Many folks experiencing homelessness have been forced to turn to drug-use as a way to self-medicate in replacement of adequate health care. As a result of this, those experiencing homelessness open themselves up to a range of infectious diseases such as hepatitis A, B and C, tuberculosis (TB), HIV/AIDS.
First let’s look at how serious these diseases are. The following information was produced by the http://www.mayoclinic.org/
Hepatitis A: a virus which causes a contagious liver infection.
Causes: Eating food handled by someone with the virus who doesn't thoroughly wash their hands, drinking contaminated water, eating raw shellfish from water polluted with sewage, being in close contact with a person who's infected — even if that person has no signs or symptoms, having sex with someone who has the virus
Treatment: practice good hygiene, rest, cope with nausea (keep eating), stop using drugs and alcohol
*there is currently no cure for hepatitis A, people must simply learn to deal with its symptoms
Hepatitis B: a virus (HPV) which causes a serious and contagious liver infection
Causes: sexual contact, sharing of needles, accidental needle sticks
Treatment: anti-viral medications, Interferon alfa-2b (Intron A), a liver transplant, have safe sex, don’t share needles, toothbrushes, razor blades
Hepatitis C: a virus (HCV) which causes liver inflammation and can lead to serious liver damage
Causes: being exposed to the blood of someone who carries the HCV virus
Treatment: vaccines, anti-viral medications, a liver transplant
Tuberculosis (TB): serious contagious disease that affects your lungs
Causes: bacteria that spread from person to person through microscopic droplets released into the air
Treatment: Isoniazid, Rifampin (Rifadin, Rimactane), Ethambutol (Myambutol), Pyrazinamide, Bedaquiline, Linezolid
HIV/AIDS: an immunodeficiency virus (HIV) which causes immunodeficiency syndrome (AIDS) which is a chronic, life-threatening condition – this interferes with the body’s ability to fight diseases
Causes: having sex, sharing needles, blood transfusions
Treatment: there is currently no cure for HIV/AIDS however certain drugs can help control the virus
As you can see, all of these diseases are contagious and can be spread through the sharing of needles and poor hygiene practices. In addition to this, many treatments which involve drugs can be costly. Other treatments which require users to stop drinking or using drugs are seemingly impossible without the help of rehab plans which takes months for those experiencing homelessness to gain access to.
Places such as The Works, on Victoria Street specialize in Harm Reduction by:
· The needle exchange program
· Supplying users with harm reduction kits (to take drugs safely) on location & mobile outreach
· Opioid substitution clinic (methadone & suboxone) – counselling & support
· POINT program – trains individuals on how to recognize and prevent overdoses as well as how to use take-home nasal-spray Naloxone kits in cases of overdose (without needing to show your health card)
· Testing and vaccination – tests for HIV (anonymous & Rapid testing available), Hepatitis C, Hepatitis B and Syphilis and free vaccines for Hepatitis A and B, Tetanus, Pneumococcal and Influenza.
· Supervised Injection Sites (to use drugs in a safe environment)
(see more here, http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=3732be9b82e0b410VgnVCM10000071d60f89RCRD)
Now at participating pharmacies like the ones in Shoppers Drug Mart have implemented programs such as the POINT program where they teach users or friends/families of users on how to recognize and prevent an overdose. They now provide FREE injectable naloxone kits however you need to provide an Ontario Health Card (see more at: https://www.ontario.ca/page/get-naloxone-kits-free). This is of course problematic since many people experiencing homelessness do not carry or have lost their health card. In addition to this, it is also problematic to have these programs in such public places since there is a lot of stigma surrounding drug users therefore not many users would feel comfortable walking into such a public place for help (Smye, Browne, Varcoe and Josewski, 2011).
(source: Smye V., Browne A., Varcoe, C., Josewski (2011). Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context. Harm Reduction Journal. 8(17), 1-12.)
FYI: Naloxone temporarily reverses the effects of an overdose caused by opioids such as fentanyl, morphine, heroin, methadone and oxycodone.
Solution: 1) We need more community-based organizations such as The Works, distributed across Canada where users feel safe. 2) If pharmacies want to help they need to primarily erase the stigma surrounding drug users. Then and only then, pharmacies should create more programs similar to The Works, however they need to stop requiring health cards as a way to access these programs because in reality it is a barrier for those experiencing homelessness. 3) There needs to be a program set up to provide free or low-cost treatment to those experiencing homelessness with infectious diseases since many of these diseases are fatal without the proper treatment. Smye et al., (2011) suggest integrating harm reduction into our primary health care to acknowledge that people have different lived experiences and our health system can support any lifestyle. This would eliminate the stigma and allow users to feel comfortable asking for help in any environment. They are people too.