Anyone else have trouble at hospital emergency depts?

[Mizzem]

As an outreach worker I have taken several teens and adults to emergency at the Jubilee trying to get them into the Archie Courtnall centre which I thought was an intake for Eric Martin. Most of them have a serious addiction to crystal meth. There are several problems.

1. My clients are always confused and usually exhibit paranoia and psychosis. They are seeing things, talking to people who aren't there, scratching and picking at themselves and don't trust anyone. When they have asked me to accompany them to hospital because they can't afford an ambulance, they wait usually up to an hour for intake, then are asked to wait their turn again, which is often up to 8 hours. Generally I cannot keep them there this long unless they are at the point of passing out where because they have been up for a week they just can't wake up and function enough to be admitted. Should they get in to A.C, there is another long wait for assessment. Because they are unable to make much sense and are often irritable and aggressive, they are encouraged to sleep or relax in a recliner or a bed if there is one. When they wake up they usually check themselves out because it is time for more of the drug. In BC people can not be held against their will for treatment as they can in Alberta and other provinces.

2. Not one has got into EMI for long term treatment and support, and it seems to me that I know more about the drug and it's effects than the staff that treat them. What is the point of taking people in if they are just going to release them because they do not have the knowledge, staff or services to deal with an acting-out drug addict? The thought that they will be turned over to the police stops many from seeking treatment though there is no treatment anyway! The whole thing is a loop with no good outcome. It seems that Emergency is embarrassed to have these people sketching out in the waiting room and is eager to be rid of them.

3. When an addict is through in emergency and it is the middle of the night, they are sent out, even in winter, to find their way back to wherever they came from. If they have been brought in by ambulance they most often have no money for a cab, often have one shoe on or no coat, and are hungry and the attitude is "it's not our problem." It seems that cab vouchers or bus fare should be available to anyone who needs to get home. Can't the volunteer services at the hospital set this up? Who speaks up for them when they do not have the skills to handle their own affairs? Many street addicts have a mental illness as well and there is no one to help them at the hospital.

The ambulance attendants are great with these people but it seems that in general the police response teams need more sensitivity training in handling addicts, although several individual officers are incredibly patient and knowledgeable about meth psychosis.

If you have had similar experiences I think this is a great place to let the health authorities know that the system sucks if you are poor, mentally ill or addicted.

[meltorme]

Your voice is a strong one.

We managed to get through one election.
I believe there are ones begging for a
federal vote?

Keep talking, your voice will be heard.

[sparkle]

Late last year in Prince Albert, staff from Ambulance, Hospital, fire department, the City Police and RCMP's joint forces unit, and the School Division gave presentations on how crystal meth is affecting their areas. It was the first time such groups have met to discuss the drug's effect on Prince Albert.

At Victoria Hospital, for instance, as at hospitals in most centres now, crystal meth is disrupting the emergency department. People who are admitted for a crystal meth overdose are often very agitated and agressive, frequently violent. These "obnoxious" cases can make it unpleasant for other patients and visitors, said Sharon Griffin, manager of the hospital's nursing unit.

The effects of a crystal meth overdose also last longer than other substances.
When a teenager was recently taken to emergency for an overdose of crystal meth, staff had to keep the youth restrained on a stretcher for 13 hours.

The city needs a medical detox centre to deal with these cases, said Giffen.
"It's becoming more and more the drug of choice."

"Crystal meth affects everyone in this room. We all pay," Craig Harper, battalion chief with the Prince Albert fire department, told the capacity crowd in the Saskatchewan Rivers School Division conference room.

''

[sparkle]

190,000 British Columbians used crystal meth in the last year.

Nightclub-goers, street youth and gay men most at risk.

Deaths related to the drug steadily rising in B.C. since 2000.

Vancouver street youth who had tried amphetamine-type stimulants:
71%

Gay men surveyed in British Columbia who had used methamphetamine:
25.4%

British Columbians who had used methamphetamine in the last year:
5.1%

And in Victoria, the number of crystal meth users treated at the youth detox centre there jumped from 11 per cent in 2000 to 61 per cent in 2003/2004. That figure continues to soar.

Dr. Doug McGhee, a representative from Victoria's youth and sexually transmitted disease clinics, told the summit there is clear evidence the (crystal meth) problem is growing in his city.

"Among people admitted to emergency for psychosis in Victoria and Vancouver Island, it used to be predominantly people suffering from bipolar disorder and schizophrenia. Now it's 50-per-cent crystal meth users," McGhee told the group.

