For people living with substance use disorder, seeking medical attention for their substance use disorder or another medical condition can be daunting. Similarly, treating patients with substance use disorder can present unique challenges that lay outside of most providers’ comfort zones.
The Addiction Medicine Consult Service (AMCS) was established to address these issues. AMCS offers rapid telephone consultation to physicians, nurse practitioners and pharmacists across Nova Scotia. The AMCS provides verbal evidence-informed clinical advice and guidance to diagnose and manage substance use disorders.
In 2020, family physician Dr. Tiffany O’Donnell began providing her addiction medicine expertise to the AMCS. Working with two other physicians, Dr. O’Donnell is on call in addition to her regular service to provide consultative support to health care providers to ensure the care of patients with substance use disorder is evidence-informed and well considered.
“We know that the nature of the disease is the erosion of choice and control, and the approach to ‘just stop using’ is not helpful or effective,” said Dr. O’Donnell. “As health care providers, we need to focus on providing care not only for the addictions that people live with, but also for other health issues that may or may not be related to the addiction. Often, it is hard for people living with addiction to access the care they need for other conditions due to the stigma around substance use.”
Dr. O’Donnell said that some of the calls she receives are directly related the patient’s substance use disorder and that is the primary issue. However, the calls come from a range of health care providers across different specialties.
“Many of the calls are from specialists who are treating a patient for a specific issue and that patient also has a substance use disorder. The patient’s addiction is another factor in the mix that needs to be addressed to ensure the other treatment can take place in a meaningful way,” explained Dr. O’Donnell.
Dr. O’Donnell said having a colleague to connect with while working through a case can provide invaluable support and collaboration and a conversation can lead to better care and improved outcomes for the patient. By equipping colleagues and peers with the tools to have these conservations and informing them of available treatment in the province, O’Donnell said the goal is to find ways to meet the health care needs of the individual.
Dr. Lana Saciragic, Gynecologic Oncologist in the central zone, consulted AMCS when she was treating a patient who was newly diagnosed for gynecologic cancer and living with substance use disorder. Dr. Saciragic says this patient’s care was complicated by a number of medical factors including her substance use disorder.
“As a gynecologist, I am trained to administer opioids and various types of pain medications, but this case was outside my scope of practice and required a different approach that wasn’t taught in my training,” explained Dr. Saciragic.
Dr. Saciragic said the service provides guidance to health care providers who may be hesitant to prescribe different medications or manage symptoms with opioids for people with substance use disorder.
“It provides support and reassurance that you are helping your patient and relieving them of the symptoms they are experiencing, but not also further contributing to the issues related to the substance use disorder,” explained Dr. Saciragic. This enables patients to remain engaged and committed to their treatment and increases the likelihood of their recovery.
Dr. Saciragic said AMCS not only provided guidance related to physical and symptom management but also advised on the necessary social supports to reduce barriers to care for the patient.
From November 20-27, National Addictions Awareness Week (NAAW) will provide an opportunity for Canadians to learn about substance use disorder and treatment, recovery, and prevention. This year’s theme is titled “Community of Caring”, spotlighting on how different communities across the country are helping those in their community with issues related to substance use or who have a substance use disorder.
For Dr. O’Donnell, this year’s theme demonstrates that no one exists in isolation, and everyone is deserving of love and support. She said support across different sectors and collaboratively between health care and community organizations is a crucial part of guiding patients through hard times.
“Community of Caring” for Dr. Saciragic means treatment and health care go beyond what happens in a physician’s office and a hospital.
The AMCS can be reached Monday to Friday 8:30am to 4:30pm at 1-855-970-0234. It is available to community pharmacists as well as physicians and nurse practitioners working in Mental Health and Addictions (including Correctional Health Services), Primary Care, Emergency Departments, Long Term Care, and Acute Care in Nova Scotia.
