Wednesday, May 30, 2018 • 12:45 - 14:15
Track 6 - SUBSTANCE USE AND THE ED
Track Chair: Dr. Kathryn Dong
Room: TELUS Glen 203-204

"Keep Calm and Legalize On": The Implications of Cannabis Legalization for Emergency Medicine and Public Health - Dr. Rebecca Haines-Saah

Description: The use of cannabis for medical purposes has been legal in Canada since 2001 and in 2018 the Government of Canada intends to legalize cannabis for recreational use. This presentation will provide an overview of the history and rationale for cannabis legalization and an examination of the public health framework guiding this policy change. A critical review of the current evidence on the potential impact of cannabis legalization for emergency medicine will be provided. An overview of Canada’s Lower Risk Cannabis Use Guidelines (LRCUG) will also be provided in order to guide discussions with patients in this new context of legalized cannabis.

Learning Objectives:

  1. Understand the history and rationale for the Government of Canada’s decision to undertake cannabis legalization using a “public health approach.”
  2. Critically evaluate the evidence on the potential impact of legalization for emergency medicine from Canada and other jurisdictions.
  3. Discuss the evidence of cannabis’ risks and benefits with patients in the context of both ‘medical’ and ‘recreational’ use.

Pearls:

  1. Don’t panic about prevalence, be cautious about potential harms
  2. Encourage patients to follow Canada’s Lower Risk Cannabis Use Guidelines
  3. Legalization with strict regulation should benefit public health

Biography: Dr. Haines-Saah is a health sociologist and an assistant professor in the Department of Community Health Sciences at the University of Calgary. Her research focuses on youth substance use and mental health through the lens of a critical public health approach that prioritizes harm reduction, social justice, and the lived experiences of people that use drugs and/or live with mental illness. Since joining the University of Calgary as Faculty in early 2016, she have focused much of her research program on the public health policy implications of cannabis legalization in Canada.

Harm Reduction in the Hospital: Preventing AMA Discharges and ED Bounce Backs - Dr. Kathryn Dong

Presentation slides

Description: Hospitals are high risk environments for people who use drugs.  Abstinence-only policies, inadequate pain and withdrawal management, and stigma contribute to premature discharge.  This results in repeat ED visits and increased morbidity.  Integrating a harm reduction approach into acute care settings has the potential to improve health outcomes and system efficiency.

Learning Objectives:

  1. Understand the philosophy of harm reduction and how it can be used to engage patients into care
  2. List three innovative harm reduction practices that have been implemented in an acute care setting
  3. Develop an action plan for incorporating harm reduction principles into your practice

Pearls:

  1. Hospitals are high risk environments for people who use drugs.
  2. A focus on reducing harm is evidence-based and ethical.
  3. Syringe exchange, managed alcohol programs and supervised consumption services should be integrated across the health care continuum.

Biography: Dr. Kathryn Dong is the Director of the Inner City Health and Wellness Program at the Royal Alexandra Hospital in Edmonton. She completed her Emergency Medicine training and a Masters of Population Health at the University of Alberta.  Her clinical work is as an addiction medicine physician on the Addiction Recovery and Community Health Team.

The Rapid Access Addiction Clinic: A Better Place to Be Than the ED - Dr. Mark McLean

Presentation slides

Description: A high prevalence of substance use disorders in patients of St Paul’s hospital led to development of a Fellowship in Addiction Medicine and a Rapid Access Addiction Clinic (RAAC). The RAAC opened 5 months after an opioid use disorder (OUD) Public Health Emergency was declared. In the first year, 812 new patients were seen, 420 of which had OUD not on treatment, and 182 of which had alcohol use disorder. The mandate of the RAAC is to stabilize patients on treatment, and transfer to a community provider.

Learning Objectives:

  1. Explain why locating a Rapid Access Addiction Clinic near an ED can have greater impact on population health and ED volumes
  2. List common addiction-related conditions that are better treated in an outpatient setting by a specialized multidisciplinary team
  3. Describe the value of ancillary staff to the success of a Rapid Access Addiction Clinic

Pearls:

  1. A Rapid Access Addiction Clinic should be a strategic priority for many hospitals given the high prevalence of substance use in ED patients
  2. Various ancillary staff are essential for success of a Rapid Access Addiction Clinic due to patient comorbidities and social stressors
  3. Patient flow from a RAAC to community providers requires good relationships with outpatient services receiving stabilized RAAC patients

Biography: Dr McLean is the Medical Lead of the Rapid Access Addiction Clinic at St Paul’s Hospital in Vancouver. His background is in Public Health and Preventive Medicine, and Urban Health. He has been involved in the development and operation of the St Paul’s Hospital – Goldcorp Addiction Medicine Fellowship, has co-authored the BC Centre on Substance Use Opioid Use Disorder Treatment Guidelines, and leads in the interface of Emergency Department, inpatient and outpatient addiction medicine stabilization services.