Overdose Prevention Ottawa Continues Life-Saving Service on Twentieth day of Operations


Nurses are part of leading important harm reduction efforts across Canada. These efforts are bringing about real changes in communities. The introduction of Fentanyl on the black market has led to thousands of deaths across North America. Overdose prevention sites have been popping up here and there to help reduce the number of victims and provide safe spaces for drug users. Here is an update on the situation in Ottawa:

Overdose Prevention Ottawa

On its twentieth day of operation, Overdose Prevention Ottawa (OPO) continues to provide life-saving harm reduction services to its guests.

OPO applauds the upcoming expedited opening of Sandy Hill Community Centre’s supervised injection service, and yesterday’s announcement that Ottawa Public Health will be opening a satellite supervised injection service on Clarence Street in the coming weeks. We are also encouraged to see Somerset West Community Health Centre’s and Ottawa Inner City Health`s supervised injection service pending approval by Health Canada.

OPO has worked collaboratively with all Ottawa harm-reduction partners and stakeholders since opening and will continue to do so moving forward. As OPO continues to be the only active overdose prevention service coupled with harm reduction services for those most affected by drug prohibition and homelessness, our services will continue operating. OPO is committed to an evidence-based model of care that is demonstrably successful and unique in the City of…

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Drug Wars, Drug Addiction, and Social Justice Issues


I have been reading Johann Hari’s Chasing the scream: The first and last days of the war on drugs. 

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This book provides a very detailed account of how we came to be an anti-drug and pro-prohibition nation that lead the way toward making criminals out of people who struggle with use of substances and millionaires out of people/ cartels who sell drugs on the black market. I have found the book in some aspects hard to read because the political manipulation of our global population and the injustices that have arisen from this global movement. I get angry about what has happened as I read and I have to step away for awhile.

Some key points from this text for nurses to consider:

  • The dominant medical establishment (in particularly the AMA) was initially very against “drug” prohibition, but key vocal players were forced into silence by the government.
  • Overall, 90% of people use substances we call “illicit drugs” without having addiction issues, yet we continue to think that people need to be cautious with drug use. For instance, many (not all) soldiers used heroin in Vietnam to get through the hellish experiences, yet many (not all) had no issues with heroin addiction when they returned stateside.
  • There is a clear connection between lack of social support, childhood abuse, and adverse childhood experiences (ACEs: see the CDc website for more info on this) with addiction. We need to be compassionate toward those who are suffering, because these childhood experiences literally changed how their brains function, making them very vulnerable toward addiction. Adverse childhood events impact young people across the socio-economic spectrum, and many people who came from “good families” have also experienced a lot of childhood trauma.
  • When it comes to death and illness, our two leading “drug use issues” are likely nicotine and alcohol, both legal, and both toxic and deadly. Yet, we simply put warning labels on these drugs and let folks self-determine their fate. Why are these drugs okay, but others are not? Because they are socially acceptable? Because they are “cheap”?

When we think of the opiate crisis, one of the biggest issues of course is people not having safe and affordable access to opiate medications: when people are cut off from safe supplies (ie, their pain prescriptions which the medical establishment has endorsed and prescribed, with potentially some of the cost covered by their medical insurance ), they may turn toward heroin and other “street” opiate medications. These drugs are expensive, sometimes hard to find, and in many ways they force or perhaps support people to live a life of crime in order to maintain their habits, if people have gone that far they must get help. And people overdose because they have no idea what is in the products they are obtaining.

Maybe, we have created an addiction monster in our society.

However, Portugal has found a way out of the addiction monster’s clutches. In 2001, with a growing heroin addiction problem, Portugal decriminalized all drugs and began to consider addiction to be a public and personal health issue. Drug addiction was viewed for what it is:  a chronic, debilitating illness. People caught with a 10 day supply of any drug are referred to a sociologist who helps to determine their treatment options. And what Portugal has realized is that not only is this a more humane approach, it is also far less expensive to provide adequate medical care and treatment to addicts versus incarcerating them. Portugal has experienced a 75% drop in addicted persons from the 1990’s, and their addiction rates are 5 times lower than the rest of the EU. Meanwhile, drug related HIV infections have dropped by 95%, and the stigma around addiction has lessened dramatically.

http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime

As nurses, we are concerned about social justice issues and public health issues. I would posit that nurses and politically active nursing organizations should be taking action around the opiate crisis in several ways:

  • Calling for safe injection sites and distribution of clean needles (or needle exchange centers) and free condoms.
  • Looking at prevention and early identification of at risk persons (both ending early childhood trauma through supporting parents at risk for enacting trauma and assessing for early childhood trauma both across the lifespan and across all populations to determine risks for addiction).
  • Supporting harm reduction techniques.
  • Supporting a view of addiction as a public health issue, and a chronic disease issue.
  • Considering a call toward decriminalization of drugs and ending incarceration for addicts (the Portugal Model).
  • Acting compassionately toward all addicts (even the “drug seeking” ones).

