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Opioid overdose is a major public health issue in BC. Death or significant morbidity such as pulmonary edema, pneumonia and neurological damage may occur following an overdose of illicit or prescribed opioids. But, since 85% of illicit drug overdoses happen in the company of others, the harm reduction program at the BC Centre for Disease Control (BCCDC) saw an opportunity to save lives.
Naloxone (Narcan) is a safe medication that reverses the effects of opioids to restore breathing within 2-5 minutes of intra-muscular administration and, therefore, it can prevent death and other harms. In the absence of opioids naloxone has no effect and cannot be abused. Although naloxone has been used in emergency settings in Canada for over 40 years and community naloxone programs occur throughout the US and Europe, Canada has been a late adopter. BC has the only provincial program in Canada which has run consecutively for more than 15 months.
Following extensive consultation and unanimous support from health authorities, professional colleges, enforcement and people who use drugs (PWUD), the BCCDC launched the Take Home Naloxone pilot program in August 2012. In just over 2 years 2,500 people including PWUD, their family and friends, service providers and shelter/hotel staff have been trained to prevent, recognize and respond to an overdose. As of October 2014, over 1,300 naloxone kits have been dispensed to people who use opioids and the program has received 130 reports of overdose reversals.
Program training materials are reported to be user-friendly and are accessible online. Participating sites identify a prescriber (physician or nurse practitioner), an educator and a dispenser and then receive naloxone kits and training supplies from the BCCDC. Currently there are 55 sites participating in the program across all five regional health authorities, including the first emergency department in Canada providing take home naloxone.
Now those who have been trained and witness an overdose know what to do while waiting for the paramedics to arrive. Empowering people who use drugs to save each other’s lives brings other positive changes. Several participants who have received life-saving naloxone have been motivated to enrol in the program so that they may in turn be able to reverse someone’s overdose. People working at the program’s sites are encouraged when clients return for a replacement kit after using one to reverse an overdose. The program promotes open communication between PWUD, their family and friends and service providers, providing an engaging environment, building trust and reducing stigma.
Ongoing evaluation has led to improvements of the program including adding amp snappers that help open the kits safely without cutting fingers, amending the administration report form and identifying ways to engage populations who do not see themselves at risk of an overdose (e.g. those prescribed opioids and long-term injectors). Also concerning is over half of those who report using naloxone do not call 911, often for fear of police attending, which highlights the need to engage law enforcement and PWUD. Other initiatives are underway to improve naloxone access including exploring the addition of naloxone to BC’s drug formulary and creating a decision support tool so that nurses can dispense without a prescription.
BC’s Take Home Naloxone Program has been recognized locally and nationally as a model of a life-saving program. Community Advisory Board meetings allow local successes and challenges to be shared. Program outcomes have been reported provincially to health partners, in the media and to national working groups, including the Canadian Centre on Substance Abuse and Canadian Drug Policy Coalition and at national and international conferences. The initial program evaluation results have been published and other sites in Canada such as Montreal and Calgary have sought advice to help start their own take home naloxone programs.