We can’t ignore opioids

We can't ignore opioids. We can save lives

The opioid crisis is more widespread in Alberta than many people think. It’s worked its way into our cities, towns, suburbs and homes. Nobody is immune to the opioid crisis. Right now, there could be people in your life who are struggling with opioids. But there is hope. There are things we can all do to make sure those at risk of an overdose are safer.

REDUCE YOUR RISK

You can save a life

 

How to Spot an Overdose

If you’re using drugs, or are with someone who is using, these are the signs and symptoms to watch out for. If they happen, don’t leave things to chance, call 911 immediately.

Signs & Symptoms of an Overdose

  • breathing is slow or not breathing at all
  • nails and/or lips are blue
  • choking or throwing up
  • making gurgling sounds
  • skin is cold and clammy
  • can’t wake them up

Naloxone SAVE ME Steps

Follow the SAVE ME steps to respond to an overdose. If the person must be left unattended at any time, put them in the recovery position (Mouth downward for fluid to drain from airway, chin up to keep throat open, arms and legs locked to stabilize position).

letter S

1. Stimulate

Perform sternal rub (with closed fist, rub knuckles up and down on person’s chest). If the person is unresponsive, call 911 if you haven’t already.


letter A

2. Airway

Ensure nothing in the mouth is obstructing the airway.


letter V

3. Ventilate

If this person is not breathing, plug their nose, tilt the head back and provide 1 breath every 5 seconds for 2 minutes. You should see the chest rise with each breath.


letter E

4. Evaluate

If nothing changes, if they are still unresponsive and aren’t adequately breathing, inject Naloxone while you wait for first responders to arrive.


If you use, don’t do it while alone. If you know someone who uses, don’t let them do it while alone.


Get Naloxone

When someone is overdosing from opioids, naloxone—which is free of charge—can be a temporary antidote and reverse an overdose. There is no shame in requesting a kit. You can save a life.

naloxone kit

Naloxone kits dispensed in Alberta (Jan 1, 2016 – June 30, 2017)

line graphSource: Alberta Health, Opioids and Substances of Misuse, Alberta Report, 2017 Q2

Treatment for opioid dependency

Treatment options, information and resources on opioids are also available to patients, family, community agencies and health care professionals through an AHS Opioid Dependency Program as well as treatment clinics for opioid dependence.

We won't ignore opioids

Pregnancy Pathways program to offer stable housing for homeless mothers

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Marissa Nakoochee was pregnant with her son when she was evicted from her home in 2006. Now she’s speaking out for a program that will help pregnant, homeless women get access to housing and medical care. (Facebook)

By Anna Desmarais, CBC News Posted: Nov 27, 2017 5:30 AM MT

Marissa Nakoochee’s baby bump was starting to show when she was evicted from her home 11 years ago.

She spent months sleeping on couches, too scared to tell her story to anyone.

“I felt so alone in my pregnancy,” Nakoochee said Sunday. “I didn’t know if I could do it.”

Now, the 33-year-old Cree woman is raising her son and is almost finished her bachelor’s degree in the Faculty of Native Studies at the University of Alberta.

She’s also using her experience of being homeless and pregnant to promote the Pregnancy Pathways program, an Edmonton coalition of 25 health-care and government organizations working together through the Royal Alexandra Hospital to address the housing needs of pregnant women.

For the first time, the program is now able to facilitate housing for the women. The first clients will move into their apartments in December.

‘Working with them where they’re at’

The Pregnancy Pathways program will work with a woman for six to 18 months. During that time, the woman will learn essential life skills. Before she leaves the program, support workers will make sure she and her baby have ongoing access to affordable housing.

The program aims to stabilize homeless women with housing, provide the necessary prenatal care for their children and connect women with mental health and addictions support if they need it.

“It’s important to create … a place where they’re going to feel accepted, no matter what the choices are in their life at this time,” Pregnancy Pathways program manager Nancy Peekeekoot told CBC’s Edmonton AM. “It’s working with them where they’re at.”

The program was supposed to start accepting its first participants this spring, but securing apartments proved to be a challenge.

