1. Community Opioid Addiction Program Tara McIntyre, Addiction/Mental Health Counsellor Megan Neill, Coordinator/Trainer of Specialized Programs

2. Principles of COAP Program Overview Improve health and social outcomes and quality of life for people living with opioid addictions Priority populations include: People living with HIV/AIDS and/or Hepatitis C Women who are pregnant and/or parenting Youth (12+) Increase access to opioid addiction treatment and primary health care Improve linkages between community programs Reduce involvement with criminal justice system

3. Community Opioid Addiction Program (COAP) Direct Client Services Screening, assessment, treatment planning, counselling, and case management Ability to meet in the community (e.g. health care centres, Methadone and Suboxone clinics, hospitals, shelters) Community Education Services Increase knowledge and awareness about opioid addiction and Opioid Substitution Therapies (OST) Presentations, educational events, consultation services

4. Individual Counselling: Common Themes First exposure to opioids often obtained through legal prescription from physician Prescription discontinued due to misuse Opioid use for pain management purposes Continued use to manage and/or avoid withdrawal symptoms Prescribed OST but supplementing with illegal opioids to avoid an increase in dosage Readiness to taper off OST Not fully aware of all treatment options and potential impacts and/or side effects of OST

5. Unique Needs of the Population Stigma of OST What is abstaining? Is OST treatment considered an addiction? Chronic Pain Narcotics Anonymous Side effects and how to manage Advocacy with doctors and pharmacists Women Specific Services Not enough research for women’s issues (e.g. OST effects on women, estrogen levels)

6. Two Groups: To Meet the Needs OST Information Session Address the lack of knowledge about Methadone/ Suboxone Provide treatment alternatives Empower individuals to make informed decisions OST Support Group Evidenced-based practice that OST combined with counselling is important for a successful recovery Group members in various stages of change Shared experiences and common themes

7. OST Information Session Educational group for people contemplating OST and/or on OST, family members, and service providers

8. OST Information Session Outline of the group: Information about Opioids What is Opioid Substitution Therapy? Benefits and Drawbacks Things to Consider with OST Mixing OST with Other Substances Overdose Resources

9. OST Info Session: Successes Creating a safe space to address questions and concerns about OST Un-biased presentation Allows individuals to make informed treatment choice/decision Building capacity of service providers Providing well-researched information from the MMT guidelines and CPSO Resolve ambivalence

10. OST Info Session: Challenges Lots of information to cover in a short period of time Attendance issues – not reaching the populations who would benefit from this material Taking it “on the road”!

11. OST Info Session: Feedback From clients: Information presented has been useful in helping them make a decision to start OST Information has helped them feel confident in their decision to choose OST as a treatment option From family members: More likely to suggest OST to someone Consider OST if unable to go “cold turkey” from opioids From service providers: Information presented will help them better support their clients on OST Feel better informed about OST and where clients can access these treatments

12. OST Support Group 10 week psycho- educational & support group for people on OST

13. OST Support Group Topics 1. OST and Me 2. Strength Through Stigma 3. Personalizing Your Treatment 4. Lifestyle and OST 5. OST Side Effects 6. Pain Management and Types of Pain 7. Safe Coping Skills 8. Working with Worries 9. Healthy Relationships 10. Beyond OST: Progressing Through Recovery

14. OST Support Group: Benefits Unique: No other similar groups Specialized focus results in high affinity Safe, non-judgemental, supportive environment Variety of participants on methadone and Suboxone and in various stages of change Share what works and what does not work about OST Helps reduce stigma of OST Group facilitators at the Suboxone clinic – wrap around and client engagement

15. OST Support Group: Challenges Challenges: Group dynamics Stigma conversations and over-generalizations Remind participants it is not a race to get off OST – can stall progression in treatment Areas to Improve: Increased referrals to OST information session Offer more women-specific information, especially around side effects More visual aids (e.g. videos) Promoting/informing patients at the clinics

16. COAP Clinic Collaborations Through service delivery partnership, increase capacity for : client engagement and retention for both ADSTV and OST clinics ease of access to OST meeting individual client needs consultation between ADSTV and OST/health care providers in our community being responsive to the relapsing nature of opioid/substance use

17. COAP Clinic Collaborations Thomas Street Treatment Clinic, Strathroy, ON Located in rural SW Ontario Serves Strathroy and surrounding area Serves 60 patients Must be a clinic patient to access counselling onsite Two physicians, Two administrative staff Dr. Lee Suboxone Clinic, London, ON Located at CMHA and operates out of same location as medical clinic Serves London population Serves 24 patients and increasing Must be a clinic patient to access counsellors onsite One physician, one admin staff

18. COAP Clinic Collaborations: Service Profile Thomas Street Treatment Clinic, Strathroy, ON One counsellor, onsite twice a week Clients required to meet with COAP counsellor at least once Full individual community treatment services onsite COAP Staff does not perform clinic duties Dr. Lee Suboxone Clinic, London, ON 2 counsellors, onsite once a week Clients required to meet with COAP counsellor at least once Limited individual community treatment onsite, depending on availability COAP staff perform clinic duties: intake, screening and urine drug screening (UDS)

19. Questions/Comments/Discussion