Dr. Srivastava sits on a park bench.

Dr. Anita Srivastava

In July, Unity Health created a new Medical Director of Addictions position in recognition of the role addiction and substance use plays in the lives of the patients we serve. Dr. Anita Srivastava, family physician at St. Joseph’s Health Centre and associate professor in the Department of Family and Community Medicine at the University of Toronto, was named as the inaugural director. We spoke with Srivastava about what’s unique about the new role, her short and long-term goals, and common misconceptions about substance use and addictions care.

Q:  Can you tell us a little bit about this new position and what’s special about it?

Srivastava: This is a new position for Unity Health, and I think it really signifies our commitment to treating patients with addictions, and to putting a concerted effort towards making sure that they are represented in our hospitals and our health care system. Optimizing care and ensuring that Unity Health meets the best possible practice standards of addiction medicine is a focus of this new role. I also think it is important that this is a dedicated role:  Addiction medicine is an area of medicine in its own right and it sometimes takes a back seat to what are considered more pressing medical concerns. I think the fact that this role is committed to looking at how we best serve our patients who have substance use disorders is very significant. I’m honored to be in this leadership role in an area that traditionally has not had its own focus and its own hospital programs.

Q: Why is Unity Health an ideal place to host a role like this one?

Srivastava: Unity Health is unique in that we have been doing much of this work for many, many years. Providence, St. Joseph’s, and St. Michael’s have a long tradition of treating patients with addiction medicine challenges. St. Joseph’s and St. Michael’s hospitals were among the first hospitals in Ontario to have dedicated addiction medicine services. This includes regular addiction medicine clinics, rapid access clinics, and consultations to the emergency department and in-patient floors. We were also among the first to research novel protocols for opioid agonist initiation (when medication is prescribed to prevent opioid withdrawal and lessen cravings) in the emergency room and were early adopters of these protocols. St. Joseph’s and St. Michael’s have been pioneers and leaders in the city, and, I would say the country, in terms of having in-patient and out-patient services, as well as having some of the most innovative and available protocols. 

Q: Why do you think addictions medicine has been an overlooked area?

Srivastava: There’s a lot of stigma associated with substance use. Patients often feel they do not receive non-judgmental care, and therefore may not feel comfortable disclosing to their healthcare team that they are using. It may also be that care providers don’t have the training or the background to recognize and/or treat addictions. Patients who have substance use disorders often present with other health concerns first. For example, somebody may present with cancer or stroke or problems with their liver, but it may not be immediately recognized that the patient has an alcohol use disorder. Or a patient may come in with an infection from injecting drugs. Of course the health care team will address the fever and infection and what is urgent and acute, but sometimes the underlying issue can get a little bit lost. The chronic issues are not always addressed, and I think it’s a missed opportunity.

A patient’s condition may not even be directly related to their substance use, but substances may play a role in their overall health status. I think it’s an opportunity for care providers to jump in and say, ‘OK, how do we identify this? Are we providing non-judgmental care for people to disclose that they’re using substances?’ Then, do we connect patients with the right resources so that when their acute healthcare needs are addressed that they can come back for ongoing help?

Q: What are some of the biggest misconceptions about substance use and addiction care you’d like to break down?

Srivastava: There is a misconception around substance use that patients should just stop using and that it isn’t necessarily a medical condition. The creation of a Medical Director of Addictions role will help integrate addictions care with the rest of the medical system. We’re saying, ‘No, this is a real issue and there is good evidence-based medical treatment for it, and it should be broadly available the same way we provide treatment and medications for so many other medical illnesses or conditions.’ My hope is that addictions care can be provided the same way that any other type of medical care is provided – where patients go to their physician or hospital not feeling well, and receive the necessary assessment and treatment.

Q: What are some of your short-term and long-term goals you’d like to achieve?

Srivastava: I think the overall goal is to make Unity Health – Providence, St. Michael’s and St. Joseph’s –  a place where patients who use substances feel that they are not only treated, but are welcomed. My goal is to make sure that all three sites offer evidence-based addiction medical care, whether it’s in an ambulatory setting, an in-patient setting or in the emergency department. My hope for all of our hospital sites, even if there isn’t an addiction medicine service there, is that care teams can recognize when there’s a substance use issue and know how to treat it or who to call for help.

I want to emphasize that I think we’re already doing a very good job. By all accounts, we’re already providing excellent care. Going forward, it’s about making sure that we’re continuing to use the best evidence-based knowledge that we have and combining that with innovation.

For short-term goals, I think we can optimize some of the protocols we’re using in our hospitals to help with the fentanyl crisis. I think we’re doing an excellent job, but I think one can always think of ways to improve.

By: Marlene Leung

Photos by: Katie Cooper