In this spotlight on a BC ECHO on Substance Use presenter, we meet Kristine Rowswell, a nurse practitioner working with a focus on HIV, hepatitis and addictions in British Columbia’s northern region. Kristine shared a case presentation for the ECHO’s first cycle of sessions focussed on Opioid Use Disorder, which took place virtually from June to December 2019.

Here, Kristine tells us about her work and what the BC ECHO on Substance Use brings to her practice in BC’s North.

Please tell us a little about your work in addiction care.

I’m a nurse practitioner in Prince George, in northern British Columbia. I work with people living with, and at risk for, HIV and hepatitis C – a population amongst which injection drug use and opioid use is common. If folks in the Northern Health Authority region fit that profile, my team and I might become involved in their care if they self-refer or are referred by a healthcare professional or community agency.

For many of our clients, opioid agonist therapy (OAT) makes sense, but it is sometimes a challenge to make sure they can get it. In lots of remote northern locations, patients might be a 40-minute drive or more away from a pharmacy, making frequent pharmacy trips difficult or impossible. It’s also hard to manage complex cases when you can’t be physically present with the person, so you have to get creative: you might find a health worker in the community to be your contact person and to do home visits with the client, for example, or take advantage of technologies like telehealth.

What motivated you to take part in the BC ECHO on Substance Use program?

Addiction care in the North isn’t quite as established as it is in other parts of the province, and so often we face challenges related to limited resources, geography, weather, and so on. When I have difficult cases, I often want to run things by an expert to make sure what I’m doing is likely to be effective, patient-centred, and safe. In situations like this, I use the Rapid Access to Consultative Expertise (RACE) line for complex substance use disorder (SUD) cases. Participating in the BC ECHO on Substance Use program seemed like a natural extension of that – a way of tapping into the amazing pool of expertise on SUD across the province.

How have you been able to incorporate the ECHO program into your practice?

During one of the early sessions in this cycle, I presented on a particularly challenging anonymized case. It was so helpful to be able to talk it over with experts from different parts of the province. Especially in the North, nurse practitioners are often practicing in isolation. When you have a complex patient, you can feel uncomfortable if you’re not sure what the right thing is to do. Hearing other practitioners talk about cases and give advice really increases your comfort level. It makes you feel like you’re not alone; it reminds you that there are other health practitioners coming up against the same challenges, and finding solutions.

Any other thoughts on the program?

Here in the North of British Columbia, I think some healthcare workers, as well as some members of the general population, are wary of the idea that we should give people with substance use disorder another substance to treat that disorder. Despite the overwhelming body of evidence that supports the benefits of OAT, there is still a stigma around addiction and being on OAT. I think that the content we learn in the BC ECHO on Substance Use can help to combat stigma present within the health care system, normalize that OAT is almost always first-line treatment, and demonstrate to healthcare workers that it’s possible to incorporate care for SUD into their practice.

Thanks Kristine! 

The BC ECHO on Substance Use (Opioid Use Disorder) is a virtual continuing education program that aims to help primary care providers and their teams build capacity in the treatment and management of opioid use disorder.

Through interactive, online, case-based presentations, health care providers enhance competencies and learn through real-world examples, how to incorporate evidence-based practices into their care setting, to improve outcomes for clients and families.

To learn more about the BC ECHO on Substance Use and Project ECHO, visit the website.