By Greg Basky for SHRF
Opioid misuse continues to take a heavy toll on individuals, families and communities in Saskatchewan. While prescribing rates for this class of pain medications have fallen in recent years, harm and death from the drug continue to climb.
National figures from the Public Health Agency of Canada (PHAC) show that between January and March 2020, there were 1,018 suspected opiate deaths, the majority (97%) of which were unintentional. During this same period, hospitals saw 1,067 admissions for opioid-related poisoning and there were more than 4,560 suspected opioid-related overdoses. Closer to home, numbers compiled by the Saskatchewan Coroners Service show there have been 100 deaths caused by opioids since the start of 2020.*
A pair of projects funded by the Saskatchewan Health Research Foundation (SHRF) is studying different avenues for addressing the crisis. Pain researcher Dr. Susan Tupper is exploring how to prevent addiction in the first place, by improving other care options for people who live with chronic pain. And Dr. James Stempien, Provincial Head of Emergency Medicine for the Saskatchewan Health Authority (SHA) is looking at ways health care providers can improve care for patients at risk of opioid misuse, by capitalizing on their visits to Emergency for other health problems. In both projects, the researchers are talking to patients themselves to ensure their perspectives are incorporated into solutions.
Project aims to end “marathon of misery” for Saskatchewan people suffering from chronic pain
An estimated 240,000 people in Saskatchewan live in chronic pain caused by injuries, diseases such as arthritis, or primary conditions like fibromyalgia. What limited services are available are poorly coordinated and have long wait lists. Research shows that undermanaged chronic pain is a primary driver of opioid misuse.
Dr. Susan Tupper, a strategy consultant and pain researcher at the Saskatchewan Health Authority, has heard hundreds of stories of people whose lives have been destroyed by pain. “They’ve lost their livelihood, relationships, and some lose their will to live. One patient partner in our research called his decade-long search for help for pain the “marathon of misery.” A major barrier is that the health care system has been slow to recognize and treat pain in the same way it manages other common chronic conditions such as heart disease or diabetes.
With support from the Saskatchewan Health Research Foundation (SHRF) and Saskatchewan Centre for Patient Oriented Research (SCPOR), Tupper is tapping into the lived experience of people suffering from chronic pain to identify programs that will meet the unique needs of this patient population.
Personal stories shared by patient and family advisors (PFAs) at a meeting in September 2019 highlighted the need to improve access to services in the community. Working with three communities -- Saskatoon’s downtown core neighborhoods, Yorkton, and Regina’s pediatric services -- Tupper and her team will help identify the needs of residents with chronic pain, then support local working groups to create and test strategies such as pain education programs for providers, patient support groups, or gentle movement therapy classes.
Tupper would like to see community-based services developed that live on after the end of the project, and that local residents find effective in managing their pain. “I’m also hoping we create awareness of the experience of pain, throughout our province, and the importance of engaging with people living with pain, as opposed to only giving them medications, because we know that doesn’t fix the problem.”
Using machine learning to improve care for patients addicted to opioids
Many people with opioid use disorders who visit the Emergency Department (ED) are there seeking help for a different health problem. They’re experiencing stomach pain, for example, because they’re in withdrawal. Busy ED staff may not recognize that a person is addicted to opioids, and simply deal with the issue at hand. Saskatoon ED physician Dr. James Stempien thinks such encounters are a missed opportunity to help this patient population.
With support from the Saskatchewan Health Research Foundation (SHRF) and SCPOR, Stempien is conducting a project that aims to use the power of machine learning to capitalize on these interactions. “We would like that visit to be as beneficial to them as possible,” says Stempien. “How can we make sure that we recognize what they’re there for, not just their presenting problem, but their global problem?”
Doctors Stempien, Donna Goodridge, and Justin Koh will supervise virtual interviews with 30 people with opioid use disorders or family members, to gather information about their experiences visiting Emergency. The team will analyze the transcripts to identify common themes. Then with the help of University of Saskatchewan computer scientist Dr. Nate Osgood, they will test whether machine learning can be used to identify clues -- based on the themes from interview responses -- that signal a patient is at potential risk of harm from opioid use.
The potential benefits of the project are huge, says Stempien, in terms of improving care for what is currently a stigmatized patient group. Knowing which patients are at risk of harm from opioid use will enable emergency staff to better direct their care, to connect them with community supports, social workers, or addiction treatment, critical interventions for addressing the ongoing opioid epidemic. “This is an important need of our patient population that I don’t think we’ve served well up to now. Rather than ignoring them, let’s focus on seeing what we can do to give them better care.”
Tupper and Stempien both see potential solutions to the opioid crisis coming through improvements to care delivery. “We have diabetes educators, we have services that support people who have other chronic diseases, but we don’t treat chronic pain in the same way,” says Tupper. “We tend to treat it as a symptom of some underlying condition. But unfortunately for the majority of people who live with chronic pain, it is a chronic disease in and of its own right. It needs to be treated in a more sophisticated way than just medication.”
Stempien knows most opioids users are going to decline referrals for counselling or addiction services. “But they come into emergency, and we offer them sensitive care, compassionate care, the right care,” says Stempien. “And every now and then it works, and they’ll sit there and say, ‘Yeah, I’m going to give that a try.’ Sometimes we can help guide them to better lifestyle choices. And if we get the occasional victory, that’s fantastic!”
* as of October 26, 2020