Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario

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1 Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario Views expressed in the attached document do not necessarily represent those of the Ministry of Health and Long Term Care or those of Kingston Community Health Centres. If you have any questions related to the document, you are encouraged to contact the source.

2 KFLA Public Health Action Plan on Opioids Dr Kieran Moore, AMOH, Professor of Emergency Medicine

3 Three learning objectives: Review surveillance data to inform action Review components of Opioid strategy of KFLA Public Health ( long term strategy ) Review mass casualty preparedness for illicit opioids ( Outbreak intervention rapid response)

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6 ODPRN April 2017 Report

7 ODPRN REPORT APRIL 2017, ODPRN, Narcotic Atlas

8 Acute Care Enhanced Surveillance 10 years experience 144 hospitals in Ontario sending data, 20 hospitals remain (GAP in the Huron, Perth, Waterloo and Haldimand regions) Average daily visit and admission volumes reach 15,000 and 3,500 respectively Collection/analysis of patient data based on disease symptoms (chief complaints), rather than disease diagnosis Chief complaints assigned to one of 84 syndromes including Toxicological (non specific) and Opiate related (specific)

9 Data Collected Collects real time anonymous data from Emergency Department visits date and time hospital age and sex postal code (5 digits) chief complaint CTAS triage score Admissions to hospital Febrile Respiratory Illness (FRI) screening results arrival by emergency medical service admission to intensive care

10 Ontario Opioid Surveillance Monitor The Ontario Opioid Surveillance Monitor has been created in response to the gap in available provincial opioid related data, especially in real time. The tool displays ACES hospital triage data relating to opiate overdoses and abuse. (Figure shows data from 2016 for participating hospitals). We also provide ICD coded data from NACRS and DAD on the site as well and update this data as soon as updates occur in intellihealth.

11 Opioid Overdose and Use in Ontario *Strictly opiate abuse records in above figure, withdrawals and misclassifications have been removed (taken from monthly Mental Health report)

12 Ottawa Use Case Historical 15 day moving average epicurve of OPI and TOX visits to Ottawa

13 Ottawa Use Case Same data and caveats as previous graphs, just zoomed in to the past 4.5 months

14 Canadian Guideline for Safe and Effective Use of Opioids for CNCP

15 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid Involved Overdose Deaths United States, MMWR Morb Mortal Wkly Rep 2016;65: DOI: The misuse of prescription opioids is intertwined with that of illicit opioids; data have demonstrated that nonmedical use of prescription opioids is a significant risk factor for heroin use (10), underscoring the need for continued prevention efforts around prescription opioids. Intensifying efforts to distribute naloxone (an antidote to reverse an opioid overdose), enhancing access to treatment, including medication assisted treatment, and implementing harm reduction services are urgently needed. It is important to focus efforts on expanding opioid disorder treatment capacity, including medicationassisted treatment and improving linkage into treatment.

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18 Prevention for the Medical Community Self reflection, change in prescribing: Narcotic Atlas

19 Chain of Survival OPIATES: Persistent and Consistent Canadian Guideline for Safe and Effective Use of Opioids for CNCP

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24 Clinical Guidelines Working on creating yearly mandatory education for all prescribing staff at Kingston Health Sciences Center on safe prescribing of opiates Created clinical guidelines for opioid prescribing in Emergency Medicine Created clinical guidelines for opioid prescribing in Walk in clinics Supporting adoption of the new McMaster Pain Center guidelines

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27 Deflating the Addiction Balloon SLOWLY To AVOID Unintended Negative Consequences Canadian Guideline for Safe and Effective Use of Opioids for CNCP

28 Prevention BIG,SDOH, Healthy Child Development, Pharmacare strategy

29 Opioid Overdose Surge Response

30 What can we do for sudden spikes in overdoses? We can Prepare!! OBJECTIVES: Discuss and determine the roles and responsibilities including the lead agency in preparing for, responding to, and recovering from a mass casualty event secondary to illicit opioids Discuss and determine the priority actions required during a mass casualty event secondary to illicit opioids Discuss and determine the resources, communication structures, and training needed to respond to an event

31 Probable Case Definition: Opioid Overdose Reportable to Public Health Fatal or non fatal overdose of unintentional or unknown exposure to suspected illicit or counterfeit narcotic AND Patient demonstrates clinically compatible signs and symptoms of opioid overdose syndrome Decreased respiratory rate, pin point pupils, obtundation, cyanosis AND Positive response to naloxone if provided CONFIRM TOXICOLOGY

32 Confirmation of Toxicological Cause Best practices Gas Chromatography, Mass spectroscopy, EIA Police Health Canada Coroner Centre of Forensic Sciences Provincial resources: if the patient is alive: CAMH, HSC, Ontario Poison Center

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36 Decision instrument to activate an emergency control group adapted from the WHO (2008) International Health Regulations (2005) 2 nd ed.

37 Incident Management Framework Confirm Diagnosis as per Case Definition Operationalize Surge Response Implement Control Measures Surveillance Generate Hypothesis Ongoing Communication

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40 Our Eyes and Ears for the Opioid Outbreak Local Advisory Group TASK FORCE Drug using community Paramedics, Dispatch Police, Fire Harm reduction services Acute Care services Addictions and Mental Health Primary Health Care Poison Control Center Regional Coroner

41 Public Health Opioid Outbreak Management Team MOH/AMOH CNO PHI PHN team Surveillance and Epidemiology HBHC Communicable Disease Drug Related Infectious Diseases IMS structure

42 Canadian Guideline for Safe and Effective Use of Opioids for CNCP

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