New Brunswick (NB) has the second highest rate of IV drug use in Canada after British Columbia (BC). Within NB it is a significant problem, drawing much attention due to the serious social and health care costs of toxic and unregulated drug supplies. Dr. Davidson’s journey towards creating a positive, destigmatized environment for those seeking recovery from substance use, is an inspiring one.

Sara’s passion for making a difference led her to pursue a career in addiction medicine

Prior to entering medical school, Sara worked with non-profit organizations in areas such as food insecurity and supporting survivors of domestic abuse. While working at AIDS New Brunswick (Fredericton), Sara learned more about needle exchange programs, harm reduction approaches, and patient-centered care. She recognized the challenges individuals faced gaining access to healthcare for substance use arose from systems-level deficiencies in providing a comprehensive support environment.

“I would hear people say ‘You know, I’d love to be on methadone, but it’s going to be a yearlong wait list’. At the time I remember thinking, that was crazy.”

“I vowed to myself that if ever I could do anything to make a difference, I would. Fast forward a few years …I ended up going to medical school. OK, that’s my chance, I can do this, so I hit the ground running. Like, here’s my shingle: Walk in.”

Following Family Practice residency (McMaster Medical School), Dr. Davidson  returned to Fredericton and began working with and gaining the trust of the vulnerable population at her family practice in the Downtown Community Health Centre.

River Stone Recovery Centre

In 2019 Health Canada’s Substance Use and Addictions Program (SUAP) announced $76.2 million in grants for innovative and evidence-informed programs to combat the opioid overdose crisis.  Sara along with a team of health care professionals were successful recipients of SUAP funding to support a five-year pilot project to create an injectable Opiate Agonist Therapy (iOAT) program.  River Stone Recovery Centre (Fredericton) opened in July 2020, offering a program to support best practices for refractory opiate use disorder treatment.

The clinic’s focus has been on harm reduction and the use of evidence-based practices to support drug users, while working to destigmatize and empower clients. The clinic provides oral medication therapy to about 80% of their clients.  For the remaining 20% of clients, for whom oral medication such as methadone may not work, the clinic’s iOAT program offers multiple daily dosing intervals. River Stone is also one of the first clinics to dispense medications off-label for stimulant use disorder.

Sara noted the positive outcomes in terms of mental health improvements and reduced criminality:

“There’s [around 80%] improvement in mental health once clients have been on the program.  We attribute that to treatment being decriminalized, not having to worry about the next dose, and fewer concerns regarding withdrawal. All the things that clients had to do to stay on top of just accessing enough medication for their physiological needs -they don’t have to do that as much anymore. In many cases, people have stopped using outside the program entirely.”

River Stone reports an 83% reduction in illicit opioid use by iOAT patients after 18 months, and 70% of iOAT patients attribute improvements in their physical and/or mental health to the program. This improvement in health has broad-ranging impacts such as enabling individuals to find housing and employment.

Once individuals have been in the program two years, they’ve gone from 80% being unhoused to 90% housed and it’s not because there’s good housing. It’s because they’ve self-resolved. Providing a program with stability has been really important.

Sara has become a very strong advocate for ensuring that any solution to the housing challenges for those managing substance use also includes resources for the complex mental health issues that can compromise one’s recovery.

River Stone’s approach to patient-centered care and harm reduction.

The staff and patients at River Stone follow well-defined processes to ensure the safety of their therapeutic procedures. In addition to supervising opioid agonist treatments, the clinic provides access to COPD puffers, and diabetic and blood pressure meds, on a regular scheduled basis. Having this regular interaction with nursing staff has contributed significantly to positive health outcomes.

Another testament to the program’s success – no waiting list.  This makes River Stone unique amongst clinics in Canada.

While their focus is on harm reduction, Sara feels that their evidence-based and person-centered approach is central to their ongoing success.

“We give a lot of room for people to adjust their doses as they see fit, so it’s not like you get to this dose and this is what then happens. It’s really their safety parameters and we follow those. It’s a very tight backbone of order sets, procedures and processes. But it’s within a very warm harm reduction-oriented environment that tries to put the person at the center so they can request dose changes; some go down, some go up. It really is putting clients in the driver seat as much as possible.”

Sara’s involvement with CRISM

As Dr. Davidson’s approaches and methods to addiction medicine evolved, she wanted to be able to share her experiences with a larger community. She became aware of Dr. Sherry Stewart’s work on personality and substance use, approaches that resonated with her own views that “it’s so much about the person and not so much about the molecule”. Engaging with CRISM has fostered connections with others who recognize that people’s individuality is critical to understanding their journey with addiction.

Sara has recently taken on the role of CRISM Atlantic Node lead investigator for the ASCME initiative (Addition of high dose Stimulant and engagement-focused Contingency management, alone and in combination, to treatment as usual for the management of MEthamphetamine use disorder), a national multisite randomized controlled trial.

We look forward to hearing more about Sara’s work and successes!

For more information about the River Stone Recovery Centre program and dedicated team, follow this link: River Stone Recovery Centre.

More insight into Dr. Davidson’s work in addiction medicine can be found through the following links:

https://globalnews.ca/news/9601796/growing-concerns-homeless-population/

https://globalnews.ca/news/9336103/new-addictions-program-in-fredericton-shows-positive-results/

https://theaquinian.net/understanding-harm-reduction-river-stone-recovery-clinic/

https://www.cbc.ca/news/canada/new-brunswick/fredericton-recovery-centre-addicitions-1.5722041

https://www.cbc.ca/news/canada/new-brunswick/homeless-death-fredericton-1.6306197

https://www.cbc.ca/news/canada/new-brunswick/opioid-fredericton-program-river-stone-recovery-ioat-1.6679190

https://journals.lib.unb.ca/index.php/JNBS/article/view/32607/1882527844