At a time when overdose deaths reach a record high in the province, the third and final part of this series explores how adverse childhood experiences can lead to substance use, and what can be done to prevent it.
Part 1:
Part 2:
The question of whether the emotional stress caused by COVID-19 will have a long-term psychological effect on British Columbians isn含羞草研究社檛 a matter of if 含羞草研究社� it含羞草研究社檚 a matter of just how widespread it will be, says a leading physician in the province.
South Surrey含羞草研究社檚 Dr. Tahmeena Ali, who this year was named the , and White Rock psychologist Jennifer Mervyn, who was among 1 in mental health, have both signed an open letter urging government to prepare for the potential short- and long-term harm from the ongoing COVID-19 pandemic.
Mervyn and Ali are joined by more than 200 child advocates, physicians, researchers and health care professionals in the province who含羞草研究社檝e signed the letter.
含羞草研究社淐hildren含羞草研究社檚 social environments have shrunk during the isolation measures, diminishing critical opportunities for co-regulation of emotion and stress through social connection and the support of broader families, communities, and culture,含羞草研究社� the letter reads.
The letter asks that a B.C. task force be created to support an evidence-based strategy for children含羞草研究社檚 wellness during pandemic recovery.
含羞草研究社淭his is potentially creating trauma for people, this COVID situation,含羞草研究社� Mervyn said. 含羞草研究社淲e don含羞草研究社檛 have as many people to bounce things off of, to regulate, to get away from the stress, to talk through things with. That含羞草研究社檚 so critical, to us as human beings, it actually changes how our brains work.含羞草研究社�
A comprehensive study by U.S. organization Kaiser Permanente published in 1998 examined the link between adverse childhood experiences (ACEs) and challenges in adulthood. The study found the more adverse experiences a child has endured in their life, the more likely they are to have health complications, including diabetes, high blood pressure, and substance abuse.
Ali said trauma doesn含羞草研究社檛 need to be overt. It can be the result of something as simple as a workaholic parent, who loved and provided for their child, but never developed an emotional connection with them.
含羞草研究社淭hat leads them down a road that isn含羞草研究社檛 as healthy in terms of self-coping mechanisms,含羞草研究社� Ali said.
In June, B.C. recorded 175 overdose deaths, the highest monthly total for the second consecutive month. The drug overdose crisis, experts have said, has been exacerbated by COVID-19.
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含羞草研究社淐OVID just illustrates the vulnerabilities in society that when any of us are under stress, our coping mechanisms are where we go to. So whether that含羞草研究社檚 getting violent, or losing our temper, or overeating, or using drugs. It含羞草研究社檚 not a surprise, to any of us, that the overdose deaths are up. It含羞草研究社檚 a sad reality that when we have dysfunctional coping mechanisms, that含羞草研究社檚 what we fall on in periods of stress,含羞草研究社� Ali said.
Preventing drug overdoses through harm reduction practices, such as safe injection sites and distribution of naloxone, has resulted in fewer overdose deaths. But some experts describe harm reduction as a Band-Aid solution to a bigger objective, which is providing citizens with the tools they need to not rely on drugs as a self-soothing mechanism in the first place.
Both Ali and Mervyn agree that the most important thing people need, whether or not they experienced ACEs, is to have connected relationships. Mervyn described relationships as a way to co-regulate stressful environments, and Ali said it含羞草研究社檚 critical for a young child to have at least one connected relationship with an adult.
含羞草研究社淲hen you含羞草研究社檙e wrapped around love and support and care and connected relationships that help you co-regulate, and bring your stress levels down and know that you含羞草研究社檙e safe and protected,含羞草研究社� Mervyn said. 含羞草研究社淭oxic stress is when we含羞草研究社檙e experiencing these stressful environments in our day-to-day environment in the absence of that support.含羞草研究社�
Both women said the medical field is in the early phases of applying ACEs research and working from a trauma-informed approach. However, there is a long way to go.
含羞草研究社淚t含羞草研究社檚 also a cultural of medicine all around us that has to start shifting to that trauma-informed approach of recognizing that our tone of voice, and how we question patients, and how we approach them universally needs to shift. So that people don含羞草研究社檛 feel ostracized when they come into emergency intoxicated with alcohol yet again, but they feel supported and understood that this is a disease that comes from other things,含羞草研究社� Ali said.