The Pregnancy Pathways committee is still working to secure a 12-unit apartment building, but it currently has a handful of units where women can live.

“I’m just so excited to connect with these women and to really see the beautiful, positive changes that will happen to them,” Peekeekoot said.

There are about 100 homeless and pregnant women in Edmonton each year. Many are hopping from home to home and sleeping on couches.

Greater risks for babies of homeless mothers

Doctors can’t release a child to a woman without a fixed address.

Because of this, some women feel too frightened to tell medical practitioners about their living conditions, Nakoochee said.

‘I was so scared that they would say, ‘I’m not able to parent.’– Marissa Nakoochee

Dr. John Lilley would see cases like Nakoochee’s at least once a month, when a homeless woman would come to the Royal Alexandra Hospital in labour.

“That baby is high risk,” Lilley told CBC’s Edmonton AM. “We want the baby to be born perfect, and to have a great opportunity.”

Homeless women are often at a higher risk of malnutrition, and of giving birth to babies who are underweight and in need of intensive care.

Nakoochee found a stable address through the help of her contacts at Boyle Street Community Services before she gave birth in 2006, but she says most women won’t get the same kind of opportunity.

Very few general social services provide supports tailored to pregnant women and new mothers, she said.

With supports like the Pregnancy Pathways program, Nakoochee believes vulnerable women have the chance to mother their children.

Program looking to help Indigenous women

Wendy Bouwman Oake, the director of Pregnancy Pathways, expects Indigenous women will be disproportionately represented in the program.

In 2016, Homeward Trust Edmonton counted 1,752 homeless people in Edmonton, and 51 per cent identified as Indigenous. However, Indigenous people represented five per cent of Edmonton’s total population in 2011, according to Homeward Trust.

Bouwman Oake said in a statement the program will be working with elders to support the women in their care during pregnancy with traditional cultural practices, such as the Cree Moon Lodge teachings of womanhood.

For Nakoochee, being asked by her support worker at the Royal Alexandra Hospital if she wanted to perform a welcoming ceremony for her son made all the difference during her delivery.

“That was big for me … I felt so supported,” Nakoochee said. “I felt connected, like I was doing something right for my son.”

Retrieved from http://www.cbc.ca/news/canada/edmonton/pregnant-homeless-coalition-first-referral-1.4420651

anna.desmarais@cbc.ca

Preventing violence against women and girls

Alberta-Government

Alberta has some of the highest rates of violence in Canada. These include:

  • intimate partner violence
  • sexual violence
  • missing and murdered Indigenous women and girls

Often, people think of violence as physical, like hitting, slapping, shoving or cutting. Violence can take different forms and it happens without consent:

Types of violence against women

Domestic violence

It is any use of physical or sexual force, actual or threatened, in an intimate relationship. It can happen many times or just once, and the abuse happens through the use of assault and controlling behaviour.

The abuse may include one or more of the following:

  • physical, emotional, psychological or sexual abuse
  • criminal harassment (i.e. stalking)
  • threats to harm children, other family members, pets and property
Intimate partner violence
Happens between people who are or were dating, common-law or married. They could also have had a child together without being in a relationship.
Family violence
Happens between parents and children, siblings, or extended family members.

Sexual assault

It is a legal term used in Canada to explain any form of sexual contact without consent. It can include forced or unwanted kissing, touching, vaginal penetration, anal penetration or oral sex. It is a crime.

Sexual exploitation

This happens when a person in a position of trust or authority uses that power to start or attempt sexual activity with another person. It can be through direct or indirect touching, violence, coercion or the use of threats.

Examples of sexual exploitation include sex work and pornography.

Sexual exploitation is a crime when the exploited person is:

  • younger than 18 years of age or
  • older than 18 years of age, has a disability, and the exploitation happens without consent

Sexual harassment

Unwanted or uninvited sexual remarks, gestures, sounds and actions that make a person feel unsafe, degraded or uncomfortable, even if the harasser claims to have been only joking.

Sexual harassment creates a frightening or hostile school or work environment. Women and girls are usually targets of harassment.

