: Thu, 29 Aug 2019 22:18:34 +0000
As Sarah Blyth arrives for work on an August morning, there’s someone overdosing on the doorstep, unconscious. A second person is on the verge of going under. Both have just minutes before brain damage sets in, and minutes after that, death.
Blyth, the director of the Overdose Prevention Society, runs one of several sites in Vancouver’s Downtown Eastside where people can use drugs under the supervision of overdose prevention workers.
If someone overdoses, her team administers naloxone, a life-saving drug that reverses the overdose long enough for first responders to arrive.
The job is getting harder. Opioids such as fentanyl are being cut with benzodiazepines, which magnifies the risk of overdose and makes patients harder to revive. Carfentanil, which is 100 times stronger than fentanyl, is increasingly present.
Sarah Blyth of Overdose Prevention Society. Photo: Arlen Redekop/Postmedia
Blyth has saved people countless times. But every time, she worries about losing someone.
“It’s a life-and-death situation every time, and it doesn’t seem to be getting any easier,” she said. “There’s that thing in the back of your head, asking if you’re doing everything right.”
August 31st, International Overdose Awareness Day, will be the 1,234th day since the onslaught of overdoses was declared a public health emergency in British Columbia.
As the epidemic moves into its fifth year, another quieter crisis is emerging: the mental health of the thousands of overdose prevention workers, many of them drug users themselves, and of first responders, who say the extent of the crisis and the trauma it has left is impacting their ability to do life-saving work.
From Jan. 1, 2016, to June 30 of this year, 4,559 people have died from overdoses in B.C. Last year, 439 died in the Vancouver Coastal Health Region alone, nearly 90 per cent of those deaths involving the powerful opioid fentanyl.
Last year, 5,426 people visited Insite, North America’s first supervised consumption site, a total of 189,837 times. There were 1,466 overdoses, none of which resulted in death.
Fatalities are down in 2019, but the rate of overdoses isn’t. For first responders, B.C. Professional Firefighters Association president Gord Ditchburn says the crisis is now the “new normal.”
“We know the system is not moving at the pace we’d like it to because the crisis we’ve been facing for four years is not ending,” said Ditchburn.
Because of the short half-life of naloxone, Ditchburn and other first responders say it is not uncommon to revive the same overdose victim several times in a single shift.
“You actually begin to develop, in its own strange way, relationships with people that you see on a frequent basis,” said Ditchburn. “You get to know them. They’re real people, and they’ve either fallen on hard times or been driven there by medical conditions. When one dies, it tears at you as much as losing a friend or a family member,”
Dr. Stephanie Knaak is a senior research consultant with the Mental Health Commission of Canada, a national non-profit. Between January and March of 2018, her team held eight focus groups and 15 interviews of front-line workers and drug users.
In both groups, it identified “nearly identical” trends of “compassion fatigue” — a sense the life-saving work wasn’t making a difference in the face of endless casualties and grief.
“They’re working in a system where they’re saving people’s lives and trying to improve their lives somehow, trying to help, and it feels in many ways very hopeless,” said Knaak. “I spoke to one paramedic and he said, ‘This is literally killing our members.’”
B.C. Ambulance Service primary care paramedics Jill (left) and Stefan display the ventilation bag with airways and the naloxone and needle that are used to reverse the effects of a fentanyl overdose. Photo: Gerry Kahrmann/Postmedia
Pierre Poirier, the executive director of the Paramedic Association of Canada, compared it to an invisible suitcase. As you put things into the suitcases — traumatic events or fatigue — it begins to burst at the seams until it can no longer be ignored.
“We see things that we really can’t unsee,” he said. “Some paramedics encounter overdose situations (involving) a death of a child, (or) a 14-year-old who’s had a first-time experience with drugs, or events where parents of a child have overdosed. Those are significantly traumatizing events for paramedics. It wears on the human spirit.”
Carolyn Sinclair is the manager of the provincial mobile overdose response team, a 14-person, government-funded team founded in 2017 that focuses on relieving the “psycho-social” impacts of the crisis across B.C.
