CRISM British Columbia: Finding evidence-based solutions as BC struggles with poor access to addiction care
In the shadows of British Columbia's majestic mountain peaks, lush forests and breathtaking scenery, there is a heartbreaking reality – huge numbers of British Columbians are seeking help for addiction with few places to turn to.
"The program where I work provides alcohol and other substance use withdrawal management and is actually the city's old animal shelter," says Dr. Evan Wood, an addiction medicine physician, Canada Research Chair in addiction medicine at the University of British Columbia (UBC). "That gives you a sense of how health policy makers have overlooked services for persons seeking addiction treatment."
This year, on average, more than six people die each day in BC due to opioid-related overdoses. Deaths that have continued to rise year over year since the province declared a public health emergency in April 2016. Alarmingly, according to Dr. Wood, the Canadian Substance Use Costs and Harms report suggests costs to society from alcohol are almost three times higher.
"It's a tragedy for families and morally distressing for everyone working in this area," he says. "Not only is substance use related harm on the rise, but investments policy makers hoped would be beneficial in addressing the crisis have clearly not been adequate."
"Substance use is one of the largest contributors to ill health, disease and social harms in our society," Dr. Wood explains. "If you look at the main reasons why people go to see their family doctor – they're struggling with insomnia, high blood pressure, or have a chronic cough – smoking and alcohol are probably two big contributors, yet I think the impacts of substance use on health are still poorly understood by health policy makers."
Research: The Key to Transformation
As a leading advocate for better addiction care, Dr. Wood believes a key path forward is through greater incorporation of evidence into policy and the generation of new evidence where gaps exist. As a Nominated Principal Investigator, he co-leads the BC Node of the Canadian Research Initiative in Substance Matters (CRISM), a Canadian Institutes of Health Research (CIHR)-funded research network organized into five regional nodes. As part of its mandate, the network is informed by the expertise of people personally affected by substance use disorders, scientists, healthcare professionals, Indigenous partners and policy makers to develop research projects addressing substance use issues in Canada.
"While each of the nodes has differing skill sets, for all of us it's very important to have every step of the research process informed by those affected by substance use and those who are in a position to affect positive changes," explains Dr. Wood. "We want to make sure that we're asking the right questions and going about answering them in a way that can overall reduce the burden of illness in our communities."
CRISM: Guiding Lights in the Darkness
The BC node is among various groups at the forefront of developing important new recommendations including first of their kind national guidelines to better treat opioid and alcohol use disorders.
Dr. Wood is the co-chair of a recently published guideline in the Canadian Medical Association Journal. CRISM's National Alcohol Use Disorder Treatment Guideline estimates that only roughly five-percent of people with alcohol use disorder get effective treatments and that commonly prescribed medications, including certain widely used antidepressants, are likely ineffective in treating alcohol use disorder and possibly worsen alcohol problems in many patients.
"The notion that the needs of patients seeking help for alcohol use can be met by fleeting visits with physicians who just prescribe antidepressants and other medications to help with alcohol-attributable mental health problems is an experiment that has been tried and failed," he says. "Studies clearly show that some medications that are the backbone of the health system response to alcohol use disorder likely increase alcohol use in certain patients."
CRISM has also developed a guideline, a first in Canada, for managing opioid use disorders, outlining optimal approaches for opioid use disorder treatment. Alongside that, CRISM researchers developed the first ever national injectable opioid agonist treatment (iOAT) guideline in the world.
In their latest project, CRISM, including partners at the BC Node, are seeking to investigate a novel treatment for stimulant use disorder in response to the lack of effective treatment options for methamphetamine use disorder across the country.
The Road Ahead: A Call for Evidence, Investment and Compassion
Dr. Wood says the key to finding solutions is to stop looking at substance use as a moral or criminal justice issue surrounded in stigma, but rather as a health and societal crisis.
"If you were to show up at an emergency department experiencing chest pains, you'd be urgently seen by a team of well-trained doctors, you'd be admitted to the cardiac unit, you'd receive effective medications and education around smoking, diet and exercise. You'd have a follow up appointment with a specialist a week or two later who would work closely with your family doctor," he explains. "But if you showed up at that same emergency department seeking help for a substance use problem, you'd be lucky to get past the front door. There is just no accessible system of care available for the majority of patients."
"We need to better acknowledge the downstream costs of this failure because a huge amount of money gets spent on avoidable consequences and suffering," adds Dr. Wood. "We need to end the stigma and instead invest in options for people seeking care for substance use disorders just like we invest in care for all other health conditions."
- Date modified: