PHOTO: NADEAN BLAIS
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FEATURE
BCNU is also ensuring that nurses are part of the conversation. The union has worked to inform politicians and policy makers about the importance of harm reduction strategies and the need to support nurses who are feeling the impact of daily resuscitations, compassion fatigue and threats to personal safety (see story on page 24). Vaness works at Vancouver’s Insite supervised injection facility in the city’s Downtown Eastside. The neighborhood is at the epicentre of the crisis and until recently, Insite was one of the only places addicts could legally inject opioids and other drugs without a prescription. He says 2016 saw a huge change in working conditions. “Around April we started to see an increased frequency of overdoses,” he recalls. “Our worst month was November, where we saw 139 emergencies in an eight-day period, and the vast majority of those were ODs.” Vaness reports that his team was struggling to handle the workload with just two nurses and the support staff on shift at any given time. This problem prompted nurses to use the professional responsibility process to secure additional resources (see story on page 25). Despite the huge increase in overdose deaths across the province, Insite staff are proud of the fact that not one of those occurred at their facility, which sees over 500 visitors per day. It’s a testament to the effectiveness of the harm reduction model. But as the year wore on, Insite staff were feeling the physical and emotional toll. By September some 80 percent of tested drugs were positive for fentanyl, the powerful synthetic opioid that has been primarily responsible for the spike in overdoses. Shevon Singh began working at Insite in 2011 after graduating from nursing school. “I felt definite burnout by October,” she reports “It was just before the fentanyl crisis peaked. We were seeing an incessant number of overdoses and there was a very unsettling kind of atmosphere – not how it used to feel.” She credits her co-workers for helping her work through the crisis. “The only thing that really kept me going was having such a great team – the nurses and the program staff and the peers who all work there support each other and the participants,” she says. “If I didn’t have that I wouldn’t know how to
SOCIAL DETERMINANTS Comox Valley community nurse Shanyn Simcoe says investments in areas like affordable housing are necessary to successfully address addiction.
go back and keep doing it to be honest.” The crisis has also led to self-imposed practice restrictions. Micah Cohen has worked at Insite since 2014. He came from the medical unit at Vernon Jubilee Hospital after being drawn to community nursing and wanting to focus on addiction and harm reduction. “With multiple back-to-back overdoses there’s no time to follow up with people and do harm reduction teaching. I don’t have a lot of time to do overdose prevention teaching or advocate for connection to other aspects of care that they might need, or follow up on STI testing – any of those things just fall by the wayside,” he explains. “It’s hard knowing that your practice has narrowed to just that.” Cohen reports that he’s not alone. “Anyone who works in the Downtown Eastside, whether it’s EMS or firefighters, this is what they are doing now – it’s a new reality and it’s taxing on everybody. I’ll often see the same EMS teams responding to overdoses over and over throughout the night and we’ll be sharing information back and forth – that never used to be a normal thing.” It’s not surprising that the restraints experienced by Singh and Cohen would lead to moral distress. Both are candid about the
impacts of their chosen profession. “It’s personal,” says Cohen. “When somebody stops breathing it’s usually someone you know really well or someone you care about.” The majority of Insite’s clients come through the facility on a daily basis and have built strong relationships with staff. “When people don’t show up we know it’s not good,” he says. “We’ve lost so many people this year and the workers are always traumatized because they are people we care about and it’s really hard.” Singh agrees. “It’s really, really difficult – it’s emotionally and mentally fatiguing work. What I’ve learned working at Insite is that people who are using drugs do care about their health. They want support but it’s so difficult to find. And when you see those numbers and think about even one of those 922 people, it’s crushing.”
E
xpanded access to harm reduction services are critical for population health, but the service is just one pillar in the so-called four pillars approach to drug addiction that was first implemented in Europe in the 1990s and later adopted by the City of Vancouver and other BC communities. Another pillar – the treatment pillar – includes a range of interventions and support programs that encourage people with addiction problems to make healthier decisions about their lives. But like so many community nurses in BC, Singh and Cohen are frustrated by the lack of available treatment options. “We need more options for people who are looking for help when they want to stop using,” says Cohen. “We’ve got line ups for weeks to get into detox and recovery beds.” Singh concurs, and says the continuum of care when it comes to addictions is lacking in BC. “Supervised injection is where the connection with people begins, but then you need to offer them support if they want to stop using, like opioid replacement therapies, more detoxes and treatment centres – when someone wants treatment and detox, you really need to jump on that moment because it can be a really short window.” Shanyn Simcoe knows what it’s like to see clients struggle with access to treatment ser-