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.

You can stay connected on all project updates by visiting this page and subscribing to our newsletter.

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

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These infections can lead to serious health complications; for people who are pregnant, infectious syphilis can be passed on to their infant, which leads to lifelong health issues and can also result in infant death. Syphilis is the third most commonly reported STI in Canada now (behind Chlamydia and Gonorrhea), and neonatal syphilis cases in Canada have surged in recent years.

Chronic hepatitis C infection is the leading cause of liver disease in Canada, which is ranked 11^th in 2019 among causes of death. While hepatitis B is a vaccine preventable disease, many people living in Canada were born in countries where this virus is highly prevalent and vaccination is less common, resulting in an estimated 250,000-460,000 Canadians living with chronic hepatitis B infection.

There is good news though; there are sensitive tests available to detect all these infections, and effective treatments are available. Hepatitis C and syphilis are curable, while HIV and hepatitis B infection can be suppressed, preventing the viruses from replicating or being able to be passed on.

Despite this, people who have experienced incarceration continue to face many difficulties in accessing testing and treatment for STBBIs, both while they are in prison and when they return to the community. There is a lack of trust and power imbalances between people in prison and the health care staff, and these further exacerbate issues related to STBBIs in regards to confidentiality and stigma. Knowledge gaps related to STBBIs, among both people in prison and the staff have also been reported. When coupled with staff shortages and other resource limitations, these issues result in gaps in care and missed opportunities to engage people in prison in testing or treatment for STBBIs.

While we continue to have a large group of people who are disproportionately impacted by STBBIs and yet unable to access care, such as people who have experienced incarceration, we are not be able to adequately address these infections in our communities. For this reason, addressing these barriers to STBBI care in prisons is a high priority.

To do this, we need a new paradigm in prison health care, and with funding from the Public Health Agency of Canada, this is what the BC Centre for Disease Control and BC Mental Health and Substance Use Services hopes to achieve through the ‘Pathways to STBBI Care in BC Provincial Corrections Project’.

As part of this project, we have been conducting educational workshops on STBBIs with staff and residents in BC Provincial Correctional Centres, as well as people with lived experience of incarceration (PWLE) in the community, then doing surveys to get input from them about their previous experiences, preferences, and needs related STBBI testing and care.

This information is being used by a Committee, which includes people with lived experience of incarceration, as well as researchers and health care providers, to create a new policy and guideline on STBBI testing and care for BC Provincial Corrections. Staff and residents, as well as PWLE of incarceration in the community, will also get the opportunity to review and give feedback or suggest changes to the policy and guideline before it is implemented.

Through centering PWLE of incarceration in the development of policies and guidelines related to STBBI testing, we hope to help them become an active partner in their own health care, giving the new policies and guidelines the greatest chance of improving STBBI outcomes for people in prison in BC.

BC Centre for Disease Control is also working on other transformative projects to improve health outcomes for people in prison related to STBBIs; we recently received funding for the Test, Link, Call (TLC) Project which will begin shortly. The TLC Project will provide smart phones with 6 months of calling credit to people living with hepatitis C infection at the time of release from provincial corrections, along with a transitional care plan for hepatitis C treatment.

The care plan and cell phone will help them connect with peer and social supports, as well as a treatment provider of their choice in the community, and phones provided will also be preloaded with the LifeGuard app, to further assist in meeting the unmet health needs of people leaving prison.

Interested in reading Dr Bartlett’s guest post “Uncovering SARS-CoV-2 Behind Bars: Understanding the Impact of the COVID-19 Pandemic in Correctional Settings”? Go here to read her article.

The post Addressing Barriers to Sexually Transmitted and Blood Borne Infection (STTBI) Screening and Care in Prisons appeared first on Pacific Public Health Foundation.

What does conversion therapy have to do with public health? Public health is about preventing disease and injury, promoting health, ensuring that everyone has the same opportunities to achieve their optimal health (health equity), and the recognition that social factors do have an impact on our health outcomes over our lifespan (or, social determinants of health).

