A harm reduction approach to overdose prevention

The Works – Toronto Public Health CPSO October 2012

Overview of Session

• Timeline of >POINT (Prevent Overdose in Toronto) program

• Overview of components of Naloxone training • Next steps….

What is the POINT (Preventing Overdose in Toronto)Program?

POINT is a service of The Works, needle exchange program, Toronto Public Health

Peer led overdose intervention program Provide take home naloxone kits to people who use

opioids

What is the risk? Opioid Overdose deaths in 2009 in Toronto – 74

(preliminary Coroner data) Oxycontin delisting Prison release New dealer Periods of abstinence illness

Where does POINT fit in?

The POINT Program is just a small part of the overdose awareness work that is happening in the City of Toronto

The Harm Reduction Task Force in conjunction with TPH is providing overdose training for drug users, family members, peers and front line workers.

“The 1st Seven minutes” video released by Toronto’s Harm Reduction Task Force – assists agencies in looking at components in creating a formal overdose response plan

Naloxone Globally • In 1995, England and Germany became the first

countries to distribute Naloxone to opiate users. • The United States started distributing naloxone in

1999 and as of 2010, 150 programs were operating in 19 states.

• In Turin, Italy Naloxone is available over the counter. • In Scotland Patient Group Directives (PGD) allow

Naloxone to be prescribed by appropriately qualified nurses and pharmacists

Naloxone in Canada and Ontario Edmonton street outreach program first to operate

take home naloxone in Canada August 31, 2011 Toronto Public Health the first health

unit in Canada to operate naloxone program August 31, 2012 Ottawa Public Health and the BC CDC

begin programs Other programs looking at ways to operate

Naloxone :

Opioid antagonist A prescription medication 1 supplier in Canada – Sandoz Average cost: $11.35/ ampoule Not on the provincial formulary Not covered by EAP (Exceptional Access Program)

How does Naloxone Work?

Naloxone has a stronger affinity to opioid receptors than opioids like heroin and fentanyl, so it knocks the opioids off the receptors for a short time. This allows the person to breathe again and reverses the overdose.

Opioid receptor on brain

Naloxone Naloxone

Opioid

Prescription Process Naloxone Medical

Directive AMOH

Registered Nurses and Counsellors at The

Works are certified to dispense Naloxone

Criteria for Dispensing

• Has a history of or is currently using opiates • Is at risk for overdose • Willing to take the overdose training • Willing to complete the follow-up evaluations • No previous hypersensitivity to Naloxone

The Training Overview: Overdose risks and prevention tips (don’t use alone,

new dealer, alcohol/benzos, ) Overdose myths – what not to do How to recognize opiod overdose 5 steps to intervening

Nurse or Counsellor and client complete Overdose History Form

Drug Categories

Recognizing an Overdose

Practice (with water ampoule), breaking ampoule, drawing up & administering

Chest Compressions

Overdose response myths

Review what not to do Encourage the correct process

Reviewing Contents of the Naloxone Kit

Naloxone Kit Syringes -Safety engineered

2 ampoules of Naloxone(.4mg/1cc/amp)

Alcohol swabs (assist with breaking ampoule)

Prescription identifier Card

Overdose Response steps pamphlet

Pamphlet

Prescription Identifier Card

Locations of trainings • Drop-in at The Works • Mobile service • Outreach to agencies (Shelters, housing..)

Length of Training 20-40 minutes

EVALUATION 2 phases – Phase 1 (completed) 1st impressions of staff, management, clients of the

program, demographics Phase 2 (applied for funding) Retention of training information, more on

demographics, experiences, etc.

Since August 31 2011…….

475 Naloxone Kits distributed!

45 reported Naloxone kits used for an opioid overdose!

Gender of Participants Gender

Male

Female

Trans

David’s Story

Next steps/work to be done: • Obtain funding for a formal research project • Lobbying to put Naloxone on the formulary • Explore options for the development of a epi-pen like

device/intra nasal device • Advocate to reach a wider audience(prisons, etc),

methadone clients, Family Health Teams, etc. etc…..