RNAO guidelines to shape care at supervised injection sites,
RNAO’s best practices aim to ensure services are delivered effectively
The opioid epidemic began in the late1990s in Canada and the United States, but the acknowledgment it had reached a crisis level came only a few years ago. Health-care workers had been witnessing the rise in opioid addiction and deaths for years, and a systematic response to the crisis was long overdue.
In February of this year, the Registered Nurses’ Association of Ontario (RNAO) released a report titled Implementing Supervised Injection Services — a series of guidelines for clinics and health-care workers who deal with patients whose addiction to painkillers, both prescription and illegal, had become potentially life-threatening.
Valerie Grdisa, director of the RNAO’s International Affairs and Best Practice Guidelines Centre, acknowledges that the health-care profession’s response to the opioid crisis has been long overdue, while the over-prescription of painkiller medication fuelled the epidemic for years.
“What we have is decades of perverse prescriptive approaches based on the relationship between the prescriber and the pharmaceutical industry that has actually contributed to this current crisis,” she says, “and now we have the criminal elements that have found their way into this black market.”
What began with a prescription pad left health-care workers in clinics across the country dealing with the results on the front lines.
The RNAO’s guidelines report drew on the expertise of nursing professionals with PhDs and master’s degrees in their fields. One of the co-leaders of the panel was Marjory Ditmars of Insite, the Vancouver supervised injection site (SIS) pioneer that had seen the opioid crisis at the beginning of its spread eastward across North America.
The report aims to be comprehensive, outlining not just the requirements for locating and setting up a SIS, but stressing the effective treatment and rehabilitation of patients, the education of health-care workers on the particulars of the crisis and its victims, and advocating for new legislation to deal with the crisis.
The report was well received as soon as it was released. Carol Timmins, chief nursing officer at Toronto Public Health and past president of the RNAO, says several public health units are using the guidelines to plan their own SIS facilities.
“My initial reaction was how timely and relevant these guidelines are to guide an evidence-based response to support accessible provision of these vital health services to people who use injection drugs. Once again, RNAO has demonstrated an incredible responsiveness to a critical publichealth issue with evidence to guide the development and provision of these critical health services in communities not only here in Ontario, but nationally and internationally,” Timmins says.
Many health-care profession- als consider the opioid crisis as a transformation in the way we think about addiction, especially since the crisis began with legal drugs and the care of increasing numbers of chronicpain sufferers.
“The thing that’s important is that when it comes to opioids it’s a long spectrum,” explains Grdisa. “One in four Canadians could open up their medicine cabinet and find some pain medication.
“Canada is moving toward more of a decriminalization philosophy on substance abuse, because criminalization isn’t actually working, unless we hold the people who hold the drug trade responsible, either the pharmaceutical companies or the drug dealers. The new thing here is that we are focused in a different way on the individual.”
Most practically, Grdisa sees the guidelines as a useful way of training future nurses working in clinics.
There are stigmas attached to drug users of all types that often hinder successful treatment, and learning to deal with preconceptions is key.
“We’re still struggling as a society with accepting this as a service-delivery model,” Grdisa says. “The practitioners who work in that area already are OK with it, but the next generation of nursing grads … we have to realize that we’re all coming in with a bias on that population.”
“Once again, RNAO has demonstrated an incredible responsiveness to a critical public-health issue.” CAROL TIMMINS CHIEF NURSING OFFICER AT TORONTO PUBLIC HEALTH