1. Communicating Drug Alerts Improving the Effectiveness of Drug Alerting to Reduce Harms Among People Who Use Illicit Drugs

2. BC Centre for Disease Control  Provincial Health Services Authority (PHSA)  Diagnostic and treatment services  Analytical and policy support to all health authorities and levels of government (1)  Harm Reduction (2) (1)

3. Significant Milestones in Harm Reduction 196419841986198919902003 Methadone Treatment Program (Canada) Needle exchange (Netherlands) Legalized injection site (Switzerland) Needle exchange (British Columbia) International Conference (United Kingdom) Supervised Injection site (North America) (3)

4. Common Adulterants DrugAdulterantLicit UsePotential Reasons for Presence Public Health Risks Health Consequences HeroinAcetaminophenPain relief (highly accessible, inexpensive) Analgesic effect & bitter taste Minimal at low doses Toxicity at high doses Liver damage Gastro-intestinal effects Adverse effects (Alcohol) CocainePhenacetinAnalgesic properties Disguise poor quality cocaine Banned in several countries (Suspected carcinogenicity and linked to renal failure) Kidney cancer Bladder cancer Haemolytic anaemia Analgesic nephropathy Adapted Table (4)

5. Study Design Focus groups & interviews Third party transcription and coding – NVivo 8 Interpretive Descriptive Qualitative Study Design Study Approach Study Methods Data Analysis

6. Participants  32 Focus Group Participants (Regular illicit drug user)  Age Range: 23 to 70 years of age  23 participants were between ages 40 to 60  17 Male/15 Female  5 VCH Key Informants (Semi-structured interviews)  Primary contact with illicit drug users  3 Male/2 Female  Primary Outreach Services, Primary care & Insite/Onsite

7. Socio-economic Status

8. Drug Use Patterns Frequency of Use/Week Years of Use Current/Pas t Injection Drug Use Poly- substance Abuse Quit Injection Drug Use Years of Abstinence from Injection Drug Use 27 Participants Daily Use Range: 4 to 48 years Median: 29 21 Participants 31 Participants 7 Participants Range: 5 to 39 Median: 8.5

9. Primary Objectives Current Quality Assurances Practices Communication Pathway Recommendations to Improve Drug Alerts  A narrative literature review was conducted  Inform focus group questions and interview guide

10. Quality Assurance “…I see the ones that have a reputation of being a good dealer down here will always have somebody recommend them” (Focus group 4 participant) “My dealer, he cares about repeat business.” (Focus group 1 participant) “By just the way it looks” (Focus group 2 participant)

11. Communication Pathways “Yeah, I’d share it with all my friends and anybody I run into”. (Focus group 2 participant) “We’ve got the fastest way”. (Focus group 3 participant) “friends look after friends”. (Focus group 2 participant)

12. Recommendations Clear Terminology A ‘potent’ drug is perceived differently by HSP & PWUD “that means it’s strong it works”. (Focus group 2 participant) Preferred Mode of Communication “Fliers”. “Web news”. “Facebook”. (Focus group 1 & 4 participants) Visibility, Accessibility & Relevance of Postings “As long as they are kept to date” (focus group 1 participant)

13. Implications for Public Health Policy & Practice Current lack of Provincial, evidence-based guidelines for communicating drug alerts CDA can Reduce risk of mortality and morbidity associated with illicit drug use Guidelines should be informed and evaluated by the target population to increase effectiveness There is limited literature and research evaluating feedback from peers in Canada Findings will be compiled into a research report and submitted for publication

14. Questions?

15. References (1) BC Centre for Disease Control. (2014). About BCCDC. Retrieved on April 7, 2014 from http://www.bccdc.ca/util/about/default.htm. http://www.bccdc.ca/util/about/default.htm (2) Provincial Services Health Authority. (2014). About PHSA. Retrieved on April 7, 2014 from http://www.phsa.ca/AboutPHSA/default.htm http://www.phsa.ca/AboutPHSA/default.htm (3) BC Harm Reduction Strategies and Services. (2013). The History of Harm Reduction in British Columbia. Retrieved on April 12, 2014 from http://www.bccdc.ca/NR/rdonlyres/7B9F63E8-7D50-4985-9BC2- 38D78C4E77AD/0/UpdatedBCHarmReductionDocumentAug2012JAB_final.pdf. http://www.bccdc.ca/NR/rdonlyres/7B9F63E8-7D50-4985-9BC2- 38D78C4E77AD/0/UpdatedBCHarmReductionDocumentAug2012JAB_final.pdf http://www.bccdc.ca/NR/rdonlyres/7B9F63E8-7D50-4985-9BC2- 38D78C4E77AD/0/UpdatedBCHarmReductionDocumentAug2012JAB_final.pdf (4) Cole, C., Jones, L, McVeigh, J., Kicman, A., Qutub, S & Bellis, M.A. (April, 2010). CUT: A Guide to Adulterants. Retrieved on April 24, f http://www.cph.org.uk/wp-content/uploads/2012/08/cut-a-guide-to-the-adulterants-bulking-agents-and-other-contaminants-found-in- illicit-drugs.pdf. http://www.cph.org.uk/wp-content/uploads/2012/08/cut-a-guide-to-the-adulterants-bulking-agents-and-other-contaminants-found-in- illicit-drugs.pdf http://www.cph.org.uk/wp-content/uploads/2012/08/cut-a-guide-to-the-adulterants-bulking-agents-and-other-contaminants-found-in- illicit-drugs.pdf