CALGARY—As the number of people overdosing on opioids in Alberta rises, front-line workers respond to calls daily, administering life-saving naloxone.
In Calgary, the Drop-in Centre made headlines when it reported a 300 per cent increase in overdose preventions during the first few months of 2019, compared to the same period last year. Staff members have responded to 43 overdoses, compared to 14 last year, and the spike is taking a mental toll on them, said executive director Sandra Clarkson. She has noticed an increase in absenteeism and sick days, and is considering hiring a second trauma counsellor to support the staff.
Clarkson would also like a nurse on staff 24/7 instead of just during the day, but said that would cost an additional $300,000, which the centre doesn’t currently have.
“We’re going to do everything we can to make sure our staff are supported,” she said. “Nobody could have anticipated the number of overdoses that we’ve been experiencing.”
But the centre’s staff members are far from alone. In Calgary and Edmonton, three people on the front line of the opioid crisis in Alberta shared what they’ve learned about the people they’ve treated with naloxone, and what it’s like to administer the life-saving treatment.
Rebecca Lane has been working at Calgary’s Alpha House for close to 11 years. She works full-time as a team lead at their downtown shelter, and is also taking online social work classes.
Lane learned how to use naloxone in 2013. At the time, she was working in a permanent supportive housing building and the agency had decided to be proactive in training staff to use the kits.
Three years later, she had the chance to use her training. But it had been a while, and with adrenalin pumping through her veins, she forgot a crucial step.
“It was intimidating. I mean, when you’re watching someone’s life slip away in front of you … You feel this urgency,” she said. “In the moment, adrenalin going, I was freaking out, and I forgot you have to add air into the vial.”
Luckily, someone was there to step in and revive the person as Lane looked on. Since then, Lane estimates she has administered naloxone 30 to 40 times at Alpha House. All staff members are trained to do it, and all team leads are capable of training others, she said. On their downtime, she’ll see staff practising the steps, strengthening the muscle memory they rely on when panic sets in.
The process is written into Lane’s body now, she says. First, you check the person’s response to stimuli, such as a tap on the shoulder or their name being called. Then you check to see if they’re breathing, taking steps to ventilate their airway. No response? You pull out the naloxone kit and give them an injection in the thigh.
In every case, another team member is calling emergency services, while someone else has 911 on the line.
Some people will revive after one dose, says Lane. In other cases, you’ll need more.
“It’s all dependent on the person and how quickly you’ve caught the overdose, and how much they’ve taken, the potency of what they’ve taken,” Lane said. “Because with a lot of the drugs that are on the street, you never know what you’re getting.”
She’s talking about fentanyl, a volatile drug that’s making its way into a variety of street drugs. One dose could have enough toxicity to kill 10 people, or just enough to get you high. There’s no way of knowing, and that’s one reason centres like Alpha House have been seeing an increase in overdoses over the past few years.
Lane hasn’t had to pass the naloxone kit to someone else since that adrenalin-filled first time. In the moment, she says she focuses on what’s important and gets the job done, relying on her muscle memory.
“I just remind myself once again, like, this is somebody’s family member … in this moment, I need to make sure that I’m doing everything that I can to make sure that this person still has another chance to make a change to their life, to go back to their family,” she said.
Through it all, Alpha House staff have access to a variety of supports to help them decompress after a particularly rough day. Lane admits the job is a difficult one, but after 11 years, she feels like she has seen it all.
“I have a passion for the work that I do, and that’s what keeps me coming back,” she said. She considers herself part of the family that Alpha House clients have made among themselves, and can’t imagine ever leaving.
“Family isn’t always about blood. Sometimes it’s about circumstance. And right here, it’s one big family,” she said.
Lane is a big advocate for self-care, and she makes an effort to leave her work behind when she leaves at the end of the day.
“Self-care is one of the most crucial things that someone in this line of work needs to do for themselves,” she said. She gestured with her hands to indicate shiny chrome nails, something she does as part of taking time for herself.
Lane says she cares deeply about the people she sees every day, which makes saving their lives in the event of an overdose all the more important to her. She sees them at their most vulnerable, and gains trust from people who trust almost no one. Alpha House is a judgment-free zone, she says, and she wishes more people could suspend their judgment and feel the compassion she does.
“This is somebody’s son, somebody’s daughter, somebody’s mother, somebody’s father,” she said. “We don’t know what brought them here. We don’t know the trauma they’ve been through, the life circumstances that have led them to this door.”
“I don’t think anyone has the right to judge another human being,” she added. “I was always raised (that) the only time you should be looking down on someone is if you’re helping them up.”
