Family physician, Dr. Tiffany O’Donnell on reversing the stigma of addiction and improving care to patients living with substance use disorder

Family physician, Dr. Tiffany O’Donnell
Family physician, Dr. Tiffany O’Donnell

Seeking help for substance use disorder can be challenging and requires strength from patients and their loved ones. While addiction stigma still exists and can deter people from seeking treatment, Dr. Tiffany O’Donnell is working to reverse the stigmatization of addiction and improve health care for people with substance use disorder.

Dr. O’Donnell completed a Bachelor Music from the Université de Montréal before completing medical school at Dalhousie University. Following medical school, Dr. O’Donnell completed her family medicine residency in Ottawa with a self-designed third year in hospitalist medicine.

At no point during her medical training did she think she would one day specialize in addiction medicine, but she said it happened organically.

When she started family practice in Sipekne’katik First Nation, a need was identified in the community for community-based treatment for opioid use disorder. In collaboration with local colleagues and community leadership with consultation from partners outside of Nova Scotia, an on-site opioid treatment program was established under the jurisdiction of Sipekne’katik First Nation. The program aligns with provincial standards for opioid treatment but in a way that the community can support and sustain guided by the experiences of the community.

“I ended up doing addiction medicine by seeing in my family practice how rewarding it can be and seeing dramatic changes in people’s quality of life,” explained Dr. O’Donnell.

In 2019, Dr. O’Donnell became certified in addiction medicine through the International Society of Addiction Medicine. With an ignited passion and training in addiction medicine, Dr. O’Donnell also provides her services through Mobile Outreach Street Health (MOSH).

“We know that the nature of the disease is the loss of choice and control, and ‘just stop using’ is not helpful or effective,” said Dr. O’Donnell. “As health care providers, we need to focus on providing care not only for the addiction itself, but also for other health issues that may or may not be related to the addiction in a way that is manageable and appropriate for the individual. Often, it is hard for people living with addiction to access the care they need for all kinds of reasons; however, stigma is a pervasive factor.”

In 2020, she began working with the Addiction Medicine Consultant Service (AMCS) which offers rapid telephone consultation to physicians, nurse practitioners and pharmacists across Nova Scotia.  The AMCS provides verbal clinical advice and guidance to diagnose and manage substance use disorders.

Working with two other physicians, Dr. O’Donnell is on call in addition to her regular service to provide consultative support to the provider to ensure the care of the substance use disorder is evidence informed and well considered.

Dr. O’Donnell said that some of the calls she receives are directly related to the patient’s addiction and that is the primary issue. However, the calls come from a range of health care providers across different specialties.

“Many of the calls are from specialists who are treating a patient for a specific issue and that patient also has a substance use disorder. The patient’s addiction is another factor in the mix that needs to be addressed to ensure the other treatment can take place in a meaningful way,” explained Dr. O’Donnell.

Dr. O’Donnell said treating patients with substance use disorder can present unique challenges that often lay outside of most providers’ comfort zones. Many physicians have not benefitted from training in this area, despite the relatively high prevalence of this condition. The consultation service is intended to present a different lens that opens the door to more genuine and authentic conversations with patients about their experiences which allow health care providers to build trust with patients. By equipping colleagues and peers with the tools to have these conversations, advising around treatment that they can provide in real time, and informing them of available support programs in the province, Dr. O’Donnell said the goal is to find ways to meet the health care needs of the individual.

“We can reduce stigma through the language we use, through the attitudes we carry, and the kind of care we can offer,” explained Dr. O’Donnell.

Dr. O’Donnell said having a colleague to connect with while working through a case can provide invaluable support and collaboration through a simple conversation. This leads to better care and help for the patient. 

“Providers really care about their patients, and we don’t want to cause further harm. When we take a little bit of time with our colleagues to discuss strategies and acknowledge that cases can be challenging, things shift in positive and meaningful ways. Much of the time, it has to do with reevaluating our own perceptions of risk and the biases we carry that have contributed.” said Dr. O’Donnell.

From November 20-27, National Addictions Awareness Week (NAAW) provides an opportunity for Canadians to learn about substance use and treatment, recovery, and prevention. This year’s theme is titled “Community of Caring”, spotlighting how different communities across the country are helping those in their community with problematic substance use or have a substance use disorder.

For Dr. O’Donnell, this year’s theme demonstrates that no one exists in isolation, and everyone is deserving of love and support. She said everyone having a community of support across different sectors and community groups is a crucial part of guiding patients through hard times.

 “We need to come together as a society to learn and unlearn lessons that contribute to the stigma of addiction,” added Dr. O’Donnell.