Ripple Effects

Drug poisoning deaths in Alberta have reached record numbers, with the province seeing 10,185 drug-related fatalities since 2016. While the incidents of opioid-related deaths or medical emergencies have increased, the resources and staff required to help the situation have not. Among those most affected have been Alberta’s frontline health care workers, especially those
dealing with emergency situations.

The effects of this crisis reach beyond opioid-related deaths and affects all Albertans through increased wait times in emergency rooms, violence, loss of loved ones, and a health care system losing vital workers due to burnout, stress, and a lack of support from management and the government.

The provincial government’s response to this crisis has been to emphasize abstinence-based and inpatient therapies to the exclusion of harm reduction and community services. Opposition by the community and health care workers to this narrow approach has been significant but ignored by the government. The resulting effect on health care workers and those at risk of harm via the poison drug supply has been monumental. Providing Alberta’s health care workers with fewer tools cannot result in a better outcome.

This study gauges how the drug poisoning crisis is impacting frontline health care workers, their personal wellbeing, and their ability to provide care.

Previous studies have explored the experiences of doctors and nurses dealing with the opioid drug crisis, but there has been limited research into the experiences of other health care professionals. Our study focuses on Alberta health care workers who are part of the Health Sciences Association of Alberta(HSAA). In this study we asked the following questions:

• What has been the personal impact of the drug poisoning crisis for health care professionals in Alberta in HSAA?
• How has the workload and nature of work changed for HSAA members because of the drug poisoning crisis?
• What workplace supports do HSAA members need to continue working during the drug poisoning crisis?

The impact on HSAA workers varied, with those working at street level (paramedics, emergency department, in-patient, and specialty department staff) being the most affected by the poison drug crisis. Our results show that participants reported lower levels of knowledge and confidence to intervene during a drug poisoning crisis, despite the high frequency of drug poisonings they encounter in their daily work. Many health care professionals lack equipment and treatment options to support clients. Participants in our study are expected to do more with less as they face rationing of staff, equipment, space, and resources in order to reduce costs. Health care professionals also faced workplace violence, which they felt was not taken seriously by their managers.

Respondents reported burnout, staff retention issues, and secondary traumatic stress. Burnout was a notable problem among this study’s participants, especially among emergency professionals. Exhaustion impacts the day-to-day experiences
of frontline health workers. Unaddressed professional quality of life issues can lead to people leaving their jobs altogether, leading to increased strain on the health care workers who stay. These factors all have the potential to affect all Albertans needing health care.

The Covid-19 pandemic and policies around its management have had a profound impact on the drug crisis in Alberta. One health care worker notes, “I would say Covid has magnified it (the drug crisis) astronomically…the stresses of Covid produced a lot of financial stress and depression, emotional anxiety. And I think people turn to drugs to deal with a lot of that. And sadly, I think that’s when we saw a huge spike in a lot of cases.”

Participants also pointed out that societal issues are also exacerbating the drug crisis and could be reduced by effective governmental intervention. One participant said, “We have to try and house people.” The lack of housing is a barrier for many people in accessing evidence-based addiction treatments in their communities.

Participants don’t feel that the provincial government listens to or addresses their concerns. Study participants are clear that governmental policies have worsened the drug poisoning crisis. Effective services that were closed during the Covid-19 crisis have not been restored. Health care workers interviewed report not being allowed to provide clients with clean needles or other supplies that would greatly improve a client’s ability to mitigate harmful outcomes.

Adherence to a singular approach in terms of the drug toxicity crisis is exacting a toll in terms of both frontline heath care workers’ quality of life and loss of life when it comes to those directly affected by the poison drug supply. HSAA members face an uphill battle when there isn’t trust in the systems that are supposed to support them.

If Alberta is to deal with this crisis effectively, health care workers need to have the proper support and tools. Education, training, governmental and managerial support, and policy based on the best available evidence are imperative, especially in rural areas.

Recommendations

Based on the results of this study, we recommend the following action items:

The Government of Alberta and Alberta Health/Recovery Alberta

• Address the drug poisoning crisis through evidence-based policies.
• Address system resource deficits in the Alberta health care and provide additional funds for improved staffing.
• Offer comprehensive counselling, mental health, and pharmacare programs to all Albertans to mitigate severe mental health difficulties.
• Support for harm reduction services. Supervised and safe consumption sites (including smoking as well as injection and oral consumption) and overdose prevention sites will reduce the volume of clients needing emergency health care services, reduce emergency wait times, and potentially decrease the risk of workplace violence faced by frontline health care workers. This support could potentially also reduce the numberof fatalities among drug users.
• Provide comprehensive resources to people who use drugs: housing, treatment options that aren’t exclusively abstinence-based, income support, and access to mental health and addiction services.

Alberta Health Services

• Offer more flexibility in scheduling and work roles without a reduction in benefits, pay, or pension.
• Offer more training, education, and resources for clinical managers to ensure health care workers have support and strong leadership.
• Provide paid education and training regarding drug poisoning, harm reduction, trauma-informed care, and addiction treatment to all heath care professionals.
• Offer greater funding for counselling and mental health support for health care workers, recognizing the need for external services.
• Create 24/7 accessible debriefing and crisis counselling systems for all health care workers.
• Introduce Connect Care in emergency medical services.
• Empower health care professionals to make changes to their health care services to address issues specific to their local area, especially in rural areas.
• Reduce workplace violence by creating health care services that are designed to meet clients’ needs in a supportive environment.

The Public

Albertans can call on elected representatives and policy makers to implement evidence-based, adequately resourced health care services that are compassionate and effective, by:

• Writing MLAs and cabinet ministers to increase funding for health care professionals and expand access to safe consumption/overdose prevention sites.
• Challenging legislation and governmental policies that go against available evidence and which demonstrate potential to cause harm.
• Challenging societal stigma about addiction and mental health issues. Reducing the stigma faced by people who use drugs may result in more compassionate and effective care and reduce moral injury to care providers.
• Support job action by health care professionals.
• Bringing the issues illustrated in this report to the ballot box.