Pubdate: Sat, 13 Jan 2018
Source: Vancouver Sun (CN BC)
Copyright: 2018 Postmedia Network Inc.
Author: Lori Culbert
Pages: A4-A5


People in crisis are seen quickly, while access to needed services

When she was mired in a seemingly endless drug addiction, Phyliss
Sauve couldn't slog her way through the health care and social
services systems that were intended to help her.

It was nearly impossible to make or keep appointments with doctors,
drug counsellors and social workers when she had no home, no phone, no
car. "You don't see any way out, and I would get frustrated, so I
would just keep doing what I was doing."

Today, after five years of sobriety, she works for the unique Rapid
Access Addiction Clinic, or RAAC, at St. Paul's Hospital, which offers
most of the services addicts need to try to get clean, under one roof.

"If I would have been able to walk through these doors and have
everything I need to access here and the help, all in one spot, I
don't think I would have struggled as much," said Sauve, a RAAC peer
navigator. "It would have saved me a lot of grief."

RAAC opened in the fall of 2016 to divert people away from St. Paul's
overburdened emergency department, which over the previous five years
had been hit with a 64 per cent increase in patients who use drugs. A
public health emergency was declared in B.C. in 2016 because of the
high number of people suffering overdoses while using opioids, which
were often laced with the synthetic drug fentanyl.

In its first full month of operation, October 2016, 169 people came to
visit RAAC's team of nurses, doctors and social workers.

A year later, in October 2017, the no-frills space tucked away on the
hospital's second floor handled 837 visits, or five times as many.

"In the beginning, we knew that this place was going to be busy,"
Nancy Chow, RAAC's clinical nurse leader, said in an interview.

"We see people right away. Some people might go to (another) place and
be told there is possibly a waitlist or they need an appointment,
which doesn't address the need at the moment - when someone is living
with addictions who needs to be seen right now and can't wait for
tomorrow or next week."

The roster of clinic employees has grown, too - from a small number to
15 addiction medicine physicians, two nurses, two social workers,
three peer navigators, and several support staff.

This spring, there are tentative plans for the clinic, which runs
Monday through Friday for eight hours a day, to expand to seven days a
week, and eventually to 12 hours a day.

"It makes sense because Monday to Friday, eight hours is not enough.
We have lots of people coming in near the closing of the day seeking
help, and we have to turn them away and tell them to come back the
next day. And especially on the weekends, too, that's two days that go
by, and they possibly will land in emergency," Chow said.

The clinic, run by Providence Health Care, which oversees St. Paul's
Hospital, has served more than 1,500 different people - 55 per cent
with opioid habits and a quarter with alcohol dependency. Others come
into the clinic for a variety of issues, including the use of
stimulants and the psychoactive drug benzo.

The low-barrier, non-residential clinic is meant to stabilize these
patients and, within three months, help them find the services they
need, including detoxication, drug treatment, housing, a family
doctor, and even a health care number and other identification if needed.

The clinic's data show 15 per cent of its clients have no fixed
address, although the staff says it feels like a higher percentage
because this group often requires the most help.

"Addiction affects all walks of life. We have professionals coming who
are patients. We have patients who are well-connected to their
families and friends and are reaching out in order to prevent that
downward spiral," said Dr. Mark McLean, the clinic's head doctor.

"And we also do see people who have had severe problems, and some of
them have no address and that situation can be very desperate."

About 30 per cent of RAAC patients come for help from other areas,
including the North Shore, Burnaby, Surrey, Richmond, TriCities,
Fraser Valley, Squamish-Whistler and Vancouver Island.

Other health authorities, though, have started to adopt the
rapid-access model. In May, the Island Health Authority launched a
rapid-access addictions clinic in Victoria that is open four days a
week, three hours a day.

In January 2017, Fraser Health started a RAAC clinic inside a drug
treatment centre that is a short walk from other medical services,
including Surrey Memorial Hospital.

It has assisted 327 patients so far. In February, Vancouver Coastal
Health opened DTES Connections in the Downtown Eastside, which mimics
the on-demand model of RAAC and offers opioid-replacement therapies,
nurses, social workers, peer navigators, and community and financial
liaison workers.

St. Paul's RAAC remains unique, its organizers say, for its placement
inside a hospital with easy access to many medical services, for its
many specialized addictions physicians, and for the early evidence
that many of its large number of vulnerable patients are getting better.