Some examples are:

  • rude jokes, sexual remarks, spreading rumours
  • sexual put-downs
  • cat calls, rating appearance, whistling
  • insults about  sexual  orientation
  • bragging about sexual relations
  • any forced sexual contact (touching, patting, grabbing, kissing)

Status of Women initiatives

Initiatives for 2016

Violence can lead to long-term harm. Women and girls who experience violence may find themselves unable to keep up relationships, work or good health. They may experience poverty or homelessness.

Status of Women is working to keep more women and girls safe while working to undo the problems that underline the violence. These plans are either under way or planned for 2016:

  • Work with other ministries to put in place the Family Violence Framework
  • Be part of the process of the national inquiry on Missing and Murdered Indigenous Women and Girls
  • Help to develop a proposal with the City of Edmonton for the United Nations Safe Cities Initiative

Supports for women and girls experiencing violence

The Government of Alberta has made progress on getting supports for those women and girls who experience violence. Funds go to these initiatives:

  • Sexual assault centres
    • $4 million each year supports 11 sexual assault centres and the Association of Alberta Sexual Assault Services.
  • Family violence prevention
    • About $95 million each year helps to address family violence. $24 million helps to address sexual violence and abuse.
  • Women’s emergency and second-stage shelters
    • $15 million new funding in 2015 increases supports for women and children affected by family violence to more than $49 million each year.
  • Operational funding
    • Alberta funds 30 women’s emergency shelters and gives program funding to 11 second-stage shelters. Operational funding also increased shelter staff salaries.
  • Shelter Enhancement Fund (2014)
    • This money funded urgent facility fire, health and safety maintenance projects in women’s emergency.
  • Family Violence Hurts Everyone: A Framework to End Family Violence in Alberta (0.8 MB)

Retrieved from: https://www.alberta.ca/violence-against-women.aspx

Yukon rolls out world-first — labels warning alcohol can cause cancer

Alcohol is a huge part of Canadian life, advertised as ‘fun,’ but consumers have a right to know the health risks, says scientist behind project

In the first experiment of its kind in the world, Yukon introduced warning labels on alcohol bottles this week detailing drinking’s cancer risk.

Health research scientists typically don’t spend much time applying labels to consumer products.

But Erin Hobin armed herself with a sticker gun and did just that for five hours this past weekend, helping Yukon usher in what she calls the first experiment of its kind in the world, one that could ultimately change how all Canadians view a popular habit.

As of Monday, bottles of liquor, wine and other alcohol in the territory’s stores now include large stickers advising that drinking can cause breast and colon cancer, and indicating “safe” consumption levels.

The content of the cigarette-style labels was informed by two new studies spearheaded by Hobin, a Public Health Ontario researcher, and colleagues at the University of Victoria. Their effect will be analyzed over the next eight months, as health groups worldwide try to increase awareness of booze’s little-known carcinogenic potential.

Only Korea has anything similar, and its labels do not contain specific alerts about alcohol’s association with multiple cancers.

Hobin’s research suggests that consumers want such information on the bottles they drink from, but she acknowledges it may seem like an intrusion for some drinkers.

“Alcohol is such a big part of our culture in Canada,” she said. “We’re inundated with alcohol marketing that shows us how much fun alcohol is. It’s part of most of our celebrations … (But) consumers have a right to know the health risks if they do choose to drink alcohol. If they do choose to drink, they can do so in a safer manner.”

Some other places — including the United States — have warning labels of a sort on alcohol, but typically they are small, text-only messages that address the commonly known risks of drunk driving and drinking while pregnant. Some studies have suggested they have minimal impact.

One of the large, red and yellow labels on bottles in Yukon warns that “alcohol can cause cancer … including breast and colon cancers.” The other uses graphics to suggest women should have no more than two standard drinks a day and men three — and should plan two or more non-drinking days a week — to “reduce health risks.”

A third label is in the works that will explain what constitutes a standard drink — five ounces of wine, 12 ounces of beer or 1.5 ounces of spirits.

