Changing the conversation: pilot projects focus on improving emergency department care for people who use opioids

A better experience for people who use opioids and their care providers is the goal of two pilot projects underway at emergency departments in Campbell River and Victoria. “We needed champions to be in both sites to do this,” says Arlene Hogan, Island Health’s Regional Overdose Response Coordinator. “You need people on the ground to create momentum and interest.”

The pilots, a first for Island Health, come under the heading LOUD in the ED – or Learning about Opioid Use Disorder in the Emergency Department. This is a provincial initiative led by the BC Patient Safety & Quality Council, in partnership with the Overdose Emergency Response Centre and the BC Centre on Substance Use.

In January 2021, Island Health received funding from the Ministry of Mental Health and Addictions to undertake the LOUD in the ED pilots. “People tell me that they avoid hospitals because of shame linked to substance use,” says Sheila Malcolmson, Minister of Mental Health and Addictions. “We’re funding these projects to help people feel safer reaching out for help. I am grateful to the Island Health teams leading this vital work to build trust between patients and care providers.”

“We recognized that we needed to do more to create a safe space for people in our communities looking for substance use support,” adds Tricia Sinclair, Interim Site Director at the North Island Hospital in Campbell River. “Historically it’s known that people coming to hospital with substance use disorders do not feel that it’s a safe place in the emergency department. We have a drive to shift that, and to be a place where people can ask about getting help and support – and not feel as though they will be judged because of it.”

“LOUD in the ED provides an opportunity for myself, my colleagues and the ED staff to open up to this complex problem and decrease fears or apprehension,” says Dr. Victor Jordan, an Emergency Physician and Co-Lead for the LOUD pilot in Campbell River. “We can make a difference if we are united, compassionate and patient.”

L to R:
Arlene Hogan, Island Health’s Regional Overdose Response Coordinator
Andy Speck, a peer with lived experience who is participating in the LOUD in the ED pilot in Campbell River
Beth Mainprize, ER/Crisis Services Clinical Coordinator at North Island Hospital, Campbell River and District
Tricia Sinclair, Interim Site Director at North Island Hospital in Campbell River and District

In many ways, the pilots in Campbell River and the south Island share a common approach. Both use micro-dosing for patients in the ED who use opioids – meaning that tiny amounts of the medication Suboxone are administered, helping prevent withdrawal and reduce cravings. Within 72 hours, the patient is then referred to an opioid agonist therapy (OAT) provider for follow-up treatment, a process handled by peers with lived experience who are also participating in the pilots. 

However, more groundwork was needed in Campbell River to build a team and establish a peer network. Much of this effort has involved collaborating with organizations such as Kwakiutl District Council Health (KDC Health) and partners including AVI Health and Community Services, the First Nations Health Authority and the local Community Action Team (CAT). 

Education sessions have also been invaluable. Twenty-four ED staff in Campbell River received Compassion, Inclusion, Engagement (CIE) training, and 32 participated in the Walk With Me project; the latter is a deeply personal experience that involves listening to the stories from those on the frontlines of the drug-poisoning crisis.

A harm reduction coordinator at Island Health delivered talks on understanding harm reduction, focusing on topics such as stigma and the criminalization of substance use. Meanwhile, specialists have provided training for emergency room physicians.

“It’s a different way of learning,” says Sinclair. “We’re having clinicians with specialized knowledge coming in and engaging with ED frontline staff.”

“I think it’s got the potential to be an amazing program,” says Andy Speck, a peer with lived experience embedded in the emergency department team in Campbell River. Speck, a member of the ‘Namgis First Nation, estimates that he had worked with about 40 patients by mid-July. “Peer support in the ED allows patients to feel safe and heard,” he says. “It makes them feel like they count and have a voice – that they’re important.”

Some patient feedback so far about the Campbell River pilot has been encouraging.

“They looked me in the eye,” was one comment, while others included “They treated me as a human” and “They asked, actually asked me, overall how I was.”

Hogan highlights the value that peers have brought to the pilots.

“Really, they are the original frontline workers, and have insider experience,” she says. “They have a different way that speaks to folks, that allows inroads much differently, in my opinion.”

“I speak the language, and they know that right away,” says Speck, noting the importance of establishing trust. “Not much is going to move forward unless there’s a relationship,” he adds. “In the ER everything’s medical. And fair enough, it’s an emergency room. But that relationship part can get missed – and that’s a crucial part with working with people who have been marginalized.”

“The ER has to be a compassionate environment to generate trust in our patients with opioid addiction for them to buy into a plan for opioid agonist therapy treatment,” says Dr. Jason Wale, Physician Lead for the LOUD pilot in Victoria. “Peer support helps that process as there is no adherence to a plan without trust, and no trust without compassion.”

Relationships, collaboration, understanding – according to Hogan, the pilots are having a big impact.

“I think it’s incredible in that it’s changed the conversation in Campbell River Hospital,” says Hogan. “It’s increased awareness, it’s brought a community together.”

Future opportunities will be considered following the evaluation of the pilots in the fall.