Members of LGBTQ2S+ communities already face health disparities ranging from disproportionate rates of HIV to higher rates of mental health and substance use challenges. Conversion therapy deliberately targets members of these communities, further exacerbating the health inequities they face as a population, and compounding their negative health outcomes. For example, a gay man who is HIV positive, who has also experienced conversion therapy will face a host of compounding inequities that will impact his health over his lifetime. To generalize, it will be harder for him to access appropriate health supports and improve his health than for a heterosexual man who hasn’t been through conversion therapy, or who doesn’t have HIV.

Or, consider a trans woman of colour who experiences poverty, perhaps because she was forced to leave her home at a young age when she came out to her family, and subsequently lived through conversion therapy. Here, her social determinants of health like her race, income, housing status, and gender identity are all factors that impact the healthcare she receives, and put her at risk of poorer health. One of the purposes of public health is to identify and address those disparities and inequities. Public health allows us to take those individual stories and experiences of trauma and address them at a systemic level, doing more good for more people. Instead of just improving health for one person, we can do it for populations.

So, there’s hope. There are people right here in BC and across North America fighting for change, fighting to protect future LGBTQ2S youth and adults from being subjected to these practices, working to ensure that future generations don’t face these same kind of systemic or institutional inequities. For those who have already lived through it, we want to best support them.

We need to know what support survivors need, where they need it, and how we can get it to them. This may sound obvious but a few ideas that were considered on Saturday were the need for peer supports, so survivors feel comfortable with their support worker and aren’t re-victimized by having to engage with a healthcare provider. And, considering the impacts of colonization and racism on Two-Spirit survivors, and examining the role that residential schools played in conversion therapy. What about new comers to Canada who may have experienced conversion therapy in their home countries? What services are they already accessing when they arrive here, how can help be offered to them in a place they already are and in a way that’s both culturally relevant and safe?

These questions haven’t been formally asked in relation to conversion therapy before. We don’t even know what questions to ask necessarily. At the event, I posed a question to my small working-group: “is there any formal training in school for psychologists, counselors, or physicians in how to help survivors of conversion therapy?” Silence. One of my group mates, an academic who is working in this area, eventually said “no, it’s mentioned that it’s happening but not how to meet the needs of patients who have experienced it”.

This is why the Foundation is running its campaign. These questions have to be answered. Survivors and all LGBTQ2S+ people deserve the opportunity to access and achieve their best health. I know that because of my privilege, I’m afforded more of those opportunities—why should anyone else be denied that? Please, join me in making that possible. Make a gift to support the health of survivors, and action to make sure future generations never have to experience it.

You can also help by sharing this post on social media and tagging us @bccdcfoundation, and by following us on Facebook, Twitter, and Instagram.

The post Reflections: Conversion Therapy Survivors Dialogue – Part 2 appeared first on Pacific Public Health Foundation.

Moderated by BC’s Provincial Health Officer Dr. Bonnie Henry–basically BC’s Public Health Wonder Woman–this event will cover important topics like immunizations, sexual health, overdose crisis response, and the “how-to” of public health like laboratory work.

We’ll answer your most pressing questions with Q&A, and answer some of the questions you didn’t even know you had, like “what’s the weirdest thing you’ve ever done in public health?” (hint: it has to do with the wrong end of a goat). Speakers include:

• Dr. Bonnie Henry, moderator and BC Provincial Health Officer
• Dr. Monika Naus, Medical Director of the Communicable Diseases & Immunization Services at BCCDC
• Dr. Troy Grennan, physician lead for Provincial HIV/STI Program at BCCDC
• Sara Young, Manager, Hepatitis and Harm Reduction Services at BCCDC
• Dr. Agatha Jassem, Clinical Microbiologist & Program Head, Virology, BCCDC Public Health Laboratory.

Join the BCCDC Foundation for this event which will also be the launch of a new public health podcast series, and learn about the often-invisible work happening in our province that keeps you safe every day. Superhero attire encouraged!

Date: Wednesday, August 7th, 2019.

Time: 7:30-9:00 pm.

Location: Science Theatre, Telus World of Science, 1455 Quebec St, Vancouver.

Link for free tickets: https://publichealthsuperheroes.eventbrite.com

The post Public Health Superheroes: a Live Podcast Event appeared first on Pacific Public Health Foundation.