If you are interested in this topic, I do recommend reading Chasing the scream. This text provides great historical insight into how we came to where we are at with the global  “war on drugs” and the escalating issue of for-profit prisons.

We have become the nation with the greatest number of incarcerated individuals (not %, but sheer number!): though we only have 5% of the world’s population, we incarcerate 25% of the world’s total prison population (this link looks at the complexity of these numbers and supports the idea of the truth that in the land of the free, we incarcerate a much higher percentage of people due to lack of alternative ways to provide help https://www.washingtonpost.com/news/fact-checker/wp/2015/07/07/yes-u-s-locks-people-up-at-a-higher-rate-than-any-other-country/?utm_term=.1ca70c3620af).

Columbia University’s CASA group has released multiple reports that link drug addiction issues to crime, incarceration, and repeat offenses. Sadly, while 65% of our prison population qualify for addiction treatment, only 11% actually receive treatment. Meanwhile, the majority of violent crimes are committed by those suffering from addiction. https://www.centeronaddiction.org/newsroom/press-releases/2010-behind-bars-II

Poverty, race, and income inequality also play a role in both addiction and incarceration, and as nurses, we are ethically obligated to advocate for change in healthcare and system wide policies that impact vulnerable populations. Raising awareness is a first step, but perhaps nursing organizations need to also start taking stances and lobbying for more humane treatment of those who struggle with addiction.

 

 

To Men in Nursing: Consider Your Privilege


I want to talk about men in nursing and privilege. I expect it will be a difficult, nuanced dialogue, but it’s an important one, and one particularly relevant to nursing, a profession so entwined with the ideals of egalitarianism, advocacy and feminism.

Before I begin, I want to clarify: I do not want to challenge the presence of men in our profession, their growth in numbers, their competency, or their intentions. I do want to challenge men in our profession to challenge themselves to analyze their privilege, and I want to challenge men in our profession who have already done this work to challenge others to do the same. Specifically, I want to challenge male nursing groups, particularly NYC Men in Nursing and the American Association of Men in Nursing, that provide networking and career opportunities for their mostly male members. Broadly, I want to challenge all male nurses who use their privilege, inadvertently or purposefully, to get higher positions and higher pay.

I identify as an intersectional feminist. Intersectionality is a term used by modern feminists to define the multiple identities that are subject to systems of oppression. An intersectional feminist holds that arguing against sexism is logically and ethically invalid if you do not also rally against racism, classism, homophobia, transphobia, queerphobia, ableism, ageism and religious discrimination in our society. Intersectional feminists work hard to examine their own identities of privilege (I, for example, am white, able-bodied, cisgendered and educated) and how they have benefitted us, and work to dismantle the systems that bolster that privilege. Intersectional feminists “call people in” instead of calling them out.

I often discuss experiences of discrimination in the workplace with other non-male identifying feminists, and through these conversations, I learned I am very lucky to be a nurse. Compared to tech or the restaurant service industry, for example, nursing is a feminist dreamland. Most men I have met in nursing have been respectful and compassionate. Disappointingly, however, only a few have demonstrated a deep understanding of the privilege they enjoy, both in our profession and society at large, due to their gender. Male nurses have great capacity to be intersectional feminists, but because they do not bear the brunt of gender inequality, it takes more work for them to recognize it than it does for women, and because it’s hard to say no to a leg up, it takes more self-sacrifice to shun its benefits.

As an intersectional feminist, I empathize with the position of men as a minority in an industry. They comprise only about 10% of nurses. Male nurses have historically been made fun of for being feminine (I’ve seen the movie Meet the Parents), which I’m sure can be hard for some men. Male-identifying nurses who are gay or queer suffer homophobia in the workplace. Our black male nurses come from identities that have higher rates of imprisonment, police brutality and death by homicide. Men are also more likely to be mistaken for doctors, according to one male classmate of mine, for whom I played my well-worn miniature violin. Seriously, though, I empathize with all of this and readily acknowledge that some identities men have (race, disability, sexuality) put them at higher risk for discrimination than some women. I even empathize with the doctor comment, but mostly just because I am proud to be a nurse. 

