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Trailblazing a Path to Quality Care: Harm Reduction Plays Pivotal Role in Supportive Palliative Care Program

By: Sabreen Huq, C-TAC Partnerships and Programs Intern

As a key component of our policy agenda, increasing access to community-based services, including palliative care, is essential to shaping an equitable and coordinated health system for all people with serious illness. Providing accessible palliative care for people experiencing homelessness carries broad implications for health, and it is critical that our coalition explores ways to offer support to these efforts in order to advance health equity.

The Palliative Education and Care for the Homeless (PEACH) Program, based in Toronto, Ontario, Canada serves as a powerful model for care delivery that prioritizes the social determinants of health (SDoH). The PEACH team’s approach to providing care integrates the key principles of harm reduction; non-judgement, practical interventions, and client-centered approach, into conventional palliative care. As disparities in rates of substance use disorder persist, a growing body of research shows that harm reduction strategies can mitigate harmful health impacts associated with substance use. Applying this framework to meet the palliative care needs of people experiencing homelessness, PEACH has helped individuals receive the comprehensive care and services they need. Leaders from the PEACH team shared the story of a person whose life was transformed by these efforts.

50-year-old Pat’s story encapsulates PEACH’s commitment to reducing the harmful health impacts of substance use disorder. Referred to the PEACH Program in January 2021, following the discovery of non-operable metastatic lung cancer with painful bone metastasis, Pat needed effective acute pain management. Pat’s diagnosis was further complicated by his severe opioid use disorder which left him with a high opioid tolerance. He presented to the hospital emergency department multiple times for pain, but was repeatedly turned away, labeled as “drug-seeking.” The stigmatization Pat faced at the hands of the health care system added an additional traumatic experience to his life. Dr. Alissa Tedesco, a palliative care resident at the University of Toronto, affirms that people suffering from substance use disorder often suffer from this sort of stigma. In Pat’s case, the stigma he faced kept him from receiving the health care he needed.

At the time of the referral, Pat was housing-insecure, couch-surfing at various friends’ apartments, and was often unreachable by phone. When the PEACH team first met Pat, his biggest concern was finding secure housing since he had been asked to leave the apartment he was staying at. He also shared that the lack of effective pain management from his providers had led him to buy pills off the street to use in addition to his prescription. To make matters worse, shortly after the initial referral to PEACH, Pat faced jail time due to possession charges. He was offered a trial of radiation therapy as the only safe treatment for his cancer made available to him. He was not deemed eligible for systemic therapy due to what was called his “social situation.” Pat was open to receiving the radiation therapy, but his low-income and lack of transportation prevented him from getting to radiation planning appointments.

Once the PEACH team got involved, Pat was connected to a newly created shelter program that operates out of a hotel in Toronto and incorporates harm reduction strategies. A taxi transportation account was set up through social services to assist with transportation to medical appointments and after multiple weekly visits, a palliative care physician was able to safely control Pat’s pain. PEACH’s thoughtful and patient-centered approach to care enabled Pat to begin his palliative radiation treatment, access a working phone, and safely manage his pain. The PEACH team did more than house Pat and provide care, they served his holistic needs and equipped him with the tools necessary to overcome the unique obstacles barring him from receiving quality care.

Pat is one of many individuals whose lives have been transformed by PEACH’s efforts using harm reduction strategies. Many individuals who are living with substance use disorder are not provided sufficient pain management treatments, even if they are receiving some form of palliative care. Shaping healthcare to meet people where they are, with tools to address their complex needs, breaks longstanding barriers to quality care and improved health outcomes for countless individuals.

C-TAC is committed to advancing health equity and underscores the need to address negative stigma and biases that inhibit the delivery of quality care throughout the health care system. PEACH’s approach to making palliative care accessible for people experiencing homelessness reflects the sort of innovation and bold action needed to bring the foundational components of our policy agenda to fruition.

To learn more about the PEACH program click here.

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