“Describe the overdose crisis from a paramedic lens, and to YOU, what needs to happen at a structural level to create change.”

By Mark Dao, Primary Care Paramedic & NaloxHome Youth Educator

**Disclaimer: Opinions are my own and not of any of my employers**

The overdose epidemic, in my opinion, is a prime example of what happens when social determinants of health are not met. One analogy I like to use is that paramedics and most healthcare workers are like rescuers downstream of a river. We can keep throwing out lifejackets and save as many people as we can (and as the numbers show, we can’t save everyone). However, if the bridges upstream are broken, people are still going to fall in and potentially drown. Paramedics can reverse the effect of an individual’s opioid overdose using Naloxone, but Naloxone doesn’t affect the broken bridges that led the individual to where they are right now. Examples of these broken bridges can include issues such as the lack of social housing programs, food insecurity, lack of safe supply, multigenerational trauma, and many, many other issues. Even if paramedics and the healthcare system successfully save the individual from the river, they will eventually have to cross that river again. If the bridges are still broken, they once again stand a risk of falling in. I would argue that this would explain why paramedics sometimes respond to overdoses by the same individual multiple times, often within the same day. Seeing the same person overdose over and over again can also take a serious toll on paramedics’ mental health. These effects can lead to paramedics taking more/longer leaves of absence, relocating to smaller communities, or even leaving the profession entirely. All of which put additional stress on an extremely strained ambulance service tackling two concurrent epidemics in British Columbia.

In my opinion, for meaningful changes to be made to the overdose epidemic, the broken bridges need to be identified and addressed. Healthcare workers, despite generally being in a “downstream” position, have a role to play by reducing our own biases and stigmas towards substance use and individuals who use substances. We should treat and interact with these patients as fellow human beings with their own stories and not as “junkies” or “addicts”. By reducing the stigma and changing the way we treat our patients, we are more likely to build rapport and identify the broken bridges that led our patients to where they are right now. How we address and fix the broken bridges are highly dependent on the individual bridges themselves. For example, a lack of safe supply will most likely require actions from agencies such as health authorities and the British Columbia Centre on Substance Use and even judicial systems. I believe that a multidisciplinary approach involving agencies at all levels of government would work best to address and fix these broken bridges, as social determinants of health do influence each other. Bottom line, I believe that creating meaningful changes to tackle the overdose epidemic will require a comprehensive approach with unprecedented levels of inter-agency cooperation.