National Addictions Awareness Week: Meet two MGH staff who are improving hospital care for people who use substances

An estimated six million people in Canada — more than one-fifth of the population — will meet the criteria for addiction in their lifetime, says the Canadian Mental Health Association. Yet addiction medicine continues to be an often overlooked area in healthcare, leading to unmet needs and poorer health outcomes for individuals who use alcohol, drugs and other substances.

Compounded with the COVID-19 pandemic, which has resulted in reduced capacity at pharmacies, outpatient clinics and harm reduction sites, this has worsened Canada’s overdose crisis and renewed calls for more robust addictions services, treatments and programs in our healthcare systems.

National Addictions Awareness Week (Nov. 22 to 28) gives us the opportunity to forward change in this area and to de-stigmatize a field of medicine that is often as stigmatized as the patients themselves. Here at MGH, our addiction and substance use teams are engaged in this work 365 days of the year, working both within and outside hospital walls to better support people who use substances in East Toronto. Below, meet two MGH staff who are engaged in this work.

Raj Sohi, director of mental health and substance use at MGH and South Riverdale Community Health Centre (SRCHC)

“I’ve been working in addiction treatment for almost 25 years and have always felt a connection to my clients and this line of work. It’s an area in healthcare that doesn’t get as much attention as it deserves and often concerns populations that are marginalized and underserved. This has really motivated me throughout my career to ensure these individuals receive better care in their communities and in different healthcare settings.

Here at the hospital, we have people who come in for medical reasons but have coexisting substance use issues. To better care for these patients, we’re developing an overarching addictions strategy that will help guide and contextualize the addiction medicine work we do. We’re working with different internal and external stakeholders to better understand where there are opportunities for improvement in the care we provide to people who use substances.

A number of MGH’s existing policies and programs, like our Substance Use In Pregnancy (SUIP) program, which aims to improve hospital care for people who are pregnant and use substances regularly, would fall under this strategy. Others will need to be developed. For example, we’re interested in developing a training program for clinical staff around substance use anti-stigmatization. This would better equip our clinicians with the knowledge they need to provide compassionate care for these patients.

My dual role across MGH and SRCHC also means there are opportunities for collaboration in the hospital’s addiction strategy. For instance, we’re exploring hiring a harm reduction worker who would be employed by SRCHC but works within MGH. This person would act as a peer support worker or advocate for patients who use substances so care providers at the hospital have a better understanding of these clients’ needs. This would improve patients’ experiences at the hospital and ensure they receive the care they need when they need it.

There have been studies that have shown that addictions have a greater impact on people’s health and well-being than other illnesses that perhaps get more ‘mainstream’ attention. However, addiction treatment continues to be overlooked in many healthcare systems. There’s a lot of heart behind what we’re doing, especially because we work with such a passionate team across both MGH and SRCHC. We see many opportunities for positive change here.”

Dr. Kate Lazier, emergency physician and addiction health physician lead at MGH

“Around 10 per cent of our medical inpatients and 13 per cent of emergency patients have some sort of substance use issue complicating their visit. Sometimes, a patient’s medical condition is directly related to their substance use; other times, it’s completely unrelated which can cause complications for that patient while they are in the hospital. For example, a patient who uses substances regularly could start to experience withdrawal symptoms while they’re undergoing treatment for pneumonia.

If we can manage a patient’s addiction better, we’ll be better able to manage their overall care, resulting in better health outcomes. You can’t separate one area from the other; they’re integrated. That’s why it’s important we do everything in our power to help these individuals manage both their medical concerns and their substance use. System-wide, we need to work on a model that provides a pathway to treatment whether a patient goes to their family doctor, withdrawal management, the Emergency Department or gets admitted to the hospital.

Lately, I’ve been working on the hospital piece of this puzzle: we’re developing an addiction consultation service that would be available for our surgical, medical and psychiatric inpatients who use substances. The patient’s physician would contact a team of addiction health clinicians for assistance in managing this patient’s care. The team would then see the inpatient to provide advice and recommendations and connect them to pharmacological and psychological treatments for their substance use concerns while in the hospital and on discharge.

Some of the services and treatments we’d connect these patients to are available at MGH, like those at our Rapid Access Addiction Medicine (RAAM) clinic and our withdrawal management services. Others are available in the broader East Toronto community such as with our partner, South Riverdale Community Health Centre, who is a leader in harm reduction. It’s important that we ensure our patients who use substances are aware of and able to access these programs, especially now when we’re in the middle of an overdose crisis that’s been worsened by COVID-19.

Traditionally, addiction medicine has been overlooked in healthcare. It’s almost as stigmatized as the patients themselves and, as a result, hospital patients with substance use problems have not always been able to access evidence-based therapies that work. We are working hard to change this and we are making progress, but there is still much, much more we can be doing. We can do better and we should do better for our patients with substance use issues.”