November 12th, 2019

Syphilis and IV drug use


By Lethbridge Herald Opinon on August 13, 2019.

Dr. R. Michael Galbraith

ELITE SPORTS MEDICINE, LETHBRIDGE

I am writing to respond to the articles “Syphilis outbreak in Alberta” and Mayor Spearman’s article “Drug crisis needs provincial support.”

I’m a family and sports medicine physician. To be transparent, infectious disease and drug use are not the focuses of my current medical practice. However, in my training I worked at various homeless shelters with many at-risk patients who used illicit drugs and acquired sexually transmitted infections (STIs). I gained new sympathy for these individuals whose lives were ravaged by addiction. I hope to provide some insight regarding these issues.

In medicine, we know that properly identifying “risk factors” is key for appropriate prevention and treatment of any condition. It tells us the “why.” How can we adequately prevent and treat a specific condition unless we understand the cause and risk factors? The article on syphilis correctly describes the magnitude of the syphilis problem in Alberta but fails to mention the most important risk factor of syphilis – IV drug use (such as fentanyl and heroin). Numerous studies demonstrate that the significant rise in IV drug use is directly linked to the dramatic rise in syphilis. IV drug use goes hand-in-hand with syphilis and many other STIs.

Why the association? In general, IV drug users participate in more high-risk sexual behaviours: sex for money, sex for drugs, multiple sexual partners, and avoiding condom use with sex. Syphilis affects all ages, races, genders, etc. In Alberta, the dramatic increase in both syphilis and IV drug use is most significant in First Nations and homosexual male populations. Again, a proper understanding of the risk factors puts us in the best position to help those at most risk, not to judge.

The article’s statement that consistent condom use is the best way to protect against STIs is false. Abstinence from sex is the only 100 per cent effective method to protect against syphilis and any other STI. This is a fact. Unfortunately, abstinence is not included as part of the current sex education curriculum in Alberta schools. Instead, sex education programs encourage young elementary children to explore their sexuality. It is not surprising that we see such a dramatic rise in high-risk sexual behaviour and sexual promiscuity in teens, leading to more STIs.

The CDC recently stated, “I think it’s impossible to eradicate syphilis and congenital syphilis unless we are simultaneously addressing the (IV drug use) epidemic.”

Oh boy, these are complicated issues. Safe Consumption Sites (SCSs) are controversial. Their main goal is “harm reduction,” not drug elimination. Numerous studies have shown that SCSs reduce overall mortality from drug overdose, ER visits from drug overdose and overall costs.

However, many argue that SCSs endanger public safety, which raises serious safety concerns for the entire community. Increased overall drug use in the city and Lethbridge’s inadequate SCS are often being blamed for increase in STIs, crime, and violence in the city, especially since Lethbridge’s “supervised” consumption site is unable to keep up with demand, allowing users to inject drugs anywhere outside the facility without supervision.

Ultimately, more needs to be done. Clearly the Lethbridge SCS isn’t working ideally as Mayor Spearman correctly noted; it is “operating in isolation without additional pillars of prevention and education, treatment and recovery.” With full knowledge, we’re providing suboptimal care for these high-risk individuals. It is no wonder Lethbridge now ranks as one of the most dangerous cities in Canada.

I don’t have all the answers, but we can do better. We have to be honest about the risk factors. Harm reduction is just the beginning. If we really want to make an impact on the drug crisis and STIs, we need to seriously focus on prevention and comprehensive care. We need to focus on rehabilitation, proper education and detox programs. We need to collaborate with opioid agonist clinics (formerly “methadone clinics”), STI clinics, and mental health professionals.

No longer can we promote SCSs operating in isolation if we sincerely want to help those most impacted by this serious public health crisis. With such a comprehensive approach, this gives us the best shot to empower these high-risk individuals and create a safe Lethbridge community for all, free from signs at every public park warning of potential needle exposure.

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5 Responses to “Syphilis and IV drug use”

  1. chinook says:

    Great Letter! Only thing missing is there was no mention of dealing with drug pushers. DRUG PUSHERS are the cancer in society – it’s time Canada brought back the death penalty so we may rid ourselves of this disease. Cut off the source and we reduce the problem. Police need far more power so they can go after the pushers regardless where they are. There should be no ‘safe’ zone for pushers.
    Drug addicts should be required to register and provide their full background history from family to medical etc. Needles should never leave the injection site. Right now its party central with one addict feeding off each other; dragging each other and society down. Crazy making has to stop.

