Nursing Organizations Missed the Mark on the Opioid Crisis, Now What?

Canada is currently facing an overwhelming opioid overdose crisis, with staggering numbers that we have never seen before:

Overdose-related deaths have increased 327% since 2008[1].

6 or 7 Canadians die every day from an opioid overdose[2].

In British Columbia, 800 people are expected to die this year alone[1].

From the beginning of 2016 to Oct. 27, 338 people died from an overdose in Alberta[3].

Last year 529 people died from an overdose in Ontario[4].

As a response to this crisis, the Federal government organized a national conference in Ottawa on November 18th, followed the next day by the release of a Joint Statement of Action to Address the Opioid Crisis endorsed by more than 40 organizations, including the Canadian Association of Schools of Nursing, the Canadian Nurses Association, and the Canadian Council of Registered Nurse Regulators.

As part of this statement, these organizations committed to the following:

  • Canadian Association of Schools of Nursing
    • Disseminating evidence-based educational resources on opioid use through a communication strategy for nurse educators, RNs, NPs, and students with CNA
    • Educating nursing faculties on the growing opioid crisis in Canada through a series of blogs, lunch-and-learn webinars, and a dedicated editorial section in our newsletter
  • Canadian Nurses Association
    • Developing and disseminating educational resources related to opioid use for provincial and territorial nursing associations and colleges in collaboration with CASN
  • Canadian Council of Registered Nurse Regulators
    • Developing a guidance document for all RN and NP regulators that will support the implementation of a consistent, standardized approach to:
    • Opioid and controlled substance prescribing for NPs
    • Education and practice for NPs with respect to harm reduction, including prescribing suboxone and methadone to reduce the harmful effects of illicit drug use
    • Utilization of electronic pharmacy management e-systems for medication reconciliation
    • Monitoring of prescribing and quality assurance
    • Entry-level and remedial education on prescribing competencies for NPs
    • Entry-level competencies for RNs that include ways to support effective pain management and limit potential for abuse amongst patients/clients

Here’s why they missed the mark.

All three organizations failed to recognize that addiction is not created by a prescription or by taking a pill. It is created by isolation, marginalization, trauma, mental health, colonization, and social conditions. Internationally renowned expert Dr. Gabor Maté has written extensively about this along with many scholars, practitioners, journalists, and lived experience experts. We expect nursing organizations to challenge the view that addiction starts with a prescription. We expect them to think as nurses. In other words, to look at addiction as a symptom of a bigger problem that cannot be fixed by prescription monitoring alone.

Many of us expected all three organizations to build their commitments on harm reduction: i.e., educating nursing students about harm reduction, allowing greater access to harm reduction nursing care, and supporting the implementation of harm reduction services where nurses provide life-saving care such as supervised injection sites. Instead, the focus was placed on opioid use and the harms associated with opioids. This is a drastic departure from what Canadian nurses have been advocating for in the past 20 years and from the extent of nursing knowledge on the topic. Placing so much emphasis on drug use and its harms could inadvertently result in greater levels of stigma against people who use drugs and little (or no) improvement in care. To make a real difference, we need to educate students and nurses about addiction, harm reduction, trauma-informed care, and cultural safety.

Unfortunately, we see nothing in their proposed commitment to support nurses who provide harm reduction care in the midst of this opioid crisis. Over the past 5 days alone, 175 people have overdosed in Vancouver. What are we doing to support nurses on the ground? What innovative solutions can we come up with to deploy more nurses in the communities and allow them to provide care? Why not provide mandatory naloxone training and free kits to all nursing students and nurses in Canada? This would not only save lives but it would also promote the role of nurses across the country. As nurses, we want nursing organizations to provide this level of leadership and innovative thinking. We want them to build on the knowledge and expertise on the ground, to propose solutions that address the needs of nurses, and to defend the rights of people who use drugs. Doing this takes courage, especially in the face of a government that is pushing its own agenda and other professional groups that may not share the same priorities.

So where do we go from here? First, these organizations need to hear the feedback of the nursing community. To help with this, the Coalition of nurses and nursing students for supervised injection sites is asking nurses to share their comments and suggestions directly with the organizations or by e-mail : nurses4harmreduction@gmail.com. Consultation will be key in the development of a concrete action plan that is based on evidence (including research, policy, clinician expertise, and lived experience expertise[5]) and relevant to the reality on the ground. Finally, we will need a strong commitment from these organizations – especially the Canadian Nurses Association – with respect to advocacy. This should include advocacy for repealing Bill C-2, implementing supervised injection sites, decriminalizing drug use, increasing access to substitution therapies and prescribed long-term opioid maintenance programs, just to name a few. Nursing organizations may have missed the mark, but what they do over the next 12 months will determine how nurses actually respond to the crisis. Let’s make sure this response is more comprehensive than what has been proposed so far.

Marilou Gagnon, RN, PhD, Associate Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Founder, Coalition of Nurses and Nursing Students for Supervised Injection Services. Follow her on Twitter: @mlgagnon_XVII and Instagram ml_gagnon

[1]https://www.hri.global/contents/1739

[2]http://www.timescolonist.com/opioid-addiction-overdose-and-death-a-canadian-crisis-by-the-numbers-1.2930165

[3]http://globalnews.ca/news/3072316/a-province-by-province-look-at-opioid-overdose-stats-including-fentanyl/

[4] http://globalnews.ca/news/2959852/ontario-slow-to-respond-to-growing-opioid-overdose-crisis-experts/

[5] https://www.ncbi.nlm.nih.gov/pubmed/15186471

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