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.

We believe we can improve the quality of life for British Columbians by investing in projects that improve health equity and social justice, by supporting upstream solutions to our modern problems, and by empowering people to take control of their health.

In other words: when we have equality and equity in our society, we all benefit. When we address root causes of issues, we see positive changes in our health and communities. When we take an active role in improving the health of our population, we’re better protected and can drive well-being in all aspects of our lives.

These core values have come through in the work we’ve done, and chosen to support at the BC Centre for Disease Control over the past year.

Reducing harms, the overdose crisis, and stigma

Through our Reducing Harms Priority, we worked closely with Toward the Heart (BCCDC’s Harm Reduction Services). The overdose crisis and stigma against people who use drugs has been ravaging our province for years. This is having catastrophic outcomes; people are not getting the support they need and are dying at alarming rates because of systemic inequities. We launched an anti-stigma campaign to break it down: your words matter. Change your language, remove the stigma, help curb the overdose crisis.

We also funded the expansion of a BCCDC program: Compassion, Inclusion, Engagement (CIE). CIE provides peer groups (people with lived experience of substance use), particularly those that are Indigenous and in remote/rural communities, with funding and capacity-building support to lead overdose response, harm reduction, and anti-stigma projects across BC. CIE empowers peers to create change at a local level, engage in life-saving overdose prevention work, and change the conversation with their local community about substance use.

During the #COVID19 pandemic, one of the groups we funded through CIE, Vernon Entrenched People Against Discrimination (VEPAD), set up a booth outside a library to hand out #naloxone & provide education on #overdose response: https://t.co/h038WYeOW1@towardtheheart @fnha

— BCCDC Foundation (@BCCDCFoundation) June 30, 2020

Activate Health

Activate Health is our battle cry for British Columbia (check it out on Instagram). It’s about empowering you to take control of your health and illustrate how our individual actions make a population-level difference.

Taking control of your health isn’t just about eating healthy and going for a jog (though, those are good, too!). You can take control of your health and improve our population’s health by being kind, curbing air pollution, recycling, using regular soap instead of antimicrobial soaps, and standing up against injustice. It’s all linked—social movements, the environment, social connectedness, law and policy, racial justice, and everything in-between impacts our health. And we have the power to improve it for ourselves and for others, making a difference to the health of society.

COVID-19

We couldn’t look back on the last year without including COVID-19. The pandemic has shown the world why we need public health, and why we need to invest in solutions before a crisis hits. Public health experts (like our superhero colleagues at the BC Centre for Disease Control) have been working to protect us and prevent a situation like this since…well, public health emerged as a field. Their work has prevented other epidemics and outbreaks, and what will get us through this. And yet, public health still receives less than 5% of government health funding in BC.

COVID-19 is scary, but we’re glad to see people invested in public health like never before. By partnering with the BCCDC we’re helping ensure that we’re prepared if something like this happens again—and you are making that possible. With the help of our donors, together we’re funding the research that will protect British Columbians from a second wave and future outbreaks.

Because of your support, we’re able to show BC that you don’t have to be a scientist to make a difference and fight this pandemic: you have the power to protect yourself, your community, and improve public health. You can wash your hands, you can stay home when you’re sick, and you can donate to the solutions that will prevent a future pandemic. Whatever you do, you’re making a difference. But we need all of us to be all-in to make it really work.

It’s been a full year. COVID-19 will be around for some time. But, we’re going to keep working with our BCCDC colleagues and with you to fight it every step of the way.

We’re going to continue advocating for health equity, and supporting public health solutions that tackle the root causes of health disparities. And of course, we’re going to keep inviting you to take control of your health and join us in our battle cry: Activate Health.

We’ll see what another year does for the health of our province. We think that with your help, it’ll look bright.

The post BCCDC Foundation Year in Review appeared first on Pacific Public Health Foundation.

But in the midst of one of the worst public health emergencies we’ve faced in recent memory, there’s still hope. By making a series of videos and downloadable resources with our partners, our goal has been to illustrate how we can all eliminate stigma by changing the way we speak. The overdose crisis and stigma are systemic issues, but you can make a difference on an individual level too. Change starts with an individual.

Social change on this level is inherently slow, but we know we’re making a difference. Over 550,000 people across BC were reached through LifeLab’s patient service centres in just the first month, and we expanded its reach beyond BC through social media. It even made it all the way to Scotland!

We’re so thankful for the support of our incredible partners, LifeLabs and Toward the Heart. Their leadership, support, and commitment to collaboration made this project possible. Just because the campaign has officially come to an end, doesn’t mean this work is over. As part of our Reducing Harms priority, we’re committed to supporting solutions to the overdose crisis, eliminating stigma, and lifting up people with lived experience as experts. We hope you’ll join us in this work by sharing these videos and resources with your friends and family, and leading brave conversations to eliminate stigma in your community.

Stay tuned with what our reducing harms priority will bring in 2020 by signing up for our monthly newsletter, and following us on Facebook, Instagram, and Twitter.

The post Shedding Light on Stigma appeared first on Pacific Public Health Foundation.