The opioid epidemic has definitely increased exponentially. It’s a bit of a perfect storm. At least in Toronto, we have no housing, we have a lack of services, and our emergency rooms are overcapacity. Now we’re seeing huge surges of fentanyl coming into the system.
It’s gratifying when I see people make changes based on some of the things that I believe in. Like not judging people, trying to understand them at their level, offering some insights for them to think about. It’s amazing to see people not necessarily recover, but make small changes that have big impacts on the rest of their lives. Like not using every day. For people who used alcohol regularly, to be able to stay sober during the week and only drink on weekends is a huge change in behaviour. I wish people saw small successes as huge successes. They can lead to people reuniting with their families, starting school, starting a job. It’s not as dark as people think.
People would describe me as being incredibly patient. I think I am authentic with people. I believe people are trying the best they can with the information that they have.
When people are in a chronic relapsing cycle of substance use, it’s not always that they are not working on their end of the bargain. Chronic relapsing is not them telling us that they don’t care or that they don’t value their lives. They're telling us they don’t know what to do. When we couple that with an invalidating environment where people are judgmental, we sometimes get maladaptive coping skills which continue the substance use.
I would like everybody to stop lumping people that they consider addicts into one group. When we categorize everybody into a community of addicts, it doesn’t address the main problem. They don’t have good coping skills. But many of us have maladaptive coping skills! I might not know what it’s like to use cocaine, but I might understand what it’s like to not be able to manage my own stress. It’s not to take away from the consequences that come from substance use. But we need to have more empathy. These people are struggling the same ways we are in our own lives.
Our health care system is a little broken on multiple levels. We are seeing way over the capacity that our emergency rooms have been designed for. We have a problem with the sheer volume of people who are desperate and in crisis and are pouring into our emergency rooms. Some funding for health care, especially emergency services, would be helpful.
I don’t think we are always able to correctly identify people with substance use problems in the ER. People might not feel comfortable sharing that they are seeking help. People go to the ER for various reasons. Some go because they need somewhere to stay for the night or it’s warm or it’s safe. Other people are there because they are in withdrawal or are not doing well. We know that when somebody is motivated to make a change, that moment can be very powerful. But it is often fleeting. We miss it all the time, because we do not have time or empathy. But I am not blaming the people in ER because they are seeing lots more than the amount that they were designed to see.
I’ve seen a lot of wonderful physicians try an approach with patients and it doesn’t work. I want them to know that their efforts are not lost, even though sometimes it must feel like they are. People remember things from a long time ago: “This person told me something. At the time I didn’t believe him. Now I get it.” The kindness that a physician can provide by saying, “When you're ready…” keeps a door open. People remember that, especially when it’s authentic.
Not to put them all into one group, but I think opioid users are very emotional and sensitive people. When people’s emotional responses to things are heightened, it’s no wonder they turn to a substance that helps turn that down. If you are judgmental, they will pick up on that because they already feel it themselves.
It’s so helpful if you can display an authentic and genuine understanding, and maybe let them know that you have struggles too… You might not use substances to cope like they do, but you use other things. When we humanize it a bit, we can take away some of the frustration on both sides.
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