Scott Gudbranson has worked for Boyle Street Community Services in Edmonton for 20 years. However, he transferred from a youth home to the downtown drop-in centre around a year ago. There, his job drastically changed.
Less than a month into his new position, Gudbranson witnessed his first overdose. He hadn’t been trained to use naloxone yet. A nurse was quickly called to revive the person as Gudbranson looked on.
“His face was all grey and his lips were blue, and it was kind of a scary sight at first,” said Gudbranson. “I did kind of panic a little bit. It was my first time dealing with something like this.”
After it was over, Gudbranson said he received plenty of support from his co-workers — and his naloxone training about 10 minutes later. He used it for the first time a couple of weeks later, and estimates he has used it seven or eight times since.
“I was a little nervous. I was kind of shaking,” he said of that first time. But with the 911 operator and a nurse watching over him, “My confidence grew and we were able to save the person,” he said.
In the moment, Gudbranson says his “crisis mind takes over.” It’s afterwards that the gravity of the situation hits you, he says, and that’s when support is needed most.
“The first couple of times that I had to deal with an overdose … my brain was working overtime,” he said. “I went home and I hugged my kids.”
When faced with an overdose, he says it’s important to pause and take stock of yourself before proceeding. If you can’t handle the situation, there’s always someone there to step in.
“Take a couple of deep breaths … clear your head and focus on what it is that you need to do,” he said.
Like Lane, Gudbranson says caring about the people he helps every day is what brings him back.
“You probably couldn’t do this very well … if you didn’t care,” he said, echoing Lane’s refrain. “They’re somebody’s family. They’re somebody’s son, they’re somebody’s daughter, they’re somebody’s brother … somebody somewhere cares about them. And that’s what we’re here for.”
Kelly Blain has only administered naloxone once, but it was an experience that will never leave her.
She learned to inject naloxone at the hospital while her son Jamie was recovering in a bed nearby. Jamie and his identical twin Jordan were similar in many ways, athletic and friendly, said Blain. But Jamie had a wider range of emotions, was prone to anxiety, and was exposed to opioids multiple times while in the hospital for sports injuries and surgeries. He also suffered several concussions. The combination of these factors led him to become addicted to opioids, she said. What followed was a frustrating cycle as her son tried to get the help he needed, whether it was a detox facility or a replacement treatment like suboxone or just the support he needed to keep going, she said.
“When my son could barely put one foot in front of the other, it was almost as if he was asked to jump through nine hoops to get the care that he needed and that he wanted and that he deserved,” she said.
One night, when Jamie was in the hospital recovering from an overdose, he was sent home with Blain. She could tell he was suffering psychosis, she said, but the nurse dismissed her concerns and so she took her son home. Jamie was normally careful, very aware of his limits, especially after an overdose, said Blain.
But through the psychosis, Jamie was unaware he had just left the hospital, and he used. Blain checked on her son and found him slumped over, blue in the face.
“I yelled his name, I shook him, I pounded on his chest, and he wouldn’t respond,” she said. “So I grabbed the naloxone kit that was in his room, I grabbed my phone and I called 911.”
Blain said Jamie looked dead, and the reality that she needed to save his life hit her, hard.
“It was terrifying. It was like every scary thing that I have ever had happen to me hit me in the gut all at once,” she said. “It was up to me to make sure he survived.”
That was in December 2016. In May 2017, at 25 years old, Jamie ended up at his grandparents’ house after a relapse. He was applying to treatment centres, and one night, he called his mother to talk. Blain said he sounded defeated, tired of jumping through hoops to try to get treatment. She told him he loved him.
The next day, Jamie’s twin brother called to tell her he had died of an overdose during the night.
Now, Blain works with Change the Face of Addiction, an organization in Calgary working to dispel the stigma Blain says her son faced as he dealt with his disorder of addiction.
“We were fighting for him. We were advocating for him,” she said. “I’m honouring his life by continuing to do his work and just to advocate for the change that we so badly need.”
Like Lane and Gudbranson, Blain said she wishes people saw what she sees — that people struggling with addictions are somebody’s family. She said she’s tired of hearing people talk about those who suffer with addiction as an “other,” as less deserving of medical attention or beyond help.
“Jamie was a radiant soul. He was a fantastic human being,” she said. “This is a huge reason why I’m doing this work … to really get rid of this stigma, because it’s a huge barrier.”
Rosa Saba is a reporter/photographer with Star Calgary. Follow her on Twitter: @rosajsaba