Because Yukon is a relatively tiny jurisdiction that could not dictate labelling to most suppliers, Yukon Liquor Corporation staff — and Hobin — had to affix the stickers to thousands of bottles for the rollout in Whitehorse.

A spokesman for Canada’s liquor industry said it is good to provide consumers with accurate information, but questioned why the warning labels discuss only cancer and other risks, and not the possible benefits for heart health.

“Simply presenting all the negatives all the time, and not the positive, is I’m not sure terribly helpful,” said Jann Westcott, president of Spirits Canada. “You have to have both messages there, because otherwise it comes off as a kind of scare message. You mention the word cancer, and people freak out. And rightfully so.”

But Hobin said the evidence of health benefits is “very conflicting,” a view echoed by the U.S. Centers for Disease Control and other groups. A 2014 report by Swedish medical organizations concluded that the science suggesting moderate drinking can prevent some heart disease is “weak” at best, while the known harms far outweigh any arguable benefits.

One of the recent label studies by Hobin, University of Victoria’s Kate Vallance and others reported on focus groups held in the territory, concluding there was “strong support” for warnings, with participants favouring larger ones that included pictograms.

View image on Twitter

The other paper was based on an internet survey of more than 2,000 Ontario residents, suggesting that most supported having alcohol labels that explain the size of standard drinks and safer levels of drinking.

The real-world study to be conducted on Yukon’s new initiative is precedent-setting, the only other such research having been done on the limited American labels, Hobin said.

But the project may well butt against some common perceptions.

Many Canadians assume that drinking in moderation is harmless, a notion encouraged by that research suggesting small amounts of alcohol can reduce heart-health risk.

In a report earlier this month, however, the influential American Society of Clinical Oncology became the latest medical organization to warn of the often-overlooked dangers, saying that alcohol is directly linked to more than one in 20 cancers worldwide.

Research suggests that even light drinking can slightly increase the cancer risk, the society concluded.

Retrieved from: http://nationalpost.com/health/yukon-rolls-out-world-first-labels-warning-alcohol-can-cause-cancer

Study sheds light on how young people’s emotional associations affect alcohol preferences

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The Globe and Mail: 

A young woman looking for liquid courage walks up to a bar and orders something stiff: bourbon on the rocks. But if she is at home, just chilling with friends, chances are she will switch to wine or beer.

Drinkers aged 18 to 34 tend to choose different types of alcohol for a specific buzz, according to a study published on Tuesday in the online journal BMJ Open.

In a survey of nearly 30,000 young adults from 21 countries, 59 per cent said spirits boosted their energy and confidence, while 43 per cent associated the tipple with sexiness.

To relax, 53 per cent of young adults would pour themselves a glass of wine, with beer the next choice at around 50 per cent.

Just 20 per cent said a spirit-laced drink would help them unwind. In fact, nearly a third of respondents – 30 per cent – ticked the box linking spirits with feelings of aggression (compared to 7 per cent for red wine).

Most people drink alcohol seeking positive effects, said the study’s co-author, Mark Bellis, director of policy, research and international development at Public Health Wales. “They’re looking for the energy, the confidence – feeling sexy.” Unfortunately, he said, “it’s not always the case that that’s what people get.”

Bellis and co-authors used data from the 2016 Global Drug Survey, the world’s largest online survey of legal and illicit drug and alcohol use in adults.

The goal was not to prove that beer makes people groggy, or that rum turns people into rageaholics. Rather, the researchers focused on the emotional associations with alcohol that may guide drinking preferences.

All drinkers in the survey had imbibed a full range of alcoholic beverages – spirits, beer, red and white wine – within the previous year. But their feelings about alcohol varied by sex and drinking levels.

Men were significantly more likely than women to associate aggression with all types of alcohol.

Women were more likely to report all emotions – other than aggression – when drinking alcohol.

Problem drinkers, compared to those at low risk, were five times more likely to feel “energized” from drinking; on the flip side, six in 10 said they had felt aggressive from drinking in the past 12 months

As heavy drinkers go down “a slippery slope,” Bellis said, they may experience increasingly positive emotions from drinking, “but they’re equally seeing much higher levels of those negative emotions.”

