Buprenorphine/naloxone Standard Dosing and Microdosing in the Emergency Department: A feasibility study (2019)

Research Lead: Dr Jessica Moe

Many vulnerable populations, such as First Nations, construction workers, and people who use drugs alone, are at high risk for overdose, and may only seek out healthcare services in Emergency Departments (EDs). Yet, EDs don’t have a good way of identifying those at risk and offering treatments that could prevent future overdoses. By preventing cravings and withdrawal symptoms, Buprenorphine/naloxone (Suboxone) is the recommended treatment for patients with opioid addiction who wish to decrease their harmful opioid use, and studies show that starting people on buprenorphine/naloxone during ED visits helps to connect them with addictions services.

At the same time, many barriers exist that prevent people from accepting this treatment, like experiencing uncomfortable opioid withdrawal symptoms like agitation, nausea, vomiting, and sweats, before starting buprenorphine/naloxone at standard doses, plus, the medication can make patients’ withdrawal symptoms worse if started too early. As a result, microdosing is a new way of starting buprenorphine/naloxone where people take small doses that gradually increase over 6-7 days. People also do not need to be in withdrawal before a microdosing method is started, and the risk of causing worsening withdrawal symptoms during initiation is low. Still, the longer time to reach a target dose is a downside. This innovative study examined the feasibility of starting people on buprenorphine/naloxone from the ED using both standard dosing and microdosing methods, and was the first to address knowledge gaps on the acceptability of these methods, further contributing to the understanding of barriers to induction methods and of how to optimize buprenorphine/naloxone provision for vulnerable ED patients.

Opioid prescribing evaluation and research activities (2016-2018)

Research Lead: Dr Roy Purcell

Deaths due to illicit drug overdoses in BC is on the rise. This dramatic increase in deaths due to illicit drugs is partially due to patients transitioning from prescription opioid use to illicit drug use, which is very common. Many drugs sold illicitly contain fentanyl, an extremely dangerous opioid that is many times more potent than heroin. Patients who transition from taking prescription pain relievers containing opioids to injecting illicit drugs will be a much higher risk of overdose death.

Funding from the BCCDC Foundation allowed researchers to use data from the BC Hepatitis Testers Cohort (BC-HTC), a comprehensive population-based longitudinal cohort consisting of all BC residents who have been tested for HCV or HIV at the BCCDC Public Health Laboratory, to investigate the association between prescribed opioid therapy and objective measures of intravenous drug use (IDU) in a population-based cohort of almost 1.4 million people in Canada. Importantly, this grant was a key component of further funding to complete this research.

CDPC National Knowledge Exchange and Consultation on Supervised Consumption Services (2016)

Research Lead: Dr Naveed Janjua

People who inject drugs face serious potential health risks, including vulnerability to HIV and HCV. As Canada is in the grips of an overdose crisis, many groups are working to establish Supervised Consumption Services (SCSs) as part of a comprehensive response to the overdose situation. Funding from the BCCDC Foundation brought the Canadian Drug Policy Coalition (CDPC) and the Canadian HIV/AIDS Legal Network (Legal Network) together for a two-day facilitated “National Knowledge Exchange and Consultation on Supervised Consumption Services (SCS)” in Vancouver, BC, hosting 100 guests from 20+ localities in Canada considering and/or implementing SCSs.

The event successfully enabled the development of a comprehensive analysis of barriers created by the Respect for Communities Act, and a greater understanding of challenges encountered when operating a supervised consumption site. Additionally, an important network of stakeholders such as community groups, health authorities, harm reduction workers, and people who use drugs, was established to further future knowledge exchange efforts and coordination. The CDPC continues to work at a national level and focuses on including a broader range of participants in its network and activities related to SCSs. With the newly refreshed network of SCS advocates, the CDPC will look at implementing new digital engagement strategies, and may create some task sub-groups to focus on issues of SCS applications, operations, and community advisory processes.

