There are all kinds of reasons a person who uses drugs might need to go to the emergency room. These could include, for example, a non-fatal overdose, severe withdrawal, delirium or an injection-related infection.
I have sought out emergency care for all four of those reasons. But I rarely found the kind of care I wanted and needed.
A lot of times, when we access hospitals for issues related to our drug use, or to a mental health crisis, health care providers just look at us in disgust. You can see the thoughts running through their minds: They brought this on themselves. They don’t deserve health care.
These attitudes not only lead to worse outcomes at the hospital, but dissuade people from going there in the first place—literally costing lives.
Luckily, other health care professionals are very different, and recognize how people have been failed.
Halifax has started an Addiction Medicine Consult Service. And in nearby Prince Edward Island, they’ve opened a whole Mental Health and Addictions Emergency Department.
Here in Atlantic Canada, we’ve seen some welcome recent moves to introduce dedicated services, in hospitals and other environments, to meet the needs of people with substance use disorders and other mental health conditions.
Halifax, Nova Scotia, where I live, has started an Addiction Medicine Consult Service that will operate in multiple locations. And in nearby Prince Edward Island (PEI), they’ve opened a whole Mental Health and Addictions Emergency Department.
A release from the PEI government described the department as a “new 8,000 square foot facility [that] offers two distinct services and spaces: a mental health and addictions emergency department, which will open at 8:00 a.m. on February 27, 2024, and a mental health and addictions short stay unit, which will open in the coming months.”
“This unique mental health and addictions emergency department, a first-ever for our region, is critical to transforming how care is provided to Islanders in need of urgent support,” said the Honorable Mark McLane, PEI’s minister of health and wellness. “This is a life-changing step forward that will touch the lives of so many.”
He’s not wrong about the scale of people’s needs, as our crises of overdose and mental health continue. And considering that, it makes me wonder why specialized emergency rooms to meet these needs aren’t the norm, rather than the exception.
A lot will depend on how services are delivered. But with a multidisciplinary team specializing in these issues—which can also connect people with other programs and services—PEI’s new department should be able to offer a lot more expertise, sensitivity and compassion than people like me have typically found in an emergency room.
Leslie Warren, director of acute and complex care for mental health and addictions with Health PEI, sounded like she understood when she spoke with CBC about the new department’s prospective patients: “Knowing that they’re coming to an inviting, welcoming, calming environment—I’m hoping it’s going to make all the difference.”
“We can take them from the busy waiting room out front and provide a quiet space,” she added. “Often people are struggling, and coming through that front door is one of the toughest things to do.”
“The service can help to manage withdrawal, discuss with people what their goals are and offer counseling, as well as medication treatments to start in the hospital.”
In Halifax, our Addiction Medicine Consult Service (AMCS) was launched in September 2023. The Nova Scotia health authority describes it as “rapid Addiction Medicine consultant advice to community pharmacists as well as physicians and nurse practitioners working in Mental Health and Addictions (including Correctional Health Services), Primary Care, Emergency Departments, Long Term Care, and Acute Care.”
Dr. Tommy Brothers is an internal medicine resident at Dalhousie University in Halifax. He specializes in addiction medicine, and has been instrumental in implementing evidence-based harm reduction and treatment services in Atlantic Canada.
He told Filter that Halifax’s AMCS team initially consists of a physician, a registered nurse and a social worker. But they soon plan on hiring a peer support worker. That will be an important addition, to help communication with patients and make sure services are responsive and stigma-free.
I asked Dr. Brothers for some examples of how the new AMCS can work.
“Clinicians caring for patients in the QEII emergency department or inpatient units at the Halifax Infirmary can contact the Addiction Medicine Consult Service and ask them to come and see the patient directly,” he said. “The AMCS can help to manage withdrawal, to help people feel well and stay in hospital. They can discuss with people what their goals are related to substance use, and offer counseling, as well as medication treatments to start in the hospital.”
Better access to medications for opioid use disorder, which greatly reduce people’s risk of death, is a crucial component. But another thing that stands out to me is the notion of asking people what their goals are—a breath of fresh air for those of us more used to having other people’s goals imposed on us.
Addiction consult teams have already been implemented elsewhere in Canada—and in some parts of the United States, as Filter has reported. Halifax is looking to lean on those experiences to create the best possible service.
“There are several models elsewhere that we are learning from, in particular at the Royal Alexandra Hospital in Edmonton, St. Paul’s Hospital in Vancouver, the hospitals in Hamilton, Ontario, and at the Ottawa Hospital,” Dr. Brothers said.
“I think they have generally been so successful,” he added,” because there is so much need, and traditional approaches to hospital care have not served people who use drugs well.”
These initiatives show intentional thinking about overlooked needs, which should be replicated elsewhere.
Just hearing that acknowledgement from medical professionals feels like a necessary first step. As Warren referenced, asking for help can be incredibly hard for those of us who have experienced stigma and discrimination, and there’s a lot of trust to rebuild.
We can’t pretend that new services like those in PEI and Halifax are the whole answer. Systemic injustices have created problems of huge scale and complexity, and we’ll need much more. As one practical example, I would want to see safe consumption sites integrated into hospitals to save lives.
But with the help of peers and compassionate providers, these initiatives can do a lot of good in Atlantic Canada. They show intentional thinking about overlooked needs, which should be replicated elsewhere. Care isn’t care unless it’s patient-centered—and for far too long, “care” for drug users has been anything but.
Photograph of Halifax Infirmary by Citobun via Wikimedia Commons/Creative Commons 4.0
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