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Life Won't Wait Capstone Presentation - final presentation


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  • My thesis defense for the Master's of Public Policy at Simon Fraser University, on a very important topic.
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Life Won't Wait Capstone Presentation - final presentation

  1. 1. Life Won’t Wait: Reducing Fatal Drug Overdoses In British Columbia Jordan Westfall Thesis Defense April 2nd, 2015. 10:00 A.M.
  2. 2. The largest yearly total since 1998. Too Many British Columbians are Dying of Drug Overdoses..
  3. 3. What happened? OxyContin, a prescription drug is taken off the market. Fentanyl sold as OxyContin or heroin illicitly. Led to worst weekend in Insite’s history for overdoses (31). Prescription pain killer overdoses are also increasing. Chronic Pain, 22% of BC adults (Corneil, 2014). Interior Region- 25, 000 people on opioid medications (Corneil, 2014).
  4. 4. Overdose Prevention in British Columbia • Take home naloxone program. • Provides Overdose Education and Naloxone Training (OENT). • OENT consists of: • Prevention of OD • Recognition/Response to OD. Challenges: • Available by physician’s prescription only. • Must take training course. • Must have a history of opioid use. How is policy is practiced?
  5. 5. Knowledge Gaps • Barriers to enhancing overdose prevention. • Drug user awareness of current policy. • Good practices from other jurisdictions.
  6. 6. Purpose of Research • AIM: To develop policy at the provincial level to reduce drug overdose fatalities. • What role can public policy play in reducing fatal drug overdoses in BC? • How can provincial legislation reduce fatal drug overdoses in BC? • How have other jurisdictions reduced fatal drug overdoses? • Are drug users in Vancouver aware of the VPD’s overdose prevention policy?
  7. 7. Methodology 1) Case Studies: • Ontario – document analysis • North Carolina- 2 interviews with NCHRC • Massachusetts –Document analysis and interview with Learn2Cope 2) Stakeholder Interviews: • British Columbia • VPD • BCCDC • Ministry of Justice • Pivot Legal • United States • Harm Reduction Coalition • National Alliance for Model State Drug Laws • Columbia University 3) Survey: • 28 respondents • Street-level People who use drugs • Sampled from Vancouver Network of Drug Users • Questionnaire asks about their awareness of the Vancouver Police Department’s overdose prevention policy
  8. 8. Case StudiesJurisdiction Distribution Method Naloxone Kits Dispensed Kits per 1,000 persons Overdose Reversals Highlights Massachusetts Standing Order 2,444/year 22, 000 (total) 0.36 kits per 1000 people 1,300 • Uses intranasal naloxone. • Learn2cope provides OENT to family members. • Police carry naloxone Ontario Directive (similar to standing order) 665/year 1,330 (total) 0.10 kits per 1000 people 120 • Restricted Access • Implementation issues stopped program. North Carolina Standing Order 2700/year 5400 (total) 0.54 kits per 1000 people 350 • Cost-effective • Broadest access to naloxone. British Columbia Physician’s prescription 650/year 1300 (total) 0.30 kits per 1000 people 125 • Comparative purposes only.
  9. 9. Stakeholder interviews British Columbia: • More education/destigmatization: • Friends, family, illicit, and licit drug users. • Lack of prescribing directive. • Inefficiency. • Naloxone by pharmacist’s prescription. • Good Samaritan Law. United States: • Misconceptions persist. • Public endorsements increase acceptability. • Celebrities, police. • No evaluation or awareness $ for Good Sam laws.
  10. 10. Were you aware of this policy?
  11. 11. Other policy considerations Both VPD and drug users need to be considered. • Why not implement a Good Samaritan law? • Out of scope. Intranasal naloxone. • Federal restrictions. Staggered welfare cheque distribution. • No evidence thus far. IM naloxone- cost effective Policy Options are divided into two categories: 1.) Overdose Education and Naloxone Training (OENT) 2.) Naloxone Distribution
  12. 12. Policy Options- OENT Findings 9.8% of trainings are for friends & family. Only those with a history of opioid use can be prescribed naloxone. “Licit” drug users need OENT Findings Most of the province’s methadone clinics don’t provide OENT. Administering naloxone is empowering for drug users. Option A OENT for “laypeople” friends, family members, & licit drug users. Option B Dual-incentive recruitment for illicit PWUDs. OENT at methadone clinics & detox centres. Criteria and Measures Effectiveness- Can bystanders respond appropriately to an overdose. Equity- increase in representativeness for non-illicit drug users.
  13. 13. Policy Options- Naloxone Distribution Findings Having a physician prescribe naloxone is inefficient. Licit drug users are overdosing at an increasing rate. Adding naloxone to provincial formulary would make it free for Blue Cross members. Findings Overdose is leading cause of death among homeless in BC. Jurisdictions that have liberalized access to naloxone have higher amounts of OD reversals. Option A Naloxone available by pharmacist’s prescription. Option B Nurse’s Decision Support Tool. (DST) Criteria and Measures Health & Safety- # of overdose reversals. Effectiveness- # of naloxone kits dispensed.
  14. 14. OENT Option A Strengths • OENT for underrepresented groups (family and friends). • Provides an access point for support services • Addresses licit ODs. • Effective under current regulations. when laypersons cannot receive naloxone kit. Weaknesses • No support for illicit drug users.
  15. 15. OENT Option B Strengths • Empowerment for drug users. • Reduced “enacted” and “self- stigma” • Methadone clinics • Secondary trainings Weaknesses • PWUDs already well represented under current efforts (less of an impact) • Ideological resistance from detox centres.
  16. 16. Naloxone Distribution Option A Strengths • Convenience. • Access for licit drug users and methadone patients. • Easy to get follow-up kits. • Reduces prescribing burden on physicians. • Added to Blue Cross • No need to use Telehealth in rural regions. Weaknesses • Pharma Net. • Negative externalities. • Licit drug users have to make separate trips for OENT and kit.
  17. 17. Naloxone Distribution Option B Strengths • Cohesion with OENT options. • Reduces physician prescriber burden. • Outreach efforts (street nurses, etc) Weaknesses • Cost inefficiencies • Clinic or other healthcare visit required. • Follow up kits require healthcare visit.
  18. 18. Recommendations • OENT efforts should be expanded to focus on friends, family members and licit drug users. • Nurse’s DST: helpful for homeless populations. • Naloxone distribution by pharmacist’s prescription for the rest of the population. • Each naloxone distribution option is cost effective. Future Considerations • Reduce waitlists for drug rehabilitation services. • Drug reformulations can increase overdoses. • Instruct police departments not to respond to overdose 911 calls.
  19. 19. Conclusions BC is leading Canada toward a rational, scientific drug policy. Naloxone is not a “magic-bullet”. But we’re losing ground to the United States. Liberal access to naloxone. Good Samaritan Laws. Housing, employment training, rehab services. These things help people stay off of drugs.