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Understanding And Addressing The Complexities Of Addiction

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With harm from opioids and alcohol on the rise, Dr. Joshua Tepper takes a closer look at two programs in Ontario that prioritize integrating care to treat mental health and addictions issues.

Chances are, you've seen the recent news about the rise of fentanyl use in Canada, and even more powerful synthetic drugs. Journalists and public health experts are now using words like "epidemic" and "public emergency" to describe the increasing number of overdose deaths.

In my practice, I have seen the terrible impact addiction can have on people of all backgrounds. It destroys jobs, families and personal health, often in the span of just a few months. This level of complexity and quick-moving consequence is something you don't often see in many other conditions, which makes finding solutions that much harder.

This disconnect between what is happening, and what should be happening isn't insurmountable, despite the seeming increase in prevalence. Addressing addiction requires approaching treatment in a much more integrated fashion across different parts of the health care system and groups of providers.

Two programs with proven positive results tackle that disconnect. They operate under the premise that integrated care pathways lead to greater success in patient outcomes for those with addiction and mental health problems.

One of those programs was recently profiled in a story in The Globe and Mail. A first-of-its-kind research project, META:PHI (Mentoring, Education, and clinical Tools for Addiction: Primary Care-Hospital Integration) streamlines care provided by emergency department and hospital staff, primary care providers, and front-line community services, such as withdrawal and management centres and shelters.

If a person with an opioid or alcohol use disorder walks into a participating emergency department, META:PHI ensures they can seamlessly transition from emergency department care through to a rapid-access addiction clinic and primary care provider.

DA VINCI (Depression and Alcoholism - Validation of an Integrated Care Initiative) is another such initiative that allows people with both a major depressive disorder and alcohol dependence to more easily access person-centred, evidence-based integrated care that targets and treats both disorders concurrently instead of separately. Clinical evidence suggests a coordinated approach can lead to improved outcomes.

Both of these initiatives have received support and funding from ARTIC, the Adopting Research to Improve Care Program, which accelerates the adoption of research evidence into broader clinical practice.

ARTIC's support has allowed them to spread from single sites to multiple hospitals and associated primary care clinics across Ontario. META:PHI started in three Toronto hospitals and has now extended its reach into additional participating hospitals and primary care clinics in Ottawa, Sudbury, London, Owen Sound, Sarnia, St. Catherines and Newmarket. DA VINCI is now being implemented at eight partnering sites in Toronto, Hamilton, Ottawa and North Bay.

Both these initiatives have real potential to change our province's approach to handling addictions. As one young man, who successfully overcame his opioid addiction with the help of the META:PHI program, said in that story from the Globe, "I can see the light at the end of the tunnel."

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