"Addiction is being recognized as a chronic disease. More research is emerging and more of the neurophysiology is being discovered." - Dr. Seonaid Nolan

World-leading Addiction Medicine

Promise Magazine: Spring/Summer 2016
by Melissa Edwards

In 2013, a young Pender Island man named Jordan was inappropriately prescribed oxycodone by a doctor inadequately trained in recognizing or treating addiction. That same year, in Vancouver, a different seed
was being planted, as five young medical professionals became the first inductees into an advanced new education program in addiction medicine at St. Paul’s.

Jordan’s story ended in tragedy in 2014. However, for the Goldcorp Fellowship in Addiction Medicine, located at St. Paul’s—a world-leading centre for the provision of care to BC’s most marginalized citizens—an astonishing story of hope and change is just beginning.

“Addiction can strike anyone’s child,” says Jordan’s mother, Leslie McBain. After her son died of an accidental overdose at the age of 25, she began advocating for change with mumsDU, a coalition of mothers who have lost children to drug-related harms.

“My son was being treated by a physician who knew very little about addiction. He didn’t know about recovery. He didn’t know what withdrawal can do to a person,” she says. Now, the dedicated physicians engaged in the Goldcorp Fellowship in Addiction Medicine will help change that narrative.

Expanding knowledge of addiction

It was witnessing the same lack of education in addiction that impacted Jordan that first drew Dr. Seonaid Nolan to the field of addiction medicine. She was one of the five inaugural fellows profiled in Promise in 2013, when Goldcorp Inc. announced its transformative $3-million gift that launched the groundbreaking program.

“Addiction is being recognized as a chronic disease,” says Nolan. “More research is emerging and more of the neurophysiology is being discovered. There have been enormous developments, but these evidence-based treatments are not being adequately implemented on the ground.”

To Nolan, who is now the addiction physician lead for internal medicine at St. Paul’s, the more medical professionals who are exposed to current research and take this knowledge back to their far-flung fields and regions, the more that gap will begin to close.

In the two years since Nolan graduated from the Goldcorp Fellowship, the program has expanded from four physicians and one nurse to six physicians and two nurses, and (as of next year) one social worker. In addition, fully one-third of past graduates have furthered their research training in US National Institute on Drug Abuse.

Leadership in active addiction treatment

A leadership program has been established to help graduating fellows promote evidence-based treatments. Together with the students taking the three formal electives (a newly established arm of the program), there are now more than 80 medical professionals receiving specialized training in addiction medicine at St. Paul’s each year, making it the largest such program in North America.

Nolan and other physicians from St. Paul’s have also been active in the development of a 16-module online diploma program in addiction medicine, soon to be made available to any doctor who wants it, anywhere in BC.

“It’s grown incredibly,” says Dr. Evan Wood, Medical Director, Addiction Services at St. Paul’s and founder of the Goldcorp Fellowship. But the field is still new, and Wood sees great need ahead—the most pressing being faster implementation of evidence-based practices, through greater involvement of primary care physicians and through greater use of relapse-preventing medicines like Naltrexone, or the new provincially accepted guidelines for the safe treatment of opioid addiction.

“The burden of addiction in the health care system is astronomical, whether it’s liver disease from alcohol use, lung disease from smoking, soft tissue infections from intravenous drug use—pretty much every organ system in the body is affected. And then, of course, you have the mental health consequences,” says Wood. “All of these, in many cases, are totally preventable by providing evidence-based treatment.”

The long-term vision for St. Paul’s, says Wood, is to unite education and research with rapid access to evidence based treatment and to the entire continuum of care, including the recovery community and harm-reduction initiatives like Insite, which has proven success in reducing the spread of disease and preventing overdose deaths: “What we’re aspiring to is something modelled after the BC Centre for Excellence in HIV/AIDS, a very research-heavy program with direct links to driving an evidence-based system of clinical education and care.”

It’s a grand vision, and one increasingly close to reality as the momentum launched with St. Paul’s Goldcorp Fellowship in Addiction Medicine continues to build.

Leslie McBain, who only two years ago could not access relapse-prevention medication or even post-detox support for her son, is hopeful that this new shift in thinking may save future mothers from the devastating loss she experienced.

“I can’t say enough good things about the work they do at St. Paul’s. It’s the best there is in Canada,” says McBain. “The education, the policy papers they put out, the research, the implementation—everything they’re doing. It can’t help but help.”

To find out how you can support ground breaking research at St. Paul’s to help patients with addictions, please contact St. Paul’s Foundation at 604-682-8206 or donate online at http://helpstpauls.com/donate