She pulled me into a patient washroom, and with fear in her eyes she muttered “I won’t let him hurt you”. I tried to calm her down. “It’s ok we are in the hospital you and I are safe”. Her look was of disbelief as her delusion was strong and her paranoia powerful over her judgement. Her big blue eyes caked with mascara told the whole story she was high. And this would be the last time I saw her alive, she would die three weeks later of a fentanyl overdose.
Tragic thing she wasn’t an opioid addict, she was an alcoholic who had started to engage in risky behaviours when drunk. It started with meth, and then that meth had fentanyl in it, and that, was a costly mistake.
Between 2017-2018 in Canada, 8000 people lost their life to opioids, most Fentanyl related. British Columbia has the highest death rate due to opioids, and the number keeps climbing (Global BC News). Although the news coverage and political discussion has died down, the death numbers keep rolling. Nurses keep managing overdoses and engaging in harm reduction, but it seems like sticking your finger into a dam to plug the hole.
Unless your life has been touched by the opioid epidemic you can’t really understand the meaning of it all. I pulled the above stats from Global News BC (2017) and was fascinated by the comments that appeared below the article. The hospitals are to blame, treating ODs then discharging only to return, we need more treatment centres. The opioid crisis is a personal problem, addicts just want free drug and needles. The courts need to be tougher on drug dealers……and the comments went on and on. There is some truth, but I believe the argument of why it’s happening is now futile, we need to look at the meaning of the crisis and continue to acknowledge the loss.
The true meaning
Fentanyl to me as a nurse, is a game changer. What I mean by that, is now no one is safe. Recreational drug users now are at risk. Seasoned opioid users are at risk. Health Care Professionals and Law Enforcement are at risk. I started my professional career working as a research assistant in an Alcohol and Drug Treatment centre. And in a group of 28 women, maybe at that time, one opioid user. Meth and alcohol were the drugs that’s that we reported as problems. Research was being done on meth and it’s affects, treatment plans and interventions adapted to encompass this phenomenon. But now it’s totally different. People aren’t making it to treatment, the stakes are high, and most opioid addicts don’t have the choice to buy heroin, its all fentanyl. One year ago, I met a young woman addicted to fentanyl. I asked her how she started using, I had assumed she was a “pill popper” maybe heroin was her gateway. But she said she exclusively used fentanyl, she has never even tried heroin. I was dumbfounded and felt old -my professional assumptions where out of date. Again, GAME CHANGING. As a nurse the only tools I have been given to be to fight this epidemic is Narcan – that’s it. No slue of weaponry no education on this crisis to better understand. Nothing. I push the Narcan, I hang the drip, sometimes it works, most often it doesn’t – that’s my lived experience.
The loss of life
I would think that even in larger centres the loss of life is noticeable, in a small site, however, its community changing. We have lost people who have lived in our community for 30 years. For 30 years they have managed to stay alive living their life style, and a simple change in supply and bam the demand is dead. It’s mind boggling to me, the loss of life. Grandparents are raising grandchildren orphaned by this crisis. And it is just that, a crisis. So where is the support to our communities struggling to get a handle on this epidemic? Our resources are strained, our options are limited. In rural communities, no further funding for mental health or addictions, one councillor for a community of 3000 people, one small ED to deal with the overdoses, and no mention of our loss. Most media attention is on the big centres and these amazing overdose tents that have been set up to deal with the influx. My ED has 100 vials of Narcan that’s it. However statistically rural sites are living the same nightmare, the rates of OD’s are high and with already stretched resources we fear that we may not be able to prevent a death because of social justice – there might not be enough Narcan to go around.
The impact on communities
Like clock work after an OD we often get the backlash of this loss, the after shock, so to speak. Families not coping, partners grieving, and friends continuing the cycle. In my small community we have lost so many of our patients to this crisis, with no increase in professional supports, no front-line acknowledgment of our loss. We keep plugging away until what? It goes away, till all drug addicts are dead? What is the end point? If there was a disease, let’s call it “fentanylitis”, there would be billions of dollars spend on research for the cure, or better treatment. How much research funding does addictions get? I don’t know but I would guess not much. Now I agree addiction treatment is not that same as treating Tuberculosis, let’s say, but the lost of life is the same – preventable. With screening and early intervention, wow mortality drastically reduced. My last TB case I had was ten years ago, my last Fentanyl OD was ten days ago.
The vicarious trauma to nurses
Christmas Eve this year, the kids are tucked into bed, gifts wrapped, and I was sitting down with my husband’s family having a glass of wine. Suddenly a wave of emotion came over me. My cheeks flushed, I felt like I was on fire. I bust into tears. “What’s wrong my family asked”? I told them that on my last shift we had an arrest from an OD, and it was a patient close to my heart and all the staff at our hospital. I went into this rant of how difficult it is to nurse patient’s crisis to crisis, and then they die as result from fentanyl. As I shake with sadness and anger, I muttered “fuck-you fentanyl, fuck you”. That’s trauma, it sneaks up on you, seeps through your pores when you least expect it. Makes you look like a drunk mom on Christmas eve barley holding it together. This isn’t the first time I have dealt with traumatic events in my job, but it seems so pervasive and hopeless. There isn’t a light at the end of the tunnel, we just wait to see who’s next.
The Take Home
When we are bombarded with images and stories of tragedy and even when we are working amongst the crisis, it’s easy to forget what this crisis really means. Families have been destroyed, communities changed, vacant holes dot our horizon, empty spaces where a life use to be. Remember that when you hear about the opioid crisis. And I invite all the nurses out there to collectively give fentanyl the fuck you and demand that we acknowledge our losses and demand help with that.
Here is a link to FREE Facebook or Instagram picture that you can download and use to show your support, so make it your profile picture or share the image, let us not forget.
