By the end of this topic, the student should be able to:
The separation of substance use treatment services from mental health services in our society resulted in obstacles to successful care coordination. This separation reinforced the notion that substance use disorders differ from other medical conditions.
Unfortunately, this has led to health care delivery often failing to adequately address substance use issues. This includes emergency departments, hospitals, and clinical care.
Service integration can address disparities, reduce cost, and improve general health outcomes.
NOTE: Doctors continue to prescribe for 91 percent of clients who suffered a non-fatal overdose (Office of the Surgeon General, 2016).
Collaboration between physicians, nurses, and other health and social service professionals leads to improved awareness of one another’s knowledge and skills.
• Fostering an attitude of mutual respect and trust helps health and social service professionals work together to the benefit of the service user (O’Daniel & Rosenstein, 2008).Formal communication is fundamental as it provides the opportunity for all team members to work together, speak a common language, and come to a consensus.
NOTE: NOTE: Emails are sometimes viewed negatively as some people do not have the time to read all the emails they receive, and some were not computer savvy (Brown et al., 2009).
Improved teamwork and communication were stated as the most important factors in improving clinical and job satisfaction (O’Daniel & Rosenstein, 2008).
NOTE: Health and social service teams that do not work together and have to collaborate are more likely to make a mistake (O’Daniel & Rosenstein, 2008).
When speaking with interprofessional teams, members should ensure their body language is inviting and relaxed and that they use a friendly tone (Lance & McCullough, n.d.). Studies suggest that up to 93 percent of communication occurs through body language (O’Daniel & Rosenstein, 2008).
Health and social service providers should be confident in communications, be personable, and ask clarifying questions (Lance & McCullough, n.d.).
Health and social service providers should be concise and clear when speaking with others and avoid using jargon and acronyms (Lance & McCullough, n.d.).
Health and social service professionals often fail to detect opioid use disorder (OUD) in their clients. However, various screening tools and strategies are available for health and social service professionals to cope with opioid addiction or overdose among people receiving services. See Module 3, Topic A for more information on screening tools.
Often, people who use opioids find it difficult to ask for help regarding a potential OUD because of reasons like:
Therefore, health and social service professionals are encouraged to offer early interventions in the form of motivational methods, when applicable. See Module 4, Topic G for more information on motivational methods.
Further, health and social service professionals must offer to counsel or refer people with possible OUD for assessment, prevention, and—when applicable—treatments for OUD.
Proper communication and vigilant discharge prescription planning are essential for perioperative care and should include coordinating with post-discharge service “with referral to multidisciplinary pain and addiction medicine services” (Macintyre et al., 2020, p. 9).
Medication-assisted treatment (MAT) is the use of medications with counselling and behavioural therapies for OUD and help prevent opioid overdose. Therefore, primary care clinics, which develop treatment models for OUD, should all integrate MAT strategies to improve client outcomes.
The interprofessional team should be aware of the following medications that may be used in this context:
Health and social service providers should ensure there is an evaluation of an interprofessional care plan, which involves:
Evaluation should be incorporated into all program services for people with OUD. Effective approaches to assessment and treatment of people with OUD should be identified, incorporated, and revised, as necessary.
Interprofessional workshops and health education programs can be developed whereby students and professionals from medicine, nursing, pharmacy, physical therapy, and social work participate in client-focused care with OUD (Monteiro et al., 2017).
Having held positions in urban studies at York University (Toronto), sociology at Deakin University (Melbourne), and anthropology at the University of Pennsylvania (Philadelphia), Dr. Christopher Smith is currently a faculty member in the School of Social Work at Memorial University in St. John’s, Newfoundland. Christopher published his first book, entitled Addiction, Modernity and the City: A Users’ Guide to Urban Space (2016), in Routledge’s Advances in Sociology series. With a primary research focus on drug policy and harm reduction practice, Christopher’s current work examines substance use education in Canada, community opposition to harm reduction, services for people who use drugs (PUD) in rural or remote contexts, and organizing/activism among groups established by and for PUD.
Tell us about your background and how you got involved in public education around opioids.
As a fundamentally interdisciplinary social scientist, it was only half-way through my doctoral studies that I began to turn my attention to that which had been a ubiquitous reality in my everyday life for virtually as long as I’ve been alive: substance use, dependence (substitution/replacement/maintenance-based), treatment, and the overlooked, neglected, ignored, or silenced voices of people who use drugs (PUD). My personal and proximate lived experience with drugs, in other words, came to inform my scholarship. Ever since, I have been involved in countless projects concerning substance use policy and practice, the philosophy of harm reduction, and the role of PUD in services and programs ostensibly developed in their interests.
What types of audiences have you spoken with?
My work has involved addressing audiences on both sides of the (service) provider/user divide, from “addiction medicine” professionals, to postsecondary students, to policymakers, to those on the “front lines,” be they street-level outreach workers, drug/service users, and/or dealers alike.
What have you learned over the years by speaking with members of the community and other groups about opioids?
Over the years, I have come to learn that during the process of becoming institutionalized as public health policy, harm reduction has become depoliticized and that opioid replacement/substitution treatments, such as methadone or Suboxone, closely embody Foucault’s notion of biopower. Furthermore, I have come to learn that—unless intentionally framed in the past tense, with explicit reference to “recovery” or “recovering”—in the present era of identity politics, perhaps one of the last truly “illicit” (and fundamentally unacceptable) identities is that of a person who uses drugs—heaven forbid actually enjoying or taking pleasure in using. Ironically, however, I have come to learn that people who use drugs can and must be the central engine of harm reduction policy and practice, yet the very thought of PUD organizing autonomously represents a significant threat to the status quo.
