Vancouver Coastal Health medical officer Mark Lysyshyn makes the case for more harm reduction

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      Gwynevere Staddon was just 16 years old when she died of a suspected fentanyl overdose in a Port Moody Starbucks washroom in August. She’s just one of hundreds of people in the province who have lost their lives to the powerful opioid that has triggered a provincial public-health emergency.

      As the epidemic persists and spreads from B.C. to the rest of the country, people on the frontlines continue pushing for ways to prevent needless, premature, and devastating deaths like Staddon’s.

      Dr. Mark Lysyshyn is one of them. As the medical health officer for the North Shore and Sea to Sky region, he’s helping lead the public-health response to the fentanyl crisis. He called for naloxone—an injection drug that blocks the effects of opiates, especially in overdoses—to be available over the counter rather than by prescription. He called for training of staff at homeless shelters and drop-in centres so they would be able to recognize signs of an overdose and administer naloxone. And he is calling for more supervised-injection services.

      The Ottawa native’s commitment to combatting the crisis stems from experiences he had while working in internal medicine at St. Paul’s Hospital more than a decade ago. That’s where he cared for many patients grappling with substance use and mental-health disorders, people he’ll never forget.

      “I’ve spoken to a lot of them about the trauma and pain they’ve been through,” he says during an interview over a freshly pressed juice in Lower Lonsdale. “A lot of these people are abused even before they’re born; they talk about things like a mother using substances while she’s pregnant or a father beating a mother while she’s pregnant. One of my patients told me his mother injected him with heroin when he was a baby to get him to stop crying. So many have such traumatic lives, but then when they end up in these horrible situations, society blames them.

      “When patients came into the hospital, even though we were giving them probably the best in the world in terms of care, it wasn’t fixing their problems; we were intervening too late,” he says. “We were putting very expensive Band-Aids on wounds that wouldn’t heal.”

      Although Lysyshyn knew in 2007 that he wanted to focus on harm reduction within public health, his road took a detour, in large part because of Stephen Harper.

      “The Public Health Agency of Canada was still relatively new and still trying to build itself,” he says. “I was interested in issues of substance use, but at the time it was the Conservative government and people mentoring me said, ‘If you want to enjoy public health and flourish, you need to work on issues that the government is supporting right now.’ ”

      So the 43-year-old competitive CrossFit athlete and former gymnast moved back to Ottawa and spent five years in communicable-disease control, with projects including the response to the H1N1 pandemic as it started, the effects on Canadians at home and abroad following the Fukushima nuclear disaster, and bioterrorism preparation for events like the 2010 Olympics and G8 and G20 summits.

      “I got to represent Canada around the world in terms of public health and attend the World Health Assembly with Canada’s delegation,” he says. “My father is a diplomat, and people were always asking me if I would do the same thing. I was not interested in that, but I was essentially doing medical diplomacy, which was really interesting. It was an amazing experience to get to travel the world and represent Canada and be part of significant health events.”

      It was satisfying work, but Lysyshyn still yearned to get back to the area of substance use. Although Vancouver seemed an obvious place to be, he was uncertain about moving across the country when job opportunities in public health are limited. A wellness vacation helped him make the leap.

      “I struggled with this decision, but I made it on a yoga retreat in Mexico,” he says. “I told one of the other guys on the retreat about this dilemma and he actually gave me a very yoga question. He said, ‘What does your heart want to do?’ I answered him with my pros and cons list, with my brain, because that’s how I had been working on the decision. Then I went into yoga class and we were looking out at the ocean and I could see whales jumping and I was all relaxed and I came out of class and said, ‘I didn’t answer you with my heart. I would love to go do that training; I could learn more and be in a place I love.’ As soon as I said those words, the decision was made and I was instantly happier.”

      Lysyshyn moved back to Vancouver in 2012 to do his residency in public health and started working as a Vancouver Coastal Health medical officer in 2014. He hasn’t looked back since.

      “It was the best decision I could have made,” he says. “Vancouver Coastal Health is very progressive, and its leadership under Patty Daly is inspiring. Insite is a world leader, and I wanted to be involved in that.

      “I feel like I’ve been able to expand what we do in terms of harm reduction,” he continues. “What a great opportunity: to be able to use skills and knowledge I have and to do something I’m passionate about and to have an organization that supports you doing that kind of stuff is amazing.

      “Public health is all about the social determinants of health, and the way we create society—the way we distribute wealth and power—causes a lot of these addictions problems,” he adds. “The medical system sees them, and the criminal-justice system has to deal with them, but fixing them is incredibly difficult. I see them as wicked problems that we haven’t figured out as a society at all how to manage.”

      Lysyshyn would like to see more supervised-injection sites. Although news of fentanyl deaths regularly makes headlines, he points out that Vancouver has not seen an increase in overdose deaths this year over last, unlike places like Surrey and Nanaimo.

      “Vancouver has seen no increase in deaths, despite having the most substance use and the most overdoses,” he says. “That shows that things like Insite work. We know it works because nobody dies there.”

      He says the legalization of marijuana is a step in that direction but that other drugs should be legalized as well.

      “With fentanyl, we have a product-contamination issue,” he says. “When we have a bad product on the shelves that’s causing an outbreak, it’s recalled and there’s a process and the problem is over, but this cannot be recalled because we don’t control the market. The ultimate solution is to legalize and regulate the substances that are causing this.

      “We have evidence that that works,” he says. “It helps people get their lives back together and it helps society too, because those people are not committing crimes. When people are getting the right dose, they don’t overdose, and if they do it can be easily reversed. That’s really where things are going. We’ve provided supervised-injection services at Insite, and at a certain point I think we’re going to have to provide the drugs. That will be the next big societal discussion.”

      Possibly other drugs could be regulated and available by prescription as well.

      “Heroin would be a prescription market,” he says. “Maybe ecstasy or other drugs that are more harmful, like crystal meth, could be approached with that model. It’s my public-health vision and also the vision of many public-health practitioners, because the harms are unnecessary.”