Transcript presentation

Trends in Opioid Use and Overdose in BC:
Making the case for greater availability of Take Home
Naloxone programs
Ashraf Amlani
Harm Reduction Epidemiologist
[email protected]
Outline
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Overdose surveillance in BC
Substance Use Trends Survey
Comprehensive Response to OD
BC Take Home Naloxone program
Questions
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Background: Overdose (OD) in BC
Opioid overdose is a public health concern in BC
• 275 deaths were attributed to drug overdose (2011)
• 70 deaths were attributed to prescription opioid medication
(2009)
BCAS administered 2377 doses of naloxone in 2012
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2020 patients
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Rx Opioid-related deaths
• Coroner’s review
of Rx opioid-related
cases from 2005 to
2010
• Accidental (61%)
vs. Suicidal (33%)
• Interior had 2X
higher rate than
Metro & Fraser
regions
Data Source: BC Coroners Service
350
8
300
7
6
250
5
200
4
150
3
100
2
50
1
0
0
2005
2006
2007
2008
2009
2010
2011
2012
2013*
* Provisional numbers – cases still under investigation
Data Source: BC Coroners Service
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Rate per 100,000
Number of Deaths
Illicit Drug Overdose Deaths
Northern
Metro
Island
Interior
Fraser
BC Rate per 100,000
Substance Use Trends
• Based on survey of harm reduction clients in Summer
2013
MayJune
2013
• 2012
survey
tool
modified
• Sites
recruited
JulyAug
2013
• Surveys
distributed
to sites
• Surveys
administer
ed
Sept
2013 Jan
2014
• Analyzed 779 surveys from 34 sites in BC
• 30% of participants are female (70% male)
• Age range 18 - 72 years (mean = 41 years)
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• Data entry
and
cleaning
• Data
analysis
Opioid use by health region
90%
Percent of Respondents
80%
70%
60%
BC (Heroin): 61.8%
50%
BC (Prescription):
54.2%
40%
BC (Substitution):
40.6%
30%
20%
10%
0%
FHA (N=98)
IHA (N=98)
NHA (N=79)
VCH (N=70)
VIHA (N=142)
Heroin
Substitution
Prescription
Heroin (BC)
Substitution (BC)
Prescription (BC)
www.bccdc.ca/prevention/HarmReduction/
SubstanceUseTrends/default.htm
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Opioids used in past week
Heroin
Morphine
www.bccdc.ca/prevention/HarmReduction/
SubstanceUseTrends/default.htm
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Overdoses in past 6 months
OD Witnessed
Opioid Use & OD Experienced
20%
15%
BC:11.3%
10%
16%
14%
5%
8%
8%
Percent of respondents
Percent of Respondents
50%
8%
40%
BC: 36.1%
30%
50%
20%
36%
31%
10%
26%
20%
0%
0%
FHA
IHA
NHA
VCH
FHA
VIHA
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IHA
NHA
VCH
VIHA
Comprehensive Overdose Survival Strategy
Prevention
• Know the risk
factors
Recognition
• Know the signs
http://towardtheheart.com/assets/uploads/files/OD_Survival_Gui
de_Tips_to_Save_a_Life_2012.08.29_upright_for_website.pdf
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Response
• Know what
actions to take
Community Naloxone
• 85% of OD happen in the company of others
• Take Home Naloxone (THN) Programs worldwide: US, Canada,
UK, Estonia, Russia, Afghanistan, Cambodia, Australia and
Africa
• Four programs in Canada:
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Edmonton (2005)
Toronto (2011)
Ontario (2012) *was on hold from Spring – Fall 2013
BC (2012)
• Naloxone does not increase drug use – people trained use more
safely and less risk of OD
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Naloxone Kit Contents
• 2 glass amps of 0.4mg/ml naloxone
• wrapped in gauze inside a pill bottle
• Label includes prescription info
• 2 retractable VanishPoint® safety
syringes
• 3cc – 25g x 1”
• 2 alcohol swabs
• 2 latex gloves
• One-way rescue breathing barrier
mask
• THN Administration Information Form
• Steps to respond to opioid overdose
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Overall Process
BCTHN Site*
(1) Review program
