In his 21 years of practicing emergency medicine, Dr. Jason Wale has always felt a little frustrated when it came to dealing with patients with addictions in the emergency department.
“We can deal with complications, people in withdrawal, people who overdose,” Wale said. “We can deal with the abscesses and infections but we didn’t have a whole lot of tools for treating the addiction itself.”
Many people who are addicted to opioids are using four to five times a day, Wale explained, making it hard for them to stay organized enough to see a referral even if it’s the following day.
In 2016, as a response to the increasing rates of opioid use disorder, the provincial government relaxed restrictions around Suboxone, a form of opioid replacement therapy similar to methadone.
Wale seized the opportunity and started a project through the Special Services Commission in B.C., which has funding to allow physicians to work on quality improvement projects.
His project focuses on three principles. He wants to be able to provide 100 per cent of the people who show up in the emergency department with opioid use disorder the option to start agonist — or Suboxone — therapy immediately, he wants to link them up with addiction providers within 24 to 48 hours and he wants to try to use peer support to help patients book appointments and actually get to them.
“I want to do everything possible to provide people with help,” Wale said. “I wanted to make a model that would work for community hospitals and could adapt wherever there is an emergency department.”
According to the BC Coroners Service, there were 1,310 illicit drug overdose deaths with fentanyl detected in B.C. in 2018. That is a seven per cent increase from 1,223 deaths in 2017.
Fentanyl or its analogues were detected in approximately 87 per cent of illicit drug overdose deaths in 2018 and 82 per cent in 2017.
Fraser Health Authority had the highest number of illicit drug overdose deaths with fentanyl detected in 2018 at 435 deaths, followed by Vancouver Coastal Health with 382 and Vancouver Island Health Authority with 215.
Wale said he remembers a 21-year-old woman who came into the emergency department with an abscess on her arm. He asked if she wanted any help with her addictions.
“She said no … she said she just wasn’t ready for that yet,” Wale said. “She was dead three days later.”
Wale’s program involves treating people who are in withdrawal with Suboxone therapy. Suboxone blocks opiate receptors and reduces a person’s urges to use opioids. It also helps reverse the side effects of opioids. But patients need to be far enough into withdrawal stages to begin Suboxone treatment which is not only uncomfortable and sometimes painful, but it also means they cannot wait in busy emergency departments.
“If somebody is in an emergency department waiting room for three hours they’re not going to wait longer,” Wale said.
Withdrawal symptoms can present themselves just hours after an individual’s last opioid dose.
A rapid access diagnostic unit at Royal Jubilee Hospital, however, allows patients to be admitted for up to 23 hours for observation so Wale set up withdrawal protocol in that unit to help patients with addictions.
He has also linked up with the Umbrella Society in Victoria. The society helps patients make connections with counselling and doctors and helps them make it to their first and subsequent appointments.
“Peer support is crucial, the Umbrella Society can help patients make it to their first appointment and not drop off anywhere,” Wale said.
The Umbrella Society helps garner trust between patients and their care providers, which can make all the difference when it comes to deciding to begin therapy.
“They’ve got to 100 per cent believe that the plan you’ve got for them is not going to put them in withdrawal again,” Wale said. “We let them know if they’re willing to trust us, we will go to the wall for them.”
Wale said that for every five people the program and emergency department has engaged with, one person is staying on the therapy.
The emergency department also has small cards that they pass on to patients they suspect are struggling with addiction.
The cards let patients know someone cares for them. They also provide patients with the phone numbers to opioid treatment, overdose prevention and peer support services in the community.
Funding for Wale’s program has now run out, but he continues to work on it on the side of his desk. The protocols are all still in place, it’s just a matter of integrating it as part of a permanent Island Health framework.
While Wale’s program addresses one small portion of a crisis that has taken the province by storm, Wale said it does its small part in helping out.
“Our role is one small part of the puzzle but it’s an important part,” Wale said. “I’m optimistic that it’s going to make a difference.”
This article is part one of a six-part special report on Greater Victoria’s opioid crisis. Find more at vicnews.com. For resources in Greater Victoria, find Black Press Media’s Overdose Prevention Guide online or pick up a hardcopy at our Victoria office, 818 Broughton St.