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Angelica Helpard shares her experience with Suboxone and drug addiction at her home in Oshawa, Ont. on Sept. 27, 2018.Tijana Martin

Angelica Helpard has had six drug overdoses this year. In the age of fentanyl, the potent synthetic opioid, any one of them might have killed her. She showed up in the busy emergency department of Oshawa Hospital over and over, only to be discharged back onto the streets to use dangerous drugs again.

Her sixth overdose was different. This time, a doctor started her right away on Suboxone, a medication that subdues withdrawal symptoms and prevents overdoses. The hospital connected her with a new clinic, right in the building, that treats and monitors people with opioid issues. Hospital workers fed her a meal, let her take a shower and gave her a fresh set of clothes.

“Before, they just treated me like an addict,” as if they thought: “What really can we do for you?” says Ms. Helpard, who is 30 and has been using drugs since she was a teenager, often supporting her habit with sex work. “It’s changed drastically. They were extremely nice to me. I was helped instantly.”

Since the opioid crisis rolled across Canada, sending the number of drug deaths soaring, hospitals have become pretty good at saving those who come through their sliding glass doors suffering from an overdose. What they aren’t so good at is keeping them from coming back.

Emergency departments such as the one in Oshawa, Ont., often see the same people, time after time – “frequent fliers,” as they are sometimes called. Doctors pull them back from the brink of death, then do it all over again a few days later. Some patients don’t even make it out of the hospital before they are using again, huddling in a washroom to use drugs, then overdosing and ending right back in emergency.

Vials of naloxone stored in a medication cart inside a resuscitation room at the emergency department of Lakeridge Health in Oshawa, Ont.Tijana Martin

For doctors and nurses, resisting the impulse to judge can be hard in such circumstances. And yet, resist they must. And so, across the medical system, an extraordinary effort is under way to change attitudes and practices. One of the centres of this effort is Oshawa, a growing city of 166,000 just east of Toronto. With pockets of stubborn poverty and homelessness, it has been hit hard by the opioid crisis. The hospital treated 347 overdoses in 2017, up from 206 in 2015.

Health authorities have concluded that if they are to have any chance of cutting the toll in death and misery from opioids, they have to do more than simply treat the overdose and send the victim along. They have to connect with their stricken patients in new and creative ways, setting them up with the medication and treatments that might keep them from returning.

“If you can’t offer them something right away, right now, the chance of losing them is incredibly high,” says Paul McGary, the director for mental health and addictions at the regional health system. These days, drug users are “spinning the roulette wheel every time.”

The federal government says that, on average, 11 people a day are dying in this country because of opioids. Altogether, more than 8,000 have died since the beginning of 2016. Many of the fatal overdoses happen in big cities such as Vancouver and Toronto, but rural areas and smaller cities are being overwhelmed, too.

Oshawa started seeing one or two people a day showing up in the emergency department with overdoses. The usual signs: blue lips, pale face, weak pulse, shallow breathing. Concerned health officials visited hospitals in Vancouver and Toronto to see how they were coping with the crisis. Then they drew up an action plan that aims to cut overdose deaths and reduce emergency-department “revisits.”

Instead of just reviving and stabilizing overdose victims and then sending them back out the door, they are using the overdose as an opportunity to help patients turn things around. Health workers are coaching users on safe habits, such as always using in the presence of a buddy. They are distributing more equipment, such as clean needles, medical tourniquets and glass pipes, to reduce the likelihood of some of the negative health consequences of drug use. They are handing out naloxone kits, containing a nasal spray that can reverse the effects of overdose. They have even started distributing a new kit that lets users test their drugs for the presence of fentanyl, which is 30 to 50 times more potent than heroin and responsible for three-quarters of opioid-related deaths.

In January of this year, authorities opened two Rapid Access Addiction Medicine clinics in Oshawa, one at the hospital and the other at the nearby Pinewood Centre. The RAAM clinics are designed to simplify the process of treating patients with Suboxone, which is replacing methadone as the favoured opioid treatment.

