The Opioid Overdose Crisis: Role of the TB Physician

Transcription

1 The Opioid Overdose Crisis: Role of the TB Physician February 22, 2019 Dr. Patricia Daly Chief Medical Health Officer Vancouver Coastal Health

2 Source: Health Canada

3 BC Overdose Deaths

4 BC Overdose Deaths Impact of Fentanyl 4

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7 FN trends Overdose data and First Nations in BC: Preliminary Findings. First Nations Health Authority (Aug 2017). Data from Jan 2015-Nov 2016.

8 Coroners Death Review Panel 1,854 Deaths Findings Most used substances regularly Most died using alone Many had recent health care or BC Corrections contact Many were in, or recently evicted from Recovery or Detox facilities Many had sought treatment in the past and relapsed Opioid agonist therapy protective against death Recommendations: Regulate and establish standards of care for Recovery and Detox Expand Opioid Agonist Therapy 8

9 Rate per 100,000 Drug Overdose Death Rate by Health Authority Nov VCH Vancouver Coastal Interior Fraser Vancouver Island Northern

10 Vancouver Coastal Deaths (Jan Nov. 2018) Gender 80% 20% Female Male % Age 23% 24% 25% 11% Fentanyl 16% Not Detected % yrs Detected 84% Fentanyl detection Jan.-Sept. 2018

11 Drug Overdose - Location of Death Vancouver Coastal Other BC Regions Private residence 38% Private residence 69% Other residence 47% Other residence 14% Social/supportive housing, SROs, shelters, hotels Outside 11% Outside 12% Other inside 3% Other inside 4% 11

12 Life Expectancy Decline in the Downtown Eastside (DTES) - Impact of Overdose Deaths Life expectancy for men in the DTES has dropped by 4 years 17 year gap compared to men on the Westside of Vancouver Years year gap between men and women in DTES Men Women All 12

13 Chart Review: 424 VCH Overdose Deaths (2017) VCH 72% unemployed 34% lived in social housing 10% Aboriginal BC 51% unemployed 13% lived in social housing 10% Aboriginal Those dying in Vancouver Coastal more disadvantaged than elsewhere in BC

14 Chart Review 424 VCH Overdose Deaths (2017) Most people dying are known to the health care system 88% had contact with health services prior to death (21% within one week of death) Emergency department most common site of contact Most people (75%) who used opioids daily had been offered treatment, but were not retained in care

15 Chart Review VCH Opioid Overdose Deaths 2017 Most people who died consumed drugs daily 39% daily opioids 44% daily alcohol, stimulants, other drugs People with alcohol or stimulant use disorder are dying of opioid overdoses Pattern of Daily Drug Use (261 charts) 17% 5% 39% 8% 12% 19% Opioid Stimulant Other non-opioid Alcohol Alcohol + Stimulant Not daily use

16 Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics

17 Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics

18 Opioid Use Disorder (Addiction) Chronic, relapsing Changes to brain structure and function Relapse is expected after detox and recovery Long term treatment with opioid agonist therapy (OAT) required

19 BC Cascade of Care for People with Opioid Use Disorder 55,469 people (as of November 30, 2017) *preliminary results Only 10% retained on treatment

20 BC Comprehensive Package of Interventions Health Sector Interventions Interventions in the health sector aimed at decreasing the impact of overdose in BC Naloxone Overdose Prevention Services Acute Overdose Risk Case Management Treatment and Recovery Enabling strategies that advance the delivery and success of health sector interventions Social Stabilization Peer empowerment and employment Cultural safety and humility Addressing stigma, discrimination, human rights

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22 22 Distribution of Take-Home Naloxone Kits

23 Supervised Consumption Sites InSite First site in Canada, opened 2003 Now: 28 sites in 4 provinces, more applications pending Operate under Health Canada exemption to federal drug laws

24 InSite By the numbers (2017) 175,464 visits by 7,301 people 28% women 18% Indigenous 2,151 overdoses treated Substances reported used: Opioids 64% Methamphetamine 25% Cocaine 6%

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26 Overdose Prevention Sites and Services 8 locations in Vancouver: 7 in the DTES and at St. Paul s Hospital Many HOPS : Housing Overdose Prevention Services in supported housing

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28 Treatment Opioid Agonist Therapy BC Centre on Substance Use Established treatment guidelines for BC Buprenorphine/naloxone (Suboxone TM ) first line treatment

29 Patients on Opioid Agonist Therapy - BC Any OAT 21,549 Methadone 15,102 Buprenorphine/ naloxone 5,443 SL Morphine 1,258 Data provided to BCCDC by Pharmaceutical Services Division, Ministry of Health

30 Injectable Opioid Agonist Therapy Injectable diacetylmorphine (prescription heroin) or hydromorphone

31 Patients on Injectable Opioid Agonist Therapy, BC 105 Diacetylmorphine 78 Hydromorphone Data provided to BCCDC by Pharmaceutical Services Division, Ministry of Health

32 Opioid Agonist Therapy Prescribers, BC 949 Any OAT 833 Buprenorphine/ Naloxone 478 Methadone 289 SL Oral Morphine 17 ioat Data provided to BCCDC by Pharmaceutical Services Division, Ministry of Health

33 Drug Checking Identify drug composition Fentanyl urine test strips Mass spectrometry Knowledge can reduce risk to user

34 Fentanyl Testing of 5,129 Drug Samples From Supervised Consumption Sites and OPS in Vancouver All Opioids 90% Heroin 87% Fentanyl 95% All Stimulants Meth Cocaine Psychedelic 4% 2% 0% 3% Fentanyl Declared Substance As identified by users before testing Depressant 7%

35 Estimated Deaths Averted in BC by Take-Home-Naloxone, Overdose Prevention Sites and Opioid Agonist Therapy 35 Figure provided by Michael Irvine, BCCDC/UBC. Preliminary results and subject to change.

36 Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept Nov People who have died from overdose due to illicit drugs, BC Number of deaths Declaration of provincial emergency 120 Overdose Emergency Response Centre Established Illicit drug overdose deaths in BC: Jan 1, 2015 to Nov 30, BC Coroners Service.

37 Health and Social Problems The Paradox of Prohibition Illegal Market Gangsterism Corporate Profit Heroin Cocaine Methamphetamine Cannabis Tobacco Alcohol Public Health Prohibition Decriminalization Market Prescription Defacto Regulation Legalize with Decriminalization Many Restrictions Legalize with Few Restrictions

38 Health and Social Problems The Paradox of Prohibition Illegal Market Gangsterism Corporate Profit Heroin Cocaine Methamphetamine Cannabis Tobacco Alcohol Medical Cannabis Public Health Prohibition Defacto Depenalization Decriminalization Market Prescription Regulation Legalize with Many Restrictions Legalize with Few Restrictions

39 Bold New Policy Proposal Proposed by people with lived experience White Paper developed with BC Centre on Substance Use Addresses concerns: Opioid overdose deaths Organized crime Money laundering

40 Recommendations for TB Physicians 1. Identify your patients with Substance Use Disorder

41 Recommendations for TB Physicians 2. Connect patients with Substance Use Disorder to care

42 Recommendations for TB Physicians 3. Provide harm reduction resources to patients with Substance Use Disorder

43 Thank You