A Canadian Approach to Opioid Problem

Sep 27, 2017

What is the best practice to address the epidemics related to opioid use in Virginia – and in the nation? Last month, WMRA’s Marguerite Gallorini reported on alternatives to prescribing opiates.  This week, a group of Canadian health care professionals are in Charlottesville as part of a two-day conference on the subject organized by the Center for Global Health at UVa. Marguerite has more.

Virginia’s HIV and Hepatitis C epidemic is closely linked to the opioid crisis, as people tend to share needles. But why look to Saskatchewan in Canada for answers? Here’s Kathleen McManus, assistant professor at UVa in Infectious Diseases and one of the organizers of this conference.

KATHLEEN MCMANUS: Doctor Dillingham [Director of the Center for Global Health] and I went to Saskatchewan two years ago and we were really impressed with our colleagues there with the work that they had achieved, and then it was really after that visit that we thought "The work they do here in Saskatchewan is so special that we want to be able to share this with our community."

The clinics she is referring to are that of Big River and Athahkakoop. Professionals from these two health centers came to talk about their experience in dealing with epidemics related to substance abuse. Dr. Stuart Skinner says Saskatchewan has had the highest rate of HIV in Canada for the past 10 years, and it especially affects First Nation reserves. His answer:  

STUART SKINNER: The most important is meeting people where they're at. My approach is to make care as accessible as we can, especially for the most vulnerable population who struggle with transportation, poverty - to try and get a tertiary care center or a city for health care is often difficult and intimidating. Canadians or Americans both should look at that model and obviously, for what I do in a rural province with lots of distance, we need to reach out to them and ensure that they get the same opportunities to access health services and treatment as everyone else.

That is the key idea: community outreach. Dr. Skinner got involved early with the Know Your Status program developed by the Big River Health Center. Federal nurse Leslie-Ann Ironstand-Smith has been nursing there for 18 years.

LESLIE-ANN IRONSTAND-SMITH: Our program does not create dependency: it creates ownership. This is your addiction: “We're going to walk with you on this journey. But it's yours. You're going to tell me what you want to do for your journey. Do you want to engage in care right now, do you want to wait?” Our first positive client we tested had 23 contacts, 19 of those contacts were positive for HIV. So we knew we were having an issue. Because they're sharing needles, and this was from a sharing episode of one night. Social networking and then peeling through the layers of the client's addiction is huge to get that bigger population - and that comes with trust and respect.

Could Virginia apply this program, with a radically different American health care insurance system as opposed to that in Canada?

SKINNER: Certainly, universal health coverage takes barriers away in having accessible care where cost isn't an issue.

NOREEN REED: Partnerships are huge, in every aspect from your clients to your higher level of people. I can't stress that enough. And another thing is advocating for our clients, advocating for better services.

That’s nurse Noreen Reed from the Athahkakoop Health Center – located about 10 miles away from Big River. Their first step was to put in place a needle exchange program, to give clean needles to people with addiction in exchange of their used ones.*

REED: Even still to this day there's a lot of questions around it from community members, but it's a matter of educating. They even went and did a puppet show to talk about needle safety. It's a community-wide education process and then showing the benefits.

And the benefits are real: according to a systematic review of the Centers for Disease Control and Prevention, these programs have reduced HIV prevalence in New York from 50 to 17 percent, and from 80 to 59 percent for Hepatitis C. In Virginia, following the declaration of public health emergency, a new law legalizing these programs went into effect on July 1, although none has been started yet.

Note: An earlier edition of this story claimed that "As in Virginia, their [clients of Athahkakoop Health Center] primary cause of HIV infection is drug use via injections."  That is incorrect.  In Virginia, sexual contact is still the main cause of HIV transmission.