Since May of that year, the team has connected with over 18,000 individual front-line workers ranging across more than 1,200 agencies.
“(Workers) see the problem getting bigger,” she said. “They see their work is not making the impact they hoped it would. They’re going to work at their own peril, because they’re not doing their own self-care.”
The silver lining is that the crisis is forcing first-responder organizations to shed what Sheldon Young, assistant chief of occupational health, safety and wellness for Vancouver Fire and Rescue, calls a “rough and tumble” attitude around mental health.
“When I started 27 years ago, the attitude was, ‘Suck it up, deal with it, get in there and look at the body,’” he said. “We dealt with it by thinking that more exposure would be better.”
Sheldon Young, assistant chief of occupational health, safety and wellness for Vancouver Fire and Rescue, and mental health chief Steve Fraser (right) with support dog Lola.
Vancouver Fire and Rescue Mental Health Captain Steve Fraser says the service vets new recruits for stress-management techniques. They also lead nearly 100 “defusing” talks after teams respond to traumatic incidents.
“For myself as a firefighter over the past 23 years, I can remember the majority of overdoses I went to,” said Fraser. “Today, the firefighters can’t, because they go to so many.”
The service has also changed up work patterns by putting a one-year cap on firefighters working out of Fire Hall No. 2, which services the Downtown Eastside. The provincial government has made stress injuries presumptive for first responders, meaning they no longer have to prove an injury to receive benefits. They have even recruited a therapy dog, Lola, the first for any fire service in Canada.
Ditchburn and Fraser say it is easier than ever for firefighters to be connected with psychiatrists specially trained to work with them, although they acknowledge the continued stigma of mental health has to be overcome. Fraser notes firefighters skew toward males aged 30 to 55 years old, the demographic most at-risk for substance abuse and suicide.
“A lot of the times, we don’t know who is struggling,” said Ditchburn. “The way we see it today, putting your hand up doesn’t mean you’re weak. It means you’re strong, and you’re asking for help to be stronger.”
Gaps still remain. Sinclair says many fire services outside Vancouver lack regular access to counselling.
Lee Lax, a representative of the Vancouver Firefighters Union Local 18, applauded new attention to mental health in the department, but says the current shift pattern — which involves multiple back-to-back 12- or 14-hour shifts — needs to be revised. He also called for better support for firefighters who might need time off.
Fraser says it’s a battle they are making progress on, but it’s far from being won.
“Personally, I don’t want to see any more of my friends kill themselves, and I’d do anything to stop that,” he said.
But while firefighters and paramedics make massive strides, one group of first responders is being left behind: drug users themselves.
Workers at overdose prevention sites are often the first on scene, the first to administer naloxone. They are often poorly paid, rarely unionized, and as Molson Overdose Prevention Site worker Nikita Volkova points out, their jobs truly never end.
“Paramedics have support, fire-and-rescue have pensions and health care and a way out at the end of this,” said Volkova. “We do not. We live down here. We work down here. We resuscitate people on our way to work and in our buildings. We are never free from this.”
For front-line workers at prevention sites who live in the area, the people they save often are family and friends — which only makes the job more difficult.
“The scale of the trauma is hard to comprehend,” said Karen Ward, a longtime Downtown Eastside resident advising the City of Vancouver on drug policy. Ward says the crisis has permeated every aspect of life for people living in the neighbourhood.
“It’s getting to the point where it’s a casual thing to say to someone, ‘Oh wait, all your people are gone, right?’” she said. “It’s at a point where people are so traumatized we can’t acknowledge that. We’re so eager to say things are fine that we’re really, really doing a lot of damage.”
The B.C. Coroners Service says from Jan. 1, 2016, to June 30 of this year, 4,559 people have died from overdoses in B.C. Last year, 439 died in the Vancouver Coastal Health Region alone, nearly 90 per cent of those deaths involving the powerful opioid fentanyl. Photo: Nick Procaylo/Postmedia
Doug Ferris is co-manager of the Molson and Maple overdose prevention sites, which are both run by the Portland Hotel Society. He says some volunteer staff don’t have easy access to counselling or psychological resources.
