I've been working as a nurse practitioner in a Thunder Bay high school for about 13 years. I see the students for everything from throat and ear infections to rashes to sports injuries to mental-health issues. The students come from 19 remote communities in the North.
Our high school has 150 students and over 40 per cent were struggling with addiction. We saw this through restlessness, absenteeism and the inability to concentrate and stay on task.
When I would see them in clinic, they would ask for something for generalized body pain, which is a withdrawal sign. They would be sitting there talking to you and their noses would be runny and they'd be sniffling; another sign of opiate withdrawal.
I started making calls to local health organizations and I was kind of disappointed that the only option suggested was methadone treatment. These young people come from remote northern communities and methadone is a highly regulated substance, so that wasn't an option. We searched the literature and were impressed with articles about the use of suboxone for opioid addiction. I wrote a proposal with the clinical team and got some funds to start a suboxone program. At the time, suboxone was not on any provincial or federal formulary, so it took a bit of convincing.
We've treated 60 students since 2011. I think we've made a difference in their lives. Some were able to get off opioids and others weren't. Opioid addiction sets up this craving that some students just couldn't handle. It's every day. They were thinking, "I need to feed whatever is calling me in my brain." Low-dose maintenance suboxone allows them to think about other things. So in addition to the medication, we provide counselling to help them understand their behaviour, understand that they aren't to blame for what's happened to them and to help them make different choices.
We let the young people's emotional needs steer our counselling. How did they handle disappointment? Frustration? Sadness? Interestingly, they were not good at labelling feelings. They just didn't have the vocabulary. I have learned that vocabulary is very important.
If they can't label it and they can't ask for help, it will come out as a physical symptom. They will say, "I have a headache. My stomach's really sore." Then after two or three days of a sore stomach you think, "Okay, what's really going on?"
Sometimes they would get angry, but they wouldn't be able to explain why. It would be an all-consuming emotion and it would trigger more craving for the opiate drugs. So, in our counselling we would intervene when we noticed things that were relapse triggers: when they were tired, hungry, had any kind of strong emotion, when they were lonely.
We help them with those feelings mostly through grief counselling. They come from an area where there have been hundreds of suicides. We ask them about childhood trauma, family issues, their use of drugs and alcohol, sexual abuse. They are so honest when they answer those questions. We use their history to focus our counselling. Helping them get through the loss of friends, of family members. Some of our students lost parents to suicide, and it totally derailed them. We try to help them have goals and aspirations and realize there isn't anything they can't overcome.
I get a real charge out of seeing progression in adolescents. One of the things about high school that's so cool is that you see them in Grade 9 and they are so frightened and scared. But you give them four years and watch their maturation process. You sit there and smile and think, "Oh my God! Two years ago, when I saw you, here's what we talked about …" When you talk to them about their progression and how they have overcome hurdles, it makes them feel like, "Yeah, it's not so bad. It was bad then, but it's okay now."
As told to Andreas Laupacis.
Mae Katt is a nurse practitioner in a Thunder Bay high school.
This interview has been edited and condensed.
This story first appeared in Healthy Debate, an online publication guided by health-care professionals and patients that covers health policy and evidence-based medicine in Canada.