Transcript Presented - Public Health Physicians of Canada

Overdose prevention training programs including takehome-naloxone: Lessons learned from BC
Jane Buxton, MBBS, MHSc, FRCPC
Physician Epidemiologist, Harm Reduction Lead
BC Centre for Disease Control
[email protected]
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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
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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,
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
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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
Participating THN site
Client and/or
Family trained
Complete training
Pick-up kit
Prescription
Visit Prescriber
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Group training programs
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
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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
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
What did you know?
When did you know it?
What did you do about it?
THN saves lives and reduces morbidity
related to opioid OD – should be
available to those at risk
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Thank you!
• Acknowledgements
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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 Program
[email protected]