DIFFERENT TACK NEEDED FOR DRUG USERS IN HOSPITAL

Street knowledge is vital in a hospital emergency room when helping
substance abusers said the program manager of Edmonton's
Streetworks.

Marliss Taylor spoke about bridging the gap between the hospital and
the street at the sixth annual Alberta Harm Reduction Conference held
in Grande Prairie last week.

Streetworks addresses the issue of HIV among injection drug users and
sex-trade workers.

Taylor, a registered nurse, said the standard emergency room response
won't work for a substance abuser.

Addictions are not logical, Taylor said, but she added "an extra five
minutes makes a huge difference."

Showing patients respect, keeping their situation confidential and
treating them like a human being will go far, she said.

"Hospital feels like jail (for them)," Taylor said.

Patients are under extreme stress and can react in sort of a "fight or
flight" mode. But they're reacting to what's going on, not necessarily
the health-care worker, she said.

People on the street are also good at reading people, Taylor
said.

"Their crowd needs to know that you think they're OK," she
said.

It's important to gain their trust so you can help them when there's
an opportunity for change, she said.

It's also important to remember that one bad hospital visit can have a
significant effect, she said.

"Hospital experiences influence how people will access health care in
the future," Taylor said.

"Respect them if you want them to respect you," said Roy Gaiason, who
attended the session and has dealt with addiction issues in the past.

It is the most important thing health-care workers can do when
treating someone with an addiction problem, he said.

Gaiason is a "natural helper" at Streetworks, working with other
people still struggling with their addictions. He's also spoken with
doctors and nurses to educate them how to better treat people with
addictions in the hospital.

Fellow natural healer Keith Miller knows first-hand what it's like to
be judged by health-care workers.

"People who are on the street long enough are bound to run into these
barriers, I guess. And these barriers are a lack of education on other
people's part," Miller said.

"It made me feel little, very little because I wasn't getting the same
medical attention because of who I am."

Gaiason is involved because he wants to educate people and, pointing
to his long hair in dreads, said people are still quick to judge.

Taylor also said labelling and gossiping in a practically wall-less
emergency room will only hurt the situation. Instead it's important to
look for strengths and humanize patients with co-workers, she said.

However, health-care workers need to also protect themselves but
shouldn't be surprised or hurt if they are scammed.

Pain is also an issue health-care workers need to understand,
especially since someone with addiction problems may have a lower pain
threshold.

Taylor spoke of a case where a 17-year-old girl, who had been in
prostitution for five years, was crying because she wasn't getting
enough pain medication.

The nurses worried about contributing to her drug problem, Taylor
recalled.

"Pain is what people say it is," Taylor said, putting to rest any
ideas that drug users come to the hospital for drugs.

"They can get better ones on the street," she said.

Patients also lack resources such as toiletries and maybe even change
for the phone and it's important to ask about life circumstances
because an early discharge may not always be a good thing if there's
abuse at home.

Holly Brenzan, a nurse from the STD Centre in Edmonton who also does
outreach once a week, agreed that there has to be a different approach.

"This was certainly helpful because you come from the hospital... I
kind of see the differences and how to get a better sense of where the
people on the street may be coming from," she said.

It's about adapting to the situation, she said. Someone who has an
addiction and has come for help might just have a different way of
interacting, Brenzan said.

"They're not trying to be difficult, it's not a personal thing. They
want help and the bottom line is you want to provide help so you're on
the same page, essentially."