COVID-19 reveals ‘stark’ disparity in public health responses
Nov 22, 2021, By: Michelle Danda
The opiate poisoning crisis is a global health epidemic that will outlast the COVID-19 crisis. The gravity of the opiate crisis was evident when the British Columbia health minister declared a public health emergency on April 15, 2016, more than five years ago. Although actions have been taken both provincially and nationally to address the increasing mortality rates of people who use substances, they pale in comparison to the speed of development and mobilization of strategies to address the COVID-19 pandemic.
As nurses, we need to ask questions about why attempts to adequately address each crisis differ so starkly (Stirley & Hoeflich, 2021). Perhaps the clearest answer is the ongoing perception that substance use is an individual choice whereby individuals assume the risk and ultimately face the consequences (Farkas, 2016). However, with research evidence showing the benefit of strategies such as harm reduction (including legalization of safe supply), the significance of the social determinants of health (such as poverty and racism) and the importance of reflecting on unconscious bias (Livingston, 2021), nurses must take a stronger role in advocating for the system changes necessary to adequately address the increasing death and ongoing stigma of people who use substances.
Dispelling myths about substance use
Nurses hold a prominent role in providing care for people who use substances. Nurses are also a population that lives with substance use issues while they are actively practising (Kunyk, 2015). Although substance use is an individual choice, it is influenced by many different contextual factors, including peer groups, age, culture, socio-economic status and health status. Substance addiction is different; it is not an individual choice but a problematic result of multiple factors, such as unaddressed or inadequately managed pain and trauma.
Perpetuating the message that substance addiction is a choice is contrary to much of the global research-based evidence. Nurses should lead advocacy and education efforts that dispel myths about safe drug supply, including the notion that it enables poor lifestyle choices. Nurses should also work to spread the knowledge that safe drug supply initiatives reduce the spread of infectious disease, prevent overdose deaths, and improve rates of recovery for illicit substance dependency.
Nurses must take a lead role in challenging the notion that all substance use is problematic and must let go of the idea that the best life is a substance-free life.
Leading system changes
Hundreds of people across B.C. of diverse ages, ethnicities, cultures and economic status are dying each month because of opiate poisoning. Downstream services such as forced treatment, recovery programs and addiction services are not enough. We need to stop shaming individuals and end “just say no” campaigns. The media is saturated with myths about substance use leading to addiction, job loss, homelessness and eventually death. Addiction might be an issue for some, but most people who use substances do not fall on this end of the spectrum. Nurses must engage in advocacy that looks beyond individual interventions to devise strategies that change the system. Systemic change involves strategies targeting policy, legislation and marketing aimed at changing people’s behaviour. Such strategies can change individual attitudes, biases and discrimination to reduce self-stigma and social isolation.
Understanding legalization and safe supply
An important focus of advocacy work is understanding legalization and safe supply. It is not a substance in itself that results in the negative consequences; instead, it is injustice in the structures in the system, such as systemic racism, ableism and sexism. Nurses must take a lead role in challenging the notion that all substance use is problematic and must let go of the idea that the best life is a substance-free life. The leap is easier to make when considering alcohol use (and more recently cannabis use). However, the same perspective must be applied to currently illegal substances, recognizing that it is not the substance in itself that causes the harms but the factors associated with illegality, such as poor quality control, a contaminated drug supply and a criminal justice approach leading to incarceration rather than a public health approach.
What can nurses do?
Nurses are trusted and knowledgeable health professionals who hold prominent roles in multiple levels of the health-care system, including direct care, executive and policy-maker positions. Organizations such as the Harm Reduction Nurses Association and the Canadian Federation of Mental Health Nurses help support Canadian nurses to learn more about specific strategies and competencies that can be integrated into day-to-day nursing practice and to promote organizational change. Nurses at all levels must not only embrace the underlying philosophy of harm reduction but also actively engage in advocacy work on substance use. Doing so will help shift public understanding of substance use — including reducing prejudices against people who use substances — and change the larger systems that perpetuate the health/illness dichotomy between being substance free and using substances.
Farkas, K. J. (2016). Substance use and abuse: Everything matters. Toronto: Canadian Scholars’ Press.
Kunyk, D. (2015). Substance use disorders among registered nurses: Prevalence, risks and perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 23(1), 54-64. doi:10.1111/jonm.12081.
Livingston, J. D. (2021). A framework for assessing structural stigma in health-care contexts for people with mental health and substance use issues. https://www.mentalhealthcommission.ca/sites/default/files/2021-05/Structural_Stigma_Assessment_Report_eng.pdf
Striley, C. W., & Hoeflich, C. C. (2021). Converging public health crises: Substance use during the coronavirus disease 2019 pandemic. Current Opinion in Psychiatry, 34(4), 325-331. doi:10.1097/YCO.0000000000000722
Michelle Danda, RN, MN, MPN, CPMHN(C), graduated from the Bachelor of Nursing Accelerated Track program at the University of Calgary in 2008. She currently lives in New Westminster, B.C. She is an informatics nurse in Vancouver, B.C., and practises mental health nursing at Lion’s Gate Hospital in North Vancouver, B.C. She has four beautiful children with her partner, who is also an informatics and mental health nurse. She is also a full-time doctoral student in the PhD Nursing program at the University of Alberta studying the history of psychiatric nurse education in B.C.