Combating the Opioid Epidemic in North America and Here at Home: Learnings from a Canadian Delegation to the United States

Almost every time you turn on the evening news or open the newspaper, you hear about the opioid epidemic plaguing provinces across Canada, including here at home in Newfoundland and Labrador. Opioid use disorder is a chronic and recurrent brain disease and is one of the most challenging and complex issues facing the health-care system in Canada today.

averge_number_opiod_poisoningsSadly, the opioid crisis is affecting many individuals, families and communities across our province. But, it is not solely a provincial or Canadian issue. North America is facing an epidemic of opioid addiction and opioid overdose with unprecedented levels of mortality. Family members, friends, colleagues, and loved ones highlight how opioid overdose is devastating for people from all walks of life and communities.

In 2016, there were 2,861 apparent opioid-related deaths in Canada and the number has risen to over 4,000 for 2017. Several provinces have even declared a state of public health emergency due to opioid overdose and non-fatal opioid poisonings. In 2017, the United States declared a national state of Public Health Emergency to combat the opioid crisis which claimed more than 42,000 lives in 2016.

Fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine, is the primary cause of the rapid increase in overdose deaths in North America. Governments at all levels, health-care organizations, and community groups all recognize the need to come together to address this urgent issue.

An amazing opportunity

Earlier this year, I was approached by the Department of Health and Community Services and the United States Consulate General in Halifax about an opportunity to participate in the United States International Visitor Leadership Program (IVLP) which was focused on combating the opioid epidemic in North America.

Dept_StateThe IVLP project is coordinated and funded by the Department of State, Office of International Visitors. Originally launched in 1940, the IVLP seeks to build mutual understanding between the United States and other nations through carefully designed professional visits to the United States for current and emerging foreign leaders. These visits reflect the visitors’ professional interests and support the foreign policy goals of the U.S. government.

I was honoured to have been asked to participate in this important delegation in my role as a Regional Addictions Prevention Consultant with Eastern Health. I was very fortunate to have the opportunity to be one of five Canadian delegates selected from across the country, along with:

  • Elaine Hyshka, Assistant Professor, Health Policy Management, University of Alberta and Scientific Director, Inner City Health and Wellness Program, Royal Alexandra Hospital (Edmonton, AB);
  • Anthony Muench, Corporal, RCMP, Primary Investigator, Project EPLAN (Surrey, B.C.);
  • Pierre-André Dubé, Pharmacist-Toxicologist, Québec National Institute of Public Health; and
  • Sandhia Vadlamundy, General Director, CACTUS Montreal (Montreal, QC).

The delegation came together with a few goals in mind, including:

  • finding ways to collaborate in order to combat the production, transfer and sale of illicit drugs;
  • advocating for change and raising public awareness; and,
  • strengthening partnerships to help decrease the number of opioid-related deaths in both Canada and the United States.
Meeting Preperation

IVLP delegate group preparing for a meeting with Jefferson County Attorney, Mike O’Connell

Over three weeks, our Canadian group travelled across the United States, visiting cities in five states affected by the opioid epidemic: Washington, D.C.; San Diego, California; Albuquerque and Santa Fe, New Mexico; Louisville, Kentucky; and Concord, New Hampshire.

Rolling up our sleeves and getting to work

We participated in over 35 site visits and meetings with organizations and services directly involved in the opioid epidemic, including:

  • federal, state, and municipal law enforcement;
  • correctional services;
  • community organizations;
  • specialized harm reduction services;
  • researchers;
  • emergency and acute care healthcare services;
  • funding organizations;
  • specialized addictions treatment services; and
  • federal and state government and public health officials.
Kentucky ER

University of Louisville School of Medicine Emergency Medicine

Having worked in the field of mental health and addictions for over 15 years, this experience was a valuable opportunity for me not only to share best practices, service delivery models and policy experience from Eastern Health and this province, but also to learn from service providers in the United States. I also learned a great deal from my fellow Canadian colleagues about how other jurisdictions and provinces across Canada have addressed and continue to address the issue of opioid addiction and overdose – lessons which I have brought back to my work with Eastern Health.

