Opioid overload
Understanding the opioid treatment journey
The opioid epidemic has become an unrelenting crisis and a major concern for healthcare providers across Canada.
Opioids are a controlled class of drug prescribed therapeutically to relieve pain.
As a registered nurse (RN) in an intensive care unit, I frequently administered opioids such as hydromorphone (dilaudid) to help patients. Effective pain management leads to better outcomes since pain can interfere with patients’ activities like sleeping and eating.
Opioids, however, are frequently misused due to their ability to cause intense euphoria. Prescription opioids have replaced illicit heroin as the primary drug of opioid misuse (Health Canada, 2012). It is estimated that one in three individuals receiving opioids for pain, crossover into opioid misuse (Bonhomme et al., 2012).
Unfortunately, opioid misuse can lead to physical dependence, withdrawal symptoms, overdose, and death. The Public Health Agency of Canada (PHAC) advises that from January to March 2017, there were over 600 opioid related deaths across the country; there were 50 deaths in Nova Scotia alone.
Opioid misuse, toxicity and overdose occur across all walks of life and affects many Canadian families. According to the PHAC, adults age 45 to 64 and seniors age 65 and older had the highest rates of hospitalizations for opioid toxicity over the past 10 years, but the fastest-growing rates were for those age 15 to 24.
It is unknown how many of these hospitalizations are due to prescribed opioids or illegally produced opioids. Regardless, anyone taking opioids requires the non-judgemental support and supervision of health care providers. Unfortunately, the stigma associated with both opioid use disorder and Medication Assisted Treatment (MAT) makes it difficult for people to access help. MAT is the use of medications – including buprenorphine/naloxone (often known by the brand name Suboxone) and methadone – along with counselling and other supports to manage opioid use disorders.
MAT is rooted in a harm reduction philosophy which focuses on continued engagement and support to help people reduce the harms associated with drug use rather than requiring them to abstain from drug use altogether. Abstinence may or may not be a treatment goal. MAT, along with counseling, social support and services reduces and/or eliminates the use of opioids, reduces death rates associated with opioid use and allows people to improve their health, relationships and reclaim their lives.
As a nurse and nursing professor at Cape Breton University, it is exciting to contribute to knowledge gaps in healthcare. Currently, I am working on a research project with Dr. Brandi Parker Cotton, assistant professor at the University of Rhode Island College of Nursing who designed a research questionnaire entitled “History, Characteristics and Treatment Trajectories among Patients Enrolled in an Opioid Treatment Program” to be conducted in Zone 3 of the NSHA.
“We know the pathways that lead to substance use disorder differ for everyone and often involve a complex interplay of social determinants of health such as poverty, trauma, violence, and social inequities.”
We hope the data we collect will help us better understand people’s treatment trajectories or ‘journeys.’ Also joining our project is Sharon MacKenzie, acting co-director of the Opioid Recovery Program, Nova Scotia Health Authority (NSHA).
We know the pathways that lead to substance use disorder differ for everyone and often involve a complex interplay of social determinants of health such as poverty, trauma, violence, and social inequities. We hope to consider how these factors and others, including prior history of MAT, relate to treatment.
Our project is well-suited to Nova Scotia’s Mental Health and Addictions Strategy, which seeks to promote health and early intervention, close treatment gaps, and improve care delivery within the continuum of opioid use disorder and dependency treatment. We plan to compare our findings with data Dr. Cotton has already collected in Rhode Island, Massachusetts, and Washington State.