communicating drug alerts improving the effectiveness of drug alerting to reduce harms among people...
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Communicating Drug Alerts
Improving the Effectiveness of Drug Alerting to
Reduce Harms Among People Who Use Illicit
Drugs
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BC Centre for Disease ControlProvincial Health Services Authority (PHSA)Diagnostic and treatment servicesAnalytical and policy support to all health
authorities and levels of government (1)
Harm Reduction
(2)
(1)
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Significant Milestones in Harm Reduction1964
1984
1986
1989
1990
2003
Methadone Treatment Program (Canada)
Needle exchange (Netherlands)
Legalized injection site (Switzerland)
Needle exchange (British Columbia)
International Conference (United Kingdom)
Supervised Injection site (North America) (3)
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Common Adulterants Drug Adulterant Licit Use Potential
Reasons for Presence
Public Health Risks
Health Consequences
Heroin Acetaminophen Pain relief(highly accessible, inexpensive)
Analgesic effect & bitter taste
Minimal at low doses
Toxicity at high doses
Liver damageGastro-intestinal effectsAdverse effects (Alcohol)
Cocaine Phenacetin Analgesic properties
Disguise poor quality cocaine
Banned in several countries(Suspected carcinogenicity and linked to renal failure)
Kidney cancerBladder cancerHaemolytic anaemiaAnalgesic nephropathy
Adapted Table (4)
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Study Design
• Focus groups & interviews
• Third party transcription and coding –NVivo 8
• Interpretive Descriptive
• Qualitative
Study Design
Study Approach
Study Methods
Data Analysis
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Participants 32 Focus Group Participants (Regular illicit drug
user)
Age Range: 23 to 70 years of age
23 participants were between ages 40 to 60
17 Male/15 Female
5 VCH Key Informants (Semi-structured interviews)
Primary contact with illicit drug users
3 Male/2 Female
Primary Outreach Services, Primary care & Insite/Onsite
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Socio-economic Status
Single Room Occupancy Hotel (SRO)
Rented Unit No Fixed Ad-dress (NFA)
Sample Total
44 25 31
Male 22 6 25
Female 22 19 6
2.5
17.5
32.5
47.5
Housing Status
Focu
s G
rou
p P
art
icip
an
ts
(%)
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Drug Use Patterns
Frequency of Use/Week
Years of Use
Current/Past Injection Drug Use
Poly-substance Abuse
Quit Injection Drug Use
Years of Abstinence from Injection Drug Use
27Participants
Daily Use
Range: 4 to 48 years
Median: 29
21Participants
31Participants
7 Participants
Range: 5 to 39
Median: 8.5
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Primary Objectives
Current Quality Assurances Practices
Communication Pathway
Recommendations to Improve
Drug Alerts
A narrative literature review was conducted
Inform focus group questions and interview guide
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Quality Assurance
“…I see the ones that have a reputation of being a good dealer down here will always have somebody recommend them” (Focus group 4 participant)
“My dealer, he cares about repeat business.” (Focus group
1 participant)
“By just the way it looks” (Focus group 2 participant)
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Communication Pathways“Yeah, I’d share it with all my friends and anybody I run into”. (Focus group 2 participant)
“We’ve got the fastest way”. (Focus group 3 participant)
“friends look after friends”. (Focus group 2 participant)
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Recommendations Clear Terminology
A ‘potent’ drug is perceived differently by HSP & PWUD
“that means it’s strong it works”. (Focus group 2 participant)
Preferred Mode of Communication
“Fliers”. “Web news”. “Facebook”. (Focus group 1 & 4 participants)
Visibility, Accessibility & Relevance of Postings
“As long as they are kept to date” (focus group 1 participant)
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Implications for Public Health
Policy & PracticeCurrent lack of Provincial, evidence-based guidelines for communicating drug alerts
CDA can Reduce risk of mortality and morbidity associated with illicit drug use
Guidelines should be informed and evaluated by the target population to increase effectiveness
There is limited literature and research evaluating feedback from peers in Canada
Findings will be compiled into a research report and submitted for publication
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Questions?
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References
(1) BC Centre for Disease Control. (2014). About BCCDC. Retrieved on April 7, 2014 from http://www.bccdc.ca/util/about/default.htm.
(2) Provincial Services Health Authority. (2014). About PHSA. Retrieved on April 7, 2014 from http://www.phsa.ca/AboutPHSA/default.htm
(3) BC Harm Reduction Strategies and Services. (2013). The History of Harm Reduction in British Columbia. Retrieved on April 12, 2014 from http://www.bccdc.ca/NR/rdonlyres/7B9F63E8-7D50-4985-9BC2-38D78C4E77AD/0/UpdatedBCHarmReductionDocumentAug2012JAB_final.pdf.
(4) Cole, C., Jones, L, McVeigh, J., Kicman, A., Qutub, S & Bellis, M.A. (April, 2010). CUT: A Guide to Adulterants. Retrieved on April 24, f http://www.cph.org.uk/wp-content/uploads/2012/08/cut-a-guide-to-the-adulterants-bulking-agents-and-other-contaminants-found-in-illicit-drugs.pdf.