Most BC residents recognize Perry Kendall’s name from his nearly 19 years as Provincial Health Officer.  However, his career has taken him back and forth between BC and Ontario. After two years in general practice in Toronto, he first moved to Vancouver to work at a free clinic (Pine Community Clinic) while working on his Masters in Health Care Planning and Epidemiology and a Fellowship in Community Medicine.

Returning to Ontario to manage the Ministry of Health’s Disease Control and Epidemiology Services for three years brought him along the path of returning to BC as Medical Officer of Health in the Capital Regional District for a couple years before returning to Toronto as the city’s Medical Health Officer, where he pioneered AIDS/HIV programs and implemented innovative harm reduction policy regarding substance abuse and was involved in developing tobacco control by-laws.

Dr. Kendall’s time as President and CEO of the Addiction Research Foundation of Ontario was notable for its collaboration with the World Health Organization. Moving back to BC in 1999, he became Vice President, Senior’s Health in Victoria, until his appointment to Provincial Health Officer.

Dr. Kendall retired from public service in January 2018 and joined the Board in March 2018. For his full biography and more info on our entire board, please visit our website

The post New Board Member Spotlight: Dr Perry Kendall appeared first on Pacific Public Health Foundation.

Dr. Naomi Dove and her team have been awarded funds for: “A pilot study to investigate models for sexual/mental health service integration in the context of population health inequities”.

Dr. Eleni Galanis and her research team have been awarded funding for: “Beyond diarrhea, to disability and death: the hidden consequences of foodborne infections”.

Dr. Amee Manges an her team have been granted funds for: “AntiRetroviral Research fOr Watoto (ARROW): Substudy on the impact of cotrimoxazole on the gut flora of HIV-infected children and adolescents”.

Dr. David Patrick has been awarded funds for: “The BC Generations Project Cohort as a Platform for Discovery in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Pilot Study”.

Dr. Mark Tyndall and Dr. Svetlana Ritovski-Slijepcevic has been awarded funding for: “Integrating research and policy to improve health outcomes for LGBTQ2S youth”.

BCCDC Faculty interested in applying for future funding, be sure to watch your email inboxes in February; the next round of applications will be reviewed in April 2018. To see some of our past research successes, search the blog for entries tagged with #OAP.

The post Open Awards Program: Five Successful Applications for Fall 2017 Competition appeared first on Pacific Public Health Foundation.

Dr. Bhagirath Singh is an internationally-recognized expert in the field of immunology with years of research experience in the regulation of autoimmunity by microbes and autoantigens and peptide vaccines. Dr. Singh is also the former Scientific Director for the Canadian Institute of Health Research’s Institute of Infection and Immunity. Currently he is the Director for the Centre for Human Immunology and Professor Emeritus in the Department of Microbiology & Immunology at Western University and a scientist at the Robarts Research Institute. In recognition of his significant contributions, Dr. Singh has been the recipient of numerous awards including the Alberta Heritage Medical Scientist Award and the Award of Excellence of the Faculty of Medicine of University of Western Ontario. In 2000 he was the Banting and Best Memorial Lecturer at the 17th International Diabetes Federation Congress and in 2001 he was Bernhard Cinader Award Lecturer at the Canadian Society for Immunology. He was elected fellow of the Royal Society of Canada in 2004 and Canadian Academy of Health Sciences in 2005. Dr. Singh continues to be sought as a speaker at international meetings. He has served as co-chair of Canadian HIV Vaccine Initiative and a member of peer review grant panels of the Juvenile Diabetes Foundation International, the Canadian Diabetes Association, Canadian Foundation for Innovation, MS Society of Canada, CIHR and the National Institute of Health etc. He has published over 220 research papers in all aspects of immunology.

The BCCDC Foundation is honoured to have as its SAB Chair such a highly-regarded member of the scientific community. We would like to thank Dr. Singh for his dedication over the last three years. For a complete list of the projects that have been funded by the Foundation’s Open Awards Program, please scroll further back within this blog, as they have been posted twice a year.

The post Scientific Advisory Board Member Spotlight: Chair, Dr. Bhagirath Singh appeared first on Pacific Public Health Foundation.