Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home Naloxone programs Ashraf Amlani Harm Reduction Epidemiologist.

Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home

Naloxone programs

Ashraf AmlaniHarm Reduction Epidemiologist

ashraf.amlani@bccdc.ca

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• Overdose surveillance in BC• Substance Use Trends Survey• Comprehensive Response to OD• BC Take Home Naloxone program• Questions

Outline

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• 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

4

Data Source: BC Coroners Service

Illicit Drug Overdose Deaths

5

2005 2006 2007 2008 2009 2010 2011 2012 2013*0

50

100

150

200

250

300

350

0

1

2

3

4

5

6

7

8

Northern

Metro

Island

Interior

Fraser

BC Rate per 100,000Nu

mb

er o

f D

eath

s

Rat

e p

er 1

00,0

00Data Source: BC Coroners Service

* Provisional numbers – cases still under investigation

Substance Use Trends• Based on survey of harm reduction clients in Summer

2013

• 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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• 2012 survey tool modified

• Sites recruited

May-June 2013

• Surveys distributed to sites

• Surveys administered

July-Aug 2013

• Data entry and cleaning

• Data analysis

Sept 2013 - Jan 2014

Opioid use by health region

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FHA (N=98) IHA (N=98) NHA (N=79) VCH (N=70) VIHA (N=142)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

BC (Heroin): 61.8%

BC (Substitution): 40.6%

BC (Prescription): 54.2%

Heroin Substitution Prescription

Heroin (BC) Substitution (BC) Prescription (BC)

Pe

rce

nt

of

Re

sp

on

de

nts

www.bccdc.ca/prevention/HarmReduction/SubstanceUseTrends/default.htm

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Opioids used in past weekMorphine Heroin

www.bccdc.ca/prevention/HarmReduction/SubstanceUseTrends/default.htm

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Overdoses in past 6 months

OD Witnessed

FHA IHA NHA VCH VIHA0%

10%

20%

30%

40%

50%

50%

31%

20%26%

36%

BC: 36.1%

Pe

rce

nt

of

res

po

nd

en

ts

FHA IHA NHA VCH VIHA0%

5%

10%

15%

20%

16%

8% 8% 8%

14%

BC:11.3%

Per

cen

t o

f R

esp

on

den

ts

Opioid Use & OD Experienced

Prevention

• Know the risk factors

Recognition

• Know the signs

Response

• Know what actions to take

Comprehensive Overdose Survival Strategy

10http://towardtheheart.com/assets/uploads/files/OD_Survival_Guide_Tips_to_Save_a_Life_2012.08.29_upright_for_website.pdf

• 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: • 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

Community Naloxone

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• 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

Naloxone Kit Contents

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Overall Process

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* E.g. PH unit, CHC, community agency, hospital ED, or detox facility

BCTHN Site*

(1) Review program material on-line; identify person(s) to:

- Provide training- Prescribe

naloxone- Dispense kits- Coordinate

program

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)

Overall Process

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* E.g. PH unit, CHC, community agency, hospital ED, or detox facility

(2) Submit new site registration form BC CDC

Harm Reduction program

Provide BCTHN resources

BCTHN Site*

(1) Review program material on-line; identify person(s) to:

- Provide training- Prescribe

naloxone- Dispense kits- Coordinate

program

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)

Overall Process

15

* E.g. PH unit, CHC, community agency, hospital ED, or detox facility

( 4) Grant new approval

( 3) Request approval for new

site

(2) Submit new site registration form BC CDC

Harm Reduction program

Provide BCTHN resources

BC regional

HA MHOs

Oversee health activities

BCTHN Site*

(1) Review program material on-line; identify person(s) to:

- Provide training- Prescribe

naloxone- Dispense kits- Coordinate

program

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)

Overall Process

16

* E.g. PH unit, CHC, community agency, hospital ED, or detox facility

( 4) Grant new approval

( 3) Request approval for new

site

(6) Regularly send training attendance,

prescription, dispensing & naloxone administration forms

(5) Send kits and training materials to

site

(2) Submit new site registration form BC CDC

Harm Reduction program

Provide BCTHN resources

BC regional

HA MHOs

Oversee health activities

BCTHN Site*

(1) Review program material on-line; identify person(s) to:

- Provide training- Prescribe

naloxone- Dispense kits- Coordinate

program

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)

Overall Process

17

* E.g. PH unit, CHC, community agency, hospital ED, or detox facility

( 4) Grant new approval

( 3) Request approval for new

site

(6) Regularly send training attendance,

prescription, dispensing & naloxone administration forms

(5) Send kits and training materials to

site

(2) Submit new site registration form BC CDC

Harm Reduction program

Provide BCTHN resources

BC regional

HA MHOs

Oversee health activities

BCTHN Site*

(1) Review program material on-line; identify person(s) to:

- Provide training- Prescribe

naloxone- Dispense kits- Coordinate

program

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)

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Gaps and Next StepsIn 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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• BCCDC Staff & Students• Arash Shamsian• Chris Jang• Despina Tzemis • Jane Buxton• Mieke Fraser• Robert Balshaw• Sonya Ishiguro• Sunny Mak• Wrency Tang

• Clients & staff at participating Take Home Naloxone and survey sites

• BC Coroners Service• Centre for Addictions

Research BC• BC Ministry of Health

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Acknowledgements

Questions?

Ashraf Amlaniashraf.amlani@bccdc.ca