Bellis and co-authors emphasized that their findings might not apply to drinkers over age 34, or other population groups. In a discussion of the study’s limitations, they noted that the analysis was based on people’s recollections of how they felt under the influence of alcohol.

Various factors may influence people’s associations with alcoholic beverages, the authors said. Advertising images often set the tone, whether it is a smoky-eyed Jessica Alba sipping Campari, or a voluptuous Kim Kardashian standing out from the crowd in an emerald green dress to match her Midori liqueur.

Social norms may play a role as well. “People might drink spirits in shots deliberately to get drunk quickly,” Bellis said. But they rarely chug bottles of Cabernet.

Moreover, spirits have a higher alcohol content. “People get that rush,” he said, “and of course it damps down the consideration of the repercussions of some of the actions they might take.”

In 2014, alcohol consumption accounted for 5 per cent of the global burden of injury and disease.

Previous research has shown that people’s expectations about how they will feel after using alcohol may affect whether they start to drink, become regular drinkers or dependent on alcohol.

“A lot of the sales of alcohol depend on creating [an] emotional relationship with the product,” Bellis pointed out.

Reminding people of the emotional downsides of alcohol use through public-health campaigns could help curb problem drinking, he said, “so that people are not overly swayed by just the positive messages, which perhaps they watch or listen to every day.”

Retrieved from: https://www.theglobeandmail.com/life/health-and-fitness/health/study-sheds-light-on-how-young-peoples-emotional-associations-affect-alcohol-preferences/article37048633/ 

Prevention with Women Living with FASD

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Many women who have FASD are able to benefit from tailored support on substance use problems. Audrey McFarlane, Executive Director of Lakeland Centre for FASDin Cold Lake AB recently shared strategies for working on FASD prevention with women who have FASD themselves. One of the LCFASD programs, the 2nd Floor Women’s Recovery Centre, provides residential treatment exclusively to women. She explained how programs can better support women who have FASD.

Challenges

Because of the possible neuro-behavioural and physical health issues associated with FASD, working with women living with FASD may pose particular challenges for the service provider due to:

  • Limited understanding of how their body works and how or why to use birth control;
  • Limited understanding of how to get housing, money and to keep themselves safe;
  • Physical health issues, such as diabetes, STDs, vision, hearing and dental;
  • Limited ability to envision the future;
  • Inability to link actions to consequences, which makes them more likely to be connected to the justice system and to have many children not in their care with multiple partners.

Strategies

McFarlane says that these and other challenges mean it often takes longer to see the benefits of supports. Yet, there are a number of strategies that have proven successful.

  • Take a family alcohol history and ask each woman, specifically, if she has a diagnosis of FASD. Woman will tell you if they do, but are often not even asked.
  • Make suggestions in key areas where they can agree or disagree rather than using client-generated approaches.
  • Prioritize building a relationship so that the woman will come back for support as needed. Reframe returning to treatment as a positive, not a negative.
  • Expect to spend more time on basic life skills and necessities. She may not have connection to family or social services. This means treatment needs to be longer.
  • Approaches that work best include solution-focused counselling, physical activities, positive touch, relaxation, and connections that develop a sense of belonging, like volunteering and cultural practices.

Resources

Here are a number of resources on trauma-informed and FASD-informed approaches for working with women living with FASD.

FASD Informed

Evaluation of FASD Prevention and FASD Support Programs website

FASD Informed Approach by Mary Mueller, RN, Waterloo Region Public Health and Emergency Services

FASD Informed Practice for Community Based Programs, College of New Caledonia

Working with Women Who May Have FASD Themselves – Webinar View SlidesRecording

Trauma Informed

Pregnancy, Alcohol, and Trauma-informed Practice, The Prevention Conversation

Trauma-informed Approaches to FASD Prevention – Webinar View SlidesRecording

Trauma-Informed Practice Resource List, Centre of Excellence for Women’s Health

_________________________

For more on this topic, see earlier posts:

