Trends in Opioid Use and Overdose in BC: Making the case for greater availability of Take Home Naloxone programs Ashraf Amlani Harm 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 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 Data 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 years (mean = 41 years) survey tool modified Sites recruited May- June 2013 Surveys distributed to sites Surveys administer ed July- Aug 2013 Data entry and cleaning Data analysis Sept Jan 2014

Opioid use by health region 7 SubstanceUseTrends/default.htm

8 Opioids used in past week Morphine Heroin SubstanceUseTrends/default.htm

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

Prevention Know the risk factors Recognition Know the signs Response Know what actions to take Comprehensive Overdose Survival Strategy 10 de_Tips_to_Save_a_Life_ _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 11

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 12

Overall Process 13 * 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 14 * 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 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

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 20 Acknowledgements

Questions? Ashraf Amlani