Changing attitudes toward opioid addictions
Greater empathy for Adverse Childhood Experiences is helping KHSC’s Medicine program provide safe, judgment-free care
Two years ago, Kingston Health Sciences Centre’s (KHSC) medicine program experienced a significant spike in the number of people admitted to its Kingston General Hospital (KGH) site with conditions related to opioid addiction. “We were overwhelmed, not only by the numbers, but also by not knowing how to provide the best possible patient-centred care to these vulnerable members of our community, their friends and families,” says Vici Del-Mei, Medicine Program Manager.
“We quickly realized we needed to seek guidance from experts in the community, and we found that expertise at Kingston Community Health Centres’ Street Health,” added Del-Mei.
Awareness of the significance of childhood adversity in addictions and mental health stared to increase in the medicine program after members of the team welcomed Street Health’s Dr. Meredith MacKenzie to the KGH site to help staff better understand how Adverse Childhood Experiences (ACEs) are strong determinants of health and social well being throughout a person’s lifetime. Team members also visited Street Health to learn more about the people they serve, including the illicit drug paraphernalia they use.
Del-Mei says it was important for staff to learn from Dr. MacKenzie that chronic toxic stress as a result of having multiple ACEs related to abuse, neglect and household dysfunction can negatively change a young person’s developing brain and body and make them more vulnerable. They also learned that the more ACEs people have, the higher risk they have of developing ill health, such as drug and alcohol use, depression, heart disease, obesity, cancer and lung disease.
Dr. MacKenzie says that, “when you get to know your patients’ early experiences and the changes that occur in the brain, the conversation shifts from ‘What is wrong with you?’ to ‘What has happened to you?’ and ‘What is it like to live where you live?’”
Over the past two years, conversations have shifted during morning huddles, when health care providers get together to discuss the day’s work. Now, when a patient returns to the hospital, staff members recognize their names and suggest where the patient should be cared for based on the care team that knows them best.
“This change in culture definitely makes for a more positive working environment, and a more accepting, understanding environment for our patients,” says Alyson Lazier, Charge Nurse on Connell 10. “I hope our patients can feel the change, and feel this is a safe, judgement-free place where they can receive care.”
Meghan Boers, a Registered Practical Nurse on Connell 9, has cultivated more open and honest communication with her patients saying, “I want them to feel comfortable telling me when they are leaving the floor, when they plan on returning, and what drugs, if any, they’ve taken while they were out. That way, I can provide the best possible, safest care while they are with us in the hospital.”
Being more trauma-informed has enabled staff like Lazier and Boers to think of patients as whole persons, to not only think about their illness or disease. “Recognizing the challenges people may have had to bring them to this point in their lives has given me more empathy and patience,” says Lazier.
“Adverse Childhood Experiences do not have to be life sentences, and by partnering together we have a hope of preventing and mitigating their outcomes,” says Dr. MacKenzie.