It takes a village to kick an addiction
Posted on Wednesday, April 15, 2020
By Melanie Ratnayake
Special Guest Writer
As a respirologist at the Ottawa Hospital, Dr. Smita Pakhalé has seen all too many patients suffering through the end stages of serious lung disease.
“Most of the individuals who walk into my clinic are so severely impacted with their disease, there is not much that I can do but provide a temporary fix,” said Dr. Pakhalé, an associate professor in the uOttawa Department of Medicine and scientist in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute.
Knowing that tobacco is the most common cause of serious lung disease, Dr. Pakhalé resolved a few years ago to co-create a quit-smoking program with some of society’s most vulnerable people: people experiencing homelessness, poverty, and those using drugs.
“We need to treat humans like humans,” said Dr. Pakhalé. “By giving people opportunities, we can reduce some of the large inequities in society.”
Dr. Pakhalé’s home base for helping people quit smoking is The Bridge Engagement Centre (The Bridge), tucked away in a community centre on Donald Street in Ottawa’s Overbrook neighbourhood. More than just a community-based research centre, The Bridge acts as a second home for many of its participants, giving them a safe space to pursue interests such as art, cooking and gardening.
But with the city now in lockdown due to the COVID-19 pandemic, The Bridge, like all communal spaces, is closed.
“Vulnerable populations are feeling the brunt of this COVID-19 pandemic, much more than others, as many people do not have access to phone, internet or banking services that we all take for granted,” she said. “Some rely on internet access at the Bridge or other public places like libraries to communicate with family and friends. But now with the lockdown, that is not possible.”
“Hence, I worry about their mental health state, access to health information and food security during this time. Almost 80% of members who access the Bridge struggle with food security, with the current situation, many more are struggling.”
Before beginning work at The Bridge, Dr. Pakhalé was interviewed by the centre’s community peer researchers and community advisory committee. After being accepted by the community, she began working on The Bridge’s first project, entitled Participatory Research in Ottawa Understanding Drugs (PROUD). This project found that the smoking rate among the urban poor in Ottawa is approximately 96% — a stark contrast with the smoking rate of only 9-12% in Ottawa’s general population
This led Dr. Pakhalé and the Bridge Community Advisory Committee to co-create the PROMPT project in 2018, which provided 80 participants with free nicotine replacement therapies, in addition to a safe space, peer support, counselling, education in life skills like banking, and access to nurses. Both projects used a community-based participatory action research approach called the Ottawa Citizen Engagement and Action Model (OCEAM)
The six-month PROMPT study found that participants who stayed in the program cut their daily cigarette use from an average of 20.5 a day to 9.3. What’s more, participants also reported an 18.8 per cent decline in their use of other drugs such as heroin, oxycontin and fentanyl.
This led to a positive downstream effect where many participants either enrolled in school or went on to work.
“All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions,” says Dr. Pakhalé. “So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes.”
Now, Dr. Pakhalé is concerned the COVID-19 pandemic, and society’s efforts to contain it, will lead to negative downstream effects for society’s most vulnerable people.
“The COVID-19 pandemic has uncovered the structural inequities within our institutions, policies, and economy, leaving vulnerable populations last in line to receive support,” she said. “Common public spaces and essential social services, such as city parks, case management services, museums, and library are closed, furthering worsening existing mental health and co-morbidity issues.
“Equity informed policies and outbreak responses are needed more than ever.”
Since the original publication of this article, Dr. Pakhale has received funding from The Ottawa Hospital Foundation's COVID-19 Emergency Response Fund to study the impact of COVID-19 on vulnerable individuals.
Melanie Ratnayake is a 4th year Faculty of Medicine students in the Honours Bachelor of Science Program in Translational and Molecular Medicine. She wrote this story originally for her Science Communications course as part of a series profiling researchers at the Faculty of Medicine. The story was updated with input by Dr. Smita Pakhalé.
The course is designed and taught by Dr. Kristin Baetz, interim assistant dean, research and special projects and professor in the Department of Biochemistry, Microbiology and Immunology, to foster in students the ability to convey complex science to a lay audience – an essential skill when making presentations, applying for grants, composing abstracts for research papers and generally communicating one’s work in the biomedical sciences.
MedPoint will be publishing profiles from this series throughout 2020 .