WEBINAR JUNE 23 – WORKING WITH PREGNANT AND PARENTING WOMEN: LEARNINGS FROM HERWAY HOME, June 16, 2016

NEW CURRICULUM FOR FASD INFORMED PRACTICE, August 1, 2016

THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, March 18, 2015

FACT SHEET ON SUPPORTING WOMEN WITH FASD IN RESIDENTIAL SUBSTANCE ABUSE TREATMENT, April 22, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES, April 17, 2013

Retrieved from https://fasdprevention.wordpress.com/2017/11/20/prevention-with-women-living-with-fasd/

Guest column: How to do holiday parties while pregnant

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Amy Hendricks: Retrieved from http://www.citizen-times.com/story/life/family/2017/11/19/guest-column-how-do-holiday-parties-while-pregnant/850207001/

It’s hard to believe the holiday season is upon us. We’re decorating, baking cookies, going to holiday parties, shopping in a frenzy for that perfect gift, gathering with family. Maybe squeezing in that “girls night out” where everyone has promised to not exchange gifts, but to just celebrate the season with friendship, great food and drinks. This can be the most wonderful time of the year. But when pregnant or trying to get pregnant, it can be challenging to face the decision about whether to celebrate the season with or without alcohol.

Drinking and pregnancy

Why is this decision so important?

According to the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecology, and the American Academy of Pediatricians, “there is no safe amount of alcohol, no safe type of alcohol and no safe time to drink when a woman is pregnant.” And yet, in 2016, the CDC estimated that 3.3 million women in the United States were at risk for having an alcohol-exposed pregnancy.

When a woman drinks so does the developing baby, who lacks the ability to process or metabolize alcohol through their liver or other organs. The baby has the same blood alcohol concentration as the mother. It makes no difference if the alcoholic drink consumed is a beer, glass of wine or a distilled spirit or liquor such as vodka.

Know the risks

Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity or sudden infant death syndrome. In addition, more than 40 years of published research has shown alcohol to be a neurotoxin in utero. This means that alcohol is a toxic substance to the developing baby just like carbon monoxide and lead.

Alcohol can cause the death of developing brain cells, even during the early stages of pregnancy. Most babies negatively affected by alcohol exposure have no apparent physical birth defects. But they can have lifelong behavioural and learning problems that often go undiagnosed or misdiagnosed as autism or attention deficit disorder instead of one of the fetal alcohol spectrum disorders (FASDs). Current studies estimate that 1 in 20 school-age children may have FASDs.

Going alcohol-free

How do you navigate and embrace an alcohol-free holiday season? Not that we condone stretching the truth, but if you have just found out you are pregnant and aren’t telling anyone yet, you can always pass on alcohol by saying you are the designated driver, that you are taking a medication that can’t be combined with alcohol or that your stomach just isn’t up for it.

Anytime in pregnancy, you can always order mocktails, nonalcoholic beverages or sparkling water with fresh fruit. They can be very festive and help you get your jingle on during this holiday season and throughout your pregnancy.

Learn more

FASDs are preventable. So, if you are pregnant or plan on getting pregnant, please refrain from any alcohol use to ensure the healthiest environment for your baby to grow and develop.

The NC Fetal Alcohol Prevention Program (FASDinNC) strives to prevent alcohol-exposed pregnancies by providing training, education and resources to women of childbearing age and the professionals that serve them. This effort includes dispelling any myths surrounding the safety of drinking alcohol during pregnancy, even light drinking.

Amy Hendricks is the program coordinator for the NC Fetal Alcohol Prevention Program (FASDinNC) at Mission Fullerton Genetics Center. For more information on how you can prevent FASDs and find great mocktail recipes, contact the NC Fetal Alcohol Prevention Program at (828) 213-0035 or go to FASDinNC.org.

More online:

North Carolina Fetal Alcohol Prevention Program, www.fasdinnc.org/

National Organization on Fetal Alcohol Syndrome, www.nofas.org/

Centers for Disease Control and Prevention, www.cdc.gov/ncbddd/fasd/alcohol-use.html

 
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