By Sophie Ash
The opioid crisis in Canada continues to be a major public health concern that has prompted numerous policy reforms. But, governing body and organizational efforts have done very little to reduce the growing number of opioid-related deaths, particularly as more people are turning to substance use during the COVID-19 pandemic. So, where do we go from here?
The opioid crisis in Canada began in the 1990s, when pharmaceutical companies were promoting opioids for safe and effective pain management yet downplaying their addictive nature. Opioid prescription numbers skyrocketed, accompanied by an increase in opioid dependency. Following pushback to reduce overprescribing, high rates of opioid dependency led to Canadians taking matters into their own hands to access these addictive drugs.
Today, street drugs are often tainted with powerful opioids, like fentanyl, making them unpredictable in their strength and content. Dr. Speranza Dolgetta, Medical Director at the Edgewood Health Network Bellwood Facility in Toronto, highlights: “The number of accidental deaths due to opioids adds to the tragedy – this is a preventable disease.” Since 2016, Health Canada estimates there to have been more than 9,000 opioid-related deaths.
The staggering number of opioid-related deaths and overdoses is heartbreaking, as is the potential for users to develop opioid use disorder (OUD). The term ‘OUD’ encompasses an intense desire to use opioids, an increased tolerance to opioids, and withdrawal symptoms when opioids are discontinued. Opioid use disorder can range from mild to severe. Severe cases of OUD are referred to as opioid dependency or addiction.
Given all this tragedy, the opioid crisis may seem hopeless. But it doesn’t have to be. We must call upon healthcare providers to help prevent, diagnose, and treat OUD. Of course, governments and organizations have an integral role to play in changing polices, but they’re far removed from an individual with OUD. Laws that remove drugs from the streets and reduce overprescribing practices are a good start. However, laws do nothing to treat the complexities of addiction. Given the relationship that healthcare providers can foster with OUD patients, and their ability to address the multifaceted nature of addiction at an individual level, providers need to spearhead their efforts to end the opioid epidemic.
Then, which tangible actions can healthcare providers take? For starters, providers must be aware of risk factors for overdosing: having OUD; consuming more than one drug at once (known as polysubstance use); or experiencing voluntary or involuntary abstinence (e.g. in prison or as part of an inpatient treatment program), which greatly reduces an individual’s opioid tolerance. By being aware of these risk factors, providers can act preventively when caring for high-risk patients.
Likewise, the importance of educating patients and those close to them on the signs of overdose can’t be overlooked. The more we are familiar with what an opioid overdose looks like – breathing slowly or not at all, foaming at the mouth, choking or vomiting, cold skin, blue nails and/or lips, and unresponsiveness – the more likely that individuals experiencing opioid overdose will receive the emergency care that they need.
Of course, recognizing an opioid overdose is critical, but so is knowing how to respond to one. Providers must be educated, and educate their patients, on naloxone kits. If providers can speak openly with their patients about naloxone, including how it’s used and where to access it, it will help reduce the stigma that users may feel, allowing them to access and use naloxone. “If you see someone overdose, call 911 immediately, then remember SAVE ME,” says Dr. Dolgetta. She urges providers to discuss the acronym SAVE ME (Stimulate, Airway, Ventilate, Evaluate, Muscular Injection, Evaluate again) with OUD patients and their friends and family so that these lifesaving steps are instinctive in an emergency.
Moreover, healthcare providers can have a significant impact on the success of an opioid detox. They must encourage positive prognostic factors, such as being employed or having a support system, to help an individual taper off opioids and refrain from relapsing. Arguably, the most impactful factor for successful withdrawal is having access to and engaging with a family doctor. Dr. Dolgetta echoes this: “Patients without an attachment to a primary care physician have a 70 per cent increased risk of opioid relapse at one year.” While a patient tapers off opioids, their family doctor can provide accountability, a safe place to talk, and the continuum of care to monitor their mental and physical health.
Last, and by no means least, healthcare providers need to incorporate a biopsychosocial treatment regimen in OUD management. Despite drugs being available to assist those with opioid detoxification, known as opioid agonist therapy (OAT), addiction treatment requires a multidisciplinary approach. “Alone, medically assisted withdrawal management has not been shown to be an effective treatment for OUD,” Dr. Dolgetta emphasizes. “A counselling and OAT combination is best to ensure successful long-term management of opioid use disorder.”
The opioid crisis is on a dangerous trajectory. Healthcare providers have an urgent responsibility to educate, diagnose, and treat OUD patients, while considering the combination of biological, psychological, and social factors at play. Until we start treating addictions at an individual level, the opioid crisis will show no signs of slowing down.
If you’re looking for help with a substance use disorder, whether for yourself, a patient, or a loved one, EHN Canada has industry-leading, evidence-based programs that help thousands of Canadians start their recovery every year. Visit the EHN website to learn more: www.ehncanada.com.
Sophie Ash is a freelance medical writer for EHN Canada.