“One or two hits of meth will last you hours and hours and keep you up for days. With opioids, you can totally predict what the course of treatment is going to be. We can totally handle anyone going through opioid withdrawal. With meth, in the blink of an eye it switches.”
Madame Chair and committee members, thank you for inviting me here today. What I just read to you was a quote from a registered psychiatric nurse at Health Sciences Centre, the largest health care facility west of Toronto and east of Calgary. This facility is at the forefront of managing the crisis.
I wanted to begin with it because it addresses one of the unique challenges that nurses face in treating users of methamphetamine and why addressing it will require some unique policy changes.
Nurses know that the rapid increase in meth consumption has reached crisis levels in Manitoba. The impacts are ravaging many of our communities and putting significant strain on our health care system. It's time for the federal government to show leadership on this critical public health issue. I hope that some of the information I will provide today will help you make an informed decision towards action.
Let me begin by addressing the impacts on our emergency departments and mental health units. Unfortunately, emergency departments are often the only place that methamphetamine users can access treatment. Some arrive in distress, escorted by police and gripped by a drug that can change their behaviour at any moment. Others present freely, and while they can appear calm at the outset, erratic and violent behaviour can emerge in an instant. This is not only a danger to the patient. It's also a danger to the nurses, doctors and health care providers who provide care. It is also a danger to other patients in the facility, many of whom also need emergency care. They are forced to wait longer as resources are dedicated to patients suffering from meth-related psychosis and other symptoms. In Manitoba, we lack consistent security standards at our urban and rural facilities. Although ERs in Winnipeg hospitals have security guards, training and presence varies between facilities.
Health Sciences Centre has the strongest security presence, but the nurses there will tell you that security are often overwhelmed and have been told not to intervene by management. Rural facilities are left especially vulnerable. In Portage la Prairie, Virden, Thompson and many other communities, nurses are reporting a large increase in the number of meth-related presentations. These facilities typically have no security. Nurses are directed to call the RCMP, who are also stretched thin and are often unable to respond as quickly as they are needed. Too often we hear stories of nurses who have been punched, kicked and spit on, and the meth crisis has made this situation worse.
One nurse described intervening when a patient began choking a clerk who was simply there to restock supplies. The injury that the nurse suffered as a result limited her to light duties for the next several months. A nurse from Brandon told us, “I've had a patient take their IV out of their arm and try and stab me with it. We've found knives on people. We have had people destroy our rooms.... I did emergency medicine for eight years and the last three years we saw an increase in meth, and in the last year it's just exploded.”
At HSC, nurses report seeing four to five patients per shift with meth-related issues. They used to see that many per month. Data released by the Winnipeg Regional Health Authority proves what nurses are telling us. Since 2013, there has been a 1,200% increase in the number of patients presenting to the ER under the influence of methamphetamine. The increase puts real pressure on nurses and other health care professionals. Often these patients require multiple people to observe or restrain them. One nurse told us that they've had to order more restraint supplies, that it takes a whole team of people—doctors, nurses, health care aides—and that all of the other patients are usually scared, too, which adds to the problem.
We know that the emergency departments are overcrowded. For some nurses, this crisis is pushing them to the breaking point and forcing them to think of leaving the profession or leaving units, such as emergency departments, that are increasingly focused on dealing with the drug. Chaotic environments often predicate violent incidences. The meth crisis has amplified this issue for nurses, but there are broader factors to consider as well.
I applaud the health committee for launching a study into security and violence against health care workers, and particularly Dr. Eyolfson from Winnipeg for championing this issue. This study is an important step forward, which I hope will lead to federal investment in security services at health facilities.
The meth issue goes much further than our emergency departments. Infection control is a concern. Addiction often hinders patients from getting treatment before the problem becomes acute. We know that many users inject the drug intravenously, which can lead to infections in their heart valves that require surgery.
I tell you these stories with reservation. We must not allow these patients to be stereotyped or stigmatized. They are suffering from a terrible illness. As nurses, we want our patients to get the care they need, first and foremost.
We see broader social factors at play, as well. One nurse described the struggle by saying that there aren't enough recovery programs out there. She said that 95% of patients who come in with a meth-related complaint are observed until they're capable of walking out the door and then discharged. For these nurses and for all of us, it's heartbreaking that we can't provide more care for these people.
Public housing and poverty reduction must be part of the solution to this crisis. The province has stalled on building more social housing units. The federal government's support and leadership on this file is desperately needed.
Meth is impacting all communities, and users are presenting from all walks of life. A public health nurse who works in our wealthier suburban communities, such as River East and Transcona, told me that she has seen a dramatic rise in meth use. A nurse in Portage la Prairie told me, “It's all races, all ages. Even the people that you least suspect who drive the fanciest vehicles, who have the best jobs, they are even trying it. It's a problem.”
Some users don't realize what they're taking. Recently a group of nurses doing harm reduction by testing drugs at parties reported that they hadn't seen a positive cocaine test since the summer. People thought they were taking cocaine, but 90% of it was actually meth.
What's the solution?
Harm reduction is a critical part. Ensuring access to clean needles is important. We need to ensure access beyond business hours. Safe injection sites can also reduce the risk of infection.
We also need treatment spaces for those suffering from addiction. The Manitoba Nurses Union is a strong supporter of the Bruce Oake recovery centre, which is a long-term treatment centre being established in west Winnipeg. At our last annual general meeting, we raised $30,000 for the centre. However, even Scott and Anne Oake will tell you that this centre won't be enough to meet demand. They are a private foundation inherently dealing with limited resources.
That's why we need the federal government to step up its support to combat this crisis. We need the resources to respond. Reducing the health transfer payments from 6% to 3% was a serious mistake. Targeted mental health funding is welcome, but the current level is simply inadequate and the situation is getting worse.
In Manitoba, our addiction and health care programs and mental health programs are overwhelmed with demand. Emergency departments and addiction programs need more support to deal with the unique challenge of meth use.
Nurses have suggested dedicated facilities and programs for users of meth. Patients need a place where they will be safe when coming off the drug, and then they need access to a recovery program.
Finally, we do need federal support for security. We need dedicated, adequately trained personnel in our cities' hospitals and enhanced services rurally. Patients and their caregivers need to be kept safe, so that we can focus on treatment. Unfortunately, the longer we wait, the higher the risk that one of these violent situations will result in a more serious injury than what we've seen.
In Manitoba, the provincial government is imposing significant health cuts, including the closure of three emergency rooms in Winnipeg. To date, they have failed to offer a significant response to this crisis.
In contrast, there is an opportunity for the federal government to take leadership by offering real support and resources earmarked for addictions, mental health and security.
Thank you. I am pleased to answer any question the committee may have.