"The overdose crisis in B.C. was declared a health emergency in 2015," said Dr. Charissa Patricelli, medical director, FIR (Families in Recovery) Square, BC Women's Hospital + Health Centre. "Because of stigma, we haven't eradicated the fentanyl crisis but it's absolutely possible. We just have to work together."
The FIR Square Combined Care Unit is the first in Canada to care for women and newborns affected by substances in a single unit. This program is made up of hard working, passionate and dedicated interdisciplinary team members who show up every day to make a difference in the lives of the women and people they serve.
"Addiction is a health care issue that can be treated," says Dr. Patricelli. "As health care providers, we need to create a safe environment where people can ask for help without feeling any stigma or shame. People deserve a safe, patient centred, harm reduction approach to care." On the FIR Square Combined Care Unit, many of the women who seek help have experienced stigma, judgement and trauma from previous interactions with the health care system which makes it even harder for them to seek care. "It's really challenging for these women to disclose the extent of their substance use, especially during pregnancy," says Dr. Patricelli. "Therefore, women often experience delayed access to care which can lead to more complications."
At the FIR program, the interdisciplinary team does exceptional work meeting with women to discuss their strengths, goals and how the team can best support them. These processes are part of implementing a renewed model of care at FIR. The renewed model of care centres on trauma and violence informed practice, Indigenous cultural safety, recovery oriented practice and harm reduction, allows opportunities for healing, respects people and helps patients focus on their vision for the future - what their birth will be like, what their wellness and healing journey looks like and who they want to support them in parenting. Dr Elder Roberta Price, Snuneymuxw and Cowichan First Nations and Elder Glida Morgan, Tla'amin First Nation are part of the Indigenous Cultural Safety programming at FIR and provide support and healing for women and families including Welcome to the World baby ceremonies which honour the mothers and the baby through a cultural ceremony
Particularly over the last year and a half there have been increasing challenges – the toxicity of the drug supply, the COVID-19 pandemic and access to mental health and substance use support. Increases in violence against women and increases in isolation have disproportionately affected the patients the FIR program supports. The FIR team has been building partnerships with Together We Can, Drug & Alcohol Education & Recovery Society, a men's recovery treatment centre licensed through Vancouver Coastal Health, to help partners if they need access to support and recovery. There is also a weekly men's support group on the FIR unit for additional support.
Right to left: Dr. Eric Cattoni MD, Vrushangi Soni RN and Erin Cox RN
"We know that families in recovery, with the right supports, are able to transition into recovery and parent successfully," says Dr. Patricelli. "We've increasingly been able to use varied types of pharmacotherapy, including injectable opioid agonist therapy, to transition women off of toxic street drugs in a safe way."
The FIR program facilitates care-planning where families can share their goals and conduct care planning with community partners.
"We work with marginalized people who have been oppressed for generations and witness them overcome substance use despite a history of trauma, violence and systemic racism. It is absolutely incredible," says Dr. Patricelli. "When you create a space and time for healing and you see the power of people becoming parents, becoming strong in their hope, exploring their true strengths and vision of what they aspire to be in their lives."
