And, since then, PHSA has taken over health care in provincial correctional centres, meaning provincially incarcerated people no longer have to wait to start opioid agonist treatment (OAT) to help relieve the symptoms of opioid withdrawal.
Opioid agonist treatment is an important part of addiction treatment for many clients and patients in which medications like Suboxone or methadone are used to help people manage withdrawal systems and reduce harm related to the drug use. It also helps people stay in recovery. In the past, clients would have to wait weeks or even months to begin this type of treatment. Now they can begin immediately.
In April of this year, Wendy Gibson signed on for a new role: opioid agonist therapy nurse. She now works in conjunction with other members of the mental health team to ensure clients get the help they need to manage their opioid use disorder — even if they’re only at Alouette for a day or two.
In this new role, Gibson administers injections, consults with clients who want to either begin or stop OAT, and ensures clients can stay on their treatment after discharge. This might mean helping them connect with a pharmacy where they can fill a prescription, or with a physician who can write them a prescription and monitor their treatment closely.
“It’s all about removing barriers,” said Gibson. “If you have been incarcerated for a couple of months, being discharged can be terrifying.
“It’s all about removing barriers. If you have been incarcerated for a couple of months, being discharged can be terrifying."
"Finding an OAT clinic can be intimidating and pose enough yet another barrier for clients, who have enough to worry about with finding housing and work. We want to help ensure they continue to get the care they need to get well.”
Studies have shown that people are at higher risk of overdose soon after release from custody — “up to 12 times more in one Canadian study,” said Dr. Nader Sharifi, the medical director for Correctional Health Services. “We have to make safer release plans. Helping clients stay on their treatment is a vital part of helping them stay alive and navigate their path to recovery.”
Wendy has been part of an exciting pilot project at Alouette that is offering an additional OAT medication option: Sublocade, a long-acting injectable version of Suboxone.
Suboxone and methadone are two of the most common opioid agonist medications. Both are taken by mouth daily, which means that clients taking Suboxone or methadone who don’t have privileges for carrying medication need to visit a pharmacy every day for their dose. This can create barriers for people who have to travel a long way to a pharmacy or for someone who might struggle to find time for a daily pharmacy visit because of work, childcare or other challenges. The COVID-19 pandemic further exacerbates these barriers.
Now however, Sublocade is providing an alternative. This newer medication is a gel that is injected under the skin and released slowly, over the course of a few weeks. Clients visit a doctor or nurse for an injection just once a month.
“In addition to not having to take medication every day, they feel more comfortable because they’re not having that spike and drop with their cravings.”
The benefits aren’t limited to how it’s administered.
“When a medication is taken orally, the amount of medication in a patient’s system can spike and drop depending on how the patient’s body processes it,” said Sharifi. “This can have an effect on cravings. Sublocade is absorbed evenly into a patient’s tissue. This means the amount of medication in the system is more constant, which can help prevent those cravings for an opioid.”
“People have been really happy with the results,” said Gibson. “In addition to not having to take medication every day, they feel more comfortable because they’re not having that spike and drop with their cravings.”
The Sublocade pilot and eliminating waiting lists for opioid agonist treatment are only two of the steps that Correctional Health Services has taken to help increase access to the treatment and keep people from overdosing.
Wendy’s position, OAT nurse, is new since PHSA assumed responsibility for care in correctional health facilities in 2017. PHSA has also created several other positions to help people in custody stay in recovery:
- Access and transition nurses help clients prepare to care for their health after release while a mental health
- Substance use nurse works with community health care facilities to help ensure that Correctional Health Services teams have adequate medical histories for clients
- OAT physicians, based out of the Forensic Regional Community Clinics, can help support clients with prescriptions until they can connect with a community provider.
- Community transition teams, based in the community, which support clients who have opioid use disorder after their release to help them stay on their treatment and in recovery.
“We know that people in custody are more likely to have an addiction, and that it’s extremely common for people with addiction to also have a mental illness. Often times, one exacerbates the other,” said Sharifi. “This is called a concurrent disorder. People with concurrent disorders are much more likely to get well and stay well if we approach them holistically and treat every aspect of their illness. Opioid agonist treatment is just one tool.”
Correctional Health Services clients also receive psychosocial treatment, including counselling from clinicians who are trained in concurrent disorders, and access to evidence-based concurrent disorders programs such as Seeking Safety and the Matrix Model.
Learn more about Correctional Health Services on our website.