Addiction is a public health issue: Nurses need to see it that way

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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2019/05/21/la-toxicomanie-est-une-question-de-sante-publique

May 21, 2019, By: Alison Drake

Lessons Learned

Addiction is a disease with a person at its centre.
No one is powerless to effect change, even if it is one nurse treating one person with dignity.
We all have a role to play in changing the way people with addiction are treated in our system.

Addiction is not sexy medicine. Football players don’t wear coloured cleats to raise awareness for addiction. I have never been asked to donate a dollar at the grocery store checkout to help fight addiction. I have never heard of an Addictions Cash and Cars lottery, because addiction is not sexy medicine. And yet, addiction is a disease that takes your whole life, before it ends it.

What does the opioid crisis mean to me? It means that we are in a public health crisis. Millions of people will fill opioid prescriptions every year, adding to a growing pool of opioid dependence. People—sons, daughters, parents, friends, partners—are dying. It may not be sexy, but it is very real.

I recently was privileged to interview a patient adviser, Cody, who has more than 20 years of experience battling this disease. We spent nearly three hours discussing the many ways the healthcare system has failed him (my words—he was far too generous to label it as such). He told me how the idea of seeking hospital care terrified him; how he avoided seeking care at all costs, even when he needed it most; and how being branded an “addict” changed the way he received medical attention. He told me that over many years and multiple healthcare encounters, he was rarely asked how his addiction affected his life, or whether he was aware of the treatment options that were available to him. He also told me how one of the few positive experiences he had had with the system was of a nurse who cared enough to listen to the words he spoke, advocated for appropriate symptom management, and dared to treat him as a person.

Reflecting on this experience, I thought of the many times I wasn’t like this nurse. The times at the triage desk when I decided someone else deserved the first bed more, or that a broken ankle somehow deserved less analgesic, or that withholding opioid administration in someone with an addiction wasn’t something to advocate against. Some of these attitudes show a lack of experience, understanding, and knowledge. Some were engrained in department culture. Some demonstrate stigma and ignorance. Regardless, I did not go into nursing to scare sick people away from seeking help or to make anyone feel like a burden. I got into nursing to be like that nurse. To listen to patients, to advocate for appropriate management, and to treat people as people, especially when those people are dying from their disease.

I do not know how to solve a problem as complex and multifaceted as this, but these are the things I have committed to doing for myself and for my practice:

Carry a naloxone kit. Recognize the signs of overdose. Many jurisdictions now have free access to naloxone kits. Naloxone saves lives, and I have had to use it.
Educate myself. Recently, national best practice guidelines have been released for opioid use in chronic non-cancer pain and opioid use disorder. Evidence has changed, and I want to be able to advocate for evidence-based care plans.
Change my language. I will no longer use the word “addict” to describe a person who has an addiction.
Conversations matter. I will respectfully advocate that addiction is not a personal shortcoming; it is a disease process.
Public advocacy. I will write to my MLA, provincial minister of health, and local health service providers regarding barriers to accessing care and inadequate service provision. Resource allocation will always be an issue, but it is a civic responsibility to communicate care gaps recognized on the front lines to those with decision-making power.

Whether addiction is sexy or not, I want to be a part of the solution for this public health crisis. What are you going to do?