[Casper]

I have got 414 days off meth, however when I tryed to get clean the Hospitals would not do much, when they addmited me it was only for one or two nights and I was right back out there. I think the only option is to try and send your clients away from Victoria, as I did and look how long I've been able to stay clean. Just keep them out of there comfort zone and hope that when they finish there treatment most of there surronds just might be different, that's what happened to me. Know I'm back in school and looking to start a job in the next 3 years.
_________________
Kevin Adam Henry

[helen]

Congratulations on your sobriety, Kevin!

[SisterCrystal]

I am a recovering addict who had been using daily for almost five years. During that time I think I must have tried every treatment option available; from long term inpatient rehab in Ontario (at Homewood, where I was admitted on two separate occassions for a two month period each time) to the detox facilities here in town; not to mention the support I have received from the wonderful people at ADS. I also have a concurrent disorder (schizophrenia) that predates my addiction, and has itself resulted in many emergency room visits having exactly the kind of problems mentioned in this thread.
There are two main points I will address in this post. I appologize for its length and will try to be as succinct as I can.
First, the barriers to treatment discussed here are very real. It took me many years and the support of my counsellors and doctors, who frequently had to advocate or downright agitate and pull strings to get me appropriate treatment, before I was able to do the seemingly endless things that need to be done before, for example, it is possible to gain admission to a government funded treatment facility. Most addicts are not nearly so fortunate in this regard, and can find it almost impossible to find a GP that will stick with them through the missed appointments, frequent relapses, and other confounding factors that people with addiction or mental illness often present. Without a GP it is virtualy impossible to access ANY other services beyond crisis management and perhaps a bed in detox - and even that takes the kind of persistence and assertiveness that too many sick people simply do not have.. Too many hoops to jump through can easily discourage and/or be beyond the abilities of the desperately sick. It should not be so difficult to gain access to appropriate treatment without requiring that a multitude of conditions be met before even getting on a waitlist! By the time most people seek help they need it BAD and they need it NOW. If long waits for admission to a treatment facility are endemic, then it is essential that there be some sort of intermediate care, and that it be available immediately and for as long as the client is waiting. The time between getting waitlisted and admitted can be very dangerous, as it is common for people to use even more recklessly and compulsively during this period than they were when they first decided they needed something as drastic as inpatient treatment to survive.
My second comment is more encouraging. I have experienced a significant improvment in the level of awareness and quality of treatment I have received over the last decade. There is still stigma, stereotyping, and a distinct lack of effective treatment and managment strategies occuring in our hospitals and other points of contact, exactly as described by Mizzem in this thread. This has serious consequences for both the patient's immediate and long term prognosis. But there is not so much of this as there used to be - however slowly and incrementaly, change IS occuring. The level of awareness has definitely gone up, although there is obviously still some way to go. Most of the problem arises, I think, from the distinct lack of coherent policies for dealing with these kinds of admissions in a way that protects the well being and peace of mind (such as it may be) of both others waiting for treatment and the addict herself. A recent study involving schizophrenic patients being admitted for the first time with serious psychosis and/or paranoid delusional ideation has shown that the manner in which they are initially treated by emergency room staff has a dramatic and potentially permanent effect on their long term prognosis. If the emergency room experience (which is already inherently traumatic to a confused, perhaps paranoid and/or psychotic individual) is not handled correctly, the chance of that patient seeking further treatment or following prescribed treatment is greatly reduced. So this issue has consequences extending far beyond the emergency room setting.
To summarize then, I can attest to the reality and seriousness of the various barriers to treatment discussed in this thread, and the need to address them in a realistic and timely fashion. I am, however, encoureged by the progress I have seen over the course of my own treatment, and in the sincere willingness to learn and make needed changes I see in health care providers as evidenced in the questions and discussion that goes on after speaking on this subject. I believe the will is there, we lack only the knowledge and skills necessary to deal with this very serious situation. A situation that will only become increasingly important and urgent as time passes, and more and more designer drugs join crystal meth as a permanent part of our social fabric.
_________________
What could possibly go wrong?
How bad could it be?
Trust me, I know what I'm doing!
It was like that when I got here (only not broken).

[orion]

Thanks SisterCrystal for your observations from experience within the treatment system.

The Community Task Force on Crystal Meth is trying
to get this info out there, trying to get education to service providers,
and trying to create a climate of expectation for improved and more accessible resources for users who want help.

We do not aim to stop yet.

Best wishes in your recovery, and thanks again for using your voice here.