"I know that a lot of the information coming out - the news about the
opioid overdose epidemic - has been rather dismal, and yet at the same
time, it is important to know that we are making an impact," McLean

RAAC's goal, McLean said, is to stabilize people with severe
addictions over a period of a few months and then transfer them to
other physicians and/or some type of long-term care in the community.

While patients are in RAAC's care, doctors have tracked their use of
medication prescribed to them, and in some cases conducted drug tests.
The results appear promising.

"We are starting to see that many of the patients we are treating are
adhering to their medication," McLean said.

"And we are finding often clean urine samples that show progress on
their addictions."

In its first 14 months, the clinic started 400 patients on
opioid-replacement therapies such as methadone or suboxone, and sent
nearly 500 to some type of community care - although clinic staff
often face the common struggle of finding enough residential treatment

"We need more. Sometimes it takes quite a bit of effort to find a
treatment centre. And sometimes it takes an application process and
then a waiting period of up to eight to 12 weeks," McLean said.

RAAC is not a residential operation, so some patients waiting for
treatment beds return to live in the same place where they had been
using drugs, making it difficult for them to abstain.

Because addiction is a complicated disorder, Chow said, for some
clients success is measured not by quitting the drug, but lowering the
harm associated with using it.

"They may continue to still use their substance or drink, but we've
reduced their use or we've provided them education, we've provided
them tools, we've given them a take-home naloxone kit to use in case
there is a risk of overdose," she said.

Last year's fatal overdose tally of more than 1,000 B.C. victims put
obvious attention on opioid addictions. But a full quarter of RAAC's
patients struggle with alcohol, McLean said.

"They come in a state where they are perhaps threatened with the loss
of their job or the loss of their family," he said.

"Many of them are (eventually) able to stabilize and stop drinking
alcohol and put their lives on a very stable pathway. And it is very
exciting to see them make those changes. Because people who have
addiction, like any other chronic disease, can be stabilized and can
lead very productive lives. Yes, like other chronic diseases,
sometimes they do relapse. But that's not different than diabetes or
arthritis or heart disease."

A number of RAAC clients do relapse and return to their addictions,
which is very tough for the staff, Chow said.

But it is encouraging when some, after months of visits, find a
treatment that works.

"They come here homeless, unemployed, and they walk out of here with
that hope," she said. "And they (later) come back and report to us
that indeed they've got their life back in order."

There was a need for the clinic, McLean said, not only to take
pressure off the emergency room, but to offer a specialized place to
send drug users for help after an overdose, as often family doctors or
basic medical clinics don't have the expertise.

Indeed, about one-third of RAAC's patients are sent by community
clinics who cannot help them, another third are referred by St. Paul's
staff after being treated in the hospital, and the final third walk
into RAAC seeking help for themselves.

"Some of the stories that patients tell me with regards to how they
developed the disease that they have is quite astonishing," McLean

"But the fact of the matter is approximately one-third of people are
genetically susceptible to developing the disease of addiction."

For some, that addiction can be sparked by childhood trauma, recurring
pain, mental illness or a dependency on prescription drugs.

Slowly, health-care professionals are changing their attitudes toward
addiction, McLean said, and he argued society must become more
understanding as well.

"People in the community could support this process by opening up
their minds and adjusting their attitudes so that they recognize that
people with addictions have serious problems, and that like other
problems it is a disease and it needs to be dealt with as a health
issue," he said.

Sauve's life was a tumultuous one. An Indigenous woman raised by
adopted parents, she had four children of her own who were taken away
from her until she fought to get them back. Now 48, she said she
battled a "revolving door of addictions" until a friend gave her the
support she needed five years ago to get clean.

Today, she shares her happy-ending story with the desperate souls who
turn to RAAC for help, hoping to make them feel less intimated when
they first enter the clinic and ultimately to provide them hope for
change. She also supports the drug users' families, as she is able to
speak with them on a personal level as well: Two of her four children
are addicted to drugs and she has not been able to save them yet.

 From offering the patients snacks when they first arrive in her tiny
office, Sauve witnesses their gradual improvement with each visit to
the clinic - making her proud of her job and proud of the people she
is helping.

"When they come in here they are so broken and hurt. When they walk
out of here with their needs met, it's so amazing to see."
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