material on-line;
identify person(s)
to:
- Provide training
- Prescribe
naloxone
- Dispense kits
- Coordinate
program
* E.g. PH unit, CHC, community agency, hospital ED, or detox facility
Banjo et al. Implementing A Provincial Take Home Naloxone
Program: Quantitative and qualitative evidence from a cross-sectional
study in British Columbia, Canada. CMAJ Open, 2014 (in process) 13
Overall Process
BCTHN Site*
(1) Review program
material on-line;
identify person(s)
to:
- Provide training
- Prescribe
naloxone
- Dispense kits
- Coordinate
program
(2) Submit new site
registration form
BC CDC
Harm
Reduction
program
Provide BCTHN
resources
* E.g. PH unit, CHC, community agency, hospital ED, or detox facility
Banjo et al. Implementing A Provincial Take Home Naloxone
Program: Quantitative and qualitative evidence from a cross-sectional
study in British Columbia, Canada. CMAJ Open, 2014 (in process) 14
Overall Process
BCTHN Site*
(1) Review program
material on-line;
identify person(s)
to:
- Provide training
- Prescribe
naloxone
- Dispense kits
- Coordinate
program
(2) Submit new site
registration form
BC CDC
Harm
Reduction
program
(3) Request
approval for new
site
(4) Grant new
approval
Provide BCTHN
resources
* E.g. PH unit, CHC, community agency, hospital ED, or detox facility
Banjo et al. Implementing A Provincial Take Home Naloxone
Program: Quantitative and qualitative evidence from a cross-sectional
study in British Columbia, Canada. CMAJ Open, 2014 (in process) 15
BC
regional
HA MHOs
Oversee health
activities
Overall Process
BCTHN Site*
(2) Submit new site
registration form
(1) Review program
material on-line;
(5) Send kits and
identify person(s)
training materials to site
to:
- Provide training
- Prescribe
naloxone
- Dispense kits
- Coordinate
program
BC CDC
Harm
Reduction
program
(3) Request
approval for new
site
(4) Grant new
approval
Provide BCTHN
resources
(6) Regularly send
training attendance,
prescription,
dispensing & naloxone
administration forms
* E.g. PH unit, CHC, community agency, hospital ED, or detox facility
Banjo et al. Implementing A Provincial Take Home Naloxone
Program: Quantitative and qualitative evidence from a cross-sectional
study in British Columbia, Canada. CMAJ Open, 2014 (in process) 16
BC
regional
HA MHOs
Oversee health
activities
Overall Process
BCTHN Site*
(2) Submit new site
registration form
(1) Review program
material on-line;
(5) Send kits and
identify person(s)
training materials to site
to:
- Provide training
- Prescribe
naloxone
- Dispense kits
- Coordinate
program
BC CDC
Harm
Reduction
program
(3) Request
approval for new
site
(4) Grant new
approval
Provide BCTHN
resources
(6) Regularly send
training attendance,
prescription,
dispensing & naloxone
administration forms
* E.g. PH unit, CHC, community agency, hospital ED, or detox facility
Banjo et al. Implementing A Provincial Take Home Naloxone
Program: Quantitative and qualitative evidence from a cross-sectional
study in British Columbia, Canada. CMAJ Open, 2014 (in process) 17
BC
regional
HA MHOs
Oversee health
activities
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Gaps and Next Steps
In BC, naloxone:
• Is not covered by provincial formulary
• Can only be prescribed by physicians or nurse practitioners
• Can only be prescribed to current opioid users
Need to expand to:
• People on substitution treatment (methadone, suboxone)
• People taking prescription opioids
• People who have been using illicit opioids for a long time
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Acknowledgements
• BCCDC Staff &
Students
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• Clients & staff at
participating Take
Home Naloxone and
survey sites
• BC Coroners Service
• Centre for Addictions
Research BC
• BC Ministry of Health
Arash Shamsian
Chris Jang
Despina Tzemis
Jane Buxton
Mieke Fraser
Robert Balshaw
Sonya Ishiguro
Sunny Mak
Wrency Tang
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Questions?
Ashraf Amlani
[email protected]