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

1. Overdose prevention training programs including take-home-naloxone: Lessons learned from BC Jane Buxton, MBBS, MHSc, FRCPC Physician Epidemiologist, Harm Reduction Lead BC Centre for Disease Control jane.buxton@bccdc.ca

2. 2 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

3. Background 3 3 • 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

4. 4 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

5. 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

6. 6 Individual training programs 2. 1. 3. Client and/or Family trained Participating THN site 7. Complete training 4. 6. 5. Pick-up kit Prescription Visit Prescriber

7. 7 Group training programs Clients + Educator + Prescriber = THN training & kit dispensing

8. 8

9. 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

10. Program Evaluation… 10 10 • Community Advisory Board • Focus groups/interviews with stakeholders • Clients • Parents of those who use opioids • Police • Service providers

11. 11 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)

12. 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

13. 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

14. 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?

15. 15 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 Program outreach@towardtheheart.com