Thank you very much.
I did not prepare an opening statement. I did, however, send a description of our current situation, and I thank the previous speakers for really defining many of the important issues.
I am going to speak as a front-line provider in the inner city of Vancouver, where, essentially, methamphetamines and fentanyl have destabilized all of my patients. We are really left with very little to offer. I'll try to explain that. Certainly all of our patients are multi-drug users. We test routinely when people do present or when we go out to them. They don't even know what they're using most of the time, but rarely do we see cocaine. You have to be very sophisticated in getting cocaine from your dealer nowadays. Everything is crystal, and if you think you're getting crystal, as was described, there is usually fentanyl, and if you think you're getting fentanyl, there is usually crystal.
Multi-drug use is a problem. We have a saturated community. I follow patients with HIV, hepatitis C, COPD and cancer who are all using these substances with a background of trauma and poverty. They're pretty good at surviving, but now, with the introduction of methamphetamine, unfortunately, that is not the case.
While we run around and give people needles and they have safe places to inject, and we work very hard to give them housing and we take their medications to them, increasingly, with the effects of crystal meth, this is becoming more difficult.
People are developing psychiatric effects from this medication that make it really difficult for them, even with the supports we provide, to be successful in treatment of their HIV or their hepatitis C, for which there are very simple treatments now. We can take people their meds every day, and increasingly we're not able to get them into their mouths. It's the same with all the other medical conditions they have. Their condition is exacerbated by the mental illness effects of crystal that we are seeing. This may be in combination with fentanyl. I don't know what the biochemical cause is, other than it's only with the appearance of crystal meth that we're really seeing this in such great depth.
Yesterday I was trying to certify a long-term AIDS patient who did well. He can no longer find words, he is incontinent in his room, and so forth. Unfortunately, when we find people like this with their paranoia, their violence and their hallucinations, which are really increasing, what we have to offer them is limited. It's limited somewhat by the way we approach these symptoms in our patients. They are psychiatrically impaired; however, it is described as a drug-use problem. It is drug-induced psychosis.
This term, unfortunately, in many cases really means that the patient doesn't receive the psychiatric support they need. They go into the emergency department, they sleep it off, they come out, and they're immediately back to where they were. We are looking at a real epidemic here. We call it the elephant in the room. We are constantly dealing with violence and people who are no longer able to engage in care.
I work on the street and I also do palliation, and more and more of my patients are really palliative in terms of the concomitant medical illnesses they are carrying. They are not able to talk to me. They're not able to engage with their support team. They are at risk of overdose. They try to modify things. They take a bit of crystal so that they don't go down with fentanyl. They will frame their drug use by saying, “Dr. Burgess, aren't you glad I don't use cocaine anymore? I just use crystal twice a day.” Unfortunately, those people are becoming more and more psychiatrically impaired.
I'm going to make my remarks short because I'm working at the bottom end of this. What I would like to see is rapid treatment of people when they are psychiatrically so unwell. Without that, everything else falls apart—absolutely everything.
We have a system where psychiatrists are really in charge of a lot of the treatments for psychosis. Depending on their assessment of a situation, they are more or less helpful. In the Downtown Eastside, the inner city area where I work, we have tried to increase the availability of psychiatric services. It's an up and down thing. It's in the middle of being fixed, I hope. The psychiatric issue here is an emergency and we need to be able to help people with this so they can re-engage with the rest of their lives. They are becoming more homeless are kicked out because they're violent. They can't really understand a lot of what's happening around them. They are open to more trauma: running into traffic and not taking their medications.
My population is, as I said, particularly HIV heavy. I'm seeing people who have been stable, with support on HIV and hepatitis C medications, falling off. I have more AIDS patients in the inner city than I had at the height of the epidemic in 1994, 1995 and 1996. From the street, it's a serious illness, this use of crystal meth, but people love it, and people love fentanyl.
While we have now developed an inner city pain program that's specific to the needs of our patients—and that's not including opioid use—as well as mobile ACT teams, assertive mental health teams, we still have a large group of people who are now permanently psychotic. Even if the patients actually appear fairly stable, in conversation, they'll say they're hearing voices and so forth. There's the mild form as well as the very extreme form of people who are totally dehumanized. I would like to see more availability of injectable anti-psychotics for these patients, otherwise I'm accompanying them to either an overdose death or a death from their chronic illnesses, like HIV and hepatitis C. It's really quite an emergency for us and for our population in the inner city.
Thank you.