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Op-ed: Shaelynn Barry and Rachel Noel

Improve trauma training and availability of harm reduction tools, say medical students

By Shaelynn Barry and Rachel Noel

Medical students at Memorial University have a critical role in advocating for patients to receive equitable health care services in Newfoundland and Labrador.

We recognize the significant impact mental illness and substance use disorders have on the people of this province.

Underserved populations

Each year, one in five Canadians experience a mental illness, and mental illness impacts each and every Canadian.

Furthermore, up to 30 per cent of those with a mental illness will experience a substance use problem sometime in their lifetime.

These issues are exacerbated by the extremely long wait times that Newfoundlanders and Labradorians face in accessing mental health care services.

Many underserved populations disproportionately experience mental illness and addiction problems.

Indigenous populations, rural populations and people experiencing homelessness, poverty or employment insecurity are often at a greater risk for mental illness, resulting in unique challenges for providing services to and supporting these groups.

Stigma and discrimination

Substance use disorders have severe impacts on families and society, including placing extra burdens on families, impairing social function, contributing to housing instability, homelessness, criminal behaviours, incarceration and increasing transmission of infectious diseases.

Patients seeking health care services for mental health and addiction-related issues are highly stigmatized and discriminated against.

This contributes to these populations receiving lower quality health care, avoiding seeking health care and social services, and practising unsafe substance and drug use behaviours.

“Naloxone kits are not currently freely available in Newfoundland and Labrador pharmacies.”

The opioid overdose crisis in Canada has continued to worsen throughout the COVID-19 pandemic.

Specifically, just a couple of months ago, it was reported that increased opioid overdoses had been seen in the province, with this trend expected to continue.

Timely access to Naloxone saves lives by increasing overdose rescue rates and decreasing mortality.

However, a recent needs assessment in the province found that 75 per cent of people who use drugs do not carry Naloxone kits, and 22 per cent did not know where to obtain a kit.

Naloxone kits are not currently freely available in Newfoundland and Labrador pharmacies; however, research supports increasing the availability of Naloxone kits in pharmacies.

Attitudes, behaviours and knowledge

Many people living with mental illness and/or addiction experience discrimination and stigma, leading to many health disparities.

Stigma and discrimination by health care providers can act as a significant barrier for people seeking health care services.

Trauma-informed training for frontline staff has demonstrated changes in attitudes, behaviours and knowledge, leading to positive outcomes for patients.

“This issue is exacerbated by health care providers being unaware of the available services.”

Thus, we are calling on the provincial government to implement mandatory trauma-informed training and harm reduction practice to help reduce stigma and improve health care outcomes for people with mental illness and addiction.

Other barriers for accessing mental health and addiction services in Newfoundland and Labrador include accessibility and availability of services.

This issue is exacerbated by health care providers being unaware of the available services, which can lead to an inability to inform or offer potentially helpful services.

Our second ask addresses this issue.

Updating the community mapping of available health services can improve the accessibility to the province’s mental health and addiction services.

Our final ask involves increasing the accessibility to take-home Naloxone programs in the province. Naloxone saves lives by quickly reversing the effects of an opioid overdose.

Studies demonstrate that increased availability of Naloxone in communities reduces opioid overdose mortality.

Therefore increasing accessibility and availability of Naloxone will reduce opioid-related overdoses.

Many challenges are avoidable

In 2017 the direct cost of substance use in Newfoundland and Labrador was $861.51 million, with $264.43 million in direct health care costs.

This health care spending is a massive cost for the province to incur, which can be partially alleviated by increasing awareness of available health care services and decreasing opioid-related illness and mortality.

Numerous studies have confirmed that Naloxone kits are a cost-effective approach to saving lives due to opioid-related overdose, including a 2021 systematic review.

The review found that all nine included studies supporting the community distribution of Naloxone as a cost-effective, worthwhile investment for high-income countries.

Many of the challenges in accessing high-quality mental health and addiction programs and services are avoidable.

We present three clear solutions to this problem and urge policy-makers to consider the identified practical and feasible solutions.

The COVID-19 pandemic has challenged nearly all aspects of the lives of Newfoundlanders and Labradorians, and mental health has especially suffered as a result.

We have a chance to undo some of this damage and prevent further harm by increasing awareness and accessibility to critical mental health and addiction programs and services in the province.

Annually, medical students at Memorial University organize provincial days of action to bring awareness to a gap in the health-care system and advocate for change. From March 21-25, the students will meet with policy-makers to present their research and demonstrate the importance of addressing these gaps.

We’d like to thank the Provincial Day of Action Working Group, the research team, and our co-chairs, Simal Qureshi and Olivia Penney, for their diligent efforts in preparing everyone for the Provincial Days of Action this year.

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