Have you participated in the evaluation of public education, treatment, prevention, or health promotion programming?
Yes. I have served as (1) a consultant and reviewer for both the Opiate Awareness, Treatment and Education (OpiATE) Project as well as the Opiate Treatment Interprofessional Education Program for the Centre for Addiction and Mental Health (CAMH) in Toronto (2008–2009); (2) an advisor for the Ontario Ministry of Health Minister’s Advisory Group on Mental Health and Addictions (2008–2010); and (3) a consultant for the NL (Newfoundland and Labrador) provincial government’s opioid dependency treatment working group (2016-2020), the Take-Home Naloxone (THN) working group (2016-2017), and a member of the Newfoundland and Labrador Medical Association (NLMA) Addictions Medicine Training Program Advisory Committee (2017).
Abe Oudshoorn, RN, PhD, is an assistant professor in the Arthur Labatt Family School of Nursing at Western University. Having worked as a nurse with people experiencing homelessness, Dr. Oudshoorn now focuses his research on health equity through housing stability. Dr. Oudshoorn is past chair of the London Homeless Coalition, is a Canada 150 medal recipient, and remains an advocate for translating research knowledge into practice for those experiencing housing loss.
Tell us about your background and how you got involved in public education around opioids.
My background working as a registered nurse with people experiencing homelessness immersed me in issues of substance use. A two-year community-wide debate regarding methadone treatment clinics and zoning brought me into public education.
What types of audiences have you spoken with?
City planning division, neighbourhood association, medical and nursing students, hospital social workers.
What have you learned over the years by speaking with members of the community and other groups about opioids?
Don’t be afraid to start at the absolute basics. Starting at just basics of pain and how medications treat pain is important. Never be afraid that covering basic terminology is too simplistic as even highly educated audiences don’t necessarily know all the language. Narratives are incredibly powerful whether they are real cases or composite cases based on your experience. So tell stories! Getting the language sorted out and telling some stories is 80 percent of the work and is what most of the audience will remember long term. A couple of key messages to consider that the public seems to struggle with the most are (1) people can simultaneously need pain management and have an addiction, (2) replacement therapies decrease harms, and (3) folks who struggle are our loved ones, neighbours, employees, employers.
Have you participated in the evaluation of public education, treatment, prevention, or health promotion programming?
The only formal evaluation I have done was looking at the geographic distribution of people who access methadone maintenance treatment in London, Ontario.
Michael Beazely is an associate professor at the School of Pharmacy, University of Waterloo. He has been involved with the Waterloo Region Integrated Drugs Strategy for 10 years and has presented dozens of talks in the community about opioids and other issues related to substance use. Prof. Beazely’s research includes the evaluation of undergraduate pharmacy education with respect to substance use and ongoing educational tool development for practising health professionals. He is interested in assessing interventions by community pharmacists aimed at reducing harms associated with substance use and understanding the intersection between drug use and ongoing pharmaceutical care, and making community pharmacists leaders in harm reduction.
Tell us about your background and how you got involved in public education around opioids.
I started working with the Waterloo Region Integrated Drugs Strategy (WRIDS) in 2009 and realized there was a need for information about substance use at multiple levels—basic community education but also education for practising health professionals, public health, police services, other service providers, and people who work with persons who use substances.
What types of audiences have you spoken with?
You name it! Online national webinars, national pharmacy conferences, provincial pharmacy and law enforcement conferences, regional forums, local TV and radio interviews, community groups—from organized events to educational sessions in local church basements, student groups at the University of Waterloo, sessions for local teachers. Working with the WRIDS has also helped to disseminate information online via its website and our School of Pharmacy opioid resource page.
What have you learned over the years by speaking with members of the community and other groups about opioids?
An understanding of what I know and what I can share and how that fits into the big picture. When you’re talking about opioids from a medical perspective, you soon realize how many other perspectives there are and how your expertise is an important but small piece. You get a crash course on how housing, social supports, generational trauma, etc., also impact the use of opioids, stuff you likely didn’t learn during your own education. Also how diverse any audience is. Whether it’s a pharmacy conference or a community group, there will be individuals that have very little knowledge about opioid use and need to learn the basics about what opioids are, what naloxone is, etc. Then there will be attendees who often know a lot more than I do about particular topics and want to have discussions about national drug decriminalization or how to get an injectable hydromorphone program started.
Have you participated in the evaluation of public education, treatment, prevention, or health promotion programming?
I’m working on a grant now to implement and evaluate an updated naloxone training program for pharmacists. However, the evaluation piece can be a challenge because often there are costs involved, and public health units, drug strategies, etc., can have a hard time finding personnel to take on the evaluation after a particular program is delivered
Now that you have reviewed this content, consider the following:
Suppose you could develop and deliver an educational session about opioids for your fellow students. What topics would you cover?
If you could present a public lecture about opioids to your city/community, what topics would you cover?
Imagine you have received a grant from Health Canada to develop three 1-minute videos about the opioid crisis. Describe the three videos you plan to create.
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National Institute on Drug Abuse. (2020). Effective treatments for opioid addiction. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction
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Office of the Surgeon General. (2016). Health care systems and substance use disorders. In Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health (pp. 244–314). U.S. Department of Health and Human Services. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf
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