Dr. Evan Wood and Cheyenne Johnson were photographed next to the Mobile Medical Unit (MMU) in Vancouver’s Downtown Eastside on March 9, 2017. The mural was painted by community members in the DTES. Image credit: Jeff Topham.

Superheroes of Addiction Medicine

Promise Magazine: Spring/Summer 2017

By Ariane Fleishchmann

The opening of the BC Centre on Substance Use is a major step forward for the province of BC, and the key players are bringing all they’ve got to the table

The saying “it takes a village” is a fitting way to describe what it takes to treat addiction. In April 2016, BC declared drug-related overdoses and deaths a public health emergency. By the end of December 2016, overdoses had claimed the lives of 914 British Columbians, a nearly 80-per-cent increase over the previous year.

There’s an undeniable stigma when it comes to people with substance use problems. Addiction is found in all regions of BC, and the disease affects people without regard to social status, income or education. Health-related concerns from untreated addiction are numerous, from medical illnesses to a range of mental health challenges. For many, treatment may seem like an insurmountable hurdle.

While the stigma seems bleak, a village of advocates, nurses, physicians, social workers, peer navigators, administrators and political leaders are working to change that. Superheroes come in all shapes and sizes and their work is changing public perception and providing support to those who need it most.

Creating a Central Resource

One of the many superheroes addressing the crisis is Dr. Evan Wood, director of the BC Centre on Substance Use (BCCSU). His previous work with the BC Centre for Excellence in HIV/AIDS (BC-CfE), which originated at St. Paul’s, contributed to a 90-per-cent reduction in HIV cases and AIDS deaths; their research and training is now used as a worldwide standard for HIV/AIDS treatment.

For Wood, turning his attention to the issue of untreated addiction so prevalent in the HIV/AIDS community and the larger population that faces sub- stance use challenges was a natural next step. The parallels between the BC-CfE and the new BCCSU are notable: “the current discovery of solutions to addiction treatment is similar to what it was for HIV in the mid 1990s,” says Wood. The success of the BC-CfE’s model of integrated research, education and care is integral to the approach used by the new BCCSU.

But addiction medicine is a complex field, and society and the health- care system have been slow to adopt new ways of thinking. So how will the creation of a central provincial resource like the BCCSU facilitate this imperative change?

First, the economic case: according to the Canadian Centre on Substance Abuse, the total cost of harms associated with substance use is estimated to be $39.8 billion annually. The BCCSU aims to implement evidence-based treatment, which according to the US National Institute on Drug Abuse offers cost savings of up to $12 per $1 invested.

Dr. Keith Ahamad with a patient at the RAAC

Dr. Keith Ahamad with a patient at the RAAC

Second, the BCCSU aims to close the gap between research and practice. Despite advancements in understanding the underlying neurobiology of addiction and the development of highly effective medications, psychosocial treatments and other interventions, studies show that fewer than 1 in 10 patients struggling with substance use receive evidence-based treatment. To change that, the BCCSU will focus on three pillars: education and training; research and evaluation; and clinical care guidance.

Core Functions

The BCCSU Addiction Medicine Fellowship, originally funded by Goldcorp, trains specialists to recognize and treat addiction using current best practices.  “We’ve also recently grown from a physician training program, adding nursing and social work streams,” says Wood.

Now the Fellowship will accept eight physicians, four nurses, a nurse practitioner and two social workers into their respective streams. The interdisciplinary fellowships combine didactic experiences and acute care with a community- based practice and addiction-related research projects.

For Cheyenne Johnson, director of the Addiction Nursing Fellowship and one of the first graduates to complete the nursing stream, the education she received has been instrumental in managing the opioid crisis. “The BCCSU is training a workforce armed with the tools to screen for and treat addiction,” says Johnson.

Prior to her fellowship, Johnson says her nursing training lacked even the basic information that a nurse would need to properly care for patients and families with substance use and addiction. Johnson, who is also the director of clinical activities and development with the BCCSU, is working to develop core competencies for entry level nurses and provide free online training for nurses across the country.

Phyliss Sauve

Phylliss Sauve, a peer navigator at the RAAC. Peer navigators are trained individuals who have personal experience with addiction.

“While the Fellowship is about training leaders,” says Wood, “we’re developing other courses across the province as well.” They range from online coursework for care providers in practice to community placements. “We have a mandate to create provincial programs, not just sit on the sidelines giving advice.”

