North America is facing a full-blown opioid crisis. These prescription medications used to be the gold standard for treating any kind of pain. They would be prescribed for everything from recovery from invasive surgeries to a patient complaining back of pain at a walk-in clinic. At the time no one knew how risky these medications really were, and a decade and a half of overprescription has led to a public health emergency of opioid addiction and overdose. Every day, approximately eight people in Canada and more than 100 people in the United States die from opioid overdoses. Vancouver, British Columbia has become the Canadian epicentre of both opioid abuse and addiction research. It’s also home to Pauline Voon, a PhD student in population and public health at the University of British Columbia who studies people with pain and addiction.
Pauline is a Registered Nurse by training who has always had an interest in social justice issues and working with marginalized populations. She specialized in HIV and did her practicum at a hospital in Vancouver with one of the only in-patient HIV units in the world. After working there for four years and at some community clinics specializing in HIV, she became a research nurse for a study on a cohort of people living with HIV and of people that use illicit drugs but weren’t HIV positive. Her interest in research, education, and policy led her to graduate school where she started a Master’s before quickly transferring to a PhD. At the same time, her research interests transitioned from HIV to addiction and pain.
For her PhD, Pauline looks at people with both pain and addiction who have been cut off from their prescription opioids. Curbing prescription practices has become an increasingly common “solution” to the opioid crisis, and patients with a history of addiction are more likely to be denied prescription opioids. While in theory this prevents people from accessing highly addictive medications, in practice it leaves these patients with no alternative way to manage their chronic pain. Pauline studies pain management in one of the longest-running cohorts of drug users in the world, the same cohort she worked with as a research nurse. Over 2,000 participants come in every six months for a check-up. They are asked several questions about their drug use behaviours, have their blood taken, and answer a pain questionnaire. Pauline’s study found that many people who had been denied pain medication by their doctor turned to heroin for pain relief or bought medication off the street.
This study highlights the need to improve pain management options for people who are denied opioids from their doctors. Harm reduction is one option that Pauline thinks could help. Vancouver is home to North America’s first legal supervised injection clinic, with several more opening this year. Rather than try to stop addicts from using drugs, these clinics offer drug users clean needles and a safe environment to inject their own drugs under the supervision of clinicians. This saves the Canadian health care system a lot of money by preventing and responding to overdoses before the individual ends up in the emergency room. The same principle could be applied to people with opioid addiction. They could take safer pain medications or treatments for opioid addiction under the supervision of a clinician (to prevent overdose) rather than being cut off completely from their prescription medication.
British Columbia has declared a public health emergency in response to the opioid overdoses crisis, and Pauline’s has used her expertise to help shape new policies to combat prescription drug abuse. She was the lead writer of new treatment guidelines for people with opioid use disorder (the clinical term for opioid-related addiction). “They started off being just guidelines for our local health authorities, and then they transitioned to being our provincial guidelines and now they’re on the way to become national guidelines for all of Canada,” Pauline explained. “It’s been one of my proudest moments.” She also wrote an opinion piece in the Globe and Mail urging Canada to take a national approach to dealing with the opioid crisis.
The number of deaths from opioid overdoses in Canada continues to grow and hearing these stories day after day further motivates Pauline and her peers to keep working towards solutions. “Being in an environment like this where the work we do is really being put into action for some of Canada’s most marginalized populations is what helps keep me going.”