Peer engagement and evaluation project (2015-2016)

Research Lead: Dr Jane Buxton

Harm reduction programs are internationally accepted as effective for reducing health disparities associated with drug use. However, there are large variations in the availability, accessibility, and utilization of these programs across BC. Partnering with people who use drugs, or ‘peers,’ reduces inequities by making services relevant and responsive. The Peer Engagement and Evaluation Project (PEEP) aimed to develop, implement, and evaluate best practice guidelines for peer engagement for harm reduction initiatives using an approach that includes capacity building, empowerment, and engagement of peers, providers, and decision makers.

BCCDC Foundation funding was granted for the purpose of a team meeting, for which one of the main findings was understanding the amount of stigma and discrimination among health providers across the province. As a result, the development of knowledge translation tools, including anti-stigma training with a photo series, were used at presentations across the province, as well as the development of best practice guidelines, which have been directly informed by the validation of their focus group findings at the team meeting.

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The post Reducing Harms: Seed and Pilot Funding for BCCDC Researchers appeared first on Pacific Public Health Foundation.

Q Sofia: Can you tell me how you describe your job with UTG, and how does UTG work?

Cheri: I’m a Peer Health Mentor with Unlocking the Gates; we walk alongside people when they are leaving corrections, help guide them on accessing services, and whatever other things they need assistance with. Having people with lived experience of incarceration involved in this period of transition when someone is leaving corrections makes a huge difference to how clients react to services that are offered!

Q Sofia: What is the Test Link Call (TLC) Project and how are you involved in it?

Tammy: We identify clients coming out of corrections who have hep C and who haven’t been linked to care or treatment yet—so we talk about hep C, hep B, HIV, we check with all our clients about that. If they have hep C infection, we find out if they did treatment yet, we tell them about the new treatments and how easy they are, I tell them about my previous clients who have done hep C treatment successfully, and we tell them about TestLinkCall Project. What that involves is we will link them to care with a treatment provider, give them a cell phone, and walk with them through treatment.

Pam: I hear things about the old hep C treatment still all the time from clients, the old interferon treatment hasn’t gone from peoples’ minds. The old treatment overwhelmed people for a long time. I’ve had clients do the new treatment and all they had was a headache. When I hear people talk about the old treatment, I address all their fears and misconceptions, so a lot of the time what we’re doing is education.

Q Sofia: How do you think TLC Project has helped UTG clients so far?

Pam: Our clients can do video calls with their hep C care providers now; that’s been a huge help for them. It’s so convenient to do their hep C treatment all by phone because a lot of them can’t get to appointments! But without a phone, telehealth, or video calls are impossible.

Cheri: The TestLinkCall program has been great because the Peer Health Mentors can check in with clients every few weeks by calling their cell phone, we just say “How you doing? How’s the treatment going? Hope you’re doing great!” It means a lot to them.

Tammy: Quite often, we are the only ones in our clients’ corner. We are often their only social connection—and giving them a phone actually helps a lot for them to feel like we are there for them.

Pam: I think it’s also been great that our clients can use social media and use video chat now to connect with family. There’s also these apps on the phones, before we give them to the clients, like the LifeGuard app, which is for safer substance use and can help alert first responders in the event of accidental overdose. I don’t know for sure that my clients who have received a phone are using the LifeGuard app, but at least we tell them about it and how to use it, and it’s on the phones.

Cheri: I know for sure one of my clients used the LifeGuard app on their phone that we gave them!

Tammy: Also, the phones are so good for the clients to be able to connect to other services, like trying to get into a drug detox facility.

Q Sofia: How do you think TLC Project can contribute to overall public health and hep C elimination in the overall population?

Cheri: Honestly I never heard of the overall goal for hep C elimination until today! But I’ll tell you, I don’t see hep C elimination being possible without things like TestLinkCall Project, or having other ways to connect people to care. We really need things like TestLinkCall Project where Peers who are connected with people at risk of hep C, like people in the prison system, have got support and resources to help link these clients to care. Or else hep C elimination is not going to work!

