Learning to save a life

When fourth-year nursing student Toby Stevens-Guille first received naloxone training during a clinical placement at St. Michael’s Homes, an addictions treatment centre in Toronto, he was immediately struck by its importance for saving lives.

Naloxone is a medication that can temporarily reverse the effects of an opioid overdose. According to Toronto Public Health (external link) , there were 308 opioid overdose deaths in Toronto in 2017, which represents a 125 per cent increase from 2015.

“I realized naloxone had recently become free, and you can get kits at pharmacies. I was interested in bringing that into the nursing program, given it’s even simpler than CPR but can be just as life-saving,” Stevens-Guille says.

Stevens-Guille has close relationships with people who use opioids — many of whom began using after being prescribed opioid medications. At St. Michael’s Homes, he worked directly with recovering opioid users and gave lectures to residents on topics relating to addiction.

These experiences have given Stevens-Guille a firsthand look at the realities of drug use — and a chance to refute some of the myths. “I think a lot of people are under the idea that opioid users are bad, scary drug dealers or drug users who are homeless and...picked up heroin. While that certainly doesn’t make them any less worthy of treatment or help — I am also aware of the fact that this isn’t the case for a large amount of people.”

While Stevens-Guille was initially unsure of how to go about bringing naloxone training into the nursing program, he found an opportunity to get other students on board while completing a group “change project” for a nursing leadership class.

With the help of his group members (Casey Wong, Denzel Alabado, Hilary Tang, Michelle Aclan and Tiffany Louie), Stevens-Guille was put in touch with Corinne Hart, an associate professor at the Daphne Cockwell School of Nursing, who teaches classes in community nursing theory and practice.

Hart was thrilled. “I had wanted to do something like this. I had thought about it as it fits tightly with the [community nursing] course that I teach. I just didn’t know how to do it. It was a no-brainer.”

Stevens-Guille then connected Hart with Samim Hasham, the pharmacist who delivered the training he received at St. Michael’s Homes. Hasham is the director of professional services at Urbancare Pharmacy, a consultant at CMHA Peel, Rapid Access Addiction Clinic and the owner of Morrish Pharmacy.

“I was all in,” says Hasham. “We all have a role to play on the frontline of this fight against opioid overdoses.”

Together, they put the idea into action. As an initial pilot project, Stevens-Guille, Hart, Hasham and a team of volunteers brought the training to Hart’s community nursing theory class in April 2017. In September 2018, they expanded the scope of the training even further to include the entire third-year nursing class of 470 students.

These sessions represent the first time naloxone training has been offered as part of the Ryerson nursing program.

“I am not sure if other universities are even thinking or doing anything about [naloxone training]. At least they weren’t at the time,” says Hasham. “Ryerson is a trailblazer in this story. It was the first university that even approached me about [the training].”

Hasham’s training goes far beyond the basics of administering naloxone to examine the complexities of opioid use and addiction. Using public health statistics, Hasham takes students through the history and politics of the opioid overdose crisis to explore how we got here and what we can do to help.

How did we get here? “When pharmaceutical companies started to pull out of the market because of concerns about over-prescription...the illegal market responded with a more concentrated form of opioid — which is fentanyl. Fentanyl is very deadly, because you only need a very small quantity in order to overdose,” says Kim Bailey, director of outreach, community engagement and partnership development at the Faculty of Community Services.

Hasham received overwhelmingly positive feedback from students. “After the training, I had over 90 per cent [of students] come up to me and say ‘thank you so much, I learned so much,’ or they shared a story about somebody they might have known that suffered an opioid overdose or witnessed an opioid overdose,” Hasham says. “They [left the training] saying ‘at least now I can have a conversation around it. I can talk to my friends about it. I know so much more.’”

Naloxone training is especially relevant to third-year nursing students, Hart says. As part of their third-year clinical placements, students work directly with clients in community-oriented settings.

“A lot of the students are in placements where they’re working with vulnerable people and they may actually...have something to do with people taking drugs, or people on the street, or people needing naloxone — and this gives them one added tool,” she says.

When Ryerson nursing students graduate, many of them will go on to work in the community or in hospitals, adds Hasham. “Nurses are part of the engagement of providing care to people who use drugs — stigma-free, barrier-free and judgment-free.”

Harm reduction and naloxone training are “fundamental to community nursing practice,” Hart says. “Harm reduction is recognizing that people do things that may not be particularly healthy and finding ways to mitigate the harms,” she explains. “Community nurses start where people are, and they work with people’s strengths and vulnerabilities.”

Stevens-Guille has collaborated with several student groups to plan additional naloxone training sessions (external link)  in November that will be open to the entire Ryerson community. “I think we’re in a great position to spread awareness that [drug use] isn’t such a hidden thing, isn’t a taboo thing, isn’t something that just happens in alleyways — this is your aunt and uncle, this is the businessman, this is everyone,” he says.

The training joins a growing number of student-led harm reduction projects taking place on campus. “In corners of the university, almost unrelated to each other, there seems to be a groundswell of student activism and interest in this issue,” says Bailey.

“The [overdose crisis] is a major public health crisis in Canada — and students are noticing that, and wanting to do something about that and responding,” she continues.

The takeaway for Hart? “When students come to us with ideas that are a little bit out of the box, or they want to try something — we need to listen. Students can make really big changes if we just help them figure out how to do it and give them the space to do it.”

This story was first published in the Faculty of Community Services newsletter.