    • grinandbearit says:

      This is a well written letter by a medical authority with no expertise in the topic of the letter. It is almost certain that his opinions reflect some ideological bias, not a familiarity with the evidence.
      To start, the mayor is almost certainly correct if he was advocating for comprehensive sex education that includes proper use of condoms. The author of the opinion is almost certainly wrong in advocating for abstinence education. Since 1996 the US government has spent $2.1 billion to support abstinence education and the results shown in a meta analysis are that this does not reduce the rate of adolescent sexual activity, does not reduce the rate of sexually transmitted diseases, and increases the rate of teen pregnancy (https://www.sciencealert.com/abstinence-only-education-is-more-of-a-hindrance-than-a-help-in-the-us). I hope this physician is more in touch with evidence in his own field of expertise.

      Our current sex education program (although not great) is certainly demonstrably better in outcomes than abstinence based programs (unless your criterion is adherence to some ideological bias).

      It is established in reviews of the efficacy of all supervised self-administration sites worldwide that STI rates and rates of other infectious disease are reduced! And by the way the CDC advocates in favour of harm reduction approaches like the SCS.

      The SCS does not operate alone, we have addiction treatment programs and facilities and the empirical evidence shows that SCSs turn more addicts to seek treatment. We need more treatment facilities (something the current government cancelled), not less harm reduction. It is simply not a rational option to shut down the SCS because we have not put enough resources into treatment.

      Like every person “Dr Galbraith” is entitled to express an opinion, but given his level of ignorance about the topics he addresses, no one should give it any special attention. It is so hard to see an OD fighting against the solid evidence on critical medical issues like these. He should stick to offering opinions about sports.

  2. Southern Albertan says:

    Again, not only does Portugal have support measures in place for drug addiction treatment, they, along with that, decriminalized all drugs in 2001. They have since had a dramatic decrease in overdose deaths, HIV rates and drug-related crime. Why Canada does not look to this success is beyond me.
    I also did some research on The Netherland’s STI rates knowing that they believe knowledge/education is power re: birth control and safe sex, and having one of the lowest teen preganancy rates in the world. In the gay male population they have also had increases in gonorrhea and syphillis and chlamydia is most common in women and heterosexual men. Their HIV rates have decreased.
    In the big picture, poverty is a big factor re: increased drug abuse, drug-related crime, etc., so, does it make sense to reach for a more equal society with a decreasing gap between the rich and the poor? Poverty, in the end, is very expensive, financially. So again, if money talks, back to Portugal:

    “Portugal has found an antidote to right wing populism. Nowadays, Portugal is considered a prime example among European countries: the economy is booming, unemployment is dropping and investments are rising.”
    kontrast.at/portugal-economy-right-wing/

    • Southern Albertan says:

      Also, to say, that it was mandatory, for us in the 1970s, to be tested for syphillis on applying for a marriage licence….”the compulsory premarital serological test in Alberta.” I’m not sure when that was discontinued.
      The somewhat horrifying thing about syphillis is that the first chancre stage can go by unnoticed and later stages result in brain damage. This can lead to expensive care in a long term care facility even at a young age. This is why, even with using protection, it might be wise to get tested for STIs, ?at least once/year.

  3. Dennis Bremner says:

    Mayor Spearman correctly noted; it is “operating in isolation without additional pillars of prevention and education, treatment and recovery.” With full knowledge, we’re providing suboptimal care for these high-risk individuals. It is no wonder Lethbridge now ranks as one of the most dangerous cities in Canada.
    —————————————————————————————————————————————–

    Spearman knew that the other 3 pillars were a LONG TIME COMING. He knew so he says that putting the SCS in place without the other 3 pillars was “suboptimal”. I must admit, I never heard of a complete screw up being call “suboptimal” before!
    The impression this Dr gives is that Spearman knew he was going to send us into this HELL and decided to pursue it anyway and was willing to risk “suboptimal”. He goes on to say: Its no wonder Lethbridge now ranks as one of the most dangerous cities in Canada??????

    Is that “suboptimal” Mr Mayor? Was it “suboptimal” to let Manning and Bourgue set up their drug clubhouse and watch the number of addicts increase by 500% in less than 18months? Is that suboptimal Mr Mayor? Is it “suboptimal that you proceeded knowing full well even if Minister Light Bulb came through with her 42 bed facility that 42 and 1000 addicts somehow does not match, yet you heralded this as a need that we badly deserved instead of laughing at the 42 bed proclamation and demanding something proportional to the problem?

    Is it “suboptimal Mr Mayor that you were warned on this very board that using the Watch, foolishly publishing their hours of operation and areas they “watched” was a published road map of where NOT TO ROB between 10AM-10PM and by default where TOO ROB and MUG?

    Mr Mayor, there is only one thing here that is “suboptimal” and that is your entire handling of this fiasco! Between you, Phillips. and the Chief of Police, you collectively own this lock stock and barrel!
    Suboptimal INDEED!