June 28, 2021

Saskatchewan doctors advocate for provincial funding for safe consumption sites

Saskatchewan’s doctors are asking the provincial government to fund 24-hour-a-day access to safe consumption sites in Saskatchewan.

“Physicians have seen overdose rates skyrocket in the last couple of years, and we’ve seen an enormous number of overdose deaths that we weren’t seeing before,” said Dr. Carla Holinaty, a Saskatoon family physician. “We recognize we have an addiction and overdose crisis on our hands. The government also seems to recognize that the number of deaths from overdoses is astronomical. We should be using every tool at our disposal to try to decrease the loss of life.”

Delegates to the Saskatchewan Medical Association’s Representative Assembly (RA) have endorsed funding for safe consumption sites. A resolution from the 2021 Spring RA asked the government to fund 24-hour-a-day access to sites in Saskatchewan, while a resolution from the 2020 Fall RA urged funding on an urgent basis.

“I think physicians have an obligation to keep pushing until we have systems in place to protect some of the most vulnerable members of our society. That’s our role as physicians and that should be our role as a society,” said Dr. Holinaty, who practises at the West Winds Primary Health Centre and presented both resolutions to the RAs.

With evidence showing safe consumption sites save lives of individuals and money for the health-care system, they are urgently needed across Saskatchewan on a 24-hour-a-day basis, Dr. Holinaty said.

The provincial government has invested addictions money into detoxification and recovery – which are important – but safe consumption sites can be a piece of an overall strategy that leads to a pathway for recovery, she added.

“We can put a ton of money into recovery and detox and things like that, but we lose many people to overdose deaths before they even have a chance to enter into that program,” said Dr. Holinaty.

“They’re not ready to go into those pathways yet. We still have an obligation to do our best to at the very least keep them alive.”

Dr. John Dosman, a Saskatoon family physician with the Saskatoon Community Clinic, says the debate around safe consumption sites has become driven by emotions rather than evidence, not just in Saskatchewan but in other jurisdictions. He spoke in favour of the resolution at the 2021 Spring RA because he says it’s important for physicians to emphasize safe consumptions sites should be part of a multi-pronged approach to tackling addictions and mental health.

“There are no simple solutions but any evidence-based approach that can help is good,” he said. “I heard some of the politicians when they responded to us at the RA – they want to emphasize a more abstinence and recovery approach. We just wanted to say those are important too, but you have to get people to that place and they have to be alive to get into recovery. The harm reduction approach can keep people alive and get to that point where they are ready to quit.”

Jason Mercredi, executive director of Prairie Harm Reduction (PHR) in Saskatoon, is grateful for the resolutions. PHR, a safe consumption site, is soon expanding its hours Monday to Friday from 10 a.m. to 10:30 p.m., and is closed Saturdays and Sundays. Mercredi asked for provincial government funding to provide enough resources to expand to 24 hours a day, seven days a week – about $1.3 million – but has been refused funding in the last two budgets. Individual businesses and PHR itself have held fundraisers to enable extended hours on weeknights.

“I don’t think you have to be an epidemiologist to realize that when you have record overdose deaths, what we’re currently doing isn’t working,” Mercredi said. “The resolutions make a big difference to our ability to engage government and hold the government accountable.”

The debate shouldn’t be about treatment centres versus harm reduction, which is polarizing, he said.

“We stop people from dying in our facility. We’ve been able to get some of them into addictions counselling, after keeping them alive for maybe six months or so. We keep them from dying and they get into counseling six months down the road,” he said. “We need a full continuum of care. We need to be able to get people to treatment centres, and in order to do that we need to keep people alive so that they have that narrative.”

Doctors issue challenge to raise fund for Prairie Harm Reduction

Saskatoon Community Clinic physicians have issued a fundraising challenge to Saskatchewan’s doctors. They are asking physicians to contribute $1,000 – or whatever they are comfortable donating – directly to Prairie Harm Reduction. The Community Clinic’s Westside Clinic, next door to PHR, serves the same clientele with similar challenges, noted Dr. Dosman.

“They realize the value in having a health-care partner next door and having a good working relationship to coordinate care,” he said. At a meeting of the Community Clinic’s medical group, physicians spoke passionately on the lack of funding in the latest provincial budget for PHR.

“We just thought it was crazy that someone doing important work like that has to spend time selling T-shirts and coffee mugs, and spend a good chunk of time on fundraising, when the volume of work is overwhelming, yet they are not at the point where they can provide 24-hour care. After-hour services are critical for safe injection sites. People don’t just inject during office hours,” said Dr. Dosman.

Safe consumption sites also provide a haven for people whose experience with the health system has not been positive, Dr. Dosman added.

“Many people mistrust the health-care system because they have been treated poorly. A safe injection site can be a person’s first connection with non-judgmental, unbiased supports, and that can be a gateway into the system, building trust, and leading to better outcomes in the long run.”

Mercredi appreciates the medical support from the Westside Clinic, where clients are often referred. “Basically, our clients don’t really like to engage with the medical community. They don’t like to see doctors and nurses, but we can always get them in to see the doctors next door because our clients all trust the Westside Clinic – the staff and the doctors there,” he said. “That makes our jobs a lot easier.”

He also appreciates the financial support from the fundraising challenge.

“This isn’t Canadian health care and the way it should work. The fact that we’re having to fundraise to stop people from dying is absolutely crazy,” he said. “We’re in this situation so we’re making the best of it. We hope to have sufficient funding for safe consumption sites eventually. In the meantime, we are very glad that the medical community has decided to step up in such a major way so that we can expand hours and try to support people as best we can.”

Physicians have seen overdose rates skyrocket in the last couple of years, and we’ve seen an enormous number of overdose deaths that we weren’t seeing before. We recognize we have an addiction and overdose crisis on our hands. The government also seems to recognize that the number of deaths from overdoses is astronomical. We should be using every tool at our disposal to try to decrease the loss of life.

Dr. Carla Holinaty

Saskatoon family physician

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