A better path towards supporting patients with addiction and substance use disorder

Dr. Joshua Tepper
Dr. Joshua Tepper, President and CEO, North York General Hospital

Last year in Ontario opioid use was associated with more than 9,000 emergency department visits, 2,100 hospitalizations and almost 1,500 deaths. It has been called a crisis by experts in numerous countries and despite substantial efforts the death rate continues to shock. I am finding it harder and harder to find people who have not been affected directly or indirectly by this issue.

The cause of the opioid crisis is complex and multi-factorial. The solutions need to be equally sophisticated and comprehensive. I am proud to say that at North York General Hospital (NYGH) we have taken the issue seriously and been part of adopting, inventing and advancing solutions. I want to share just two examples of our contributions to help solve this crisis:

First, is the recently opened Rapid Access Addiction Medicine (RAAM) clinic at North York General. This is one of several across the province. It offers quick access to those seeking care for problematic use of substances such as alcohol, opioids and problematic behaviours such as gambling. The clinic operates on a drop-in basis and is open to anyone who needs help – a low barrier access option which is often vital those who struggle with their substance use. People can be referred to the clinic from the ED, inpatient units, primary care or patients can self-refer. I have had several patients repeatedly overdose, have permanent injury and in some cases die.

The RAAM Clinic is interprofessional and patient-centred in its approach to care. Dr. Caryn Green, a NYGH family physician who serves at the clinic, recently told The Pulse that a patient-centred lens allows her to collaborate with patients to try to meet their goals. Dr. Green, strives to “provide a safe therapeutic space for my patients, and offer them evidence-based treatments appropriate to their goals and stage of recovery.”

The RAAM clinic is a partnership between Addiction Services for York Region(ASYR). ASYR is a partner in the North York Ontario Health Partners Ontario Health Team along with NYGH. The RAAM clinic is a key component of our first year of work in the Ontario Health Team where we hope to increase access to the model.

While the RAAM clinic helps those who have developed dependency and addiction, prevention is another important approach to this public health crisis. Studies have shown that unused prescription opioids often find their way into the hands of teenagers and people with addiction issues. According to the Centre for Addiction and Mental Health “more than two-thirds of students (67%) using opioid painkillers non-medically reported getting the medication from home.”

This statistic sparked the concern of Dr. Sanjho Srikandarajah, a NYGH anesthesiologist, who received a NYGH Exploration Fund grant to collaborate with members of the Pharmacy team and Department of Surgery to delve deeper into this issue.

Dr. Srikandarajah conducted a three-month study to look at how many opioids patients were prescribed after surgery were actually used. The results showed that the vast majority of patients took only a fraction of the pain medication they were prescribed or none at all. The research also revealed most people are not familiar with how to safely store prescription opioids or dispose of unused medication.

In a recent article in The Pulse, Dr. Srikandarajah noted “we realized that thousands of unused pills had been prescribed within these three months alone and that many of these opioids were probably still circulating in the community – potentially contributing to accidental harm or misuse.”

Following the study results, NYGH took a series of steps to reduce the number of opioids prescribed to day surgery patients by almost 50%.We now have a new standardized electronic prescription, which provides just 10 tablets of opioid medication, down from 20-30 tablets, without impacting patient satisfaction scores with their pain levels. In addition, patient education material has been developed, in partnership with the Institute for Safe Medication Practices, to ensure they are aware of the need to store pain medication securely out of reach of minors and that they can return left over pills to a pharmacy when they no longer need it.

We've also been actively sharing all of this work with other hospitals and provided our insights to Health Quality Ontario's Cut the Count campaign. Today, there are 47 hospitals in the province participating in the campaign, where almost 80% of surgeries in Ontario take place. The potential impact on the supply of opioids across the province is significant.

I want to thank our staff and physicians who are committed to working to research, prevent and treat substance abuse. The type of work we are doing makes a difference and we will continue to do even more to address this crisis. If you or someone you know is struggling with addiction and substance use disorder, please seek the support of your health care team including the RAAM clinic which takes walk-in appointments.


Joshua Tepper
President and CEO

October 17, 2019