“I’ve been doing this 16 years and I’ve hit that wall of burnout about a dozen times and managed to make it through, but it’s pretty common for unionized co-workers to take stress leave,” said Ferris. “Unfortunately, that model doesn’t exist the same way for community workers. When you’re about to melt down, knowing you have an appointment in a week isn’t necessarily helpful.”
That barrier, Volkova says, is compounded by the fact most professionals don’t know what their peers have been through or what their clients might have undergone.
“The reality of the Downtown Eastside is that just because you have demons doesn’t mean you’ve become one,” she said. “And if people would remember that, I think they’d have a lot more compassion.”
In many ways, the overdose crisis is a war. They are on the front lines. Their clients are sometimes “street-entrenched,” and the enemy, says Ferris, is an unregulated drug supply that is continually becoming more dangerous.
The mobile response team can’t end that war or stem its trauma. But it can provide sanctuaries from it. Every Wednesday, the team sets up an open house in the Molson site for first responders and front-line workers of all kinds to stop by, visit or chat.
Donna Huywan, a crisis intervention specialist with the provincial overdose mobile response team inside Molson Overdose Prevention Site in Vancouver. Photo: Arlen Redekop/Postmedia
Donna Huywan is a crisis interventionist with the team — her job is to go to communities across the province to build resiliency, connect workers to resources, and develop practices for managing trauma. But in practice, everyone she works with compares her to a mom. She knows when it’s right to give someone a hug, or a touch on the arm, or just to sit back and listen.
“We’re not holding anybody up. They’re strong. They are the strongest people I’ve ever seen in my life — they can hold their own,” said Huywan. “We are there to stand by them.”
The response team hosts a gambit of activities like this, from coffees to free massage appointments to a 24/7 support hotline. But the most interesting is led by Brittany Martell, another crisis intervention specialist with the team, who is trained as a social worker but currently runs her own fight club.
Every week, she runs the Frontline Fight Club where first responders practise punching mats to work out the day’s frustrations.
“Boxing is shown to help people get things up and out,” says Martell. “If people have things they’re struggling with, they can go and get out some sweat with people who are going through similar things.”
The effect, Martell says, is that front-line workers feel a sense of community that helps them weather tragedy when it hits.
Brittany Martell, a crisis intervention specialist with the provincial overdose mobile response team inside Molson Overdose Prevention Site in Vancouver. She hosts a fight club for first responders to help them shake off the stress of their jobs.
Ditchburn thinks of trauma as stones in a backpack. After walking for some time, you stop and unload them, and you carry on.
First responders and front-line workers interviewed for this article applauded government measures like the mobile response team, saying it’s one of many ways they can unload their backpack. But the weight is getting heavier, and more systemic changes are needed to lift it.
Knaak says a major complaint among first responders, for example, is the underlying systemic issues of addiction and mental health can’t be directly solved by their work. Some programs have piloted approaches to connect overdose survivors with first responders to help connect them with medical help and give the first responder “a greater sense of completion and closure.”
But, Sinclair notes, some first responders are so busy — and so traumatized — that it just isn’t a possibility.
“I hear a lot of worry (from first responders) about forgetting the names of people who they’ve lost,” said Sinclair. “They save people all the time and just keep moving, and they’re afraid of forgetting who they lost.”
On the side of first responders, the attention to mental health, according to Lax, has “increased tenfold” in recent years.
Julie Day, a front-line worker at the Molson site who attends events with the mobile response team, says that same attention should be brought to her and her colleagues.
“You have to reach down and really deal with that, otherwise nothing will change,” she said.
Volkova is the first to say her work is gruelling. But she also knows its importance — and knows unless her colleagues have some relief, and soon, there’s only so long they can walk before the weight knocks them down.
“We come in here every day and prove everyone wrong,” she said. “It may be a war zone, and we may not always stick the landing, but we have not lost a single person here. Not a single person has died.”
“But in 20 years, you’re going to have some broken, broken people, because they’ve seen what no one should ever see.”
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