In Canada, opioids took more than 9,000 lives between January 2016 and June 2018, and killed three people per day in Ontario in 2018. Every day 17 people are sent to hospital as a result of opioid poisoning across the country.

Opioid-related harm continues to be one of Canada’s most devastating and pressing social and health-related issues and influences how physicians and dentists practise on a daily basis.

In 2018, faculty and learners across Schulich Medicine & Dentistry took the issue head-on on a number of fronts by devising new protocols, lobbying municipal government and educating the public. All in an effort to have a positive impact.

Advocacy with Impact

In February last year, a group of medical students as part of the Political Advocacy Committee at the School developed a harm-reduction pitch and began lobbying London city councillors to increase access to naloxone in city-owned facilities. Naloxone can be administered through a nasal spray and reverses opioid overdose long enough to seek medical help. The group was motivated by the fact that the rate of hospitalizations due to opioid overdose in London is one of the highest in Canada.

The idea was modelled after a similar initiative in the City of Kingston and involves including naloxone kits alongside automated external defibrillators (AEDs) in city-operated facilities.

The students began by meeting with city councillors to pitch their idea. They engaged the media and attended committee and council meetings as their idea gained steam at City Hall.

“Early on we met with a number of Councillors who were largely receptive to our idea and provided helpful feedback as well,” said Rebecca Barnfield, Medicine Class of 2020 and member of Political Advocacy Committee. “Receiving support of the council was an exciting next step.”

After City staff was tasked with looking further into the idea, Council voted to move forward with a pilot project to include naloxone in 29 city-owned facilities in London, a major accomplishment for the student-led pitch.

“Advocacy on every level is crucial as physicians. Whether it be advocating for individual patients to get the services they need, or at a municipal, provincial or federal level, we have the ability to affect change for the better,” said Jamie Riggs, Medicine Class of 2020, who was part of the pitch. “I think this experience has only encouraged those of us involved to continue advocating for better communities for our patients.”

Trystan Nault, Medicine Class of 2020 and Chair of the Political Advocacy Committee, says he feels extremely proud to see the idea come to fruition. “If the public knowledge that AED machines are stocked with naloxone results in a single life saved, that is a huge victory for both this project and harm reduction in the city at large.”

Socially Responsible Homecoming

Nault took his advocacy on the topic even further, taking part in a School-organized panel discussion on the opioids crisis as part of Homecoming activities last year. The School’s value of social responsibility and accountability was front and centre, as experts from all sides of the opioid crisis came together in front of a standing-room-only crowd to discuss this complex issue and explore ways to move forward.

“The opioid crisis continues to be one of the most serious health-related issues in today’s society, and as a medical and dental school it is part of our mission to be socially responsible leaders in the advancement of human health,” said Dr. Davy Cheng, Acting Dean. “Because this is a complex and complicated issue with multiple causations that all our alumni are faced with across the country, we felt it was vital that we come together from multiple levels to understand the issue and offer solutions.”

• “I think any time you can bring together different people that are looking at different parts of an issue is a great place to start in terms of coming up with more profound solutions.”

  Trystan Nault, Medicine Class of 2020

The panel was moderated by Kate Young, Parliamentary Secretary to the Minister of Science and Sport and MP for London West, and included perspectives from Trystan Nault as a medical student; Dr. Sharon Koivu, a family physician focused on addiction; Steven Laviolette, PhD, a professor in Anatomy and Cell Biology and neurobiologist studying addiction; Daryl Longworth, Deputy Chief, Administration, London Police Service; and Dr. Chris Mackie, Middlesex-London Health Unit’s Medical Officer of Health.

“I think any time you can bring together different people that are looking at different parts of an issue, that is a great place to start in terms of coming up with more profound solutions,” said Nault.

The panel addressed treatment for opioid addiction, the role that police play in addressing the crisis, and what science is telling us about why opioids are so addictive. The panel also took a hard look at the role that physician prescribing plays in the opioid epidemic.

A Protocol to STOP Narcotics

In an effort to address that very issue, a group of faculty and learners from Department of Surgery developed a new protocol called STOP Narcotics with the goal of reducing unnecessary opioid prescriptions, and to educate the public about proper disposal of unused drugs.

The protocol included a combination of patient and health care provider education, limited prescriptions for opioids and an emphasis on non-opioid pain control. A peer-reviewed publication looking at the efficacy of the protocol found that it reduced the overall amount of opioids being prescribed after general surgery by 50 per cent, with only 45 per cent of patients actually filling their opioid prescription while still adequately treating a patient’s post-operative pain.

With more than 45,000 outpatient surgical hernia and gallbladder procedures performed in Ontario per year, the research team says this has the potential to remove over one million opioid pills from the system.

“We recognized that before STOP Narcotics, every surgeon had a different approach to pain control, and that most surgeons were prescribing more narcotics than are actually needed,” said Dr. Ken Leslie, associate professor in the Department of Surgery and Chair/Chief of the Division of General Surgery. “When we looked at the data from this new protocol, we saw that the patient’s pain-control was just as good with this pathway, without a huge prescription for narcotics.”

The study involved patients at London Health Sciences Centre and St. Joseph’s Health Care London who underwent laparoscopic cholecystectomy or open hernia repair. The group is now expanding the protocol for applications beyond general surgery.

As health care professionals, researchers and advocates, the School community rallied together in a number of different ways to explore and address the issues surrounding opioid addiction and opioid-related harms, demonstrating the continuous effort to be socially responsible in every facet of their work.