However, a change towards a trauma-informed society doesn含羞草研究社檛 start or end with the medical community.
Mervyn suggested that prenatal classes could be re-tooled to teach young parents how to establish meaningful connections with a newborn, ACEs, early brain development, stress management, and a way to break generational trauma.
Sources manager of substance use services George Passmore said a prenatal program of that nature would be the 含羞草研究社渦ltimate dream.含羞草研究社�
Decriminalization
Over the course of this series, Peace Arch News has interviewed health and addictions experts, an active substance user, people who are in recovery and a man who lost a child due to overdose. Everyone that PAN spoke to agreed that decimalization of drugs would be an effective tool to save lives.
Recently, the Canadian Association of Chiefs of Police president, Vancouver police Chief Adam Palmer, called for the decriminalization of simple possession of illicit drugs. B.C. Premier John Horgan put his support behind the call, as did provincial health officer Dr. Bonnie Henry, adding 含羞草研究社渢here含羞草研究社檚 no more important time for us to do this than now.含羞草研究社�
含羞草研究社淲e need to put as much time and effort and kindness and compassion into caring for people who use drugs as we have been successful in doing in responding to the COVID-19 crisis,含羞草研究社� Henry said at one of her near-daily July COVID-19 briefings.
The is often touted for its success for decriminalizing drugs and turning substance misuse into a health issue, not a criminal one. In the 1990s, Portugal was averaging 360 drug overdoses per year (in comparison, B.C. has half the population of Portugal and recorded 728 overdose deaths so far in 2020).
After Portugal decriminalized drugs, the overdose deaths dropped to 26 in 2016. The number of heroin users in that country dropped from more than 100,000 when they created the policy in 2001 to less than 25,000 in 2017, according to the country含羞草研究社檚 health ministry.
Portugal paired decriminalization with a rehabilitation program and safe drug supply. People caught with a personal-supply of drugs in the country are not put in the criminal justice system, but instead are encouraged into treatment programs that are immediately available and fully subsidized.
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含羞草研究社淭his is a very difficult conversation to have, and it含羞草研究社檚 understandable,含羞草研究社� Passmore said. 含羞草研究社淚 struggle with some of the implications of the ideas around fixed drug supply. I struggle with it, and yet, when I look at what含羞草研究社檚 happening, I think, let含羞草研究社檚 stop empowering the organized crime.含羞草研究社�
White Rock含羞草研究社檚 Ryan Nielsen, 26, who含羞草研究社檚 recovered from a six-year heroin addiction, said the most effective way to save lives is to provide a safe drug supply.
含羞草研究社淥f course that含羞草研究社檚 a very tricky slope. We can do the whole counselling or whatever there is, but there are addicts that maybe won含羞草研究社檛 want to do those steps. If you actually add a safe drug supply that would save a lot of lives,含羞草研究社� he said. 含羞草研究社淚 know a lot of people don含羞草研究社檛 like that idea. It would immediately save lives.含羞草研究社�
White Rock Mayor Darryl Walker agreed in that drug use is a health-related issue, not one of criminality. However, Walker said people who sell illicit drugs need to be held accountable.
含羞草研究社淒ecriminalization speaks to a level of control where people can get it and they don含羞草研究社檛 have to worry about getting it through somebody who含羞草研究社檚 a pusher, trafficker, or whatever. Where they can actually get it safely. We need to talk about it as a health-related issue. We含羞草研究社檝e gotten partway there with marijuana,含羞草研究社� Walker said.
It含羞草研究社檚 discussion, he added, that needs to involve the whole community.
含羞草研究社淎nd we have to do it under a guise of health-care as far as I含羞草研究社檓 concerned, because that含羞草研究社檚 what it is,含羞草研究社� Walker said.
Ali said the issue with policing personal drug use is that it doesn含羞草研究社檛 resolve the root cause of why people to pick up substances.
含羞草研究社淪o putting them in jail or fining them isn含羞草研究社檛 going to fix the hurt inside that they含羞草研究社檙e trying to heal,含羞草研究社� Ali said.
aaron.hinks@peacearchnews.com
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