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Dr. Tiffany O’Donnell takes a new approach to addiction medicine

When Dr. Tiffany O’Donnell entered medical school at Dalhousie Medical School, she discovered family medicine would allow her the freedom and flexibility to generate meaningful change.

Dr. O’Donnell’s passion is Indigenous health and addiction medicine. She started her career at the Sipekne’katik Health Centre in 2015, and was called to leadership in addiction medicine early on, when the community identified the need for a community-based opioid treatment program. The program was developed through collaboration with colleagues and community leadership, and launched in 2017. Dr. O’Donnell worked to enhance her skills treating opioid use disorder, attaining certification through the International Society of Addiction Medicine.

It was during this time that her passion for working to improve the social and structural determinants of health and systemic racism developed.

“Once you see it, you can’t unsee it,” said Dr. O’Donnell. “Our social systems were designed by a privileged population a very long time ago. Those systems have not only failed to evolve with society, but they exclude people by design. Populations are vulnerable because our systems make them so – and physicians are well positioned to influence change.”

Conversations with colleagues, many of whom also work in addictions medicine, showed Dr. O’Donnell that they were seeing the same issues. The criminalization of substance use and the people who use substances often leads to more trauma, risk and harm than the substance use itself.

“The war on drugs continues to fail people. Criminalization has not decreased the use and availability of drugs – in fact, it has worsened the harm associated with drug use.”

Spurred on by the need for change, Dr. O’Donnell helped create a national non-profit coalition called Doctors for Decriminalization to advocate for change.

“Having witnessed the harms that certain government policies and legislation impose on people, I can’t help but think there must be a better way,” said Dr. O’Donnell. “As a profession, we need to think hard about our perception of risk and understand that stigma within our systems is the riskiest factor of all.”

Doctors for Decriminalization recognizes that those harms disproportionately impact people who are racialized, economically disadvantaged, underserviced and under-resourced.

“We are advocating for evidence-informed drug and substance policy to promote the health and safety of all Canadians” said Dr. O’Donnell. “If we look at the existing evidence, which we tend to do as physicians, decriminalization as a concept is a no-brainer. The question is ‘how,’ not ‘if.’”

The group suggests that resources used for criminalization of substance use should be used instead to support policies and programs to promote health, equity, social stability and safety.

Doctors for Decriminalization asks physicians to talk to their MPs about taking a health and human-rights based approach to substance use by decriminalizing the possession and use of drugs and treating substance use as a public health issue.

Looking for new opportunities to make an impact in Indigenous health, Dr. O’Donnell recently left the Sipkene’katik Health Centre for a position at Dalhousie University. She works in collaboration with Dr. Brent Young, Dalhousie University’s Faculty of Medicine Academic Director of Indigenous Health, out of the Wije’winen Health Centre. There, medical learners are offered a comprehensive experience in Indigenous health.

Dr. O’Donnell continues to work with the Mobile Outreach Street Health (MOSH) as the physician lead for its Justice Initiative, a program designed to support people who are involved with the carceral system. She said she has found that when charges relate to substance use, addictions treatment can be the turning point that inspires people to make other changes to their health or to access supports and services they may not have known about previously.

She also works as an addiction medicine consultant with Nova Scotia Health and is involved in planning for the inpatient addiction medicine consult service (iAMCS). She also became Professional Competencies Unit Head for first-year medical students at Dalhousie last year. With her passion for equity, diversity and inclusion, Dr. O’Donnell will be able to advocate for a focus on the social and structural determinants of health and systemic racism.

Recognizing the need for physicians who serve Indigenous populations to connect with and support one another, Dr. O’Donnell helped establish Doctors Nova Scotia’s Section of Physicians for Indigenous Health. The section allows physicians to strategize on solutions, discuss best practices and share successes to improve care for their patients.

Nova Scotia is fortunate Dr. O’Donnell chose to practise here. She says she chose family medicine feeling overwhelmed by the idea of choosing a specialty.

“Family medicine seemed to offer the most opportunity to explore new things along the way and have the most diverse experience.”

*This blog post is an excerpt of a longer article that appeared in the June 2023 issue of doctorsNS magazine.

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