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Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home Naloxone programs Ashraf Amlani Harm Reduction Epidemiologist ashraf.amlani@bccdc.ca. Outline. Overdose surveillance in BC Substance Use Trends Survey Comprehensive Response to OD

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  1. Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home Naloxone programsAshraf AmlaniHarm Reduction Epidemiologistashraf.amlani@bccdc.ca

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

  3. 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 Background: Overdose (OD) in BC

  4. 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 Rx Opioid-related deaths Data Source: BC Coroners Service

  5. Illicit Drug Overdose Deaths * Provisional numbers – cases still under investigation Data Source: BC Coroners Service

  6. 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)

  7. Opioid use by health region www.bccdc.ca/prevention/HarmReduction/SubstanceUseTrends/default.htm

  8. Opioids used in past week Heroin Morphine www.bccdc.ca/prevention/HarmReduction/SubstanceUseTrends/default.htm

  9. Overdoses in past 6 months OD Witnessed Opioid Use & OD Experienced

  10. Comprehensive Overdose Survival Strategy http://towardtheheart.com/assets/uploads/files/OD_Survival_Guide_Tips_to_Save_a_Life_2012.08.29_upright_for_website.pdf

  11. 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: • 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

  12. 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

  13. BCTHN Site* • 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 Overall Process 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. (2) Submit new site registration form BC CDC Harm Reduction program Provide BCTHN resources BCTHN Site* • 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 Overall Process 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. (2) Submit new site registration form • 3) Request approval for new site BC CDC Harm Reduction program Provide BCTHN resources BC regional HA MHOs Oversee health activities BCTHN Site* • Review program material on-line; identify person(s) to: • Provide training • Prescribe naloxone • Dispense kits • Coordinate program • 4) Grant new approval * E.g. PH unit, CHC, community agency, hospital ED, or detox facility Overall Process 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. (2) Submit new site registration form • 3) Request approval for new site BC CDC Harm Reduction program Provide BCTHN resources BC regional HA MHOs Oversee health activities BCTHN Site* • Review program material on-line; identify person(s) to: • Provide training • Prescribe naloxone • Dispense kits • Coordinate program • (5) Send kits and training materials to site • 4) Grant new approval (6)Regularly send training attendance, prescription, dispensing & naloxone administration forms * E.g. PH unit, CHC, community agency, hospital ED, or detox facility Overall Process 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. (2) Submit new site registration form • 3) Request approval for new site BC CDC Harm Reduction program Provide BCTHN resources BC regional HA MHOs Oversee health activities BCTHN Site* • Review program material on-line; identify person(s) to: • Provide training • Prescribe naloxone • Dispense kits • Coordinate program • (5) Send kits and training materials to site • 4) Grant new approval (6)Regularly send training attendance, prescription, dispensing & naloxone administration forms * E.g. PH unit, CHC, community agency, hospital ED, or detox facility Overall Process 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)

  18. 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

  19. Acknowledgements • Clients & staff at participating Take Home Naloxone and survey sites • BC Coroners Service • Centre for Addictions Research BC • BC Ministry of Health • BCCDC Staff & Students • Arash Shamsian • Chris Jang • Despina Tzemis • Jane Buxton • Mieke Fraser • Robert Balshaw • Sonya Ishiguro • Sunny Mak • Wrency Tang

  20. Questions?Ashraf Amlaniashraf.amlani@bccdc.ca

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