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]
Dec 14, 2015
Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home
Naloxone programs
Ashraf AmlaniHarm Reduction Epidemiologist
2
• 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
3
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)
6
• 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
8
Opioids used in past weekMorphine Heroin
www.bccdc.ca/prevention/HarmReduction/SubstanceUseTrends/default.htm
9
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 [email protected]