Over the course of our meetings and site visits, I was continuously inspired by so many remarkable individuals, leaders, innovative programs and organizational and government policies designed to support individuals with opioid use disorders and their families.

Over the three weeks, we visited and learned about many innovative programs and services. Some of the stand-outs for me, included:

  • The Milagro Program in Albuquerque, New Mexico
    • A specialized and comprehensive care program for pregnant women with a history of opioid addiction.
  • Safe Stations Program in Manchester, New Hampshire
    • A service designated to provide a safe environment for individuals seeking treatment to start their path to recovery. Firefighters are on duty 24 hour/day to arrange or provide a medical assessment for these individuals and support transition to addiction treatment services or medical health services.
  • Santa Fe, New Mexico Police Department’s LEAD Program
    • A police-led diversion program designed to connect people with substance use disorders and/or mental health needs with social services rather than funnel them into the criminal justice system.
  • Kentucky All Schedule Prescription Electronic Reporting system (KASPER)
    • A robust prescription drug monitoring program.
KASPER Program Meeting, Kentucky

Meeting with delegates from Kentucky All Schedule Prescription Electronic Reporting system (KASPER) and Kentucky Cabinet for Health and Family Services

We met with health-care professionals, policy makers and individuals with living and lived experience with opioid addiction who offered invaluable insights into how to best approach this public health issue. We met dynamic individuals and representatives from community coalitions – individuals with passion, empathy, and compassion – interested in rolling up their sleeves to address the issue of opioid addiction and overdose in their local communities and states.

All hands on deck

During our travels, there were many lessons learned and repeated confirmation that we need an “all hands on deck” comprehensive and coordinated approach to address this public health issue. Opioid addiction and overdose affects all areas of our society and the costs to individuals, families, and society can be devastating.


Visiting the White House

It was interesting to hear stories and innovations from across North America and to think about how they could be applied to the situation in Newfoundland and Labrador. I learned that we must consider our local and provincial context as we continue to increase opportunities for treatment, harm reduction, and prevention initiatives.  We must also continue to collaborate to strengthen the connection between substance use treatment services and primary care medical practices, and to develop opportunities for knowledge sharing, education and partnership development.

Eastern Health, along with the Department of Health and Community Services, the other regional health authorities and our community partners, has already taken strides to address the opioid epidemic including the implementation of:

  • safe prescribing course for health-care professionals;
  • province-wide Naloxone take-home kit program;
  • naloxone community pop-up tents; and,
  • improved access to Suboxone as an alternative drug to Methadone.

Eastern Health has also recently received three–year funding from Health Canada under the Substance Use and Addictions Program (SUAP) for the development and implementation of a Provincial Centre of Excellence for Opioid Dependence Treatment.

Ready to tackle the challenge

It was a true honour to travel with my Canadian colleagues over the three weeks with many lessons learned, knowledge shared, and innovative research and practical approaches discussed. Certainly, lasting relationships were made with these new colleagues and friends.

I’m fortunate that I get to go to work every day with the many skilled and caring people at Eastern Health, government and our partners in the community. Substance use and addictions prevention is a complicated and diverse area of practice and in my current role, I’m proud to provide leadership in the development, implementation and evaluation of addiction prevention initiatives. Opioid overdose has continued to climb and the need for effective and evidenced-based treatment, harm reduction, and prevention initiatives are needed now more than ever.

We have a tremendous amount of knowledge and expertise in Eastern Health to help address the issue of rising opioid addiction and overdose.  While there is still much work to do, I have come from this experience with renewed enthusiasm and motivation to tackle the challenge and to continue to work with my colleagues to provide the best possible support to individuals facing addictions. ■

This story was written by Wayne Bishop, a regional addictions prevention consultant with Eastern Health.


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