Aug 04, 2020
A nurse’s crusade to bring evidence-based treatment to substance use
Cheyenne Johnson never wants anyone else to graduate from nursing school as unprepared to care for patients with substance use and addiction as she was.
“My nursing education, as fantastic as it was, did not prepare me at all for the reality of the scope of substance use and addiction in the health system,” says Johnson, the co-interim executive director of the British Columbia Centre on Substance Use.
As a new nurse working in the emergency department and on medical floors of hospitals in British Columbia, Johnson often saw patients admitted with an arm or leg they’d broken while intoxicated.
She nursed people admitted for other alcohol-related illnesses who went into withdrawal, but who were discharged without any treatment or follow-up plan.
When Johnson approached her colleagues for guidance on medications to treat those patients’ withdrawal, she got no answers. Instead, the patients were stigmatized, avoided, and judged.
Alcohol, Johnson points out, is related to more than 200 chronic diseases, including cancers. Yet she didn’t learn that fact in nursing school. Nor was she taught to screen for alcohol or drug use, to support someone in withdrawal, or to access treatment and recovery services.
“Substance use is prevalent in every area in which nurses practise. This was a gaping hole in my knowledge,” she says.
That knowledge gap is not limited to nursing — it exists throughout the entire health-care system, Johnson believes. Filling the hole was her motivation for becoming a leader at the British Columbia Centre on Substance Use, a cutting-edge institution operating at the intersection between addiction medicine and public health.
The centre’s focus is to evaluate and translate world-class research into clinical practice and education that reaches professionals across the province — and beyond.
As part of that mandate, Johnson wants to bolster the skills of primary care professionals, including nurses and nurse practitioners, so they can manage substance use disorders just as they manage other chronic conditions.
“Substance use is so prevalent in our society that we [all] should be required as health professionals to understand and to treat it,” she says.
Drawn to public health in nursing school at Queen’s University, immediately after graduating Johnson pursued her master’s degree in population and public health at Simon Fraser University. She worked part-time in labour and delivery and emergency medicine at the same time.
When a job opened as a clinical nurse research manager at the University of British Columbia’s ophthalmology and visual sciences department, she took the opportunity to gain experience in research and clinical trial management.
Specialized certificates in clinical research and addiction nursing followed. That training led Johnson to become the founding director of the British Columbia Centre on Substance Use’s Addiction Nursing Fellowship Program, supervising 10 other nurses in the program. It’s the only fellowship in North America that trains nurses in addiction medicine for clinical practice, administration, and research.
Concurrently, Johnson served as the director of the centre’s clinical activities and development. At 35, she’s now co-interim executive director.
“It’s been quite accelerated,” Johnson says of her career. “I feel like I’ve been called to this role. It’s connected to all of my past experiences in terms of the research world and the clinical world.”
“Every area that you look at — from prevention to recovery — everything needs to be improved.”
Johnson’s role is also fraught with pressure.
As co-interim executive director, Johnson oversees the centre’s clinical and community-based research and helps to lead its 250 staff.
Her goal is to change the face of provincial addiction care, making evidence-based treatment paramount. She knows she has an uphill battle.
Traditionally, addiction treatment has been the purview of either psychiatrists or unregulated, often private, programs based on 12-step models.
Only recently has addiction medicine been recognized as a medical specialty, as the American Board of Medical Specialties did in 2016.
“We don’t have a functioning addiction treatment system, so how can we expect the system to succeed?” Johnson asks. “I do think it’s changing, but it’s a mess. Every area that you look at — from prevention to recovery — everything needs to be improved.”
As a woman who describes herself as being of “mixed settler and Indigenous ancestry,” Johnson is also driven to improve addiction care because she knows Indigenous Canadians are disproportionately affected by a flawed treatment system.
In B.C., First Nations, Métis and Inuit people are twice as likely to die from overdoses and more than five times more likely to have non-fatal overdoses than non-Indigenous Canadians, she says.
Johnson, who is a member of the Tootinaowaziibeeng Treaty Reserve in Manitoba, has personal knowledge of the way trauma fuels addictions. Her maternal grandmother suffered in residential school, and members of her extended family have struggled with substance use and addiction. That experience influences her view of the need to incorporate culturally safe and trauma-informed treatment into the health-care system.
“Thinking about ways you can incorporate culture and healing is incredibly important to me,” Johnson says.
Influencing life-saving public policy has been particularly critical because B.C. is in the midst of an opioid crisis.
Undervalued and underpaid
Since 2016, there have been, on average, close to 24,000 overdoses a year — up from 10,000-15,000 in previous years. More than 1,500 people died from overdoses in 2019 alone. The COVID-19 pandemic complicated the opioid epidemic further, jeopardizing people’s ability to access safe injection sites and disrupting previously established drug supply lines.
“Thinking about ways you can incorporate culture and healing is incredibly important to me.”
In addition to that charged political context in which she works, Johnson faces another challenge: she’s undervalued because she’s a nurse.
“There’s a hierarchy in the health-care system, and physicians are at the top of that heap,” she says. “On an everyday basis, I still face that.”
In practice, that means if Johnson and a physician colleague are in a meeting, the person they’re meeting will often want to speak with the doctor, not her. It also means she’s not as well compensated as doctors in a similar role.
“I know more than the average family doctor about addiction medicine,” Johnson says. “Yet I am consistently underpaid and undervalued, as a nurse.”
She hopes having more nurses in leadership roles in the province’s health-care system signals the system’s willingness to recognize nurses’ value. “Having people like myself in these roles — it makes things marginally better,” Johnson says.
When the pressure gets to her, she seeks release in a daily walk and a good night’s sleep. She also enjoys hiking on the weekends with her partner, Jason Ververgaert, a graphic designer who also works as a member of Air Canada’s ground crew.
Ultimately, Johnson remains motivated by her unique opportunity to assess novel strategies and make sure people who use substances get the best possible treatment and care the province can provide.
“Substance use is a feature of human society,” she says. “We have to take a hard look at the way we deal with it.”