Implementing a new model of substance use care in British Columbia: healthcare staff experiences from the road to recovery initiative

Background To address the increasingly potent unregulated drug supply and the complex withdrawal syndromes that accompany it, a hospital-based withdrawal management unit was launched in September 2023 as part of Vancouver, Canada’s Road to Recovery (R2R) initiative. This study explores healthcare staff experiences working within the new unit to identify opportunities to improve clinical service delivery and working conditions. Methods This study employed a mixed method design. Between May and July 2024, R2R healthcare staff were invited to complete a cross-sectional survey to characterize their experiences working in a new hospital-based withdrawal management unit. A purposive sample of healthcare staff were selected to complete a one-time semi-structured qualitative interview between July and August 2024. Descriptive statistics were used to summarize survey data, while conventional content analysis was used to analyze qualitative data. Results Thirty-three healthcare staff completed the study’s cross-sectional survey, including clinicians (e.g., nurses, physicians, pharmacists) and other staff such as social workers, peer support specialists, and Indigenous Wellness Liaisons (IWLs). Overall, 97% ( n = 32) reported feeling satisfied with their role at R2R. Most respondents felt the model of care was well-rounded (82%, n = 27), trauma-informed (82%, n = 27), culturally and spiritually sensitive (85%, n = 28), and safe (94%, n = 31). Qualitative interviews ( n = 8) revealed a consistent sense of pride in delivering ‘recovery-oriented’ care. Participants also felt R2R care provision was individualized, high-quality, and promoted meaningful engagement with patients through the cultivation of a safe environment. Job satisfaction was linked with feeling autonomous in providing patients access to a comprehensive spectrum of substance use services. Integration of traditional healing practices, as well as the incorporation of unique provider roles including peer support specialists and IWLs were identified as unique factors contributing to positive work experiences. Areas identified to be challenges included overly rigid approaches to patient care following relapses to substance use, as well as ongoing shortages of experienced, culturally safe healthcare staff, contributing to capacity constraints and burnout in the midst of the ongoing toxic drug crisis. Conclusions Overall, healthcare staff reported job satisfaction working in a new hospital-based withdrawal management unit. Furthermore, participants described the R2R model of care as comprehensive, trauma-informed, and culturally safe.