Substance use is adding significant stress to Canada’s already-strained health-care system.

More than 200 people in Canada die every day because of it and substance use also led to  13.4 billion worth of health-care costs in 2020, according to the Canadian Substance Use Cost and Harms project.

That included day surgeries, emergency department visits, inpatient hospitalizations, paramedic services, prescription drugs, physician time and specialized treatment for substance-use disorders. The most costly were physician time ($4.48 billion), prescription drugs ($4.24 billion), and inpatient hospitalizations ($3.29 billion).

These costs and their implications for the health-care system cannot continue to go unaddressed. We know they can be reduced. The federal government is starting to act, putting in place a new drugs and substance strategy. An increasing number of diverse and innovative strategies are yielding good results.

But there is no time for incremental change. Meaningful investment in further research and innovation is foundational to reducing the costs and harms of substance use, and the stress they put on the health-care system.

New approaches to substance-use care

The new drugs and substances strategy calls for equitable access to the “full continuum of care, including treatment, harm reduction and recovery options as well as other social services and supports to help people reduce their substance use and related harms.”

Several bold and innovative ideas are improving equitable access by addressing issues related to substance use in the health-care system.

A Sudbury hospital unit

Health Sciences North Hospital in Sudbury opened an addictions medicine unit in 2021, allowing patients in crisis due to alcohol-use disorder or other substance-use disorders to use substances while in care. When needed, they are given safe-injection kits with clean needles and cookers.

The unit employs a team of addiction workers, social workers, peer consultants, registered nurses and psychiatrists. It is not a treatment centre. But the nonjudgmental and stigma-free environment helps health-care providers build trust with patients. It connects them with community programs and helps get them on waiting lists for subsidized housing.

The program has prompted providers to learn about substance-use disorder and to teach nursing students about it, something not usually included in their curriculum. It’s been called a “novel and leading practice in addiction medicine” by Accreditation Canada, an internationally recognized body that assesses programs for safety and quality

The Sudbury hospital is a member of HealthCareCAN, the national voice of hospitals, health-care and health-research organizations across Canada. Several other member organizations have begun offering something called rapid access addiction medicine clinics.

Regular substance-use treatment centres generally require appointments or formal referrals. But these rapid access clinics offer walk-in consultations for treatments targeted to withdrawal from opioids, alcohol or other substances, as well as counselling and referrals to community services.

Substance-use related visits to hospitals generally result in individuals needing to stay for long periods of time for inpatient care.

But the use of hospital-based rapid access addiction clinics has succeeded in engaging and retaining patients in ongoing substance-use treatment, according to a separate 2020 report from the Canadian Centre on Substance Use and Addiction. These clinics showed a reduction in emergency department visits, repeat emergency department visits and inpatient care, all while being more cost-effective.

A Toronto supportive-housing project

Additionally, a new social medicine supportive housing project is in the works in Toronto. It is a first of its kind and will offer 51 units in a four-storey building for people who use substances, frequently use hospital services, are homeless or at risk of homelessness.

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This project is different from other subsidized social-housing initiatives in that it will address not just homelessness but also the range of services and supports that are difficult to access for the chronically homeless or people at risk.

These include housing security, food security and financial security –social determinants of health that have long-term impacts on the quality of life. The project will offer onsite services related to mental health, career development and harm reduction, and will provide connections to primary care and other health services.

It’s an initiative of the University Health Network, a HealthCareCAN member, and the Gattuso Centre for Social Medicine in partnership with the City of Toronto, United Way Greater Toronto and community partners.

Moving forward

Accurate and timely research and data are vital in supporting evidence-based decision-making and informing innovative approaches. Projects such as the Canadian Substance Use Cost and Harms build the capacity to understand the impact of harms related to substance use.

But further investment is needed to support targeted data collection among diverse and vulnerable populations to generate a clearer understanding of the societal and health implications of substance use and the unique experiences that some populations face.

Investment and innovation in substance use must not stop here. It is well-known that adverse childhood events, trauma, chronic pain and mental health conditions can increase the likelihood of poor health outcomes, including harms related to substance use.

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But what is also known is that coping skills, social inclusion, stable relationships and safe environments can serve as protective factors to promote overall health and well-being, decreasing the likelihood of experiencing harms related to substance use.

This means rethinking and focusing on prevention and harm-reduction strategies that promote the tools and resources, and establish the supports necessary, to influence the health and well-being of people.

Incorporating substance-use education and competencies in medical training for health-care providers will undoubtedly support a more comprehensive and compassionate approach to promoting health. Further standardizing indicators for monitoring and reporting of substance use across the provinces and territories will also advance and promote the health and well-being of people.

Urgent change is needed. This work cannot be done alone. It requires using a wide range of tools and partnerships and investments. Innovative and effective approaches such as the addictions medicine units, rapid access addiction medicine clinics, and supportive housing for social medicine will help transform the system to better serve both the people at risk and the health-care providers who care for them.

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Aisha Giwa
Aisha Giwa is a knowledge broker at the Canadian Centre on Substance Use and Addiction. as well as a research associate in Black and racialized people’s health at the University of Calgary.
Chandni Sondagar
Chandni Sondagar is a senior knowledge broker with the Canadian Centre on Substance Use and Addiction. She has more than 10 years of experience in public health, health promotion and knowledge mobilization. X: @ChandniSondagar
Siri Chunduri
Siri Chunduri is a policy and research analyst at HealthCareCAN with more than 10 years of experience in public health, policy and research, and consulting. X: @chunduri_siri

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