I had the opportunity to connect with another Masters of Health Studies Graduate Student – Darri O'Neil. I will be the first to admit that since I first read her introductory post in week one of this course, I was fascinated by her work within a small Community in Northern B.C. She has a fulfilling career as a clinician working with individuals living with addictions and mental health. It was evident in our conversation that she is passionate about the lives she touches within her community health role. Although she works within a community health program, the physical space is within a hospital setting that brings about its challenges. The same concerns that I had voiced regarding the clients I see who also use substances often need encouragement to seek medical attention for wound abscess. However, many are reluctant to go (some never) because of negative past experiences of stigma and discrimination in an emergency department or walk-in clinic. Darri's primary focus is working with the clients within the program; however, she is often called upon by hospital staff to provide assessments, work collaboratively and be a liaison within the community team.
Pre Pandemic I work as a Public Health Nurse within a Sexual Health and Harm Reduction Program. Currently, I am an Acting Supervisor with managing outbreaks within schools, childcare centers and workplaces. I am in a unique position as I still receive frequent updates from my previous program but am up to date with COVID-19 in our Community. One area that Darri and I were interested in exploring from each other were our thoughts of how the pandemic affected our vulnerable populations despite our demographics being vastly different. Similar to our thoughts, Dubey et al., (2020) analysis of the bidirectional relationship between COVID-19 and addictions suggests that both are pandemics on the verge of causing a significant public health threat. We both agreed that there were issues within our communities before the pandemic, and mental health concerns and addictions have not gone away. If anything, all problems have become intensified by the pandemic. Results of a rapid assessment on the impact of COVID-19 on mental, neurological and substance use services show the already limited availability of community-based and mental health services is more disturbed and in more need due to adverse mental health impacts (World Health Organization, 2020).
In both our programs, harm reduction services have been impacted by the pandemic. Harm reduction is a public health approach that aims to reduce harm related to substances. It includes strategies such as needle and syringe exchange programs, supervised consumption sites, OAT programs, distribution of naloxone kits for opioid overdose, and safer sex. We both have had to adapt and develop innovative ways to connect with our clients to adhere to provincial guidelines to prevent transmission of COVID-19. In the program I work, nurses provide education and support for low-cost birth control options, risk assessment for STIs, stages of change counselling, pregnancy options counselling, vaccinations, and harm reduction strategies for both sexual health and substance use. We build capacity within the community to external providers to broaden services to allow greater access. We liaison with mental health experts and refer clients, always completing suicide risk assessments and safety planning if applicable. The pandemic has impacted our publicly funded services. We cannot see as many clients in the time we would usually have due to enhanced precautions (i.e., IPAC measures, physical distancing, quarantine and isolation). Our mobile outreach service has not been affected; however, the fixed sites are not accessible as they are closed. Before each appointment, we complete assessments and health education over the phone versus in person. Due to the nature of our client's concern, this has presented us with challenges to connect and build rapport. Once they visit the clinic, it is a quick visit for treatment or harm reduction supplies with education for overdose prevention such as naloxone. Although different from before, there is still value in the clinic visit despite being less time and personable. We are grateful that our vulnerable population can still access our program as we strategize various ways to engage our clients and build upon our nurse-client therapeutic relationship.
The program in which Darri works started their Opioid Agonist Treatment Program (OAT) in 2017. Because of the limited number of General Practitioners within the community, Vancouver's contracted practice operates as OAT prescribers. I had never taken time to reflect on how OAT programs are affected and the effects of COVID-19. One of the significance is that people who use opioids are at risk of misinterpreting COVID-19 symptoms as opioid withdrawal and manage this by using more opioids (Dunlop et al., 2020). Both situations could place them at risk for several things, including complications due to COVID-19 or unknowingly transmitting to others and, most, concerning, an opioid overdose.
Darri is the lead for this program and works with the lead physician. Before COVID-19, she would work one day per month to do all the new intakes and physical exams with other weekly clinics held virtually through an internet platform. Due to the pandemic, currently, all clinics are held virtually and thus far working well. The clients visit the clinic weekly to provide a urine sample test then follow-up for dosing by the Physician. Due to lack of means for internet access, there are some accommodations for in-person visits and harm reduction supply exchange. Darri is appreciative of advancing technology both pre and post-COVID-19. It has provided the ability to connect via virtual clinics and, in many ways, become more accessible to those who would usually have to travel a far distance.
Dunlop et al. (2020) suggest that individuals who use substances or access treatment may be most at risk during the pandemic. They must continue to receive services despite the numerous challenges during this time. Strategic ways to adapt programs and services to limit barriers are crucial in their mental health and their use of substances and provision of overdose prevention kits. During the pandemic, I believe that reaching out to community partners to build capacity and empower community clinicians to educate and advocate for people who use substances to access the various supports within our community as more demands come of the health care system. We can promptly work toward this by providing clear health information for people to learn of treatment and access, any service changes, and testing for COVID-19 (Dunlop et al., 2020). By strategizing throughout this unprecedented time, our programs have provided care to clients with the least amount of impact as otherwise they may be left behind. Although thousands of kilometres separate Darri and me, our passion remains the same regardless of the challenges the current pandemic presents. That is meeting our vulnerable clients to where they are at in their journey in life.
Thank you, Darri, for taking the time and allowing me to explore your profession and your passion. If you would like to learn more about this leading professional, please visit her e-Portfolio.
References
Dubey, J., Ghosh, R., Chatterjee, S. et al. (2020). COVID-19 and Addiction. Diabetic & Metabolic Syndrome: Clinical Reviews & Research, 14(5), 817-823. https://doi.org/10.1016/j.dsx.2020.06.008
Dunlop, A., Lokuge, B., Masters, D. et al. (2020). Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J , 17(26). https://doi.org/10.1186/s12954-020-00370-7
World Health Organization International (2020). The impact of COVID-19 on mental, neurological, and substance use services: results of a rapid assessment. Retrieved February 1, 2021, from http://www/who.int/publications/i/item/978924012455
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