NUR1 421 Lecture Notes - Lecture 5: Opioid Overdose, Opioid Use Disorder, Opioid Epidemic
11 Jun 2018
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Department
Course
Professor
NUR1 421 – RESOURCES: SPECIAL POPULATIONS
Lesson 5 ~ February 9th, 2018
ANNOUNCEMENTS
- Final exam schedule out
o NUR1 421 Exam on April 23rd, 9:00AM
- Midterm take-home paper to be posted next week
- Next week’s topic is LGBTQ health
o Two guest speakers
o Only reading is textbook chapter
o Two videos posted on MyCourses
o Theme: are you an ally
o Recommend reflecting on questions in textbook about gender identity to explore one’s own
individual thoughts, biases and perspectives
- Mini Assignment due Monday
o To be completed in groups
POWERPOINT – DRUG USE AND HARM REDUCTION
- Image of park
o Carre Saint Louis/Saint-Louis Square
o Beside Sherbrook Metro!
- Professor Miller would bike past this square early in the
morning when she first moved to Montreal
o Observe people injecting/sniffing/smoking drugs
- She later started working at Info Santé as a nurse
o Learnt all the drug names
o Anonymous line
o Increased her knowledge and understanding about
drug use and effects
- A few years ago, she passed by the park again
o Saw a person unconscious
o Recognized that he was in an overdose
o At that time did not have Narcan (opioid overdose treatment)
o When tried to call an ambulance, realized she did not know the name of the park or the cross-
streets
o Had only labelled it in her head as the “druggie park”
- Addictions and drug use affects a huge part of the population
o Example: Current “opioid crisis”
- Article in weekly readings
o Focus is on making nurses reflect on how there are stigmatizing others, and instead look at the
problem from a different point of view
- This class will aim at trying to “reframe” individuals who use drugs, reflect on the words we use, and
challenge each person within that
- History of Carre Saint Louis
o Rich artistic history
o Émile Nelligan and Michel Tremblay were frequent visitors
o Now park is filled with drugs
§ ALSO people trying to build community
§ Playing guitars, gathering together
o By labelling as a “druggie park” miss out on the other aspects
o Same thing happens when label people as just “drug users”, “druggies”, etc.
- Substance Use is a complex public health issue
o Many costs involved
o Interconnected with intimate partner violence
o Substance use is a risk factor for many other issues
o Focusing today on harm reduction
o Starting substance-use early is a risk factor for later life
o Textbook highlights that concurrent issues / disorders are very prevalent in people who have
addictions
§ Example: mental health
o Multifactorial
o Idea of “othering” is a dangerous path
o We are ALL at risk
§ Even nurses à article in OIIQ about nurse with an opioid addiction
- Things are a’changing
o News and policies in Canada are changing
o Why this change?
- 978 Deaths in British Columbia alone in 2016
o Finally recognizing that we do have a crisis
- Map of Canada from 2017
o Shows that there were over 3000 deaths in Canada for that year
- BC Data and rates
o Graph shows illicit drug overdose deaths and death rate for the population
o Evidence that drugs have always been with us
o However, dramatic increase in recent years
- Harm Reduction
o “A pragmatic public health approach aimed at reducing the adverse health, social and economic
consequences of at-risk activities” (CNA, 2012)
o Value neutral
§ Not coming in with judgement
o Respect, dignity, and compassion regardless of at-risk behaviours
§ Nurses sometimes come in as moralists
§ Our role is not to judge
§ Instead, about recognizing risks involved and acting to diminish those risks
- Principles of Harm Reduction
o Pragmatism
§ It is a human/cultural phenomenon to ingest non-medical, often psychoactive substances
§ If really self-reflect see that every person has a pattern in using substances
• Example: Alcohol, coffee
§ Drug users are using drugs as a means to cope
§ Recognize that encompasses a slew of behaviour from abstinence to over-use
o Evidence-Based
o Cost-Effective
§ Safe injection sites actually decrease long term costs associated with harm reduction
• Even if need to heavily invest in these sites at the beginning
o Immediacy of goals:
§ Establishes a hierarchy of achievable steps that, when taken one at a time, leads to a
healthier life
§ Example: If you tell a student that they need to stop coffee and start exercising right away
• Student will probably fail
§ Keep the immediate focus on the most pressing needs
§ Harm Reduction focuses on incremental steps
§ Recognizes where the person is at now, what the risks/harms are, and how we can reduce
these
• Instead of just telling people to “stop drugs now”
§ Facilitates a trusting relationship
§ Eventually there is the potential of taking steps to stop drug use completely
o Human rights
§ Respect rights and dignity of people who use drugs
§ Often, we just want to eliminate the drug
§ Supreme court recognized that preventing access violates the constitutional rights of
individuals who use drugs
o Participation in policy and program development
§ Health care workers (HCW) did not invent these policies/programs
§ Drug users themselves are involved in program and policy development
§ Role as HCW is to participate and not take over
• Taking over can alienate drug users
§ By participating, drug users are empowered to make choices and change their lives
§ Can join service providers to reduce risks
o Challenges policies/programs that maximize harm
§ Advocacy
- Advocacy, Nurses, Harm Reduction, Politics
o Nurses in Canada have and should be continuing to lobby the government
o Huge part of harm reduction in government policies and program development
o Need changes to make harm reduction a significant part of government policies
§ Also to ensure that HCW giving harm reduction intervention will not be at risk of fault
- Infographic from British Columbia (2013)
o Can see that from 2013, times are changing fast
o Examples of harm reduction actions:
§ Distributing condoms
§ Distributing Clean Needles
§ Distributing Narcan
• Emergency treatment for opioid overdose
• Given out in pharmacies
• Often seen as a little red purse (holding supplies) that women can carry
o Result of harm reduction actions
§ 78% decrease in new reported cases of HIV among people who inject drugs
§ Demonstrates how a safe space can reduce risks
- CATIE
o Canada’s Source for HIV and Hepatitis C information
o There are many risks of sharing crack pipes
§ Many are made from glass
§ If broken can cause lesions, infections, etc.
§ Increases risk of HIV and Hepatitis C transmission
o CATIE is great resource for prevention and safer crack smoking
§ Very participatory and anti-oppression
- Vulnerabilities for Initiating Drug Use
o Access and experimentation at a young age does increase risk for further drug use
o There are factors at the individual, family, school/peers and neighbourhood/community levels at
each age of development
§ Also genetic predispositions
o Examples:
§ Childhood exposure to alcohol
Document Summary
Final exam schedule out: nur1 421 exam on april 23rd, 9:00am. Midterm take-home paper to be posted next week. Mini assignment due monday: to be completed in groups. Image of park: carre saint louis/saint-louis square, beside sherbrook metro. Professor miller would bike past this square early in the morning when she first moved to montreal: observe people injecting/sniffing/smoking drugs. She later started working at info sant as a nurse: learnt all the drug names, anonymous line, increased her knowledge and understanding about drug use and effects. Addictions and drug use affects a huge part of the population: example: current opioid crisis . Article in weekly readings: focus is on making nurses reflect on how there are stigmatizing others, and instead look at the problem from a different point of view. This class will aim at trying to reframe individuals who use drugs, reflect on the words we use, and challenge each person within that.
