“One crisis is manageable. A concurrent second feels impossible.”
While the country is increasing financial resources focused on deaths related to opioid overdose, examination of alcohol caused fatalities reveals increased harm and morbidity. We examine the challenges facing health authorities as they grapple with this often under resourced population.
Defining The Concurrent State
The current state of consequences from substance misuse reveals a dark reality affecting every major demographic throughout the country (Canada). While money is directed towards improved access to treatment centres, deaths continues to rise.
Most notably, opioid misuse leading to premature death, continues to increase year over year. Between 2016 and 2018, more than 9,000 Canadians lost their lives to overdose, with heavy concentrations in Vancouver BC. Approximately 76% of opioid related deaths were men age 20 to 59. Moreover, anecdotal accounts indicate increased numbers of youth seeking replacement treatment.
Meanwhile, Alcohol related health events continue to increase. Between 2015 and 2016, British Columbia hospital admissions saw nearly 15,000 admissions related to alcohol. Nationally, the rate of admission sits at 239 per 100,000 individuals – BC was 349.
Opioids Crisis and Clinical Burnout
While the opioid crisis methodically marches forward affecting every sector of society, the use of alcohol continues to account for substantial emergency room visits and deaths. We diligently focus on to abate one problem at the cost of another.
Substance misuse clinicians note the overwhelming nature of working in the current overdose crisis affecting much of the United States and Canada. Yes, we are able to acknowledge the dangers of excessive alcohol consumption. However, clinicians are unable to shift focus due to care provider burnout. Therefore, what are our options?
Primary Care Integrated Team Model for ORT
In order to address the concurrent opioid/alcohol crisis, a broad biopsychosocial-spiritual approach is recommended. This means increasing the access and ease of flow into primary care clinics able to address the problem from an integrated model of care. This means that treatment teams must include Addictions Physicians, Nurse Practitioners, Mental Health Clinicians, and support staff.
In Canada, primary care settings with an addiction focus, are managed by local health authorities centred in proximity to vulnerable populations. This popular model often provides Opioid Replacement Therapy (ORT) to dependent individuals. It is arguably the most powerful lifesaving approach to care when organized as low barrier entry for the most marginalized and chaotic clients.
Primary Care Integrated Expansion for Alcoholism
In order to address alcohol misuse, an integrated primary care model should be considered a priority approach by health authorities. Currently, patients presenting to emergency departments are treated and discharged with no clear connection to community programs other than AA//NA. While many patients have a family physician on record, examination of the quality of this connection is often overlooked.
However, we should consider training as a current barrier to this proposal. Individuals presenting with alcohol misuse often present with complicated medical challenges requiring deeper integration in the clients care home. Mental Health Clinicians also need additional education (controlled drinking, Motivational Interviewing, etc.), and mentoring supports to navigate the complicated nature of patient concerns.
Health Authority Refocus
The current system is robust. Nevertheless, burnout, as indicated at the beginning of this article, is a priority concern for implementation. Simply building a system with expanded mandates will, in the end, increase caseload and burnout, thus decreasing essential quality.
Health authorities should organize care with increased personnel resources (FTEs). It is critical to hire in new staff with population experience, while bringing current staff up to speed through ongoing mentorship and training.