Synthesis of MHST601 Learnings and Application to the Opioid Crisis

Over the past 13 weeks, I have been learning and exploring important concepts that contribute to the foundations of health systems in Canada. The objective of this course as part of the Master of Health Studies degree is to understand how to conceptualize, study, and analyze factors influencing the health of Canadians within the context of the Canadian health system. I have had the opportunity to research a number of health-related topics that are of interest to me and those that are applicable in my practice as a pharmacist. In this final assignment for the course, I will be drawing upon the multiple domains explored within the last 13 weeks and summarizing key concepts as they relate to the opioid crisis in Canada.

Professional and Social Media Identity

We began this course by reflecting on our professional identity. The federal approach on Canada’s opioid crisis embodies four key pillars: prevention, treatment, harm reduction, and enforcement. As a pharmacist in the hospital setting, there are multiple ways I can contribute to these strategies. The Ontario College of Pharmacists (OCP) has a mandate to regulate pharmacy practice to serve the interests, health and well-being of the public. I recently led the OCP annual accreditation at the hospital pharmacies I manage. One of our action plans will be to focus on ensuring that narcotic and controlled drugs management processes in the hospital system are robust against diversion. This can be achieved through technology, regular audits, and ensuring that polices and procedures are updated to reflect legislative requirements. In my role, I have the advantage of participating in advisory councils and safe medication practice committees to be aware of medication incident trends. Data gathered can inform on gaps in the system, so that mitigating strategies can be implemented to minimize risks to staff and patients. I am cognizant of my participation in social media as a professional, but will take advantage of it to share important educational and evidence-based resources regarding the opioid crisis with my network. Generating awareness and sharing best practices across the nation will be helpful in a publicly funded health system where resources are scarce. Efficiency can be maximized if we collaborate to minimize reinventing the wheel.

Redefining Health and the Prevalence of Chronic Illnesses

The next unit prompted me to examine the definition of health and the need for its redefinition in an era with an aging population, prevalence of chronic illnesses, and medical advances in effectively controlling symptoms manifested by chronic illnesses. It is now possible to lead a “healthy” life despite the diagnosis of a condition. Like other chronic diseases, such as diabetes and hypertension, substance use disorder has no cure and requires long term treatment and longitudinal follow up. According to the Centre for Addiction and Mental Health, the disease burden (including years lived with less than full function and years lost to early death) of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together and more than 7 times that of all infectious diseases. Strategies employed for the management of other chronic diseases may be applicable to substance use disorder by integrating treatment and follow up into the primary care domain. A public health approach with respect to health promotion and prevention can impact upstream and minimize the number of people turning to substance use as a coping mechanism. Redefining health as one’s “ability to flourish without being unduly impeded by illness or disability or, if necessary, by overcoming illness or disability” (Misselbrook, 2014, p. 582) may contribute to destigmatizing substance use.

Social Determinants of Health and the Social Ecological Model

In assignment 2, an in-depth review of the social ecological model in the context of the opioid crisis concluded that despite strategies addressing the various levels of influence, the epidemic continues to escalate nation wide. In my research, I came across the story of Marcel (Official W5, 2017, 41:20), who lost his life at the age of 54 as a result of an apparent opioid overdose in British Columbia, a province most plagued by the opioid crisis. Marcel started working at the age of 16 to help support his family, consisting of 5 siblings. He was employed as an iron worker for 25 years. In 2014, Marcel was injured in a car accident. He did not receive effective treatment for the resulting chronic pain and eventually turned to heroin to help ease the pain. Marcel’s story captures the many social determinants of health, from an individual, interpersonal, community, organizational, and societal level, that led to him eventually becoming a statistic in the opioid crisis.

Figure 1. Social ecological model. Adapted from “Toward an experimental ecology of human development” by U. Bronfenbrenner, 1997, American Psychologist, 32(7), 513-531. Retrieved from http://www.esourceresearch.org/Default.aspx?TabId=736

Vulnerable Populations

Delving further into the social determinants of health in vulnerable populations, I learned that residential schooling as part of colonization left deep scars in Indigenous peoples. Many suffered from physical, sexual, psychological, and spiritual abuse, resulting in a cycle of mental health issues and addiction. The traumatic effects have been found to be intergenerational, with parents passing psychological damage to their children. Other determinants such as poor living conditions, crowded housing, high unemployment and suboptimal education rates all contribute to increased risk of substance use.

Indigenous health disparities contribute to the disproportionate impact of the opioid crisis on these communities. The First Nations Health Authority estimated that First Nations people in B.C. are five times more likely to experience an overdose and three times more likely to die from one. A disturbing reality to accept that in a country with universal health care, some Canadians are much vulnerable than others. The Truth and Reconciliation Commission reveals that there is a historical lack of clear government accountability, leaving gaps in the system that leads to disputes between provincial and the federal government over fiscal responsibility for specific services. The resulting mistrust in the health care system means Indigenous populations are less likely to seek timely care. With the creation of the Ministry of Indigenous Services in 2017, conversations to address Indigenous health disparities can hopefully be prioritized, with a focus on enabling access to the kind of treatment facilities that promote healing in a way that is culturally sensitive.

