Caption: Sarah Estacaille is the North Shore’s Outreach Worker with VCH’s Overdose Outreach Team.
You’ve got to beat the dealer.
The tip from a client struggling with opioid use disorder (OUD) was not only an enlightening moment for Sarah Estacaille, the North Shore’s Outreach Worker with VCH’s Overdose Outreach Team (OOT), it led to a huge breakthrough with that client after months of hard work.
“Having conversations with her have been really profound,” Estacaille said. “She told me ‘my dealer is a really good friend of mine. He doesn’t judge me for being grumpy and dope sick. Sometimes when I don’t have money, he’ll come over and give me some dope so I don’t feel sick anymore.’”
With an understanding of the role and relationship the dealer played in her client’s life, Estacaille started adjusting her approach. It started by giving her client a ride a twice a week to HealthConnection clinic to ensure she received opioid agonist therapy (OAT) prescriptions. Estacaille worked closely with her client, prescribers and nursing to ensure she got to a therapeutic OAT dose as soon as possible to ease her withdrawal symptoms. When Estacaille learned her client suffered from PTSD and anxiety, and was sometimes incapable of leaving her home to go to the pharmacy to pick up her medication, Estacaille arranged for a pharmacist to drop off her medication so she wouldn’t miss a dose. It took several months, but her client hasn’t missed her medication and has started to participate in her care without support.
“Beating the dealer was an important frame for me,” Estacaille said. ”When I first met this client, they would miss appointments, show up just after closing and be lost to care for months. Now that she has regular access to OAT, she has the capacity to show up and self-manage her care.”
Since the introduction of the OOT on the North Shore, Estacaille has had 244 referrals and 100 active clients. None of her clients have experienced an accidental fatal overdose.
The Overdose Outreach Team, which was originally based out of Vancouver, expanded to Richmond, the North Shore, Sea to Sky corridor and Powell River in 2018. OOT serves clients who have suffered an opioid overdose or are at risk of opioid overdose. OOT services include connecting these clients to medical services, Primary Care, OAT prescribing and social services. OOT also provides Naloxone training and overdose prevention education.
Estacaille, who was the lone outreach worker until a recently added part-time social worker, was drawn to the position after seeing the opioid overdose crisis first-hand as a front-line worker on Vancouver’s DTES. Having reversed some 50 overdoses, she was motivated to make a difference, even if the situation looked bleak.
“There’s always something that can be done,” she said, adding she’s gained a greater understanding of the fundamental role medicine plays in OUD treatment. “I try to move my focus to what can be done with the tools that I have.”
The outreach efforts have not gone unnoticed. Katie Hume, Community Programs Lead, with the HealthConnection Clinic in North Vancouver, suggested Estacaille and the partnerships between the services involved in the community have saved lives.
She explained to have someone like Estacaille, who can go out and find and engage the marginalized clients outside the clinic, is critical to their work.
“Clients really connect with her because she doesn't judge and she really cares about people," Hume said.
While the need for opioid outreach may be understated due to the affluent perception of the community, the landscape and scale on the North Shore is also very different from Vancouver.
Hume explained the HealthConnect Clinic was the first place on the North Shore to start prescribing OAT and is a large part of the service offered there. She explained that resources are limited on the North Shore, adding it means everyone involved in providing care has to be more creative and flexible. At the same time, she noted having fewer options for services means that clients really get attached to the clinic and they get to forge relationships with them.
Both Hume and Estacaille agree the successes on the North Shore in quelling the opioid overdose epidemic is due to the partnerships between the different groups involved in care in the community.
The North Shore Opioid Agonist Therapy (OAT) group (Foundry North Shore, HealthConnection Clinic, Stepping Stones Concurrent Disorder Clinic) have a combined 116 clients with an Opioid Use Disorder diagnosis receiving OAT. The Group was a participant in the 2019 provincial best practices in Oral Opioid Agnonist Therapy Quality Improvement collective. The group's quality improvement goal was for 95% of clients with the disorder accessing the therapy to have active OAT prescriptions. The group hit that target in spring 2019, thanks to the collaboration by prescribers, administration and outreach. By November 2019, 100 per cent of clients had active prescriptions.