A few years ago, Nick Politi was homeless, heavily using drugs and in out of hospital after multiple overdoses—each time he says he was swiftly revived, discharged and sent on his way.

But every time he overdoses, what he describes as his meth-induced psychosis became worse. He would experience severe episodes of paranoia, fear, and depression, he said, and imagine voices in his head. “It’s a very dangerous place to be,” Politi said. After six years of prolonged drug use, he recalls being in desperate need for help.

“I thought people were after me,” Politi said. After his very last hospital discharge, Politi remembers crying uncontrollably. “I just wanted to stop,” he said.

Politi said he overdosed around 33 times on GHB — a depressant that can cause people to go unconscious in large doses — and methamphetamines between 2012 and 2018. But with each discharge, Politi said he didn’t receive adequate help from hospitals to get him off drugs and into recovery.

The drug and opioid crisis has dominated headlines in Canada in recent years, as policy makers grapple with the most effective way to save lives. But while surviving an overdose is often celebrated as the victory it is, patients’ stories don’t end there. Many who survive overdoses still need long-term care but face issues accessing it, experts say.

Sabrina Atwal, spokesperson for Alberta Health Services, said hospitals have care teams on hand to ensure a smooth transition back into the community, and that all patients undergo a needs assessment prior to discharge, including an assessment of the patient’s housing, financial and ongoing care needs.

Those who visit the emergency department as a result of an opioid overdose are also connected with increased access to care, Atwal said. As of May 2018, a new program began connecting eligible patients to Suboxone treatment — an opioid addiction recovery treatment that involves giving patients a dosage of the drug — and has supported 581 patients by initiating Suboxone in its first year.

But during a cycle of being in and out of hospitals, Politi said he never felt fully supported by the medical system.

“Once they figured out it was drugs, they told me to go home and sleep it off,” Politi recalled one time, where he overdosed on GHB and received treatment at the hospital. He told the hospital staff that he doesn’t have a home, he said.

It’s difficult to gauge how many people in Alberta struggle with long-term health problems related to prolonged drug and opioid use, said Petra Schulz, a founding director of Moms Stop the Harm. Schulz noted there aren’t any statistics, for example, about the potential brain-damaging effects of overdoses and the patients who need care as a result of this.

Schulz would like to see more attention paid to keeping records of this, especially when it comes to opioid use, to show the drug crisis’ overall impact. This could both help doctors diagnose and treat patients, but also display a wider scope of the effect the opioid crisis is having on families who support loved ones after they overdose. That support can create financial stress and job insecurity as families either try to find long-term care for these patients, or take care of them at home.

Another reason for the lack of awareness on this issue is because medical professionals are focused so much on overdose reversals and saving lives, that less attention is being paid to those who survive, said Monty Ghosh, an assistant clinical professor at the University of Alberta.

“We are geared toward managing things in an acute state, like managing a crisis and dealing with the acute ramifications of the crisis, having immediate gratification from saving lives. But we’re not dealing with long term consequences down the road, necessarily,” Ghosh said.

“I think as the crisis progresses and as things shift in terms of the crisis, we’ll need to examine long-term management of these issues”

This issue extends to medical knowledge on how drug poisoning can affect people’s cognitive abilities long-term. Ghosh, an addiction and internal medicine specialist, said much of what he knows on the topic is only theoretical because there isn’t enough research on this topic.

What the province’s doctors do know is that the number of accidental fentanyl poisoning deaths increased across Alberta in the second quarter of 2019 over the first three months of the year, according to the most recent Opioid Response Surveillance Report. Anecdotally, doctors have also reported a rise of meth-related hospital visits.

Ghosh has seen patients struggle with treatment for drug use if they’re also feeling some kind of cognitive decline after a brain injury. He added that overdose can also cause patients to continue to use drugs to cope with the trauma of their experience.

Many of Ghosh’s patients after they’ve survived an overdose have told him they feel like they can’t learn new things as easily and are more forgetful. Ghosh himself has noticed changes in patients’ personalities, though he doesn’t know if this is a result of physiological changes after an overdose or because of the emotional trauma of the experience.

One response Schulz and Moms Stop the Harm, a national network of families who’ve lost loved ones to drug addiction, would like to see is more preventative measures to stopping overdoses before they occur. One example of this is ensuring a safe supply of drugs through centres like supervised consumption sites.

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But Schulz worries that the stigma surrounding drug use prevents can at times prevent families from accessing the care that they need to support their loved ones after an overdose.

“We hear from families that they see a lot of social isolation when they reveal that their child is struggling with substance use, and they see social isolation even after the child dies. Is this something that people don’t want to hear or talk about? And I’m quite sure it’s the same in case of a permanent injury like this,” Schulz said.

Politi said he wishes he’d been connected with resources that could’ve helped him while he was in and out of the hospital, or that a peer outreach support worker was available through the hospital to help point him in the right direction. Instead, he said he had to reach out to recovery services on his own through a psychosis that was at its peak.

Since then, Politi’s life has changed drastically. The 37-year-old Edmonton man has been sober as of March 2018 and lives independently in a one-bedroom apartment with his cat, Felicia. He works at AAWARE — Alberta Addicts Who Educate And Advocate Responsibly — as a peer outreach worker, connecting others who use drugs to support and recovery services.

“I want to give back what was given to me,” Politi said.

With local addiction programs like Recovery Acres and meetings with Crystal Meth Anonymous, Politi said he’s also been able to find a network of support and remain sober. “If it wasn’t for these meetings, I don’t know where I’d be,” Politi said.

But Schulz believes Alberta needs more long-term care facilities in place that can specifically help patients who may need intensive rehabilitation after drug poisonings, including physical and occupational therapy.

“We should not just look at if the person is dead, (or) are they alive, but we have to look at what kind of quality of life they have afterwards, and that that is often overlooked,” Schulz said.

Politi wishes the path was clearer for him through his overdoses and hospital visits. He added he believes health facilities should invest in hiring outreach workers with lived experience so they can connect with patients battling drug addiction.

“There needs to be some kind of change,” Politi said.

Ghosh added he sees there’s limited programming when it comes to creating a set pathway for these patients, but that doctors need to see more actual diagnoses of brain injuries after overdoses to better understand and help patients like Politi.

“We’re not screening for it. We’re not trying to look for it. It’s something that doesn’t come across our radar. And if we can’t diagnose it to start off with, we can’t actually treat it,” Ghosh said.

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