Homelessness

Question 1

Demographics of Homeless in Calgary

Answer 1

77% male, 23% female

14% (18-24), 25% (25-35), 36% (36-50), 23% (51-64), 2% (65+)

56% Caucasian, 29% Aboriginal, 7% Other

98% Canadian, 2% Other

Question 2

Housing First

Answer 2

Provides safe, supportive housing first, then helps clients address the issues that contributed to their homelessness. This respects client choice, follows harm reduction approaches, and sees housing as a basic human right.

The 10 year plan launched in 2008 has the goal that nobody will spend more than a week in an emergency shelter or sleep outside for more than a week before moving them into a safe, decent, affordable home with support services required to sustain them.

Question 3

Health Risks of Homelessness

Answer 3

Increased morbidity and mortality

Likely to access healthcare, but socioeconomic/personal factors decrease healthcare access

Physician role is to DARE - Diagnose, Advocate, Refer to support, and Encourage

Question 4

Challenges in Providing Services

Answer 4

Mental health issues

Not accessing healthcare

Can’t afford drugs

No address for follow up

Not compliant

Bad social environment

No social support

Lack of transportation

Question 5

Tolerance:

Answer 5

Decline in the response to a specific dose of a drug over a period of continued use (receptor down-regulation)

Question 6

Dependence:

Answer 6

Physiological phenomenon related to adaptation to long-term exposure to the presence of a drug; a reduction in dose or discontinuation will result in withdrawal syndrome

Physical dependence

Question 7

Addiction:

Answer 7

Compulsive use and loss of control of a drug despite overt social or physical harm

Question 8

Harm Reduction

Answer 8

Provides “safety nets” which provide individual outcomes and community outcomes.

Can save money.

Focus is not on removing the underlying cause, but on lessening its impact and complications.

Goal is not to cure, but to prevent physical deterioration and to maximize QOL and minimize sequuelae.

Question 9

Examples of Harm Reduction Strategies

Answer 9

Needle exchanges

Methadone maintenance

Safe injection sites

Abscess management and wound care services

Question 10

Iatrogenic Addiction

Answer 10

Occurs when a doctor places a patient on long term opioids, tolerance develops and leads to ever increasing doses, the patient becomes physically dependent, the doctor becomes skittish with the amount of drug being used and stops it, and the patient is left drug sick with no way to source relief but to turn to friends or shady sources.

Do not fucking do this to your patients.

Question 11

Misuse:

Answer 11

The use of prescription medication in any other way than in the manner it was intended to be used.

Question 12

Abuse:

Answer 12

Prescription drug abuse is the ongoing misuse of a medication despite overt negative health consequences.

Question 13

Addiction:

Answer 13

While physical dependence is a physiologic process, addiction has a social component. Addiction is defined as the compulsive use and loss of control of use of a drug despite overt social or physical harm.

Question 14

Tolerance:

Answer 14

A decline in the response to a specified dose of a drug over a period of continuing use. Classically, tolerance is thought to be a result of receptor desensitization and down-regulation.

Question 15

Dependence:

Answer 15

Like tolerance, is a physiological phenomenon related to adaptation to long-term exposure to the presence of a drug.

Question 16

Withdrawal:

Answer 16

With dependence the adaptation is such that a reduction in dose or a discontinuation of the drug will usually result in a withdrawal syndrome (as does each user) which is usually a fairly profound combination of the lessening of tolerated side effects, the resumption of whatever it was the drug was alleviating, and a sense of being physically unwell.