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.