Preventing Avoidable Deaths: A Narrative Review and Recommendations On Opioid Overdose

Transcription

1 Preventing Avoidable Deaths: A Narrative Review and Recommendations On Opioid Overdose Supporting Innovative measures to address the reduction of drug related harm in Europe Overdose prevention in Europe Collating lifesaving practices (JUST/2011/DPIP/AG/3605) Translating research into Policy and Practice Paper session 13 September 24 th With financial support from the Drug Prevention and Information Programme of the European Union In partnership with:

2 1. BACKGROUND & GOALS Drug overdose: leading cause of death among problem drug users; 3.5 % of all deaths in people between years old (EMCDDA, 2015; Eurostat, 2012; UNODC, 2013) Average mortality rate estimated at 16 deaths per million population aged in 2013; Rate of over 40 deaths per million reported in seven countries / / a slight increase? e.g. Germany, Sweden, UK Opioids found in 66% of fatal overdoses; heroin presence generally falling but synthetic opioids presence rising Formulating effective responses to reduce drug induced deaths remains a key policy challenge in Europe (EMCDDA, 2015) Europe s drugs problem increasingly complex AIMS 1) Overview on the existing measures to reduce drug induced deaths in Europe 2) Establish a group of experts on drug related deaths in Europe 3) Design recommendations to prevent opioid overdose

3 Dec METHODS GROUND a) Secondary data collection (28 EU Member States, Norway & Switzerland: To map HR measures for drug induced deaths b) Narrative literature review on measures to address druginduced deaths c) 1 st Experts Meeting c) 2 nd Experts meeting a) + b) + c) + d) = Recommendations on Good Policies and Practices Dec d) Discussion Meetings ES; N=12 HRP + Ac GR; N=15 HRP BE; N=30 HRP + PUD + D M PT; N=20 HRP + PE HRP: Harm Reduction Professionals; Ac: Academic representatives; D-M: Decision- Makers; PE: Peer Educators; PUD: People who use Drugs

4 3. METHODS GROUND Dec Why a narrative review? b) Narrative literature review on measures to address druginduced Deaths Dec Reviewed: 89 European documents and 67 worldwide Study design: diverse population: current or former opioid users; relatives and peers, health and social professionals Contents categorized according to measures to prevent druginduced deaths addressed

5 Dec METHODS GROUND Criteria for Experts selection 1)Acknowledgeable work experience on the field of Drugs and Addiction 2)Territory: ES, FI, GE, IT, PT, UK c) 1 st Experts Meeting c) 2 nd Experts meeting Dec )Scientific Production on DRD/DID adjustment, topicality, quality and number ES; N=12 HRP + Ac d) Discussion Meetings BE; N=30 HRP + PUD + D M GR; N=15 HRP PT; N=20 HRP + PE HRP: Harm Reduction Professionals; Ac: Academic representatives; D-M: Decision- Makers; PE: Peer Educators; PUD: People who use Drugs

6 3. METHODS GROUND a) + b) + c) + d) = Recommendations on Good Policies and Practices Dec Future Directions Evaluate and grade the strength of recommendations Dissemination, implementation (& adaptation) Evaluation of impact Plan for update

7 4. RESULTS: Summary & Key messages

8 4. RESULTS: Summary & Key messages Environmental prevention: Gaps Scarce inclusion of environmental strategies on overdose prevention programmes Limited research on socioeconomic determinants of drugrelated mortality Preventing OD occurrence Drug treatment Supervision practices as both a risk and protective factor Insufficient and unbalanced access to the different substances used in OST in some European countries Key messages Intervention programs should stress environmental strategies in order to delineate upstream preventative measures It is vital to promote the access to treatment through multiple entry points, a timely response to those requesting treatment, create conditions for the equal access to the different opioid substitution substances and weight the advantages of tight supervision practices

9 4. RESULTS: Summary & Key messages Gaps Preventing OD occurrence OD risk assessment Individual overdose risk assessment: almost half of European countries don t have/have rare to limited coverage PUD unawareness/underestimation of their overdose risk Insufficient liaison between services misleading overdose risk assessment Training PUD & families/social network Considerable resistance in offering overdose prevention training to PUD and their families/social network when associated with the naloxone topic Encouraging evidence on the effectiviness of take home naloxone to decrease overdose related mortality Key message It is necessary to extend the provision of individual overdose risk assessment: increase training for professionals; include risk assessment in the contracts made with services; implement assessment protocols for services It is important to disseminate the current evidence on take home naloxone effectiveness. It is urgent to scale up these programmes implementation and coverage

10 4. RESULTS: Summary & Key messages Gaps Preventing OD re occurence after non fatal episodes Lack of opportunistic interventions provided by emergency and hospital personnel Actions following fatal overdose drug related deaths registry systems Insufficient standardization of data collection and report proceedings across European countries Constrained capacity for developing toxicological analysis and/or implement toxicological studies Missed opportunities for collect information on overdose risk factors Key message Opportunistic interventions need to be extended: inform on overdose prevention, promote approximation to health services and schedule a subsequent check up for morbidities screaning It is necessary to refine record systems on drug related deaths, as well as the standardization of data collection and report procedures

11 5. FINAL REMARKS Figure 1: Framework for multi level strategic overdose prevention.

12 5. FINAL REMARKS Current definition people who die directly due to use of illegal substances, although these often occur in combination with other substances, such as alcohol or psychoactive medicines. These deaths occur generally shortly after the consumption of the substance (EMCDDA, 2009a, p. 6) Distinction between illegal/legal substances involved on overdose Slow onset episodes Figure 2: Overdose prevention cycle.

13 Acknowledgments We would like to acknowledge to: othe European Commission oall the Euro HRN partners othe WS partners Heino Stöver & Christiane Bernard (Akzept) othe European group of experts oall technical staff, researchers and policy makers concerned with the overdose issue opeer educators committed in saving lives. For more about this work please consult the handbook authored by APDES & Akzept in: sto_set.pdf

14 Thank you for your time and attention APDES Agência Piaget para o Desenvolvimento facebook.com/apdes youtube.com/chann el/ucxgfgau6frum 3UytxQ4iDog twitter.com/apdes1 soraia.teles@apdes.pt