An increasingly toxic drug supply combined with the effects of the COVID pandemic has led to a steep increase in the number of opioid-related deaths. Nationally, more than 7,500 deaths were recorded last year by
The Public Health Agency of Canada.
As an Emergency and addictions physician, UHN's Dr. Hasan Sheikh is on the frontlines of this public health crisis.
"Last month, there was another public health alert after a spike in overdoses," he says, speaking in advance of International Overdose Awareness Day on Aug. 31. "I've had patients in tears because they've lost their partner and their closest friends.
"Seeing the impact on people is really hard to take."
As UHN's first Medical Lead for Substance Use Services, Dr. Sheikh is working to enhance and integrate services for patients who use substances, and raise awareness of the effective treatments available.
"Substance use disorder is an illness that's been undertreated in the past," says Dr. Josée Lynch, addiction psychiatrist at the UHN Centre for Mental Health. "A dedicated Medical Lead offers us the chance to formally advocate for this group of patients and find opportunities to improve their care."
Educating colleagues to understand that substance use disorder is an illness, and not a matter of personal choice or moral failing, is a key priority for Dr. Sheikh.
Focused on raising awareness about evidence-based tools
Patients struggling with this disorder face discrimination and barriers to getting help. When perpetuated by healthcare workers, stigma can lead to ineffective treatment and drive patients to avoid care all together, extending substance use's vicious cycle.
"People develop stigma towards a population when they feel like there is nothing they can do for them, that it's just hopeless," says Dr. Sheikh. "If you give people hope that we can make a difference in someone's life it really breaks through that barrier."
Dr. Sheikh is particularly focused on raising awareness in TeamUHN about the evidence-based tools available such as medications for opioid and alcohol use disorder.
"These interventions are very under prescribed," he says. "It helps bring people along to say there's a medical piece to addiction and we can provide the right treatments and people will get better."
Another stigmatizing misconception to tackle: providing pain medication to patients with an existing opioid use disorder.
These patients are often more sensitive to pain and have a higher tolerance to pain medication. They need to have their pain treated more aggressively, says Dr. Sheikh, but are less likely than other patients to be prescribed pain relief.
"It comes from not wanting to make someone's addiction worse, but it makes it hard for people to remain in hospital and get the care they need," he says. "We can make the hospital a much less traumatizing, much more compassionate place for people who use drugs."
Mission to build capacity for more integrated care
A further complication for substance use disorder patients is the increased likelihood of co-occurring mental or physical health conditions that can be caused or worsened by their substance use.
In an effort to provide a holistic approach to treat both causes and symptoms, Dr. Sheikh has embarked on a mission to build capacity for more integrated care — in line with a UHN strategic priority.
"If you're a plastic surgeon treating a patient abscess caused by frequent injections, the support you need to take care of a patient might differ from someone in internal medicine treating a patient experiencing alcohol withdrawal," says Dr. Sheikh. "The formal structure of a Medical Lead provides a place to hear about various needs in different departments and figure out how to best support colleagues."
Since he joined the Emergency Department (ED) in 2016, Dr. Sheikh has reached out to colleagues about substance use disorder interventions, and led similar initiatives with General Internal Medicine (GIM), Family Health Teams and other services.
He's now overseeing the completion of a series of short modules on substance use disorder treatments being created with the Michener Institute of Education at UHN to better educate TeamUHN.
Dr. Sheikh's interest in improving addictions care developed early in his time at UHN when he observed how frequently substance use disorder patients revolved in and out of the ED.
"They had so many touch points with the healthcare system, but weren't getting the help they needed," he says. "I started to look at what models of care were out there and how we could provide something better."
'Expanded hours means we are more responsive to patients'
Along with Dr. Lynch, he co-founded in 2017 Toronto Western's
Rapid Access Addiction Medicine (RAAM) clinic, which provides low barrier access to medication and counselling as well as connecting patients to community services.
(Dr. Sheikh subsequently helped launch a RAAM clinic in Calgary while serving as Bloomberg Policy Fellow for the city.)
The RAAM clinic is often a patient's entry point to care. They are seen on a drop-in basis and do not require a referral or appointment, which are often obstacles for patients that use substances.
Reflecting an increased patient volume, the RAAM clinic recently expanded its service hours and now operates five half-days a week (previously it was three). They also added social worker Ewa Konart to their interdisciplinary team.
"Expanded hours means we are more responsive to patients — able to see them that day to manage prescriptions or treat withdrawal — and this eases the burden on the ED," says Dr. Sheikh.
UHN's ED sees roughly 17 patients with substance use disorder daily.
Planning is also underway for a pilot project — an addictions consultation service that would support patients hospitalized at Toronto Western whose care can benefit from substance use disorder treatment. The pilot is scheduled to roll out in January 2023.