Figure 2. The First Nations perspective on health and wellness. Adapted from “Overdose data and First Nations in BC: Preliminary findings” by First Nations Health Authority, 2017. Retrieved from http://www.fnha.ca/newsContent/Documents/FNHA_OverdoseDataAndFirstNationsInBC_PreliminaryFindings_FinalWeb.pdf

Future Health

The story of another case (Official W5, 2017, 34:08), John, provides insight into the innovation and courage required to explore the future of health. John is a heroin user. He was homeless and spent most of his days hustling for his next fix. John attempted to quit and tried a variety of treatment options without success. It was not until a good friend, whose life bore many similarities to John’s, became a victim to opioid overdose that he sought additional help. John found a lifeline at an innovative clinic, the only clinic in North America that dispenses prescribed medical-grade heroin to drug users, legally, funded by the government. John visits the clinic three times a day to receive a dose just sufficient to control his withdrawal symptoms. The clinic models similar programs in European countries that have been in existence for 25 years. The objective is to minimize the societal burden of opioid use by keeping drug users out of the correctional system and the hospitals. Patients at the clinic also have access to addiction counselling and referral to other social services, essential in supporting them to regain control of their lives. With this treatment, John returned to school, became employed, and got his own apartment. Perspectives of people like John can bring valuable insight in discussions on the development, implementation, and evaluation of opioid-related legislation, regulation, policies and programs.

Course Reflection

One of the key learning objectives of the course is to develop a methodology in curating resources and I am satisfied with the progress I have made over the past 13 weeks. The first 6 weeks formed an exploratory phase, as I experimented with available tools and read feedback from my classmates about their process. I must have tried close to 10 tools including Microsoft OneNote, elink, Diigo, Raindrop, Feedly, and Google Docs. All of the tools had their advantages and disadvantages and I commented on a previous blog post that combining the strengths of all of them could yield an ultimate content curation tool. With my busy schedule, the chosen tool must be easy to use on a mobile device. I am now settled into a curation routine where Microsoft OneNote is used to curate content on-the-go, and once reviewed, I use Google Docs to share my resources and annotated bibliographies via my e-Portfolio created using Wix.

What I have valued most about this course is the applicability of the learned concepts. It was eye-opening to read about how my classmates from different health disciplines have interpreted and incorporated the learnings into their practice. These concepts can be applied to any other health issue. With a deeper understanding of these foundational elements, I find myself asking different questions and considering different perspectives when faced with issues in my work place. I am more cognizant about health equity, determinants of health, and vulnerable populations. I have a greater appreciation of the complexity of our current health system and am challenged to think about how we can change or improve the current way things are done. I feel I have only scratched the surface of a wealth of information that is available to continue to build onto the foundation we have built, and am excited to contribute to discussions applicable to my practice that can impact health care positively.

References

Centre for Addiction and Mental Health. (2018). Mental illness and addiction: Facts and statistics. Retrieved from: https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

First Nations Health Authority. (2017). Overdose data and First Nations in BC: Preliminary findings [Report]. Retrieved from: http://www.fnha.ca/newsContent/Documents/FNHA_OverdoseDataAndFirstNationsInBC_PreliminaryFindings_FinalWeb.pdf

Misselbrook, D. (2014). W is for wellbeing and the WHO definition of health. British Journal of General Practice, 64(628), 582. Doi: https://doi.org/10.3399/bjgp14X682381

Official W5. (2017, April 25). W5: Opioid fentanyl street crisis documentary [Video file]. Retrieved from https://www.youtube.com/watch?v=F1ojeXgyAu0&has_verified=1

Palmer, K., Tepper, J., Nolan, M. (2017, September 21). Indigenous health services often hampered by legislative confusion. Retrieved from https://healthydebate.ca/2017/09/topic/indigenous-health

Providence Crosstown Clinic. (2018). Overview. Retrieved from Providence Health Care website http://www.providencehealthcare.org/hospitals-residences/providence-crosstown-clinic

Saitz, R., Larson, MJ., LaBelle, C., Richardson, J., Samet, JH. (2008). The case for chronic disease management for addiction. Journal of Addiction Medicine, 2(2): 55-65. doi: https://doi.org/10.1097%2FADM.0b013e318166af74

Wilk, P., Maltby, A., Cooke, M. (2017). Residential schools and the effects on Indigenous health and well-being in Canada – a scoping review. Public Health Reviews, 38:8. doi: https://doi.org/10.1186/s40985-017-0055-6