East Kootenay prescribes additional resources, strategies for substance use care

While the media tends to centre discussions on substance use around Vancouver’s Downtown Eastside (DTES), the public health crisis is in no way limited to Hastings & Main. The East Kootenay Division of Family Practice—along with community partners, Ktunaxa Nation, and Shuswap band—are helping to address similar concerns in their own backyard.

Started in 2022, the East Kootenay Adult Mental Health and Substance Use (AMHSU) Project engaged with Interior Health, Opioid Agonist Therapy (OAT) providers, and Indigenous partners to gain a better understanding of the need for AMHSU support.

“The majority of the work that needs to be done is essentially talking to people,” explains Dr JoyAnne Krupa, family physician and co-physician lead for the project. “It takes relationship building, and it takes identifying who the key people are in the community, supporting those people, and having that relationship established where they trust you, they’re consulting with you, and you’re doing more education.”

Jim, 33, had been living with homelessness and without income for five years since his opioid usage began interfering with his work. Growing up in a home where both parents used drugs and were in and out of prison, he was subjected to trauma, neglect, and emotional abuse. His own drug usage began at age 12.

Things worsened throughout his teenage years, going to prison for petty crime, becoming severely depressed and hopeless, and injecting opioids daily. One night, everything came to a head as he overdosed and was resuscitated in the local emergency department. Lying in his hospital bed, suffering from withdrawal symptoms, the emergency physician asked him what he wanted in life going forward, to which he replied, “I just want to be a normal person.”

“Because of the stigma that surrounds mental health and substance use, and a limited understanding of MHSU amongst primary care providers, a culture shift is needed to better support the MHSU population,” explain Dr Krup and her co-physician lead Dr Johnny Chang. “This culture shift begins with conversations and relationship building amongst care providers in the community.”

With this people-centric approach, the project set out to develop a system of care that enables better access and services to anyone seeking addiction and mental health care in the East Kootenay region.

Fast forward to 2024, outcomes of the project include:
 

• Facilitating educational opportunities for providers on the topics of harm reduction, trauma-informed care, and OAT.
• Creating a workflow resource tool to guide physicians and provide clarity around how and when to treat patients for substance use in Cranbrook.
• In partnership with Interior Health, developing a standardized process for privileging and methadone prescribing in hospitals.
• Support and advocacy for the creation of a curriculum for specialist training in psychiatry as part of family physician medical education, in partnership with UBC.

While the project, as proposed and approved by the Committee, has concluded, the team continues to refine and build on their work. They hope to submit an updated proposal to continue the work that’s already begun, including spread of their Invermere provider model, a comprehensive scan of resources and providers across all communities, and continued relationship-building with First Nations communities and partners.

Interested in learning more? Please reach out to Jacqui Van Zyl, Program Manager at East Kootenay Division of Family practice. This project was funded in part by the Shared Care Committee, one of four joint collaborative committees representing a partnership between Doctors of BC and the Government of BC.