In order to disseminate evidence- based treatment for addiction, researchers at the Centre are steadily making advancements. “Part of the research is clinical trials and analyzing the impacts of treatment and systems to create effective guidelines,” says Wood. The research and evaluation pillar informs system-wide recommendations – all based on evidence – determining the cascade of care that substance use patients will receive in the province moving forward.

Established in September 2016, the BCCSU already has several research projects in progress. Focused on the opioid crisis and beyond, they’re looking at strategies to improve outcomes for those struggling with addiction: “We’re working with recovery systems and linking acute treatment to after-care and relapse prevention,” says Wood. The Centre also has experience with new extended- release medications, in which the opioid receptor is blocked to reduce cravings.

The Centre’s Research Informs the Clinical Care Guidelines They Release

Gathering data from hospitals and clinics across BC is crucial for evaluation and monitoring. “The province is trying to move toward an academic health sciences network,” says Wood. “We’ll have collaborating clinicians and experts from around the province, and our governance will bring all of those groups together to the BCCSU advisory board along with people affected directly by substance use.”

Already, the Centre has released guidelines for the clinical management of opioid addiction. Coming into effect across the province in June 2017, the guidelines will give health-care providers the tools they need to better treat opioid addiction. It’s just one example of how evidence-based information will help patients and families in BC.

A Provincial Response

Supported by the province of BC – $10 million in funding has already been announced, as well as $1.9 million in ongoing funding to support operations – and St. Paul’s Foundation – working with the donor community to raise millions of dollars in additional support – the Centre aims to be connected to the five main health authorities as well as the First Nations Health Authority. “We’re trying to break down the traditional silos that have been an impediment to progress in the field,” says Wood.

Providing a Cure

Though Wood says “cure” is a strong word, he says the traditional paradigm is based on a chronic disease model. “Unlike some chronic diseases in which we know it’s a life sentence, emerging interventions, treatments and approaches have a real potential to allow for a meaningful recovery,” he says. Like with other chronic diseases, recovery may include regular treatment and communication with a team of specialists to ensure success. While supporting opioid recovery is more challenging than tobacco addiction recovery, for example, the BCCSU is dedicated to thinking outside the box when it comes to substance use and the health and social harms that are incurred by our current lack of treatment, harmful policies and stigma. “We will look at prevention and treatment policies through an evidence-based lens so we can support people and families, while also addressing stigma,” says Wood.

Cheyenne Johnson and her Colleague Dr. Keith Ahamad recently received a letter from a former patient who had taken part in an evidence-based treatment study to treat his alcohol addiction. Now over two years free of alcohol, he credits St. Paul’s, his doctors and his support network for a successful recovery. With a family member now going through a similar addiction challenge, the patient says he’s able to provide guidance and support. He can be a superhero too.

Superheroes of the Community

Leslie McBain lost her son, Jordan, to an opioid addiction in 2014. Today, she leads Moms Stop the Harm, a substance use policy change advocacy group that she co-founded. “Harm reduction is our goal,” says McBain, though the group also provides much-needed support to members who have lost family to drug harm.

“We need better treatment in suburbs,” says Jennifer Woodside. In 2014, her son Dylan died of an overdose from oxycodone laced with fentanyl. Woodside recently founded Voice of the Family (VOF), which works with families who have lost children to addiction across Canada, specifically in the western provinces.

Tracey Morrison is the president of the Western Aboriginal Harm Reduction Society (WAHRS). She also acts as a committee member at the BCCSU. She says it’s “somewhere we can voice concerns and keep things moving forward.” For members of WAHRS, representation at the BCCSU means their concerns will be heard, and addressed, by the Centre.

Now in recovery for more than 11 years, Marshall Smith is the executive director of the Cedars society at Cobble Hill. His goal is to ensure substance use patients have a safe and effective system through which to navigate. “I envision a system that is the full continuum of care, from harm reduction to long-term abstinent remission and everything in between,” says Smith.

Funding the Fight

We rely on the community to help end stigma and provide funding so that the BC Centre on Substance use can accomplish its goals. We thank the behind-the-scenes heroes who keep the wheels in motion at the BCCSU through donations to St. Paul’s Foundation. A special thank you to Peter Bull, the Mackay Family, the John Volken Academy and Rick Ilich for their generous support.

Funding for the BCCSU supports hiring and retaining the world’s best addiction medicine doctors, research projects, facilities, province-wide training and education for medical professionals, and much more. To be a part of it, visit helpstpauls.com/BCCSU and donate today.