But we must remember, a minority population is not always a victimized one. Male nurses are more likely to hold advanced practice positions, and they earn more money than female nurses in comparable positions with comparable accreditation and experience. Men are less likely to be the recipient of sexual harassment from a patient or coworker. Men are less likely to be demeaned and ignored as professionals by MDs and other team members. Men are promoted faster and more often. Ultimately, the privilege men, particularly white men, still have within our profession is difficult to reconcile, and to me, despite my empathy, trumps their minority status.

As a student at NYU, the most active group at my school was Men Entering Nursing. Despite their good intentions, I could not shake my philosophical argument with the group. I keep coming back to one analogy:

Imagine that we had a student interest group for white students. Imagine that the group for white students became the most active group in the school. The group hosted events with all white presenters. The professor leading the group was friendly and available and helped you find jobs and study for tests. The group had a strong affiliation with the citywide white group, which provided excellent career guidance and networking opportunities. Of course, non-white students would be allowed as well, if they wanted to join the group and enjoy its networking and academic benefits. Some non-white students even sat on the e-board, but most avoided joining because they had enough on their plate trying to address non-white issues. To top it all off, one month after the election of Donald Trump, all the white students in the school (even if they weren’t Whites in Nursing members) were asked to gather after the last exam before graduation in their scrubs and take a group photo, and no one questioned it at all.

Even if white people only comprised 10% of the student and professional population, this would be inappropriate. I am a white person, and I would do everything I could to reduce this group’s influence at the university, or I would try to funnel the momentum of the group toward events and dialogue focused on privilege analysis. This is what I suggest men in nursing do in the future. 

This is my perspective, but I am open to others. I am open to being called wrong and being corrected. I am open to dialogue. Please share your ideas.

Jillian Primiano, RN, BSN, recently graduated from NYU Rory Meyers College of Nursing, where as a student, she worked with the Hartford Institute of Geriatric Nursing to develop education for geriatric care providers and improve health outcomes for older adults. Before earning her nursing degree, she studied History and Journalism at Boston University with a focus on Cold War anti-war activism, feminism and the Civil Rights Movement. After her first stint in college, she spent three years teaching English, American Studies and International Relations at An Giang University in Vietnam’s Mekong Delta, where she learned about her privilege in ways she could never have imagined.

Calling All Critical Feminist Nurse Action Researchers!


Greetings from Nancy Murphy. I am on a quest to bring together Critical Feminist Nurse Action Researchers and others who are interested in Critically Focused Action Research and Health Care.  After attending the Action Research Network of the Americas (ARNA) Conference (its 4th) last year in Knoxville, TN and speaking with people in leadership, I decided to initiate and facilitate a Health Care – Action Research Community within ARNA.  Action Research Communities (ARCs) are ways for members to create small but active groups of people who want to share resources, strategies, practices and ideas around a specific topic.  They are established as the needs and interests of ARNA members evolve.

I have long been interested in action research and I am hoping the Health Care ARC will become a resource for nurses and others who are doing/who are interested in health care related critical participatory research.  Over the years, I have found it challenging to locate and network with nursing action researchers.   I attended the Critical and Feminist Perspectives in Nursing Conferences back in the ’90s & early ’00s and more recently the, In Sickness and in Health Conference, where I have had opportunities to meet with critical nursing scholars and researchers, some of whom are doing various kinds of action research.  However, there is an absence of a central resource in North America for Nursing/Health Care action researchers and I am hoping the ARNA Health Care ARC will serve to fill this void.

Since September 2016, I have slowly been contacting nursing  faculty at various universities who I know conduct critical participatory research or who may know others who are doing health care related action research, to see if they might be interested in learning more about the Health Care ARC.  It is slow going, but very rewarding to reach out and begin to make connections.  To date I have been in touch with about a dozen nursing researchers in the US and Canada, to share information about ARNA, the Health Care ARC, the upcoming ARNA conference and the exciting possibility of developing this ARC further.  Several folks have expressed great interest.

I will be heading for Cartagena, Columbia in June to the 5th ARNA conference “Democratization of Knowledge: New Convergences for Reconciliation.”  I am very much looking forward to this wonderful opportunity to meet new folks, connect with those I met last year, and make future plans.  I am hopeful that over time the Health Care ARC will bloom and will become a community of ideas, strategies and action to support social justice work and improve the health of all beings!  Will be back to report post conference and keep you updated on the ARNA Health Care ARC.  Please email me and be in touch if you would like to hear more.