Chronic drug users often lack a family doctor or even a health card, so it can be hard for them to get on Suboxone. Now, they can just walk into the clinic, where a nurse practitioner can get them going and track their progress. If they show up at the hospital suffering from an overdose, doctors will sometimes hold them overnight and have someone walk them down the hall to the RAAM clinic the next morning. Once they are in the system, health officials can track their progress and try to get them into addiction programs.

Just as important as these practical steps is the shift in mindset. Doctors and nurses are striving to see drug users the way they see any other sick person: as a human being in need of help. These days they like to call their repeat visitors “familiar faces,” instead of frequent fliers.

“There is sometimes this perception that patients with addictions are a lost cause,” says Dr. Larry Nijmeh, one of the doctors leading the changes. “Have these patients actually been offered treatment?” If not, “we haven’t done our job.”

Dr. Larry Nijmeh, left, emergency physician and lead for the Lakeridge RAAM and Nicole Wood, emergency assistant manager, stand outside the emergency department on Sept. 26, 2018.Tijana Martin/The Globe and Mail

Early results of the new approach are promising. Several other hospitals have called Oshawa to learn about it. Officials hope smaller hospitals in the region will adopt it. “For the first time in a long time, we’re quite optimistic about where we’re going,” Dr. Nijmeh says. “The last six months have seen a lot of change.”

As of mid-September, 269 people had visited the RAAM clinics. Patients say the visits are doing them a world of good. On a recent weekday morning, a husky construction worker who preferred to be identified only by his middle name, Francis, was visiting the RAAM clinic for a checkup. Not all victims of opioids are living on the street. Aged 57, Francis calls himself “an ordinary Joe.”

He became addicted to prescription painkillers after going through seven operations for a work injury. When his concerned doctor started lowering his dosage, Francis was in such agony that he decided to quit the drugs altogether. He ended up in emergency with vomiting, diarrhea and unbearable headaches.

Now he is on Suboxone and doing better. One of the drug’s advantages is its “ceiling effect.” Users don’t have to take higher and higher doses to get the benefit. In France, deaths from overdose dropped sharply after doctors started treating users with buprenorphine, the main ingredient in Suboxone.

“These people probably saved my life,” said Francis, as nurse practitioner Helen Manohararaj took his blood pressure and other vital signs. “I really don’t know what I would have done.”

Darcy Lee Anne Brioux, left, attends an appointment at the RAAM clinic with lead nurse practitioner Helen Manohararaj at Lakeridge Health in Oshawa, Ont., Sept. 27, 2018.Tijana Martin

Another of Ms. Manohararaj’s patients, Darcy Lee Anne Brioux, 50, landed in emergency after taking pain pills she bought on the street. Her boyfriend called 911 when she passed out and started foaming at the mouth. Emergency doctors started her on Suboxone after she came out of the overdose. The drug makes her tired, but “I should have done it a long time ago. I didn’t know there was another treatment program.”

Ms. Manohararaj ends up spending a lot of time with her visitors, chatting with them about what they are doing as she checks them over. After working in emergency medicine for a decade, she welcomes the change. Without it, “All we are doing is saving your life, literally, and then kind of sending you back.”

Hospital officials admit the new approach is not for everyone. Some drug users still won’t go anywhere near the medical system. Many overdose victims use alone and die alone. Others still dash out the door as soon as they are on their feet, headed straight back to their usual patterns. Engaging drug users – drawing them into treatment and recovery – is notoriously tough. But what is being tried in Oshawa offers at least a chance to avoid the cycle of overdose, emergency visit and repeat.

Ms. Helpard is trying to break that cycle. Before she had her sixth overdose and the turnaround that followed, “I was a daily user – non-stop, every day, all day long. I would inject and inject and inject to the point where I was just a walking pincushion.” She is still vulnerable. She admits that she still drinks too much. She has occasionally relapsed and used drugs. But she says she isn’t using intravenously or resorting to sex work. It’s a beginning, and that’s all the staff at Oshawa Hospital want.