Pam: The prison population has such a high number of people living with hep C infection, it’s such a good place to start to get people connected to care, as part of these overall hep C elimination goals. But you know there’s so many other places we could also go to! Like recovery houses or homeless shelters, so I think this project could be scaled up or expanded even more!

Cheri: And I think if Peers could collect samples for hep C testing or do point of care tests, this would reach a lot of people and would be very acceptable for our clients. And this would work really well with TestLinkCall Project and the process we already established for linkage to care!

Tammy: Yes, if Peers could do testing or collect samples, clients would feel so much safer, and everything will move by so much quicker because we would be able to do everything on the spot at the shelter or wherever else we find them.

To learn more about Test, Link, Call (TLC) Project, read Dr Bartlett’s guest blog post Test, Link, Call (TLC) Project: Improving Connection to Hepatitis C Virus Treatment After Release from Provincial Prisons in BC.

The post Interview: Peer Health Mentors Work to Improve Connection to Hepatitis C Virus Treatment After Release from Provincial Prisons in BC appeared first on Pacific Public Health Foundation.

The post Newsletter #21: February 2021 appeared first on Pacific Public Health Foundation.

For those affected by substance use, supporting someone who is using drugs, engaged in harm reduction and overdose prevention work, or connected to the peer community, COVID-19 has not replaced the overdose crisis, instead, it has compounded it.

In 2019, overdose rates were steadily decreasing in BC, but as COVID-19 took hold, we started to see the number of overdose deaths creeping up again, until we sadly had our worst month ever in June 2020 when 185 people died in our province from overdose.

Between April 2016 and December 2020, 6,078 people died of overdose in BC, and 901 people were taken too early by COVID-19.

We know the toll COVID-19 is taking on our essential workers and are deeply grateful for their heroic efforts. Peers are often the overdose prevention “front line” workers in their communities, yet, preventing and reversing overdose among their friends, neighbours and family with little support or recognition.

CIE has been working with peers in communities across the province to build networks of support and improve harm reduction and overdose prevention services.

CIE provides small community grants to peer groups who are an essential part of the network of support across the province, and the BCCDC Foundation has provided much of the funding for these grants since 2018. Grant funding has enabled peers to stay connected during COVID-19 by providing access to technology and ongoing outreach activities like community lunch programs.

Since 2018, peer groups who have received CIE community grants have created supportive peer connections, as well as building bridges to their communities. Peer groups have organized community clean up efforts, created connections with local businesses, municipal governments and community groups, as well as participating in the provincial opioid overdose response by contributing to planning tables like Community Action Teams.

At CIE, we are guided by the principles of harm reduction and firmly believe that peers are the experts in their lives and their communities. With the BCCDC Foundation’s help, we hope to continue to support peers in BC to build and sustain supportive networks, create connections in their communities, and be a strong and influential voice in decisions that affect their lives.

As Johann Hari said in his TedTalk in 2015, “The opposite of addiction is connection.” If COVID has taught us anything, it is how very true this is.

Supporting peers to stay connected during this very stressful time is more important than ever. Providing support directly to those most affected by service disruptions and exposed to a toxic, deadly street drug supply is a tangible step toward a truly equitable approach to health.

Additional resources:

• Johann Hari TEDTalk
• Principles of Harm Reduction
• CCSA Report on the impacts of COVID-19 on people who use substances
• Nothing about us without us

*Bios:
Sally Maguet is the lead for CIE. She has a public health background and works on projects that support Indigenous Cultural Safety, harm reduction, and climate change adaptation.

Charlene Burmeister is a provincial peer coordinator for CIE and has been working in research and harm reduction for over 12 years.

Marnie Scow is a provincial peer coordinator with CIE with over 10 years experience providing and managing harm reduction services, and bringing an Indigenous perspective to research, education and harm reduction approaches. 

Laura Moore is CIE’s project coordinator. She has a Master’s of Health Administration and has been working in harm reduction for many years supporting research and capacity building projects across the province. 

The post Compassion, Inclusion and Engagement: The Role of Peers in the Overdose Crisis appeared first on Pacific Public Health Foundation.