Overdose prevention training programs including take-home-naloxone: Lessons learned from BC

Jane Buxton, MBBS, MHSc, FRCPCPhysician Epidemiologist, Harm Reduction LeadBC Centre for Disease Control

jane.buxton@bccdc.ca

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Conclusions/summary

• THN programs well established and effective▫ Acceptable clients, OD reversals▫ Empowers individuals who have been trained

• PHPM role and challenges▫ Broad engagement process - “it’s a no-brainer”▫ On-going evaluation – responsive & address

misinformation▫ Prescribing regulations and funding

THN saves lives and reduces morbidity related to opioid OD – should be available to those at risk

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Background

• Unregulated- unknown content/potency of illicit drugs

• Canada highest rate prescription opioids1 • Naloxone – safe, opioid competitive antagonist • THN - US >180 programs past 16 years; cost

effective2

▫ 50,000 doses dispensed; 10,000 reversals3

- Canada - Edmonton 2005; Toronto 2011; ON,

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1International Narcotics Control Board 2Coffin P Ann Intern Med 2013 3MMWR Feb 2012

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BC – Overdose reduction efforts• Drug Overdose and Alert Partnership

▫ Enforcement, ambulance, coroner, public health, drug and poison information centre, research, PWUD etc

• Developed OD survival guide ▫ Prevent/recognize/respond

• THN provincial program development▫ Understanding policies/regulations

BC naloxone - prescription only medication, ▫ Learning from other programs

US +++; Edmonton; Toronto▫ Engaged with regulatory bodies, other stakeholders

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Stakeholders engaged• Medical

▫ BC College of Physicians and Surgeons▫ BC Ministry of health; (exploring provincial formulary listing)▫ BC Provincial Health Officer and Medical Health Officers ▫ Vancouver - addictions doctors; managers, detox staff, ER docs ▫ BCMJ feature article June 2012; OD events (CARBC bulletin)

• BCCDC▫ pilot funding from HR budget; outreach nurses, DPIC

• BC College of Nurses▫ Developed Decision Support Tool

• BC College of Pharmacists ▫ Presented to board – support to + schedule IV so pharmacist prescribed

awaiting formulary• BC Centre for Excellence HIV/AIDS• People who use drugs

▫ Various user groups• Vancouver Police Department

▫ Supportive – membership on CAB and DOAP▫ Met with Chief and Deputy

• Vancouver City• BC ethicists• Pivot Legal Society

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Individual training programs

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Participating THN site Client and/or Family trained

Complete training

Prescription

Visit Prescriber

Pick-up kit

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Group training programs

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Clients + Educator + Prescriber = THN training & kit dispensing

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BC THN launch Aug 31, 2012; 9mths later

• 19 sites currently participating:

• 9 in Vancouver Coastal o

• 6 in Interior o

• 3 in Vancouver Island o

• 1 in Fraser o

• 1100+ kits at participating sites

• 425+ people trained

• 270 kits dispensed to trained clients

• 16 OD reversals reported to date

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Program Evaluation…• Community Advisory Board• Focus groups/interviews with stakeholders

▫ Clients ▫ Parents of those who use opioids▫ Police▫ Service providers

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Program Evaluation…• Focus groups/interviews with stakeholders

▫ Clients (n=44) Feel empowered and valued Reported kits confiscated by the police (1-pager) Training sometimes brief and not complete (review w.

sites)▫ Parents

Support; concern training - stigma, confidentiality (site o/s DTES)

▫ Police Lack of communication; misinformation (1-pager)

▫ Service providers On-line tools great, adaptable. Clients reluctant to call 911 Forms complex, not always returned (video)

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THN – learning process• Implementation - supportive team to overcome

obstacles and celebrate successes • Stigma - training people who use drugs, requires

trust & paradigm shift • Service providers “no brainer”

▫ but concern re time, challenge finding prescribers

• Engagement is key; champions make it happen • Don’t make assumptions re communication

▫ multiple engagement with police so kits are not confiscated

• Slow to start

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Take Home Message

•THN is empowering for all involved

•Public health has an important role implementing THN programs ▫Credibility▫Relationships - engagement/collaboration ▫Advocate – for programs and adding

naloxone to provincial formulary

THN saves lives and reduces morbidity related to opioid OD –

should be available to those at risk

What did you know?When did you know it?

What did you do about it?

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Thank you!

• Acknowledgements• All the sites taking part in the BC THN program• Our community board and those who helped/consulted with us• Folk at the BC CDC who support this program especially: Erin Gibson, Dylan Collins, &

Kristy Williams

• Questions?

• Contact information:BCCDC Harm Reduction Programoutreach@towardtheheart.com

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